Table of contents
This story of our patient is not about a miracle and not about a single extraordinarily successful protocol.
It is about something significantly more important — a well-structured cumulative treatment strategy, where we evaluate not the result of a single stimulation, but the woman’s entire reproductive journey and step by step move toward the main goal — the birth of a child.
And this story is also about trust. About the ability to keep going after unsuccessful attempts. About the resilience of a woman who, despite a complex diagnosis and not always encouraging intermediate results, did not lose sight of her goal.
Where this story began
At the time of coming to Reprolife, the patient was 36 years old, and her reproductive history by that time was already quite complex.
Even before surgical treatment, in 2023, her AMH level was only 0.69 ng/ml. In the same year, the patient underwent laparoscopy for a large right ovarian endometrioma 72 mm in diameter — cystectomy, excision of peritoneal endometriosis foci, and chromohydrotubation. Both fallopian tubes were patent.
After the surgery, the right ovary became afollicular — follicles were no longer visualized in it. At the same time, two endometriotic cysts remained in the left ovary.
In 2024, at the age of 35, her ovarian reserve parameters were as follows: AMH 0.4 ng/ml, FSH 16.7 IU/l.
So, when the woman came to us, we were dealing with a significantly reduced ovarian reserve, endometriosis, and virtually only one ovary from which we could expect a follicular response to stimulation.
This was a situation in which every retrieved oocyte mattered. But at the same time, we understood: a low AMH is an important part of the prognosis, but it cannot independently determine the entire reproductive perspective of a specific woman.
There was already an unsuccessful attempt behind her
Prior to contacting Reprolife, the patient underwent an IVF program at another medical center.
Back then, during egg retrieval, only 2 oocytes were obtained, from which one embryo of good morphological quality was formed — 4AA. According to PGT-A results, it was euploid (chromosomally healthy).
It seemed that the most difficult stage had already been passed: there was a chromosomally healthy embryo, there was a chance for pregnancy.
However, after its transfer in January 2025, pregnancy did not occur.
For the patient, this was a difficult moment. When behind you lies a low ovarian reserve, ovarian surgery, endometriosis, and then even the transfer of an euploid embryo does not result in pregnancy, it is very easy to lose faith in further treatment.
One might start asking: is there any chance left at all?
We believed that there was.
We were not looking for a single “ideal” retrieval — we began accumulating chances
In women with a reduced ovarian reserve, a single stimulation cycle often yields only a few oocytes. Psychologically, it is very easy to treat each such cycle as an isolated exam: many oocytes mean “success,” few mean “failure.”
But reproductive medicine is much more complex.
We looked at the situation not through the lens of a single month’s result, but through a cumulative perspective. Our goal was to consistently obtain oocytes and embryos, evaluate their potential, and gradually increase the likelihood of getting an euploid embryo.
And this patient’s subsequent journey demonstrated very clearly how different ovarian response can be, even in the very same woman.
During the first egg retrieval at Reprolife, we obtained 4 oocytes: 2 mature MII, 1 MI, and 1 degenerate oocyte.
The next stimulation yielded 7 oocytes, of which 5 were mature MII. 3 embryos were obtained.
According to the results of preimplantation genetic testing (PGT-A), this time there was no euploid embryo. One of them — a 4AA blastocyst — had a mosaic duplication of part of the long arm of chromosome 22 with 59% mosaicism. Other tested embryos had chromosomal abnormalities.
This was another moment when we could have stopped.
But we continued.
During the third retrieval, we obtained 4 oocytes, of which 3 were mature MII. Another 3 embryos developed; however, among those tested, we again did not get an euploid one — chromosomal abnormalities were detected.
After several such cycles, it is very easy to think that the body has already shown its maximum and the next attempt will be roughly the same.
But reproductive biology does not always unfold according to a linear scenario. And the next stimulation became, perhaps, the best proof of this.
The fourth stimulation — and a completely different ovarian response
In one of the subsequent cycles, we obtained 16 oocytes, of which 14 were mature MII.
From these, 5 blastocysts developed.
And the PGT-A results this time differed fundamentally from the previous ones: we obtained two euploid embryos at once — 5AA and 4AA. Another tested embryo had a chromosomal deletion.
And here we want to return once again to the point where our journey began.
The patient is 36 years old. AMH — 0.4 ng/ml. The right ovary after surgery is afollicular. In the left — two endometriotic cysts. Behind her — a previous unsuccessful transfer of an euploid embryo.
And yet, after consistent treatment, we obtained two euploid embryos.
And this story demonstrates very clearly:
AMH is an important marker of ovarian reserve and helps predict the ovarian response to stimulation. But a single AMH number cannot tell a woman’s entire reproductive story and should not be viewed as a sentence.
Obtaining euploid embryos was only part of our journey
We remembered that the patient’s history already included an unsuccessful euploid embryo transfer. Therefore, the next step was working not only with the embryo, but also with the uterine cavity and the endometrium.
We performed a hysteroscopy and polypectomy for the patient, after which we proceeded to transfer preparation.
In the autumn of 2025, a 5AA euploid embryo was transferred.
Pregnancy was achieved.
Then came the first positive test results, the first ultrasound, the waiting, the pregnancy monitoring — that entire long journey for which treatment had once begun.
And today we can write the most important thing: our patient gave birth to her son.
And this story may still have a continuation
What is particularly valuable is that the birth of the first child is not the entirety of the cumulative result of the treatment performed.
The family still has one more euploid embryo.
That is, today we are speaking not only about an already born child, but also about preserved reproductive potential for a possible future pregnancy.
A 4AA mosaic embryo with a mosaic duplication of part of chromosome 22 also remains preserved. A mosaic embryo cannot be equated with an euploid one, and the question of the possibility of its use must always be considered individually following genetic counseling.
And this very point helps clarify the concept of cumulative IVF efficacy.
Cumulative efficacy is more than the result of a single stimulation
Patients often ask us: “How many oocytes did we get this time?”
That is an important question. But especially in cases of reduced ovarian reserve, it is sometimes far more important to ask another one:
“What reproductive potential were we able to create over the entire treatment period?”
In our patient’s case, the number of oocytes retrieved at Reprolife changed from stimulation to stimulation as follows:
4 → 7 → 4 → 16.
If we had drawn a final conclusion after the first retrieval, we would have seen only 4 oocytes.
If we had stopped after the third, we might have decided that the ovarian response consistently remained low.
But the next stimulation yielded 16 oocytes, 14 mature MII, and ultimately two euploid embryos.
One of them has today already become a born child.
The second remains stored in the cryobank.
That is why a cumulative strategy is an individualized decision regarding the appropriateness of continuing treatment for a specific patient, taking into account her age, ovarian reserve, previous response, obtained embryos, and overall reproductive goal.
Not every cycle needs to end in pregnancy on its own to be an important part of successful treatment.
Sometimes the path to the birth of a child consists of several stimulations, several retrievals, obtaining and accumulating embryos, PGT-A, endometrial preparation, and only then — the transfer.
It is this entire journey that forms the cumulative result.
Behind every result stands more than just medicine
For us, this story is special for another reason as well.
Infertility treatment is never just tests, medications, retrievals, the number of MII, or PGT-A results.
Behind every number is a woman who comes back for an ultrasound. Who waits for a call from the embryologist. Who receives a result different from what she hoped for — and still finds the strength to keep going.
Therefore, we want to separately thank our patient for her trust in our team.
For allowing us to walk this path together with her.
For her patience, consistency, and incredible resilience at times when the outcome of the next stage was impossible to predict.
In reproductive medicine, we cannot guarantee how many oocytes we will retrieve in the next cycle or which embryo will become that future child.
But what remains extremely important is mutual trust between patient and doctor, a willingness to analyze each previous cycle, and together make the next well-founded decision.
On the long journey to cherished motherhood, this is of immense importance.
The main result is not the number of oocytes
This story accurately reflects the philosophy of personalized reproductive medicine at Reprolife.
We do not treat an AMH number. We do not evaluate a situation based solely on the number of follicles seen on a single ultrasound.
And we do not put an end to it just because a single stimulation yielded few oocytes. We look at a woman’s entire reproductive journey, analyze her response to prior treatment, and together build a strategy designed to lead to the main goal.
In this story, the starting point was challenging: 36 years old, AMH 0.4, right ovary afollicular after surgery, two endometriotic cysts in the left ovary, and a previous unsuccessful transfer of an euploid embryo.
Today, her cumulative result is a born son, another euploid embryo in the cryobank, and a mosaic embryo that is also preserved.
And perhaps this is the best way to explain the concept of cumulative efficacy.
It is not only the answer to the question:
“How many did we get today?”
It is a much broader question:
“What result did our entire reproductive strategy lead to?” In this story, it led to the most important thing — the birth of a child.
And it left this family with a reproductive opportunity so that one day this story might receive another continuation.
We thank our patient for her trust, strength, and resilience. It is a great honor for us to stand beside her on such an important journey.
