Severe Male Factor Infertility and Poor Ovarian Reserve Leading to an Ongoing Twin Pregnancy

After several unsuccessful attempts to conceive naturally, this young couple came to Birla Fertility & IVF seeking a second opinion. They had previously been advised to consider donor treatment because of severe male factor infertility and low ovarian reserve. Determined to explore the possibility of conceiving with their own gametes, they chose a personalised treatment approach. Through carefully planned IVF, advanced sperm selection, and staged embryo creation, the couple achieved a successful twin pregnancy using their own eggs and sperm.

- Birla Fertility & IVF, Chennai, (Dr. Shyla Usman Ali)

Case Snapshot

Patient AgeFemale: 25 years | Male: 27 years

ChallengesPoor ovarian reserve (AMH 0.6 ng/ml), severe oligoasthenoteratozoospermia (SOAT), history of cryptorchidism, Grade III varicocele, previous failed ovulation induction cycles, previously advised donor treatment

TreatmentPersonalised ovarian stimulation, two IVF/ICSI cycles, microfluidics-assisted sperm selection, blastocyst culture, diagnostic hysteroscopy, frozen embryo transfer (FET)

OutcomeSuccessful twin pregnancy using self-gametes, ongoing healthy pregnancy at 23 weeks

TimelineFollowing previous unsuccessful fertility treatments, the couple underwent two personalised IVF cycles before frozen embryo transfer.

Journey Timeline

1. Complex Challenges

2. Personalised Plans

3. Safe Retireval & Transfer

4. Guided Transfer

5. Successful Pregnancy

The Barriers They Faced

Poor Ovarian Reserve

At just 25 years of age, the female partner had an AMH level of 0.6 ng/ml, limiting the number of eggs available for IVF.

Severe Male Factor Infertility

The male partner was diagnosed with severe oligoasthenoteratozoospermia (SOAT), significantly affecting fertilisation potential.

Underlying Male Reproductive Conditions

A history of cryptorchidism and Grade III varicocele further compromised sperm quality.

Previous Treatment Failures

Multiple ovulation induction cycles had failed to result in pregnancy.

Recommendation for Donor Treatment

Due to the combined male and female fertility factors, the couple had previously been advised to pursue donor treatment but wished to conceive using their own gametes.

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. Shyla Usman Ali

The Treatment Plan that made the Difference

Individualised Ovarian Stimulation

A personalised stimulation protocol was designed to maximise egg retrieval despite the patient's low ovarian reserve.

Two Planned IVF Cycles

To increase the number of embryos available for transfer, treatment was carried out over two oocyte retrieval cycles. During the first cycle, six oocytes were retrieved, three were mature, and one high-quality Grade 4AA blastocyst was successfully cryopreserved. During the second cycle, four oocytes were retrieved, resulting in another high-quality blastocyst suitable for transfer.

Advanced Sperm Selection with Microfluidics

Microfluidics-assisted sperm selection was performed before ICSI to identify sperm with better functional quality, helping improve fertilisation outcomes in severe male factor infertility.

Diagnostic Hysteroscopy

Before embryo transfer, a diagnostic hysteroscopy was performed to evaluate and optimise the uterine cavity for implantation.

Personalised Frozen Embryo Transfer

Following careful endometrial preparation, two Grade 4AA blastocysts were transferred during a frozen embryo transfer (FET) cycle.

A Story of Perseverance and Personalised Fertility Care

This case demonstrates that poor ovarian reserve and severe male factor infertility do not always require donor treatment. With careful planning, advanced laboratory techniques, and a personalised IVF strategy, pregnancy using self-gametes can still be possible. By combining individualised ovarian stimulation, microfluidics-assisted sperm selection, staged embryo creation, and comprehensive uterine evaluation, the clinical team helped this couple overcome significant fertility challenges and achieve a successful ongoing twin pregnancy. It reinforces the importance of evidence-based, personalised fertility care and reminds couples that every treatment plan should be tailored to their unique clinical situation rather than based on prognosis alone.

The Outcome

The personalised treatment approach resulted in:

Successful pregnancy following frozen embryo transfer Twin pregnancy established Healthy progression of pregnancy Normal amniotic fluid assessment during follow-up Ongoing pregnancy at 23 weeks