Overcoming Age-Related Ovarian Decline with Advanced Blastocyst Technology

Case Background

Basic Case Information

Primary Doctor: Dr. Songpan
Case Type: Ovarian function decline due to advanced age

Female Patient Profile (Ms. A)

Age: 41 years old
Previous Treatments in China: Underwent two IVF cycles
- First egg retrieval: 4 eggs retrieved
- Second egg retrieval: 3 eggs retrieved
Hormone Levels:
- Prolactin: 17.38 ng/mL
- Follicle-Stimulating Hormone (FSH): 7.49 mIU/mL
- Luteinizing Hormone (LH): 3.78 mIU/mL
- Estradiol: 41.91 pg/mL

Male Patient Profile

Age: 45 years old
Semen Analysis:
- Semen volume: 3.4 mL
- Sperm concentration: 21.46 million/mL
- Total motility: 56.04%
- Normal morphology: 4.74%
- Sperm DNA fragmentation rate: 9%

Key Issues Identified

The female patient’s advanced age has led to diminished ovarian function and low ovarian reserve.
The female patient also has uterine fibroids.

Case Summary

Diagnosis and Treatment Outcome

Both partners are of advanced reproductive age and had previously attempted IVF twice without success. After evaluation, the doctor diagnosed the female patient with diminished ovarian reserve (DOR) due to her age. Ultrasound revealed only 3 usable follicles (diameter > 4mm), indicating a significantly reduced ovarian reserve.

Following controlled ovarian stimulation, 4 eggs were successfully retrieved, of which 2 fertilized and developed into blastocysts. Genetic testing showed that 1 embryo was chromosomally normal. On November 27, 2024, the embryo transfer was performed, and the embryo successfully implanted. On December 24, 2024, a transvaginal ultrasound confirmed normal fetal development, with fetal heartbeat and yolk sac detected, marking a successful pregnancy.

Controlled Ovarian Stimulation (COS)

Stimulation Protocol: Antagonist Protocol

- Day 2 of Stimulation (Thailand)
  - Ultrasound Findings: 3 baseline follicles (<3mm: 2 follicles)
    - Right ovary: 1 follicle (2mm)
    - Left ovary: 4 follicles (9mm, 7mm, 6mm, 2mm)
  - Hormone Levels:
    - FSH: 10.6 mIU/mL
    - LH: 5.0 mIU/mL
    - Estradiol: 42.9 pg/mL
    - Prolactin: 9.8 ng/mL
  - Treatment Plan: IVF-M-HP 225 IU + Clomiphene + Provera

- Day 5 of Stimulation (Thailand)
  - Ultrasound Findings:
    - Right ovary: 1 follicle (10mm)
    - Left ovary: 3 follicles (14mm, 11mm, 10mm)
  - Hormone Levels:
    - LH: 11.15 mIU/mL
    - Estradiol: 393 pg/mL
  - Treatment Plan: Menopur 150 IU + IVF-M-HP 225 IU + Cetrotide 0.25 mg + Provera

- Day 7 of Stimulation (Thailand)
  - Ultrasound Findings:
    - Right ovary: 1 follicle (11mm)
    - Left ovary: 3 follicles (18mm, 15mm, 15mm)
  - Hormone Levels:
    - LH: 1.4 mIU/mL
    - Estradiol: 800 pg/mL
  - Treatment Plan: Menopur 225 IU + IVF-M 225 IU + Cetrotide 0.25 mg

- Day 9 of Stimulation (Thailand)
  - Ultrasound Findings:
    - Right ovary: 1 follicle (16mm)
    - Left ovary: 3 follicles (23mm, 20mm, 18mm)
  - Hormone Levels:
    - LH: 0.9 mIU/mL
    - Estradiol: 1357 pg/mL
  - Treatment Plan: Menopur 225 IU
  - Trigger Shot Before Egg Retrieval: Cetrorelix 250 mcg + Diphereline 0.1 mg

Embryo Development Results

Oocytes Retrieved: 4
Mature Eggs: 3
Normally Fertilized: 2
Day 3: 2 embryos with 8 cells each
Day 5: 2 blastocysts formed and biopsied
Chromosomal Screening: 1 normal embryo

▲ Ms. A’s blastocyst culture report

▲ Ms. A’s embryo screening report

Pre-Transfer Endometrial Hormone Preparation

- Day 2 of Menstrual Cycle (China)
  - Hormone Levels:
    - Estradiol: 44.48 pg/mL
    - Progesterone: 0.29 ng/mL
  - Ultrasound Findings:
    - Endometrial thickness: 5 mm
    - Multiple uterine fibroids, largest measuring 24×13 mm
  - Treatment Plan: Estradiol valerate (Progynova), aspirin, prednisone

- Day 17 of Menstrual Cycle (Thailand)
  - Hormone Levels:
    - Estradiol: 299.8 pg/mL
    - Progesterone: 0.31 ng/mL
  - Ultrasound Findings: Endometrial thickness 11 mm
  - Treatment Plan: Estradiol valerate (Progynova), aspirin, prednisone, dydrogesterone, vaginal progesterone suppositories, Ventolin

- Day 20 of Menstrual Cycle (Thailand)
  - Hormone Levels:
    - Estradiol: 470 pg/mL
    - Progesterone: 17 ng/mL
  - Treatment Plan: Estradiol valerate (Progynova), aspirin, prednisone, dydrogesterone, vaginal progesterone suppositories, Ventolin

Embryo Transfer Day

Procedure: Transferred 1 normal embryo (Grade: HB, B-B-)

Pregnancy Confirmation

Gestational Age	B-hCG (mIU/mL)	Progesterone (ng/mL)	Ultrasound Findings
4 weeks + 5 days	55.9	11.8	–
5 weeks	41,759	15.06	Gestational sac: 24×18×10 mm, yolk sac: 3.3 mm, no fetal heartbeat or embryo visible
6 weeks	–	–	Gestational sac: 30×22×19 mm, yolk sac: 3.1 mm, fetal heartbeat and embryo (5×3 mm) visible