Twin Live Birth After Azoospermia and Reduced Ovarian Reserve

For nine years, this couple had been unable to conceive. The female partner was 30 years old but had endometriosis, reduced ovarian reserve and a previous history of polyp removal. The male partner, aged 39, had azoospermia, meaning sperm were not present in the ejaculate. Only a very limited number of sperm could be obtained surgically, and those retrieved also showed poor morphology. The treatment therefore required close coordination between ovarian stimulation, surgical sperm retrieval and the embryology laboratory. TESA was used to retrieve sperm directly from the testis, followed by ICSI and blastocyst culture. The treatment ultimately resulted in the birth of a healthy baby boy and baby girl.

- Birla Fertility & IVF, Gachibowli, (Dr. Spandana Nuthakki)

Case Snapshot

Patient AgeFemale: 30 years | Male: 39 years

ChallengesNine years of primary infertility, reduced ovarian reserve, endometriosis, azoospermia, limited surgically retrieved sperm and poor sperm morphology

TreatmentIndividualised ovarian stimulation, TESA, ICSI, Day 5 blastocyst culture and personalised embryo transfer

OutcomeTwin pregnancy followed by live birth of a healthy baby boy and baby girl

TimelineNine years of infertility with no previous IVF treatment before visiting Birla Fertility & IVF

Journey Timeline

1. Azoospermia + Reduced Reserve

2. Egg Retrieval + TESA

3. ICSI

4. Day 5 Blastocyst Transfer

5. Twin Live Birth

The Barriers They Faced

Azoospermia

No sperm were present in the ejaculate, making surgical sperm retrieval necessary before fertilisation could be attempted.

Limited Retrieved Sperm

Only a small number of sperm were available following surgical retrieval, increasing the importance of careful laboratory handling.

Reduced Ovarian Reserve

The female partner also had reduced ovarian reserve, meaning both egg and sperm availability were limited.

Endometriosis

Endometriosis added another female fertility factor to an already complex treatment scenario.

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. Spandana Nuthakki

The Treatment Plan that made the Difference

Individualised Ovarian Stimulation

Stimulation was tailored to obtain mature oocytes despite reduced ovarian reserve.

TESA for Surgical Sperm Retrieval

Sperm were retrieved directly from the testis because of azoospermia.

ICSI With Retrieved Sperm

ICSI was used to inject an individually selected retrieved sperm into each mature oocyte.

Day 5 Blastocyst Development

Following fertilisation, embryos were cultured to the blastocyst stage before transfer planning.

Personalised Embryo Transfer

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

A Story of Possibility Through Teamwork

With reduced ovarian reserve on one side and azoospermia with very limited surgically retrieved sperm on the other, both egg and sperm availability required careful management. Close coordination between the fertility and embryology teams allowed treatment to progress from surgical sperm retrieval and ICSI to blastocyst development and embryo transfer.

The Outcome

Pregnancy was successfully established and confirmed as a twin pregnancy. The mother later delivered a healthy baby boy and baby girl and was discharged in stable condition.

This case shows how surgical sperm retrieval and ICSI may provide a treatment pathway for selected couples facing azoospermia alongside female fertility challenges.