A Bengaluru couple welcomed their first child after struggling with infertility for nearly eight years and experiencing three failed embryo transfers. She was advised donor cycles due to the repeated failures. Fertility specialists identified the root cause as a combination of fallopian tube issues and sperm damage that had gone undetected, enabling the woman to successfully conceive using her own embryos.The couple, Ananya, 35 years, and Aswin, 36 years (name changed for privacy), were married for eight years and have been trying to conceive since then. They had undergone three IVF cycles at another centre, and unfortunately, all embryo transfer resulted in negative outcomes despite having good-quality blastocysts. The couple was advised to use donor gametes in the next cycle.When the couple approached Dr. Rubina Pandit, the woman’s fertility parameters (AMH) were found to be normal. But the husband’s semen analysis showed poor sperm quality with high DFI indicative of sperm DNA damage. A self-egg and sperm IVF cycle was planned. After egg retrieval, an advanced sperm selection technique ( PICSI + Microfluidics) was used to select the healthiest sperm to perform ICSI. Four good-quality embryos were developed, which were then screened to identify any genetic abnormalities through Preimplantation Genetic Testing (PGT-A); all four came back normal, ruling out embryo quality as the cause.Speaking on the case, Dr. Rubina Pandit, Fertility Specialist, Nova IVF Fertility, Basveshwaranagar, Bengaluru, said, “We observe that atleast 40% of couples who seek fertility treatment come to us after experiencing IVF failures. While embryo quality is often assumed to be the primary reason, many of these cases have underlying causes, be it the issues related to the fallopian tubes and uterus that require a far more personalised evaluation. In failed IVF cycles, it’s very important to identify the root cause; if I do the same treatment as the previous doctor, then it may not give the right result”With embryo quality ruled out, the team shifted its focus to the uterus and fallopian tubes. During detailed ultrasound examinations, the doctor noticed a streak of fluid inside the uterine cavity which was not getting resolved with antibiotics and other medical management; this fluid can, at times, interfere with the embryo getting implanted. A hysteroscopy and laparoscopy were planned to check the condition of the fallopian tubes. Before the procedure, the couple was informed that if fluid-filled, damaged tubes (hydrosalpinx) were found, they might need to be disconnected. During the procedure, the tubes were found to be unhealthy, tubal disconnection was done. Post-procedure, further ultrasounds showed no fluid in the uterine cavity.Even the healthiest seed won’t grow if it’s planted before or after the soil is ready. The embryo was healthy, but doctors planned to check the correct window of implantation before doing transfer via endometrial receptivity assay (ERA). In this case, Ananya’s uterus was ready a day later than the standard embryo transfer timeline (120 hours). Hence, the embryo was transferred according to ERA result. The patient conceived and delivered a healthy baby. Their extra embryos are still frozen in case they want to plan a second child in the future.While embryo quality remains an important factor, fertility specialists increasingly recognise that uterine conditions, fallopian tube-related problems, and sperm damage can all contribute to the success of an IVF cycle. The case shows that in the case of failed cycles, one size fit will not work, and it needs a more personalised approach.
