IVF for Unexplained Infertility

Successful Pregnancy Following Standard IVF Protocol and Embryo Transfer

Patient Profile

Age	29 years
Gender	Female
Occupation	Working Professional
City	Navi Mumbai
Presenting Complaint	Unable to conceive after 18 months of regular, unprotected intercourse
Diagnosis	Unexplained infertility with normal uterine cavity and ovarian reserve
Previous Treatments	No prior fertility treatment
Date of Procedure	March 2025
Outcome	Successful Positive beta hCG confirmed at 14 days post-transfer

The Problem

Condition

This patient was 29 years old, married for two years, and had been trying to conceive for eighteen months without success. Baseline investigations showed a normal uterine cavity on sonohysterography. Her AMH was 2.3 ng/mL with an antral follicle count of 11 on transvaginal ultrasound. Both values were within normal range for her age. Partner semen analysis was also within acceptable limits on standard WHO parameters. There was no obvious anatomical obstruction and no clear hormonal explanation for the failure to conceive.

In clinical terms, this presentation falls under unexplained infertility. It is more common than many patients expect. Normal reports do not always translate into natural conception, because fertilisation and early embryo development involve processes that standard investigations do not evaluate directly. In such cases, a structured evaluation by a Fertility Specialist in Nerul is essential to identify the appropriate treatment path.

Emotional and Psychological Impact

By the time she came to Dr. Prajna Shetty, a Fertility Specialist in Nerul, Navi Mumbai, she had already been through eighteen months of uncertainty. Every month had followed the same cycle: hope, wait, disappointment. Without a clear diagnosis to point to, the frustration was compounded. She said she felt “stuck” because she didn’t know what was wrong, and nobody had yet given her a concrete reason for the delay.

What she needed was not just a test result. She needed someone to explain what the normal reports meant in context, what they did not rule out, and what a structured treatment plan would look like going forward.

Baseline fertility investigations transvaginal ultrasound and hormonal profile assessment

Consultation & Treatment Plan

What Was Assessed During Consultation

Uterine cavity: Sonohysterography confirmed normal cavity with no polyps or fibroids
Ovarian reserve: AMH 2.3 ng/mL, AFC 11 on transvaginal ultrasound
Tubal assessment: Hysterosalpingography confirmed bilateral tubal patency
Partner semen analysis: Count, motility, and morphology reviewed; DNA fragmentation test ordered
Menstrual cycle regularity and ovulation pattern assessed via serial scans
Thyroid, prolactin, and androgen profile checked to exclude subclinical hormonal causes

Why IVF Was Chosen

After reviewing all investigations, IVF treatment with standard insemination (and ICSI backup) was recommended. The reasoning was specific:

Unexplained infertility of 18 months duration in a 29-year-old is a clinically recognised threshold for moving beyond observation
IVF allows direct assessment of fertilisation, which no prior investigation had evaluated
The patient’s age and ovarian reserve made a good response to stimulation likely, reducing cycle risk
IUI was discussed but considered less efficient given the duration of unexplained infertility and the patient’s preference for a definitive diagnostic and therapeutic step

Procedure Details

IVF laboratory procedure egg retrieval and embryo culture under controlled conditions

Step-by-Step Overview

Baseline transvaginal ultrasound and hormone profile confirmed on Day 2 of the cycle
Ovarian stimulation started on Day 2 using a standard antagonist protocol with gonadotropins
Follicular monitoring performed on Days 5, 7, and 9 via serial transvaginal ultrasound
Trigger injection administered when lead follicles reached 18 to 20 mm
Egg retrieval performed under short general anaesthesia 36 hours post-trigger
8 mature oocytes retrieved; standard IVF insemination performed with ICSI on 3 as backup
6 oocytes fertilised normally; 4 developed to Day 5 blastocyst stage
Freeze-all strategy adopted; all 4 blastocysts vitrified
Endometrial preparation initiated in the following cycle using oral oestrogen for frozen embryo transfer treatment
Single blastocyst transferred on Day 5 of progesterone support
Beta hCG blood test confirmed positive at 14 days post-transfer

Procedure Facts

Stimulation Duration	10 days
Eggs Retrieved	8 mature oocytes
Fertilised	6
Blastocysts Formed	4 (all vitrified)
Transfer Type	Frozen embryo transfer (FET), single blastocyst
Anaesthesia	Short general anaesthesia for retrieval only
Complications	None
Hospital Stay	Day procedure for retrieval; transfer is OPD

Post-Treatment Results

Embryo transfer procedure single blastocyst transferred on Day 5 of progesterone support

The patient responded well to stimulation and produced 8 mature oocytes. Fertilisation was successful in 6. Four reached blastocyst stage by Day 5. The frozen embryo transfer in the subsequent cycle was straightforward. The endometrial lining measured 8.4 mm on the day of transfer. Beta hCG at 14 days was positive and confirmed a doubling trend at Day 16. An early pregnancy scan at 6 weeks confirmed a single intrauterine gestation with fetal cardiac activity present.

Outcomes at a Glance

Outcome Metric	Result	Status
Eggs Retrieved	8 mature oocytes	Achieved
Fertilisation	6 oocytes fertilised	Achieved
Blastocysts Formed	4 blastocysts vitrified	Achieved
Implantation	Single intrauterine pregnancy	Confirmed
Complications	None	Clear
6-Week Scan	Fetal cardiac activity present	Confirmed

Positive beta hCG confirmed at 14 days post-transfer intrauterine pregnancy with fetal cardiac activity at 6 weeks

Patient Feedback

“I had been trying for over a year and every test came back normal, which somehow made it more confusing. Dr. Prajna spent a lot of time explaining what IVF would actually do differently and why it made sense for us at this point. The process was well-managed. When the beta hCG came back positive, I couldn’t believe it. The 6-week scan made it real.”

Post-Procedure Care & Recovery

Instructions Given to the Patient

Progesterone support continued for 12 weeks post-transfer
Complete bed rest not required; light activity encouraged from Day 3 post-transfer
No heavy lifting, strenuous exercise, or intercourse for 2 weeks post-transfer
Protein-rich diet and adequate hydration advised during stimulation and early luteal phase
No NSAIDs during the luteal phase; paracetamol only if pain management was needed
Beta hCG on Day 14 post-transfer; repeat at Day 16 to confirm appropriate doubling
Early pregnancy scan booked at 6 weeks gestation

Recovery Timeline

Timeframe	What to Expect
Day 1 to 3 post-retrieval	Mild bloating and pelvic discomfort. Rest advised. Emotional fluctuation is normal.
Day 4 to 10	Body recovers. Endometrial preparation begins in subsequent cycle for FET.
Transfer Day	Simple OPD procedure under no anaesthesia. Rest for the remainder of the day.
Day 14 post-transfer	Beta hCG blood test. Repeat at Day 16 to confirm doubling.
Week 6 of pregnancy	Early scan to confirm intrauterine location and fetal cardiac activity.
Week 12	First trimester screening. Progesterone support tapered gradually if all is well.

FAQs

Q1. What is IVF and how does it work?

Eggs are stimulated to grow over 10 to 12 days using daily injections. Once mature, they are retrieved under anaesthesia, fertilised in a lab, and the resulting embryo is transferred into the uterus. A pregnancy test is done 14 days later.

Q2. What happens during egg retrieval?

A fine needle is passed through the vaginal wall under ultrasound guidance while the patient is under short general anaesthesia. Eggs are aspirated from the follicles. The procedure takes around 15 to 20 minutes. Mild bloating for one to two days afterward is normal.

Q3. What is the difference between IVF and ICSI?

In IVF, eggs and sperm are placed together and fertilisation happens naturally. In ICSI, a single sperm is injected directly into the egg. ICSI is used when sperm quality is poor, fertilisation has previously failed, or as a precautionary measure.

Q4. Why is frozen embryo transfer sometimes preferred over fresh transfer?

After stimulation, the uterine lining may not be in the best condition for implantation. Freezing embryos and transferring in a separate prepared cycle allows better lining conditions and generally improves implantation rates.

Q5. How long does a full IVF cycle take from start to pregnancy test?

Stimulation and egg retrieval happen in the first cycle, taking about 12 to 14 days. Frozen embryo transfer occurs in the next cycle. The pregnancy test is done 14 days after transfer. Total duration is typically 6 to 8 weeks across both cycles.