Ongoing Pregnancy at 40 From a Single Day 3 Embryo

At 40, with an AMH of 1.0 ng/mL and an antral follicle count of only 1–2, this patient entered IVF treatment knowing that only a very limited number of eggs might be obtained. Ultimately, just one egg was retrieved. That single oocyte fertilised normally following ICSI and developed into an 8-cell Grade I embryo on Day 3. With no additional embryos available, the couple was counselled about whether to continue culture to Day 5 or proceed with an earlier transfer. They chose a single fresh Day 3 embryo transfer. The result was an ongoing intrauterine pregnancy with fetal cardiac activity.

- Birla Fertility & IVF, Lucknow, (Dr. Shreya Gupta)

Case Snapshot

Patient AgeFemale: 40 years | Male: 45 years

ChallengesAdvanced maternal age, AMH 1.0 ng/mL, antral follicle count 1–2, one egg retrieved and only one embryo available

TreatmentIndividualised antagonist stimulation, ICSI and single fresh Day 3 embryo transfer

OutcomePositive pregnancy test followed by confirmation of a single intrauterine pregnancy with fetal cardiac activity

TimelineOne stimulation cycle, one oocyte retrieved, one Day 3 embryo developed and transferred fresh

Journey Timeline

1. Very Low Ovarian Reserve

2. One Egg Retrieved

3. One Day 3 Embryo Developed

4. Single Fresh Embryo Transfer

5. Ongoing Pregnancy

The Barriers They Faced

Advanced Maternal Age

At 40, age-related reproductive changes were an important factor in counselling and treatment planning.

Very Low Ovarian Reserve

An AMH of 1.0 ng/mL together with an AFC of 1–2 suggested that only a small number of follicles were likely to respond.

Only One Egg Available

The stimulation cycle yielded a single oocyte, making every subsequent laboratory and clinical decision particularly important.

Day 3 VS Day 5 Transfer

With only one embryo available, the couple had to decide whether to transfer on Day 3 or continue culture to the blastocyst stage.

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. Shreya Gupta

The Treatment Plan that made the Difference

Individualised Antagonist Stimulation

The stimulation protocol was planned according to the patient's advanced maternal age and very low ovarian reserve.

One Oocyte Retrieved

Egg retrieval resulted in a single oocyte.

ICSI and Normal Fertilisation

ICSI was performed on the retrieved oocyte and normal fertilisation was achieved.

Day 3 Embryo Assessment

The embryo developed into an 8-cell, Grade I embryo on Day 3.

Shared Decision-Making on Transfer Timing

After discussing the advantages and limitations of Day 3 transfer versus continued culture to Day 5, the couple chose to proceed with a single fresh Day 3 embryo transfer.

A Story of One Chance, Carefully Nurtured

With only one egg retrieved and one embryo available, there was little room for a standardised approach. Every decision, from fertilisation to whether the embryo should be transferred on Day 3 or cultured further, was made around that single opportunity, with the couple involved throughout the decision making process.

The Outcome

Beta-hCG measured 3,841, and subsequent ultrasound evaluation confirmed two gestational sacs.

This case shows that in selected low-egg-yield cycles, even one mature oocyte and one developing embryo can represent a meaningful treatment opportunity when decisions are tailored to the individual patient.