Surgical and nutritional interventions for endometrial receptivity: A case report and review of literature

Table 1 Cycles and interventions for the case

Categories	First cycle	Second cycle	Third cycle	Fourth cycle
Nutritional intervention	None	Caloric restrictiona	Ketogenic dietb	Ketogenic dietc
Stem cell treatment	None	None	None	Live cells trans-myometrial injection
Anthropometric parameters (at the cycle starting point)
Age (years)	37 (2019)	38 (2020)	39 (2021)	40 (2021)
Weight (kg)	73	69	59	59
Waist circumference (cm)	81	73	65	65
BMI (kg/m2)	29.24	27.64	23.63	23.63
Blood pressure (mmHg)	120/80	120/78	119/80	111/74
Biochemical parameters
Fasting glucose (mg/dL)	104	102	86	78
Urine ketones (mg/dL)	-	Negative	40-80	50
Insulin (U/mL)	-	13.89	3.20	2.4
HOMA-IR	-	2.95	0.67	0.46
Insulin resistance	-	Yes	Corrected	Corrected
Triglycerides (mg/dL)	-	89	92	82
HDL-Cholesterol (mg/dL)	-	58	62	71
IVF parameters
Ova source	Patient	Patient	Donor	Donor
Ova collected	26	15	Not applicable	Not applicable
Own embryos frozen (day), quality	7 (day 5), BC	1 (day 5), BC	---	---
		1 (day 6), BC
Endometrial intervention/treatment	None	Hysteroscopic evaluation and mild reactivation	Pentoxifylline	Pentoxifylline
			E-Vitamin	E-Vitamin
			L-Arginine	L-Arginine
				Stem cells
Endometrial thickness final size (mm)	3.6	4.3	5.9	6.9
Transferred thawed embryos and PGTA result	n = 2	n = 2	n = 2	n = 2
	Quality: BC	Quality: BC	Quality: AC and BC	Quality: AC and BC
	Day 5: Euploid	Day 5 and 6: Euploid	Day 5: Euploid	Day 5: Euploid
Transfer result	Failed	Failed	Failed	Success
β-hCG serum levels on day 14	Negative	Negative	Negative	Positive, 90.89 mUI/mL
Clinical pregnancy	-	-	-	One sac, 158 bpm week 18
Pregnancy outcome	-	-	-	Healthy baby girl, 37 wk, 2690 g; 47 cm; Apgar 9

^aStandard 1800 calorie-diet with 55% carbohydrate content.

^bNutritional intervention inducing ketosis with a maximal consumption of 50 g of carbohydrates/day (15% on an 1800 calorie diet).

^cNI controlling fasting glucose and urine ketones; carbohydrates/d: 50 g before the transfer, 100 g after embryo transfer, and 150 g during pregnancy.