VMPL
New Delhi [India], August 26: Infertility is often a test of patience and resilience for couples. For some, it's riddled with unanswered questions and repeated disappointments. Such was the experience of a 28-year-old woman and her husband, married for three years, who had sought medical help at several clinics before finally getting clarity and care at Birla Fertility & IVF, Kolkata.
The clinical picture
Tests painted a difficult scenario. The woman's AMH was 0.02 ng/mL, and scans revealed small ovaries with no visible follicles. A hysteroscopy showed a uterine septum. In simple terms: there were no eggs to work with, and the uterus itself had an obstacle that could make implantation harder. For a woman in her early twenties, it was a difficult diagnosis.
The first steps
Given the confirmed ovarian failure, the team discussed and sensitised the couple and planned IVF using donor oocytes with ICSI. Four high-grade blastocysts were developed. Before any transfer, the septum was surgically resected so the uterine lining would have a better chance of supporting pregnancy. The first transfer was carried out after preparing the endometrium to 8.7 mm thickness. The embryos were good, the lining looked right yet the result came negative.
Digging deeper
Rather than repeating the same process, the team investigated further. An Endometrial Receptivity Array (ERA) was done. It revealed the lining was "pre-receptive," meaning the timing had been off. Armed with this knowledge, the doctors adjusted the transfer window. Two top-quality blastocysts were placed back in the uterus, but this time at the corrected timing.
The outcome was a success this time with the woman conceiving, and her pregnancy progressed normally under routine antenatal care.
Reflections from the team
Dr Swati Mishra explained, "This was a layered case - premature ovarian failure, a uterine anomaly, and even after correction, a failed first transfer. ERA helped us understand the endometrium's timing, and that small detail changed the outcome. Just as important was keeping the couple informed and supported through every stage."
What this case teaches
* Donor oocyte IVF remains the best chance for women with very low ovarian reserve.
* Hysteroscopic correction can make the uterine environment more favourable.
* ERA testing has value after a failed first attempt.
* Even younger women can present with premature ovarian failure, which makes early evaluation critical.
For this couple, the journey was anything but easy but with precision, adjustment, and steady guidance, the path to parenthood finally opened.
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