A Case of Cervical Agenesis in a Patient Who Desires Fertility

INTRODUCTION: The objective of this study was to understand how cervical agenesis affects fertility management. Congenital absence of the cervix with functioning endometrial tissue is extremely rare. Primary amenorrhea and cyclic abdominal pain are the usual presentation. Creation of a functional cervix is difficult as a result of a lack of cervical mucus production. Thus, women who desire pregnancy must undergo in vitro fertilization with zygote intrafallopian transfer. METHODS: A 33-year-old nulligravid diagnosed with cervical agenesis, uterine didelphys, and blind vaginal pouch desires fertility. A 25-year-old patient was diagnosed after ultrasound finding of a pelvic mass of unknown origin. Desirous of fertility, the patient received thorough evaluation and was determined to have a functional uterus with thin endometrium of 4 mm, functional ovaries, and endometriosis. The patient was not a candidate for cervical anastomosis; thus, her only option was in vitro fertilization. RESULT: During the ovarian stimulation process, it was discovered her endometrial lining did not respond to standard doses of follicle-stimulating hormone and leuprolide. Increased doses were given; the patient achieved a 6-mm endometrial echocomplex along with 31 retrieved oocytes. Despite an additional endometrial anomaly, likely secondary to years without menses, a zygote intrafallopian transfer procedure was performed and deemed unsuccessful. CONCLUSION: Cervical agenesis in the setting of uterine didelphys is an uncommon cause of infertility. The anatomical and hormonal changes present a unique challenge for conception.