The present study aimed to evaluate the repeated assisted reproductive technology (ART) failures in a couple struggling with primary infertility and teratozoospermia after 8 years of marriage. The study envisaged the role of comprehensive hormonal evaluation and advanced genetic analysis in the ART outcomes. The case study examined a non-consanguineous couple in an 8-year marriage struggling to conceive naturally despite regular unprotected intercourse. Couples had no history of fertility issues in their families. The male partner, a 36-year-old Marine Engineer, and the female partner, a 32-year-old software engineer, have had repeated ART failures, including intrauterine insemination and in vitro fertilization (IVF) from 2019 to 2022. In 2023, the couple underwent two cycles of advanced fertility treatments, including IVF and intracytoplasmic sperm injection (ICSI), at a tertiary-level fertility clinic. All diagnostic tests and procedures were carried out in accredited clinical laboratories with the written consent of the couples. All ART procedures were carried out by professionally qualified reproductive medicine experts, as per the prevailing guidelines in India. The clinical and ART history showed that an imbalance in hormonal functions were contributory factor for the failure of repeated ART procedures in the couple. The hormonal imbalances due to the low anti-Müllerian hormone (AMH0, high follicle stimulationg hormone, low testosterone, and hyperprolactinemia in the early follicular phase had likely contributed to suboptimal ovarian function, disrupted ovulation and poor ART outcome. The conventional hormonal evaluation and advanced genetic analysis were integrated to resolve the fertility complexity in this case. Genetic testing of the female partner revealed a homozygous wild-type luteinizing hormone/choriogonadotropin receptor genotype associated with poor ovarian response and higher IVF failure rates.Follicle-stimulating hormone receptor analysis indicated a G/G genotype linked to increased androgen levels and reduced ovarian reserve. In contrast, favourable ESR1 genotypes suggested better response to ovarian stimulation. Endometrial receptivity analysis suggested a personalized embryo transfer at 144 ± 3 h after progesterone. Two frozen embryo transfer attempts with thawed blastocysts were made. The second frozen embryo transfer (IVF-ICSI) led to a positive pregnancy, confirmed by β-hCG levels. The couple welcomed a healthy baby girl at full term. We have highlighted the importance of comprehensive hormonal evaluation and advanced genomic analysis in this case. The personalized ART approach should be adopted by integrating genomic testing in early stages of the ART journey, which helps to enable tailored treatment protocols by reducing trial-and-error treatment protocols.
Aparna et al. (Sat,) studied this question.