IVF for Blocked Tubes & Low Ovarian Reserve Casestudy

Patient Profile

Age	34 years
Gender	Female
Occupation	Working Professional
City	Navi Mumbai
Presenting Complaint	Unable to conceive after 2 years of trying; 5 failed IUI cycles
Diagnosis	Bilateral tubal damage (confirmed on laparoscopy) + Low ovarian reserve (AMH 0.9 ng/mL, AFC 4)
Duration of Issue	2 years of infertility
Previous Treatments	5 IUI cycles over 18 months; laparoscopic evaluation done
Date of Procedure	February 2025
Outcome	Successful — Positive beta hCG at Week 2 post-transfer

Patient identity withheld per confidentiality guidelines. All other details shared with written consent.

The Problem

Condition

This patient came in with two separate fertility problems happening at the same time. First, her tubes were blocked. Laparoscopy had already confirmed bilateral tubal damage, meaning eggs could not travel from the ovaries to the uterus naturally. Second, her ovarian reserve was low. Her AMH was 0.9 ng/mL and her antral follicle count on scan was just 4, both below the threshold where standard treatments tend to work. On their own, either of these would be a significant barrier. Together, they made natural conception or IUI medically impractical.

Emotional and Psychological Impact

By the time she came to Dr. Prajna Shetty‘s clinic, she had already gone through five IUI cycles over eighteen months. That is a long time to be trying, waiting, hoping, and then starting again. She described feeling “numb” after the fifth failure. She wasn’t sure what was left to try. The diagnosis of tubal damage had already been given to her elsewhere, but nobody had explained clearly what it meant for her options going forward. A lot of the anxiety wasn’t about the diagnosis itself. It was about not understanding why the previous treatments had failed, and whether anything would actually work.

What she was looking for was a Fertility Specialist in Nerul, Navi Mumbai who would sit across from her, explain the anatomy of the problem, and walk through every option, including IVF treatment for tubal factor infertility, before recommending a path forward. Not just the next prescription. The next plan.

Consultation & Treatment Plan

What Was Assessed During Consultation

Tubal status confirmed via previous laparoscopy report and reviewed in detail
Ovarian reserve markers: AMH 0.9 ng/mL and AFC 4 on transvaginal ultrasound
Partner semen analysis: count, motility, morphology, and DNA fragmentation
Uterine cavity assessment via sonohysterography to rule out fibroids or polyps
Patient’s fertility history: number of IUI cycles, response to stimulation, prior outcomes
Psychological readiness and understanding of the IVF process

Why IVF Was Chosen Over Other Options

Given the findings, IVF with ICSI was the only medically sound path forward. The reasoning was specific:

Tubal factor ruled out IUI entirely: With both tubes damaged, sperm cannot physically reach the egg without assisted fertilisation. For patients with this diagnosis, tubal blockage treatment
Low AMH required careful stimulation: With an AMH of 0.9 and AFC of 4, the protocol needed to maximise egg retrieval without over-stimulating. A tailored low-dose antagonist protocol was chosen.
ICSI added given borderline morphology: Partner’s morphology was at the lower end of normal. ICSI, where a single sperm is injected directly into each egg, reduced the risk of fertilisation failure.
Frozen embryo transfer selected over fresh: Given the low reserve, Dr. Prajna Shetty opted to freeze all viable embryos and transfer in a subsequent cycle after the uterine lining was optimally prepared. This approach consistently shows better implantation rates in low-reserve patients.

If you have been diagnosed with tubal blockage or low AMH, a IVF treatment consultation is the most direct way to understand what your options are.

Pre-Operative Documentation

Pre-treatment transvaginal ultrasound — Antral follicle count scan (AFC = 4, bilateral)

Hormonal baseline report — AMH 0.9 ng/mL, FSH, LH, Day 2 profile

Pre-IVF hormonal baseline report showing patient details and a multi-test result table (AMH, FSH, LH, Estradiol, TSH, PRL) with reference ranges and status flags (LOW/HIGH/NORMAL). A clinical interpretation box is visible below.

Procedure Details

Step-by-Step Overview

Pre-treatment evaluation completed including uterine cavity check and partner semen DNA fragmentation test
Ovarian stimulation started on Day 2 of cycle using low-dose gonadotropins with antagonist protocol
Follicular monitoring done on Days 6, 8, and 10 via serial transvaginal ultrasound
Trigger injection given when lead follicle reached 18mm
Egg retrieval performed under short general anaesthesia; 5 mature eggs retrieved
ICSI performed on all 5 mature eggs; 3 fertilised and developed to Day 5 blastocyst stage
All 3 blastocysts vitrified (freeze-all strategy)
Endometrial preparation for FET started in subsequent cycle
Single blastocyst transferred on Day 5 of progesterone support
Beta hCG blood test confirmed positive 14 days post-transfer

Procedure Facts

Stimulation Duration	10 days
Eggs Retrieved	5 mature oocytes
Fertilised (ICSI)	3
Blastocysts Formed	3 (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

For more on how frozen embryo transfer works and who it benefits, visit the frozen embryo transfer treatment page.

Post-Treatment Results

The patient responded better than initially expected. Despite a low ovarian reserve, stimulation produced 5 mature eggs, 3 of which fertilised and reached blastocyst stage. The frozen embryo transfer was done in the next cycle with a well-prepared endometrium. Beta hCG at 14 days was positive and rising appropriately. An early ultrasound at 6 weeks confirmed a single intrauterine pregnancy with fetal cardiac activity.

Post-transfer ultrasound — Intrauterine pregnancy confirmed at 6 weeks

Ultrasound of early pregnancy showing an intrauterine gestation with visible embryo, CRL 0.46 cm, GA 6 weeks 1 day, fetal heart activity 120 bpm (EDD 01/16/2025).

Outcomes at a Glance

Outcome Metric	Result
Eggs Retrieved	✔ 5 mature oocytes
Fertilisation	✔ 3 blastocysts formed
Implantation	✔ Successful — single intrauterine pregnancy
Complications	✔ None
Patient Satisfaction	✔ Very high — relief and gratitude expressed at follow-up

Patient Feedback

“I had almost given up after the fifth IUI. Dr. Prajna explained everything so clearly at the first appointment. She told me exactly why IUI wasn’t working and what we needed to do differently. I felt like someone finally understood what I was going through. When the scan showed the heartbeat, I couldn’t stop crying.”

Profile: Female · 34 years · Working Professional · Navi Mumbai

Procedure: IVF with ICSI + Frozen Embryo Transfer · drprajnashetty.com, Navi Mumbai · February 2025

Treating Doctor: Dr. Prajna Shetty · Fertility Consultant · Nerul, Navi Mumbai

Patient feedback shared at clinical follow-up. Published with written consent. Patient identity withheld.

Post-Procedure Care & Recovery

Instructions Given to the Patient

Progesterone support (vaginal pessaries) continued for 12 weeks post-transfer
Complete bed rest not required; light activity encouraged after Day 3
Avoid heavy lifting, strenuous exercise, and intercourse for 2 weeks post-transfer
Hydration and a protein-rich diet advised during the stimulation phase
No NSAIDs during the luteal phase; paracetamol only if needed
Beta hCG blood test on Day 14 post-transfer; repeat at Day 16 to confirm doubling
Early pregnancy scan booked at 6 weeks gestation

Recovery Timeline

Timeframe	What to Expect
Day 1–3 post-retrieval	Mild bloating and cramping. Rest advised. Normal to feel emotional.
Day 4–10	Body recovers. Endometrial preparation begins for FET in subsequent cycle.
Transfer Day	Simple OPD procedure. No anaesthesia. Rest for remainder of day.
Day 14 post-transfer	Beta hCG blood test. This is the moment everyone waits for.
Week 6 of pregnancy	Early scan to confirm heartbeat and location.
Week 12	First trimester screening. Progesterone support tapered if all is well.

FAQs

Q1 When is IVF the right treatment option for a woman?

IVF is usually recommended when tubes are blocked, ovarian reserve is low (AMH below 1.2 or AFC below 5), or after 4 to 6 failed IUI cycles. Age above 37 also shifts the treatment of choice toward IVF because egg quality and quantity decline significantly after that point.

Q2 What is AMH and why does it matter for IVF?

AMH (Anti-Mullerian Hormone) tells your doctor how many eggs are left in your ovaries. A value below 1.2 ng/mL suggests low reserve and usually means IVF with a tailored stimulation protocol will be needed rather than simpler treatments.

Q3 Can IVF work even with a low AMH or low egg count?

Yes, though fewer eggs are retrieved. What matters most is egg quality, not just quantity. At Dr. Prajna Shetty’s clinic in Nerul, Navi Mumbai, even patients with an AFC of 3 to 5 have had successful outcomes when the stimulation protocol is planned carefully. You can read more about how low reserve is managed in the poor ovarian reserve treatment guide.

Q4 Why is frozen embryo transfer (FET) sometimes better than fresh transfer in IVF?

In a fresh transfer, the body is still recovering from stimulation, which can affect the uterine lining. FET allows the lining to be prepared under controlled conditions in a separate cycle, which often results in better implantation rates, especially in low-reserve patients.

Q5 How many IUI cycles should I try before moving to IVF?

Most fertility specialists recommend considering IVF after 3 to 6 failed IUI cycles, especially if you are over 35 or if any structural issue such as tubal blockage has been identified. Waiting longer than this rarely improves outcomes.