The Case I Didn’t Expect to Win

By Dr. Avanthi Vellala

She was 31. AMH of 0.1. Decreased ovarian reserve for the last three years. Follicle count of four on a good day.

From the very first consultation, I was honest with them clearly. With numbers like these, success in the first attempt wasn’t something I could promise. We might need multiple stimulation rounds. We might end up needing donor eggs. I wanted them to walk into this with their eyes open, not with false hope that would hurt more later.

They heard all of it. They understood. And they said we want to try with our own eggs first.

We started.

We expected two eggs. We retrieved two. Both mature. Both fertilised. Both made it to blastocyst. Average to good quality.

100% blast conversion. With an AMH of 0.1.

I want to be clear about what that means because it doesn’t happen often. With a reserve this low, forming even one blastocyst is considered a success.

For sperm selection, I used microfluidics a technique that selects the best quality sperm and reduces DNA damage, specifically useful in cases where we have limited eggs and every one counts. They weren’t thrilled about the add on. I understood that. But when you’re working with that low AMH and the journey to get here has already been hard, I wasn’t going to leave anything on the table.

Then we found a polyp.

I advised a hysteroscopy and polypectomy before the transfer. They pushed back on this too. I understood the reluctance another procedure, more waiting, more cost. But I held firm. When forming embryos is already this difficult, you don’t transfer into a cavity that isn’t perfect. This had to be our best possible attempt. I wasn’t willing to compromise on that.

They agreed. We did the hysteroscopy. Then a HRT FET cycle. Transferred both embryos.

Positive.

I was cautiously happy on the outside. Deep down I was quietly celebrating. I was eagerly waiting for the heart beat scan.

Yesterday I did the scan. Eight weeks. Heartbeat there, strong and clear.

And here I am, writing this.

I’ll be honest I didn’t expect this outcome. Not in the first attempt. Not with these numbers. Very low AMH, 100% blast conversion, positive clinical pregnancy, first go. We don’t see this all the time.

This is one of those cases I’ll carry with me for a long time. Not because I did something extraordinary but because I’ve seen couples walk away after hearing the odds. And I understand why. When a doctor says the chances are low, it’s hard to hold on to hope. But this is exactly why I say you never know what’s waiting for you unless you try.

Wishing her a safe and smooth delivery.