Dr. Natasha Bansal
Obstetrics and Gynecology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I am a 38-year-old female (166 centimeters in height and 105 kilograms in weight) with a complicated gynecological history. I was diagnosed with infertility issues a few years ago. I had a relatively late first period as a teenager at 15 years, but my parents never took me to any specialist doctor. During my teenage time, I visited a gynecologist due to stomach pain, and I had that on and off for a couple of years. After examination, it turned out to be ovarian cysts on the left and right ovary, growing undetected over several years and measuring 14 centimeters and 18 centimeters. They were removed surgically along with a lot of ovarian tissue, leaving me with barely any ovaries and a stomach full of adhesions 17 years back. I had not been sexually active until that time. Later on, I got married five years back, and a year after that, we started trying for a child and underwent a gynecological examination again. During that time, the doctor told me that I had another small cyst measuring 2 centimeters on my ovary and that it had to be removed laparoscopically. However, because of my previous adhesions, they could not get thorough with the instruments, and later on, they cut my stomach and opened it again on the same site as the last surgery that was done 17 years back. They also told me that one of my tubes was blocked because of adhesion, and the chances of becoming pregnant were 2 percent. I also had a hormonal imbalance, so the doctor suggested going for donor eggs rather than a classic IVF.
I became pregnant via a donor egg three years ago and had my daughter. I had some pregnancy complications, delayed labor, and developed pre-eclampsia, and I was under observation for nearly 27 hours. After 27 hours of labor, they told me I had to get a C-section. During the C-section, they tore my bladder, and I had to stay at the hospital for ten days with a catheter, taking all kinds of antibiotics and medication for blood pressure, which remained high, as well as for my liver and kidneys. After a few days, my blood pressure was back to normal, and about six months after birth, I had done an overall health assessment, and everything seemed to be fine.
Now we are again planning to have another child. It took us a long time to decide about a second child, but we are finally ready. I discussed my medical history with my new gynecologist, and he suggested that it would be a high-risk pregnancy and that I have to be monitored more often than in the previous pregnancy. In addition, my fertility doctor suggested taking tablet Aspirin to reduce the possible risk of pre-eclampsia. So here is the situation: I had three abdominal surgeries, pre-eclampsia, an emergency C-section, and a torn bladder.
We did a fresh embryo transfer during my first pregnancy with day five blastocyst implantation. We implanted two high-quality (A-quality) embryos, but only took one. The specialist doctor advised not to implant two embryos because of the high risk of twins since both were high-quality. Now we have two embryos, one is B-quality, and the other is C-quality. And the specialist doctor recommends transferring two embryos because the quality is not great compared to the last time. My queries are:
1. Should I follow the specialist doctor's recommendation and transfer two embryos?
2. Given the fact that the embryos are not so high quality, it sounds like either one will implant or none. But what do I do if both embryos implant?
3. Will I be able to handle a twin pregnancy and birth, considering my medical history?
4. Should I be worried about any other health issues?
Kindly help.
Thank you.
Hello,
Welcome to icliniq.com.
I have read your query and understand your concern.
I suggest the following.
1. I think you should follow the specialist doctor's advice to implant two embryos as the quality of the embryos is not that good. The chances of implantation are not 100 percent, even with good-quality embryos. So usually, in all cases of in vitro fertilization (IVF), multiple embryos are transferred to increase the chances, and two embryos are the optimal number for this.
2. The chances of pre-eclampsia occurring in the subsequent pregnancy are not 100 percent; it is usually around 25 to 30 percent, so do not worry about that. You will be advised to take tablet Aspirin (Acetylsalicylic Acid) from the beginning of the pregnancy; thus, you might not even have pre-eclampsia this time.
3. You had three abdominal surgeries before, and the main complication that may arise is similar to last time due to adhesions. Thus there are chances of bladder and bowel injury, and this will remain the same even if you have a singleton pregnancy or a twin pregnancy since the number of adhesions has no relation to it.
4. For pre-eclampsia, you will be taking tablet Aspirin, and your blood pressure will be continuously monitored so it can be managed on time. However, it can lead to chances of early delivery (cesarean section) and prematurity. Apart from this, if you regularly monitor blood pressure and all other blood tests, there will not be any further complications.
Thank you.
Patient's Query
Hello doctor,
Thank you for your response.
My queries are:
1. Are there any ways to prevent the chances of bladder and bowel injuries due to adhesions?
2. Should I discuss this with the specialist doctor who will perform the C-section about the complications?
3. Will the risk of pre-eclampsia increase even more if both embryos are implanted, and I have a twin pregnancy?
4. What other complications could happen with a twin pregnancy, considering my history?
5. Is there any chance of cardiac arrest or complication from heavy blood loss during the C-section surgery?
Kindly answer these queries, doctor; I am concerned about the chances of having a healthy and risk-free pregnancy.
Thank you.
Hello,
Welcome back to icliniq.com.
I read your query and understand your concern.
I suggest the following.
1. The surgeon performing the cesarean section (C- section) surgery will take adequate measures to prevent complications. There is nothing one can do before the surgery to avoid it, and it is not confirmed that this injury will occur in 100 percent of cases. Due to previous adhesions, the chances are more, and only the surgeon performing the surgery can decide on the preventive measures during the cesarean section (C-section).
2. The chances of pre-eclampsia are increased with a twin pregnancy compared to a singleton pregnancy, which is why tablet Aspirin (Acetylsalicylic Acid) will be even more useful in your case. With a twin pregnancy, all the normal effects of pregnancy are more pronounced, like more abdominal distension leading to more discomfort, more chances of pedal edema, varicose veins, and breathlessness. Similarly, the chances of landing in preterm cesarean are higher as the uterus is more distended. Also, the chances of postpartum hemorrhage are higher with twin gestation, leading to more blood loss.
3. The cardiac workload is also increased during pregnancy. However, that does not mean you will have cardiac arrest; there is no such association. It depends on what medical conditions you will have at that time.
4. I can understand your concerns and know why you are so concerned. However, we cannot conclude whether your pregnancy will be high risk irrespective of whether singleton or twin pregnancy. But the chances of complications during pregnancy are more with a twin pregnancy.
Thank you.
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Obstetrics and Gynecology
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