MRKH Syndrome

Mr. and Mrs. XYZ first approached our clinic with their problem of Primary Infertility on 31st January 2005. The couple has been married for the past two and a half years and came to us asking for IVF with gestational surrogacy. Mrs XYZ, 30 years of age, was aware that she had a rare a congenital uterine abnormality called Mayer- Rokitansky Kustner Hauser Syndrome. Patients with MRKH syndrome have failed development of the embryonic Mullerian ducts. They have absolutely normal secondary sexual characteristics like breast development etc. Normal development of these ducts result in the formation of the uterus, cervix and the upper 2/3 of the vagina. However, failure of the same results in a variety of abnormalities, most common being vaginal atresia and agenesis of the uterus and cervix. There is however normal ovarian development and normal ovarian function.

A preliminary examination and a basic hormonal screening test were done to rule out other hormonal imbalances. The patient was then advised to keep a Basal Body Temperature chart for a month to confirm the dates of ovulation to help us plan a cycle. As soon as a we localized her cycle dates, her treatment cycle was begun and synchronized with the surrogate's cycle. She was given gonadotropin injections to stimulate her ovaries to produce multiple mature eggs. A laparoscopic Ovum pick-up was scheduled as her ovaries high in the pelvis making vaginal ovum pick-up difficult. We managed to obtain
just three mature eggs which were then fertilized with her husband's sperms and finally two embryos were transferred into the surrogate on day 2 but her pregnancy test came negative.

The patient, however, did not lose hope and decided to do another treatment cycle. We started the cycle again with a little more ovarian stimulation with fertility injections to get more eggs. The surrogate was also started on hormonal replacement therapy to prepare her uterine lining. This time we managed to obtain 10 eggs of which 9 fertilized and we transferred four embryos. The surrogate got pregnant and subsequently delivered full term twins . The treatment has fulfilled the hopes and dreams of this woman who was born without a womb. We are now in the midst of treating three other women with MRKH syndrome.