Is AGE just a number in fertility ?

By Dr. Avanthi Vellala

They were 42 and 45. Fourteen years of marriage. Primary infertility.

I’ve learned not to ask why people waited. There’s always a reason, a life that happened, circumstances that weren’t simple, choices that made sense at the time. What matters is who is sitting in front of me right now and what we can do from here.

Her evaluation came back with critically low ovarian reserve. AMH of 0.1, follicle count of one or two. I told her honestly the success rates with her own eggs at this age with this reserve, were not something I could recommend gambling on.

She didn’t flinch. Said she wanted to go ahead with donor egg.There was a quiet strength in that room that I didn't expect.

Then we evaluated her husband.

He had anejaculation, the inability to ejaculate. Not low sperm count, not poor quality. The body simply doesn’t release. It’s more common than people realise and almost never spoken about openly. And for a man of his generation where these conversations weren’t normalised, where there was no free access to information, where speaking about this kind of thing with anyone felt impossible I think just hearing the word was already a lot.

They disappeared for a month.

He tried home sample collection multiple times but failed.

A man in his mid-forties, trying quietly and privately to solve something he didn’t fully understand, with no one to ask and no language to describe it.

He tried Vibrator stimulation, Vasodilators before the attempt. Failed every time.

Then we talked about TESA surgical sperm aspiration, a straightforward procedure done under IV sedation, fifteen to twenty minutes, where sperm is retrieved directly from testis. It bypasses ejaculation entirely. It’s a real option and it works.

We sent him for pre-anaesthetic evaluation. And that’s where things got harder.

The anaesthetist as they are trained to do went through the risks. Age. High BMI. Complications of anaesthesia. All of it, listed out clinically and correctly.

They walked out of that room and spent an hour at a relative’s place nearby thinking about the complications listed by anaesthetist.

They came back. Same day

I sat with him and said you’ve had anaesthesia before. The surgery for your fracture after the accident. The knee replacement. You came through both of those. This procedure takes fifteen minutes. It’s minor compared to what you’ve already been through. Don’t let the list of risks scare you away from a surgery that’s simpler than ones you’ve already had.

He agreed. We went ahead with donor egg combined with TESA. Good embryos formed. We transferred one in a natural cycle.

She got pregnant. They’re currently at 10 weeks and 5 days. Time to refer them to their gynaecologist.

Her relatives have been calling since the news got out. Everyone wants to know where she got treated, how she found us.

She found us on Google. I teased her about it — told her she chose the clinic, not me.

She looked at me and said “You are the angel I found. I stayed for you.”