47-Year-Old Woman’s Successful Twin Pregnancy After Fibroids, Adenomyosis, and High-Risk IVF

At Saraogi Hospital’s IRIS IVF Centre, we often manage IVF cases involving advanced maternal age, complex uterine conditions, and long-standing medical disorders. One such challenging case was that of a 47-year-old woman who came to us with infertility, a prior miscarriage, and significant uterine pathology, including fibroids and adenomyosis. With a carefully planned surgical approach, personalised IVF treatment, and close medical supervision throughout pregnancy, she successfully conceived and went on to deliver healthy twin babies. This case study outlines the clinical decisions and intensive care that helped achieve a positive outcome despite multiple high-risk factors

A 47-year-old woman and her 54-year-old husband approached us in 2024 after facing infertility and a previous miscarriage following fertility treatment done elsewhere. Given her age, the patient already had several medical concerns, including chronic hypertension for over 10 years, for which she was on regular antihypertensive medication.

She also reported irregular and heavy menstrual cycles, which had been attributed to her perimenopausal age group. This combination of advanced maternal age, medical comorbidities, and prior pregnancy loss placed her in a high-risk fertility category from the outset.

A detailed ultrasound evaluation revealed significant uterine pathology. The uterus was found to be very bulky with multiple large fibroids, causing severe distortion of the uterine cavity and displacement of the endometrial lining. Additionally, the patient was diagnosed with adenomyosis, further reducing the chances of implantation and increasing the risk of miscarriage.

The major challenges in this case included:

Advanced maternal age

Long-standing hypertension

Multiple large uterine fibroids

Severe cavity distortion

Adenomyosis

Previous miscarriage

High risk of IVF failure and pregnancy loss

Fibroids and adenomyosis significantly divert blood supply away from the endometrium and act as space-occupying lesions, thereby increasing the risk of both IVF failure and miscarriage—particularly when they distort or indent the uterine cavity. According to Ivf doctor in Mumbai, Dr. Mohit Saraogi, careful surgical correction and individualised fertility planning are crucial in such cases to improve implantation potential and overall pregnancy outcomes.

After completing routine blood investigations, it was clear that surgical correction was essential before attempting IVF. The patient was planned for a combined hysteroscopic and laparoscopic procedure.

During hysteroscopy, an endocervical polyp was identified and removed. Endometrial scratching was also performed to improve endometrial receptivity, particularly important in the presence of adenomyosis. Laparoscopy revealed seven uterine fibroids, all of which were removed. The largest fibroid measured approximately 6 × 5 cm, with several others measuring 5 × 4 cm and smaller fibroids of 2–3 cm. A hemorrhagic cyst in the right ovary was also identified and excised.

Histopathology confirmed an endocervical polyp and leiomyoma with hyaline degeneration, validating the surgical findings.

Post-surgery, the patient was given a two-month recovery period, during which she was placed on hormonal suppression using combined oral contraceptive pills to allow optimal uterine healing.

Given the patient’s age (over 45 years) and reduced ovarian reserve, IVF was planned using donor eggs and donor sperm. The first embryo transfer showed good endometrial development but unfortunately resulted in a negative outcome, likely due to persistent adenomyosis.

Before the second transfer, the patient’s blood pressure was brought under stricter control, as it had become less controlled during the initial attempt. Endometrial preparation was repeated, and the second embryo transfer was performed in March 2025, which resulted in a strong positive pregnancy test with a beta-HCG value of 527.

As the pregnancy progressed, several complications arose:

Worsening hypertension requiring multiple antihypertensive medications

Need for injectable medications to prevent miscarriage

Development of gestational diabetes, requiring active management

Twin pregnancy with short cervix and prior myomectomy history

A cervical cerclage (stitch) was placed to reduce the risk of preterm delivery. Despite optimal medical therapy, the patient’s blood pressure and blood sugar levels required continuous monitoring and repeated adjustments, along with lifestyle modifications.

[Image of cervical cerclage procedure]

At around 20 weeks, the patient developed bleeding and a sudden rise in blood pressure. She was diagnosed with complete placenta previa, where the placenta covers the cervical opening, posing a high risk of recurrent bleeding. She required multiple hospital admissions for conservative management of bleeding and uncontrolled hypertension.

With meticulous obstetric care, continuous use of low molecular weight heparin, strict blood pressure and sugar control, and close fetal surveillance, the pregnancy was successfully prolonged until 35 weeks.

At 35 weeks of gestation, the patient delivered healthy twin babies, weighing approximately 2 kg and 1.6 kg, respectively. Both babies cried immediately after birth and required no major neonatal interventions. Despite advanced maternal age, extensive uterine surgery, adenomyosis, chronic hypertension, gestational diabetes, placenta previa, and a twin pregnancy, both mother and babies were safe and healthy.

This case highlights how comprehensive pre-IVF surgical correction, individualised fertility planning, and intensive antenatal management can lead to successful outcomes even in extremely high-risk patients. It reinforces that with the right expertise and perseverance, complex fertility cases can still achieve positive and life-changing results.