Clinical Pregnancy at 41 With Low Ovarian Reserve, Fibroids and Male-Factor Infertility

At 41, this woman had been trying to conceive again for nine years. Her fertility journey was complicated by reduced ovarian reserve, multiple uterine fibroids, previous miscarriages and two unsuccessful IUI attempts in Bangkok. Her husband, aged 45, also had teratozoospermia with poor sperm morphology. Because only a limited number of eggs were expected from an individual cycle, treatment was planned across two separate retrieval cycles. Blastocysts were created and cryopreserved before a personalised frozen embryo transfer was performed.

- Birla Fertility & IVF, Hyderabad, (Dr. A. Jhansi Rani)

Case Snapshot

Patient AgeFemale: 41 years | Male: 45 years

ChallengesAdvanced maternal age, AMH 0.82 ng/mL, reduced ovarian reserve, uterine fibroids, previous miscarriages and teratozoospermia

TreatmentTwo ICSI cycles, blastocyst cryopreservation across both cycles, personalised endometrial preparation and frozen embryo transfer

OutcomePositive pregnancy test followed by confirmation of a multiple clinical pregnancy

TimelineNine years of secondary infertility, two failed IUIs and two planned IVF retrieval cycles before frozen embryo transfer

Journey Timeline

1. Multiple Fertility Factors

2. First ICSI Cycle

3. Second ICSI Cycle

4. Embryo Accumulation & FET

5. Clinical Pregnancy

The Barriers They Faced

Advanced Maternal Age

At 41, both ovarian response and age-related changes in reproductive potential had to be considered while planning treatment.

Low Ovarian Reserve

An AMH of 0.82 ng/mL meant that only a limited number of eggs were expected from each stimulation cycle.

Multiple Uterine Fibroids

Fibroids formed part of the overall uterine assessment and had to be considered together with the patient's reproductive history.

Previous Pregnancy Losses

A history of miscarriages added another important element to treatment planning.

Male-Factor Infertility

The male partner had teratozoospermia, with a high proportion of abnormally shaped sperm.

Doctor's Quote

“The key was to tailor every aspect of care to this patient's unique needs, balancing safety, comfort, and clinical effectiveness.”

— Dr. A. Jhansi Rani

The Treatment Plan that made the Difference

First ICSI Cycle

The first ovarian stimulation and egg-retrieval cycle was followed by ICSI and blastocyst development.

Second ICSI Cycle

A second retrieval cycle was performed to provide an additional opportunity to obtain embryos.

Embryo Accumulation

Blastocysts from the two cycles were cryopreserved before proceeding to transfer.

Personalised Endometrial Preparation

The uterine lining was prepared before frozen embryo transfer according to the patient's clinical findings.

Frozen Embryo Transfer

Laser-assisted hatching and intralipid support were also used as supportive components of the individualised transfer protocol.

A Story of Planning With Patience

Advanced maternal age, low ovarian reserve, uterine fibroids, previous pregnancy losses and male factor infertility all had to be considered together. By planning treatment across two retrieval cycles and preparing for transfer after embryo accumulation, the team created a staged strategy around the patient’s individual fertility profile.

The Outcome

The frozen embryo transfer resulted in a positive pregnancy blood test, followed by confirmation of a multiple clinical pregnancy.

This case highlights how treatment may sometimes need to be staged across more than one retrieval cycle when ovarian reserve is low and several fertility factors coexist.