Primary Infertility with Low AMH and Obstructive Azoospermia Leading to a Successful Pregnancy

After years of trying to conceive, this couple came to Birla Fertility & IVF with multiple fertility challenges affecting both partners. The female partner had low ovarian reserve (AMH 0.73 ng/ml) along with hormonal disorders, while the male partner was diagnosed with obstructive azoospermia, requiring surgical sperm retrieval. With a personalised IVF plan, advanced sperm retrieval techniques, and endometrial optimisation, the couple achieved pregnancy in their very first IVF cycle and welcomed healthy babies.

- Birla Fertility & IVF, Varanasi, (Dr. Deepika Mishra)

Case Snapshot

Patient AgeFemale: 32 years | Male: 32 years

ChallengesPrimary infertility, low AMH (0.73 ng/ml), diminished ovarian reserve, hyperprolactinemia, hypothyroidism, obstructive azoospermia requiring surgical sperm retrieval

TreatmentPersonalised ovarian stimulation, TESA with ICSI, hysteroscopy, PRP therapy, blastocyst transfer

OutcomeSuccessful conception in the first IVF/ICSI cycle, healthy pregnancy, successful delivery of healthy babies

TimelineLong-standing infertility followed by successful pregnancy in the first personalised IVF cycle.

Journey Timeline

1. Complex Challenges

2. Personalised Plans

3. Safe Retireval & Transfer

4. Guided Transfer

5. Successful Pregnancy

The Barriers They Faced

Low Ovarian Reserve

The female partner had an AMH level of 0.73 ng/ml, indicating diminished ovarian reserve and raising concerns about the number of eggs that could be retrieved.

Hormonal Disorders

Hyperprolactinemia and hypothyroidism further complicated fertility and required careful management before treatment.

Obstructive Azoospermia

The male partner had no sperm present in the ejaculate due to obstruction, making natural conception impossible without surgical sperm retrieval.

Need for Endometrial Optimisation

Preparing the uterine environment was essential to maximise the chances of successful implantation.

Combined Male and Female Infertility

The presence of significant fertility factors in both partners required a coordinated, multidisciplinary treatment approach.

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. Deepika Mishra

The Treatment Plan that made the Difference

Personalised Ovarian Stimulation

Despite a low AMH level, an individualised ovarian stimulation protocol helped achieve a satisfactory ovarian response, resulting in the retrieval of five mature (MII) oocytes.

Surgical Sperm Retrieval with TESA

Since the male partner had obstructive azoospermia, Testicular Sperm Aspiration (TESA) was performed to retrieve viable sperm for fertilisation.

ICSI and Blastocyst Development

The retrieved sperm were used for ICSI, leading to successful fertilisation and the development of two high-quality blastocysts (Grade 5AA and 5BA).

Endometrial Optimisation

Before embryo transfer, the uterine cavity was optimised through hysteroscopy and Platelet-Rich Plasma (PRP) therapy to improve endometrial receptivity.

Personalised Embryo Transfer

Both high-quality blastocysts were transferred under carefully optimised conditions, maximising the chances of implantation.

A Story of Personalised Care for Combined Infertility

This case demonstrates that low AMH and obstructive azoospermia do not necessarily prevent biological parenthood when managed with advanced reproductive technologies and personalised treatment. By combining individualised ovarian stimulation, TESA with ICSI, and endometrial optimisation through hysteroscopy and PRP, the team successfully addressed both female and male infertility factors in a single treatment plan. It reinforces the importance of multidisciplinary fertility care, advanced laboratory techniques, and evidence-based interventions in helping couples overcome complex infertility and achieve successful pregnancy outcomes.

The Outcome

The personalised treatment approach resulted in:

Successful conception in the first IVF/ICSI cycle Pregnancy confirmed on ultrasound Healthy progression of pregnancy following appropriate obstetric management Successful delivery of healthy babies