Patient: Mrs. R, 48 years
Diagnosis: Advanced Maternal Age with Extremely Diminished Ovarian Reserve

✨ The Challenge

Mrs. R presented to AFGC IVF Centre in July 2024 seeking fertility treatment after an emotionally devastating reproductive journey. Married for 29 years, she had experienced the profound loss of two children—her first daughter, who passed away at 3 months of age, and her 22-year-old son, who tragically died in a road traffic accident in 2023. Her only surviving child is a 23-year-old daughter.

Despite being 48 years old, her desire to rebuild her family remained unwavering.

Her evaluation revealed:

• AMH: 0.04 ng/mL, indicating extremely diminished ovarian reserve
• Normal semen parameters (95 million/mL, 70% motility, 70% normal morphology)
• Hypothyroidism, well controlled on Thyronorm

Given her age and severely reduced ovarian reserve, the couple was counselled that donor egg IVF offered the best chance of achieving pregnancy.

🔬 The Clinical Journey

Although fully informed about the very low likelihood of success with her own eggs, Mrs. R wished to make one sincere attempt before considering donor oocytes.

A high-dose ovarian stimulation protocol using HMG 450 IU was initiated. Unfortunately, there was no ovarian response, and the cycle had to be cancelled.

Following further counselling and emotional support, the couple decided to proceed with donor egg IVF.

Endometrial preparation was carried out using Progynova along with folic acid. On Day 14, the endometrium measured 8.5 mm, providing an optimal environment for embryo implantation.

A Day-6 blastocyst transfer was performed on 19 March 2025.

❤️ The Outcome

The treatment resulted in a positive β-hCG of 251.6 mIU/mL, confirming pregnancy.

Subsequent ultrasound demonstrated a live twin intrauterine pregnancy.

The pregnancy progressed successfully under close obstetric supervision, and Mrs. R ultimately delivered two healthy babies, bringing hope and joy after years of unimaginable personal loss.

🌈 Learning Points

• Extremely low AMH (0.04 ng/mL) and advanced maternal age significantly reduce the likelihood of success with self-oocyte IVF, and patients should be counselled realistically regarding expected outcomes.
• Individualized counselling is essential, allowing patients to make informed decisions while respecting their emotional needs and reproductive wishes.
• Donor egg IVF largely overcomes the age-related decline in egg quality, making maternal age less predictive of success when the uterus is adequately prepared.
• Careful endometrial optimization, appropriate embryo selection, and meticulous antenatal care can result in excellent pregnancy outcomes, even in women of advanced reproductive age.
• Fertility treatment extends beyond medical intervention—it requires compassion, patience, and shared decision-making to help couples navigate one of the most challenging phases of their lives.

AFGC IVF Centre

Turning Dreams into Reality—One Family at a Time.