Mrs. Mariam (Name Changed), a 42-year-old woman from the United Arab Emirates, and her 39-year-old husband, Mr. Omar (Name Changed), encountered significant difficulties in their journey to have a child. Their concerns deepened after three unsuccessful IVF cycles, highlighting the need for a more customized approach. Seeking further treatment, they turned to Milann Fertility Center in Indiranagar, Bengaluru.

Under the care of Dr. R Suchindra, Senior Consultant – Reproductive Medicine, Milann Fertility Center the couple underwent a comprehensive evaluation. It was determined that Mariam faced the dual challenges of advanced maternal age and a reduced ovarian reserve, with an antral follicle count of 4. Meanwhile, Omar was diagnosed with oligospermia and a high DNA fragmentation index (DFI).

Based on the diagnosis and evaluations, Dr. Suchindra recommended, “IVF/ICSI combined with Preimplantation Genetic Testing for Aneuploidies (PGT-A) to increase the chances of a successful pregnancy, Mrs. Mariam underwent a carefully monitored IVF/ICSI stimulation cycle, which resulted in the retrieval of three mature oocytes. All three oocytes successfully developed into blastocysts. The blastocysts were then subjected to PGT-A, a technique used to screen for chromosomal abnormalities. The results revealed two euploid (chromosomally normal) embryos and one aneuploid (abnormal) embryo.

Dr. Suchindra explained, “Mariam underwent a Frozen Embryo Transfer (FET) cycle, a procedure designed to assist in achieving pregnancy. In this process, embryos that were previously fertilized and frozen are thawed and then transferred into the uterus. The timing of the transfer is carefully coordinated with your menstrual cycle to maximize the chances of a successful pregnancy.” In this case, one of the euploid blastocysts was chosen for transfer, further increasing the chances of a successful pregnancy.

Fifteen days after the embryo transfer, Mariam’s beta-hCG level was recorded at 4280 mIU/ml, indicating a positive pregnancy. An early pregnancy scan confirmed the presence of an intrauterine gestational sac. A follow-up scan at 6 weeks and 2 days revealed a gestational sac with a fetal pole and cardiac activity, confirming a viable pregnancy.

The couple shared, “Initially, we had lost all hope, but the Doctor took the time to explain the entire process and encouraged us to give ourselves another chance. What truly made the difference was the personalized care we received.”

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“Mrs. Mamta, aged 35 years old, obese with a BMI of 27 kg/m² has been struggling with infertility for the last five years. One diagnosis was found that she has a history of anovulatory cycles and hysterosalpingography (HSG) revealed tubal blockage. The anovulatory cycle is when the egg is not released from the ovaries during menstruation. In the case of tubal blockage, fallopian tubes don’t allow egg and sperm to meet. Both lead to infertility,” shared Dr. Jasneet Kaur, Consultant and Clinical Director – Reproductive Medicine, Milann Fertility Center, Chandigarh.

She added, “Along with this, she also had borderline hypertension and a family history of diabetes, so in general she had impaired glucose tolerance or prediabetic. She was also diagnosed with bilateral fimbrial blockages and a positive test for tuberculosis (Koch’s disease) in her endometrial tissue causing atypical complex hyperplasia, which is the abnormal growth of endometrial cells (uterine lining), and well-differentiated endometrioid adenocarcinoma (Grade 1) means cancer cells are almost exactly replicating the endometrial cells, and slowly progressing towards cancer.

Based on the analysis, she was prescribed to undergo definitive surgery which could have possibly eliminated her natural conceiving, but she opted for fertility preservation.”

What is Fertility Preservation?

It is a process to preserve your eggs, embryo, sperm, and reproductive tissues for future use. It is usually recommended for those with cancer, and other health issues – autoimmune diseases, age, or transgender.

Fertility preservation can be categorized under two types – minimizing the impacts of drugs or diseases on reproductive tissues while getting treated for cancer and removing or freezing reproductive organs.

Procedure for Fertility Preservation

The procedure is mostly personalized based on body conditions and functioning. The process starts with ovary stimulation. And then hormones are injected. Eggs are drawn using needles under proper sedatives. This process is done under ultrasound guidance. Then eggs are directly frozen or after fertilization, it is done.

“But in her case, the team decided to treat her hormonal therapy beginning megestrol acetate 80 mg three times a day and placing a levonorgestrel intrauterine contraceptive device (LNG-IUCD) for treating cancer with the preservation of her reproductive organs. In addition, she resumed metformin for glucose control and was advised to lose weight for overall improved health,” she explained.

“The process was done under regular observation. After three – and – six months when the cancer was negative, hormonal therapy followed by assisted reproductive technology was done. Given her condition, controlled ovarian stimulation (COS) was started with a progestin-primed ovarian stimulation (PPOS) protocol. Ovarian stimulation was successful, giving rise to four mature oocytes: all were fertilized, making two blastocysts of high quality that have been frozen, “she added. 

The embryos or fertilized eggs are then placed in the womb of the mother or someone else’s womb who’ll conceive your child. Ultimately, Mrs. Mamta had to choose surrogacy due to the return of cancer, although it didn’t spread it made unable her to carry the child.

People should opt for conceiving naturally instead of going through many artificial procedures until it is needed for artificial methods. And also, this case suggests that woman should at least do a fertility test in their 20s to 30s.

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