Successful Pregnancy After Therapeutic Apheresis in a Complex Case of PCOS, Hashimoto Thyroiditis, Recurrent Implantation Failure, and Potential Occupational Environmental Exposure

Both polycystic ovary syndrome and Hashimoto thyroiditis are commonly associated with female infertility. Each condition may impair reproductive function through distinct but sometimes overlapping mechanisms, and their co-occurrence has been associated with an even higher risk of infertility. In this single-case report, we describe a 33-year-old female with established polycystic ovary syndrome (anti-Müllerian hormone [AMH] 20 ng/mL) and autoimmune thyroiditis (anti-thyroid peroxidase [anti-TPO] antibodies 917 IU/mL) with infertility persisting since 2020. After multiple unsuccessful cycles of ovarian stimulation, advanced fertility treatment with in vitro fertilization and repeated embryo transfers was initiated in 2023, initially without success. Extracorporeal therapeutic apheresis was applied as an adjunctive intervention with the aim of modulating markers of oxidative stress (baseline nitrotyrosine level 883 ng/mL). It was also intended to reduce potential environmental contaminants, including elemental mercury and anesthetic gases, which the patient, a dentist, may have been exposed to in her occupational setting. These exposures have been associated with adverse reproductive outcomes. Pregnancy was successfully documented in December 2024, followed by the birth of a healthy girl in September 2025. This case demonstrates a temporal association between targeted interventions and successful pregnancy, highlighting the importance of considering both immunological and environmental factors in the management of complex infertility. The findings underscore the need for individualized strategies to address multifactorial infertility challenges.