Hello doctor, Husband is 39 and wife is 38. Married for the past 11 years. Late pregnancy planning. Open myomectomy, right ovarian cystectomy, and adhesiolysis were done three years back. Conceived normally two years back with low AMH 1.34. CS a year back. Congenital heart disease - aortic stenosis, large PDA. Aortic valvotomy and PDA ligation surgery were done. The child died after 71 days. Trying to conceive with Letrozole, CoQ 10, Fol XT, Prastova SR, etc. No result. Severe pelvic pain and cramping for the last four months. No result in Drotin, need to take Jonac Suppository. CA 125 Value 55.6. Husband semen analysis and culture are normal. AMH 1.1, AFC 4 to 5. Small fibroids found in the uterus. A follicular study was done in the last six months. Regular ovulation on day 12 to 13. Consulted fertility doctors and gynecologist. Suspected endometriosis. Advised Lupride injection followed by Laparoscopy, IVF. We need advice.
Hello. Keeping your history in mind, it is suggested that possible endometriosis or PID which can be the cause of raised CA125 should be ruled out with a diagnostic laparoscopy and peritoneal lavage for culture and possible malignant cells (if any, ovarian). This is mandatory to justify rising CA125 levels which indicate epithelial ovarian cancer. Once that is clear, then you should ideally opt for IVF- ICSI (intracytoplasmic sperm injection) procedure with wife ovum and husband sperm pre-genetic implantation diagnosis (PGD) of the embryo to rule out any age-related congenital anomalies followed by embryo transfer and maintenance of pregnancy on progesterone support and IVF drugs. Considering that fibroids usually do not support IVF pregnancy but they are presently small and once implantation and growth occur, they shall thin out, so still best is IVF. If the cause of raised CA125 levels turns out to be malignant, then pregnancy should not be opted for and treatment for malignancy would take priority.