Fertility treatment for Low Ovarian reserve

BACKGROUND

A 33-year-old female  patient married for 2 years  came for fertility treatment. She had a known case of endometriosis  with a decreased ovarian reserve, an AMH of 0.2ng/ml, and an FSH of 16.1 units, which reflects an extremely low ovarian  reserve and predicts a very poor response to ovarian stimulation. She had 3 cycles of IVF attempted in the U.S.A, and in  view of very poor response to treatment, the egg collection was cancelled in all attempts there.

TREATMENT

The patient was very keen on trying IVF with self-eggs again and did not want to go for donor eggs. She was put on Folic acid, antioxidants, and multivitamins for 3 months to improve her egg quality and response to treatment. IVF was done here with Recombinant  gonadotropins. We managed to get 6 oocytes out of which we got 3 good embryos, which were frozen. The endometriosis was then treated with a GnRH Agonist suppression therapy followed by a frozen thawed embryo transfer. SBHCG 2 weeks after transfer was 463.7 mIU/ml. The latest scan showed a single live foetus with cardiac activity and a CRL of 0.8cm corresponding to 6 weeks 6 days of pregnancy.