Patient Profile
- woman 42 years old
- Infertility history of about 18 years
- Over 20 previous IVF attempts
- Multiple previous hysteroscopies and laparoscopies
- Very burdened reproductive history
- Perimenopausal hormonal profile at first assessment
effort history
The patient had behind her an extremely long infertility path, lasting almost 18 years.
There had been more than 20 attempts at IVF, as well as repeated invasive procedures, such as hysteroscopies and laparoscopies.
Despite many attempts, no pregnancy had been achieved.
When we first met, the picture was particularly difficult. The hormonal profile was very bad, with perimenopausal status characteristics, while the response of the ovaries to IVF drugs was practically non-existent.
clinical challenge
The main difficulty of the incident was the extremely low ovarian response.
Despite the administration of maximum doses of injectable drugs for IVF, in four consecutive attempts no follicle was developed.
This means that there was not even the possibility of receiving an egg.
In such a context, the prognosis is considered extremely unfavorable. The patient did not simply have a low response; essentially, she did not respond at all to the usual drug stimulation.
This is one of the cases where medical logic could easily lead to the cessation of efforts.
Psychological dimension
Despite the long course, repeated failures and extremely difficult medical data, the couple maintained a rare persistence and faith.
The strength with which they persisted was so clear that there was no doubt that it deserved to continue the effort.
It was not a persistence blind or absurd. It was the deep need of two people who, despite everything, could not yet accept that their journey was over.
Diagnostic & Therapeutic Approach
- Complete reassessment of history
- Recognition of extremely poor ovarian response
- Avoiding repetition of the same intense protocols to no avail
- Personalized Therapy Scheme Design
- Adapting the pharmaceutical approach to the real potential of the ovaries
- Objective: not the production of many eggs, but the possibility of recruiting even one functional follicle
After four cycles without any follicle, it was decided to apply a fully personalized treatment regimen, different from previous attempts.
Logic was no longer the maximum stimulation with large amounts of drugs, but a more careful, adapted and targeted approach.
IVF Strategy
In the fifth attempt, with a personalized therapeutic protocol and smaller, carefully adjusted amounts of drugs, a follicle was finally recruited.
An egg arose from this one follicle.
One egg was fertilized and developed into an embryo.
And this one fetus eventually led to pregnancy.
Result
The result was the birth of a healthy girl.
A child who emerged after 18 years of infertility, over 20 failed attempts and four consecutive cycles without any egg.
Today we have the pleasure of seeing this little girl in the wife's pediatric clinic.
The couple, even after years, seems to have a hard time believing that they had a child.
And we rejoice from a distance for them, with respect for their journey and without participating in any dramatization of this story.
clinical conclusions
- Very low ovarian response does not always mean absolute end of effort
- Repeating the same intense protocols is not always the right solution
- In some cases, smaller and more carefully planned pharmaceutical interventions may be more effective
- Even a single egg can matter
- The individualization of treatment can change the prognosis even in extremely unfavorable cases
- The couple's faith and perseverance, when combined with medical judgment and proper planning, can lead to unexpected results
- The effort should not always stop because the previous shapes failed
The lesson of the incident
This couple taught something very important.
That the effort should not be mechanically stopped, just because the data seems extremely difficult or because the previous attempts did not work.
It does not mean that false hopes should be cultivated.
But it means that when there is even a small margin, when the couple is fully aware and when medical planning can be effectively adapted, it is worth considering every possibility.
Through this incident, this lesson helped many other couples later.
Final message
There are stories that do not impress with the quantity.
There weren't many eggs. There weren't many embryos. There were no great chances.
There was a pocket. an egg. an embryo. And finally, a child.
In some incidents, life doesn't need much to begin.
You just need not to stop just before the unique opportunity appears.
