Successful pregnancy after male factor infertility, PGT-A and frozen embryo transfer
This case describes a couple with three years of primary infertility who sought fertility treatment in Spain after previous unsuccessful assisted reproductive treatments in the United Kingdom. Their case involved advanced maternal age, severe male factor infertility, previous IVF failure, and a prior biochemical miscarriage. Because the couple wished to continue attempting treatment with their own gametes while also considering alternative options, the treatment plan required careful counseling, individualized decision-making, and a balanced discussion of prognosis.
Key Clinical Points
- Primary infertility of three years’ duration
- Female patient aged 37 and approaching 38 at initial consultation
- Irregular menstrual cycles ranging between 28 and 40 days
- Obstetric history of one biochemical miscarriage after previous IVF treatment
- Severe oligoasthenoteratozoospermia in the male partner
- Previous unilateral varicocele surgery with very limited improvement
- Previous IVF-ICSI and frozen embryo transfer attempts in the United Kingdom
- Mixed-factor infertility related to male factor infertility and advanced maternal age
- IVF-ICSI with higher gonadotropin doses to maximize oocyte yield
- Partial insemination using partner sperm and donor sperm
- PGT-A performed on biopsied blastocysts
- Single euploid frozen embryo transfer
- Successful pregnancy and delivery of a healthy baby girl at 38 weeks
The couple presented with primary infertility of three years’ duration and sought fertility treatment in Spain after previous assisted reproductive treatments in the United Kingdom.
The female patient was 37 years old at the time of the initial consultation and approaching 38 years of age. She had no relevant personal medical history. Her gynecological history was notable for irregular menstrual cycles ranging between 28 and 40 days. Her obstetric history was G0P0010, corresponding to one early biochemical miscarriage following a previous IVF treatment.
Her partner’s most relevant background factor was severe oligoasthenoteratozoospermia, consistent with severe male factor infertility. He had previously undergone unilateral varicocele surgery with very little improvement. Hormonal evaluation had shown elevated FSH levels and slightly low testosterone levels. He also reported a prior history of intramuscular testosterone use, which had been discontinued two years earlier..
The couple had previously undergone assisted reproductive treatments in UK. Their first IVF-ICSI cycle was performed using a long agonist protocol with relatively low gonadotropin doses, resulting in retrieval of 8 mature metaphase II (MII) oocytes. Fertilization rate was 5/8, followed by a fresh single embryo transfer without pregnancy. Subsequently, the patient underwent one frozen embryo transfer (single embryo transfer under substituted cycle), resulting in a biochemical miscarriage, and a second frozen embryo transfer with double embryo transfer, also unsuccessful.
Given the combination of moderate male factor infertility and advanced maternal age, the couple sought further counseling regarding alternative strategies and prognosis. Although they wished to attempt another IVF-ICSI cycle, they expressed significant concerns regarding the emotional and physical burden of ovarian stimulation, as the patient had tolerated previous treatment poorly.
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Diagnostics – what was diagnosed with the woman and the man?
The couple was diagnosed with mixed-factor infertility, primarily related to moderate male factor infertility combined with advanced maternal age.
The impact of sperm quality on embryo development and reproductive outcomes was discussed extensively with the couple. Although semen donor treatment was considered as a potential option, it was explained that, at that stage, the indication for exclusive donor sperm use was not entirely clear given the existing fertilization potential with partner sperm.
The couple expressed concerns regarding the possibility of repeating another IVF cycle with similar outcomes, particularly because significant improvement in sperm quality had not been achieved despite previous interventions. Additional complementary testing, including sperm DNA fragmentation testing, was discussed whenever sperm concentration permitted. The role of preimplantation genetic testing for aneuploidy (PGT-A) was also reviewed in light of maternal age and male factor infertility.
Counseling was additionally provided regarding the medical and legal aspects of gamete donation in Spain in the event that donor sperm treatment became necessary in future attempts.
Dr Alicia Saborit
What protocols and procedures were used? What was done differently?
An antagonist IVF protocol was recommended using higher gonadotropin doses compared with the couple’s previous treatment in order to maximize oocyte yield. The rationale behind this strategy was to increase the number of available oocytes and embryos, thereby improving the probability of obtaining euploid embryos after PGT-A analysis.
The possibility of inseminating part of the retrieved oocytes with partner sperm and another portion with donor sperm was discussed in advance. However, it was emphasized that this approach would only be reasonable if a sufficiently high number of mature oocytes were obtained, in order to avoid significantly compromising the couple’s chances of success using their own gametes, especially considering the plan to perform PGT-A.
The stimulation protocol consisted of recombinant FSH 225 IU combined with hMG 75 IU, together with GnRH antagonist (ganirelix) suppression. Final oocyte maturation was induced using triptorelin 0.2 mg. The patient completed a total of 9 days of ovarian stimulation.
A total of 15 cumulus–oocyte complexes were retrieved, including 14 mature MII oocytes and 1 immature MI oocyte. Following extensive counseling regarding the strategy for insemination with partner versus donor sperm, careful consideration was given to balancing the couple’s desire to maximize the probability of achieving pregnancy with their own gametes against the potential impact of severe male factor infertility on embryological outcomes. Given the limited number of available mature oocytes and the already compromised semen parameters, it was ultimately recommended to inseminate the majority of oocytes using the partner’s sperm in order to preserve a meaningful chance of success with autologous gametes. The couple elected to inseminate 9 MII oocytes using partner sperm and 5 MII oocytes using donor sperm. Fertilization rates were 7/9 with partner sperm and 3/5 with donor sperm.
What were the results before embryo transfer?
Embryo development was favorable overall. On day 5 of embryo culture, six blastocysts were biopsied for PGT-A analysis. Three blastocysts originated from donor sperm fertilization and were graded as 5AA, 5AA, and 6AA. Three additional blastocysts derived from partner sperm fertilization and were graded as 5AA, 5AB, and 5BB.
On day 6 of embryo culture, one additional blastocyst derived from partner sperm fertilization reached biopsy stage and was graded as 5AB.
PGT-A results demonstrated two euploid embryos overall: one day-5 5AB blastocyst derived from partner sperm and one day-5 6AA blastocyst derived from donor sperm.
Additional complementary reproductive evaluations and possible future strategies were reviewed with the couple before proceeding with embryo transfer.
The embryo transfer
A hormonally substituted frozen embryo transfer protocol was planned. Endometrial preparation was carried out using oral estradiol valerate 2 mg every 8 hours in combination with ganirelix 0.25 mg daily for 5 days in order to minimize the risk of spontaneous ovulation.
Frozen embryo transfer was performed without complications using a single euploid embryo. The procedure was well tolerated and no technical difficulties were encountered during transfer.
After the embryo transfer – pregnancy details and result
The frozen embryo transfer resulted in a successful clinical and ongoing pregnancy. Pregnancy follow-up progressed appropriately without major reported complications.
The patient ultimately delivered a healthy baby girl at 38 weeks of gestation through vaginal delivery.
How many couples in similar situations are treated in the clinic? How common is this medical background among the patients?
Couples presenting with a combination of advanced maternal age and moderate to severe male factor infertility are frequently encountered in clinical practice. Repeated implantation failure and recurrent unsuccessful IVF attempts are also common among patients seeking second opinions after treatment abroad.
Cases such as this one highlight the complexity of reproductive decision-making when both gamete quality and maternal age contribute to prognosis. The emotional burden associated with repeated treatments, especially when patients are reluctant to undergo additional ovarian stimulation cycles, is also commonly observed.
This case additionally illustrates how individualized counseling and flexibility in reproductive planning may help couples feel more actively involved in treatment decisions. The possibility of combining partner sperm and donor sperm within the same cycle required careful ethical, medical, and emotional discussion tailored to the couple’s preferences and reproductive goals.
This case reflects the importance of individualized reproductive medicine and shared decision-making. Couples experiencing repeated fertility treatment failure often arrive emotionally exhausted and uncertain about how to proceed, particularly when concerns regarding both ovarian reserve and sperm quality coexist.
One of the key aspects of this case was respecting the couple’s values while continuing to provide realistic and evidence-based counseling regarding prognosis. Rather than imposing a single treatment pathway, different alternatives were openly discussed, including the possibility of using donor sperm selectively depending on ovarian response.
Importantly, this case also demonstrates that reproductive care should not only focus on laboratory outcomes or statistical success rates, but also on helping patients feel informed, supported, and actively involved throughout the decision-making process. Ultimately, the treatment resulted in the birth of a healthy child and represented a positive outcome after a long and emotionally demanding reproductive journey.
About the Author:
Dr Alicia Saborit graduated in Medicine and Surgery from the University of Elche in 2013. She later specialized in the field of reproductive health by completing a Master’s Degree in Reproductive Medicine at IVI Global Education in 2019, followed by a Master’s Degree in Reproductive Medicine, Gynecology and Endometriosis at the University of Navarra in 2021/2022.
Since 2017, Dr Saborit has been practicing medicine, building extensive experience in reproductive medicine and gynecology. She currently serves as the Medical Director of Reproclinic, where she is committed to providing personalized and high-quality patient care.
Dr Saborit speaks Spanish, Catalan, French, and English, allowing her to support and communicate effectively with international patients.
