They Chose Me Back. Jai Balayya.

By Dr. Avanthi Vellala

This one I’ve been waiting to write for a long time.

She was 32, he was 35. Married four years, trying for nine months when they first walked into my clinic in August 2024. Two cycles of OI with timed intercourse, two IUIs. Nothing. They got exhausted and took a break.

And then I ran into them at a Balayya movie. Daaku Maharaaj. If you know, you know Dabidi Dibidi. They spotted me, I spotted them, and they told me they were going to come back.

They came back. One more IUI cycle. Then we moved to IVF.

13 expected, 12 retrieved, 10 mature, 9 fertilised, 4 frozen. Good response for a young couple with healthy reserve and normal semen parameters. We transferred a single day-5 blastocyst, good grade.

Negative.

I didn’t jump to conclusions. I did a frozen-thawed biopsy on one embryo and an ERA. Followed by a PGT and ERA-based FET with the chromosomally normal embryo.

It implanted. She was pregnant.

Blighted ovum. An empty gestational sac. No fetal pole.

They were shattered. I was too, quietly. A PGT euploid embryo, the right endometrial timing, and still a blighted ovum. These are the moments that stay with you as a doctor. Not because you don’t understand the biology, but because understanding it doesn’t make it easier to sit across from someone and explain it.

They took a break. I understood.

In the meantime, under family pressure and advice from people around them, they visited another doctor. Did another fresh IVF cycle. 7 retrieved, 5 mature, 4 fertilised, three day-3 embryos transferred fresh.

It failed.

They came back to me immediately after the negative UPT.

They told me what had happened that they’d gone elsewhere because of family pressure. I told them I don’t mind those things. Frankly i was happy that they chose me back.

And I meant it. I genuinely did not mind. Patients make decisions under enormous social pressure. Families mean well. The decision to seek a second opinion is never something I take personally. What matters is that they came back and that we could keep going.

Now let me tell you where we stood clinically. One failed FET. One PGT euploid transfer that ended in a blighted ovum. One fresh ET with day-3 embryos at another clinic, also failed. Young couple. Healthy reserve. Normal parameters. Immunological evaluation was the next step.

We had discussed immune workup after the miscarriage. They had consulted a reproductive immunologist and got the tests done but at that point they weren’t ready to proceed. Now, after the outside failure, they came back ready.

We did Lymphocyte Immunisation Therapy.

We discussed IUI cycle vs transfer of remaining embryos. Another cycle of IVF to form good embryos wasn’t on the list NOT because I expected it to work but just to let her body settle

We had two remaining embryos from the first cycle a 3CC and a 2CC. Not the best. I want to be very honest about that. I told them exactly what these embryos were not ideal, but usable. I want to hold on to that word. Usable.

In IVF we sometimes get so focused on the best embryo that we write off the rest. But embryos that don’t look perfect on a grading scale can still carry life. The evidence supports this. And sometimes all you need is one.

I was realistic with them about success rates.

ERA based FET. Both the untested grade 3 embryos 3CC and 2CC transferred together.

Beta HCG 710.

Positive.

I was celebrating inside. Quietly, cautiously because I had been here before with this couple and I knew what could still go wrong. Every scan before I went in, I was holding my breath more than they were. I kept telling myself I just need a heartbeat. Just that.

When I heard the fetal heart beat on the scan I cannot explain what that felt like. Cases like this feel like an achievement. Not just a clinical outcome. A real, proper achievement.

NT scan was fine. NIPT normal. She is currently in her second trimester, doing well.

I’ve had so many conversations with this couple over nearly two years in the clinic, after failed transfers, during the blighted ovum, during the break, when they came back. I don’t remember all of it. What I remember is that they never gave up. And they came back to me.

They are a charming couple. Extremely obedient as patients they ask questions, but they also listen. She took every injection, every tablet, every procedure without once complaining. Not once.

She left a heartfelt review on Google. I am grateful for that because it tells me she felt seen and cared for. That’s the part that matters.

This case will stay with me for a long time. Not because it was complicated, though it was. But because they chose me back. After going elsewhere. After being disappointed. After everything. They came back, trusted me with what were not the best embryos we had, understood the odds, and tried anyway.

If you’re reading this I hope you’re doing well. I hope the baby is doing well. I hope the next time we run into each other it’s at another Balayya movie. Same theatre. 8 PM show.

Will you be pregnant then or will you have already delivered? I genuinely don’t know. But either way see you there. I am eagerly waiting to hold the lion or lioness

Jai Balayya.