Case Report

A Journey of Perseverance, Precision & Hope

Patient: 39-year-old Female
Diagnosis: Primary Infertility | PCOS | Recurrent IVF Failure with Pregnancy Loss

✨The Challenge

This case highlights the resilience of a couple who continued their fertility journey despite multiple setbacks over several years.

• Primary infertility with long-standing PCOS and irregular menstrual cycles
• AMH: 2.52 ng/mL
• Normal semen parameters
• Underwent laparoscopic adhesiolysis and hysteroscopy (2017)
• Failed to conceive naturally despite surgery
• Two unsuccessful IUI cycles
• First IVF-ICSI cycle (2022): Fresh Day 3 embryo transfer – Negative
• Second IVF cycle (2024): Frozen embryo transfer with one Grade A and two Grade B Day 3 embryos resulted in conception but unfortunately ended in a missed abortion, requiring dilation and curettage (D&C)

Following the pregnancy loss, the couple took time to recover emotionally before returning for further treatment.

🔬 The Clinical Strategy

Considering the patient’s advanced maternal age, previous failed IVF attempts, and miscarriage, the couple was counselled regarding the possibility of donor oocytes as well as another self-IVF cycle combined with Preimplantation Genetic Testing for Aneuploidy (PGT-A).

After extensive counselling, the couple chose to proceed with self-IVF with PGT-A.

The genetic analysis revealed:

• One low-level mosaic embryo
• One non-informative embryo

Given the limited embryo availability, the couple underwent detailed counselling with a clinical geneticist regarding the implications, expected outcomes, and available options. Following informed consent, a Day 6 frozen embryo transfer of both embryos was performed.

❤️ The Outcome

The treatment resulted in a successful implantation and an uncomplicated ongoing pregnancy.

The patient subsequently delivered a healthy baby girl at term, bringing an end to a fertility journey marked by years of persistence, courage, and hope.

🌈 Learning Points

This case demonstrates that:

• PGT-A can provide valuable information, but clinical decision-making must be individualized when only mosaic or non-informative embryos are available.
• Low-level mosaic embryos can result in healthy live births after appropriate genetic counselling and careful patient selection.
• A non-informative PGT-A result does not necessarily indicate an abnormal embryo, and in selected circumstances may still be considered for transfer after comprehensive counselling.
• Shared decision-making, multidisciplinary care involving reproductive specialists and genetic counsellors, and personalized treatment planning can help couples achieve successful outcomes even after repeated IVF failures and pregnancy loss.

Every embryo deserves thoughtful evaluation, and every patient deserves individualized care. Sometimes, hope lies not in the perfect embryo, but in the right clinical judgment.