In assisted reproduction, not all cases can be explained by a single factor. Some patients face challenges not only with egg quality, or embryo genetics, or the endometrium alone. Often, multiple elements are interfering at the same time, and this requires a deeper, more precise, and well-coordinated strategy.
This is exactly what is shown in a clinical case accepted for publication in Clinical Case Reports: how the combination of four complementary technologies helped a 36-year-old patient with complex fertility challenges achieve a full-term pregnancy and the birth of a healthy baby. The case is particularly relevant because it integrates in one protocol metabolic evaluation, molecular selection of oocytes, embryonic chromosomal analysis, and endometrial preparation.
A Case That Required Seeing the Bigger Picture
The 36-year-old patient came to Ingenes with her partner seeking a second pregnancy through in vitro fertilization (IVF). They had previously had a successful IVF cycle in 2020, resulting in the birth of their first child, but this time the situation was different.
She had been diagnosed with polycystic ovary syndrome (PCOS) and mild overweight. Her partner had teratozoospermia, a sperm morphological issue that can complicate fertilization. Additionally, lab tests revealed that the patient had hyperinsulinemia and insulin resistance, a metabolic factor that can subtly yet significantly affect various stages of the reproductive process. Recent evidence shows that insulin resistance is linked to ovarian response issues, egg quality, and endometrial receptivity, especially in patients with PCOS.
During the patient’s first IVF cycle at Ingenes, oocytes were retrieved and PGT-A (Preimplantation Genetic Testing for Aneuploidies) was performed. The analysis confirmed that only one of four embryos was euploid, meaning genetically normal. Later, a hysteroscopy revealed that the endometrium was only 3.6 mm thick, far below the optimal thickness for implantation. Platelet-rich plasma (PRP) was applied to try and improve the environment, and the one euploid embryo was transferred. However, implantation did not occur.
In a case like this, repeating the same protocol might seem like the obvious course of action. But instead, a different decision was made: to stop and analyze whether multiple factors were simultaneously affecting the outcome.
A Four-Level Protocol
1. Nutritional Intervention to Correct Insulin Resistance
One of the first steps was to address the metabolic component. In patients with PCOS, insulin resistance not only affects general metabolism but can also impact follicular development, egg quality, and endometrial receptivity.
With clinical nutritional guidance, the patient transitioned from a high-carbohydrate diet to a ketogenic diet, with ketosis monitoring to confirm adherence. Within just two weeks, significant improvements were observed in fasting glucose, triglycerides, and HOMA-IR index, indicating better insulin sensitivity.
This wasn’t just about weight loss. It was about improving the metabolic environment in which the entire reproductive process takes place.
2. Implantation Score to Evaluate Oocyte Quality from a Molecular Perspective
In IVF, traditional morphological assessment allows the appearance of the oocyte and embryo to be observed, but it does not always reveal their true biological potential.
This is where a second tool came in: the Implantation Score, developed by the Ingenes research team and previously published in Journal of Ovarian Research. This method analyzes the transcriptomic profile of the granulosa cells surrounding the oocyte to better estimate their implantation potential.
In the second cycle, this evaluation was applied to each oocyte retrieved. Three of them exceeded the established threshold, allowing for a more accurate identification of which ones had a higher chance of leading to viable embryos.
3. PGT-A to Confirm Chromosomal Normality
Once the blastocysts were obtained, PGT-A was performed to examine the 23 pairs of chromosomes and identify euploid embryos.
Out of the five embryos obtained, three were euploid. The team didn’t stop at just this information; they cross-referenced it with the molecular data from the Implantation Score. This way, embryo selection was not based only on appearance or chromosomal status, but on a more comprehensive reading of each embryo’s biological potential.
This combination allowed for the identification of two male embryos with high scores in both criteria: euploidy and higher implantation potential.
4. Endogen to Prepare the Endometrium
Even with a genetically normal embryo, pregnancy cannot occur if the uterus does not offer favorable conditions for implantation.
Since the patient had shown a very thin endometrium in her previous cycle, Endogen was used during the endometrial preparation phase. From the patient’s own blood, growth factors were concentrated and applied directly into the uterine cavity.
The result was a significant change: the endometrium reached a trilaminar structure of 11.8 mm. This means it went from being clearly insufficient in the first attempt to a much more suitable environment for receiving the embryo.
The Final Outcome
The pregnancy progressed until the 39th week. A healthy boy was finally born, measuring 53 cm, weighing 3,465 grams, and with an Apgar score of 8/9.
Beyond the positive outcome, what makes this case valuable is the way the result was achieved.
What This Case Teaches Us About Complex Fertility
One of the most important findings in this case is that none of the tools, on their own, explained the entire problem or solved the entire process.
For example, in the first cycle, a euploid embryo was identified using PGT-A, but that wasn’t enough. The endometrium wasn’t ready, and the metabolic context continued to affect the reproductive environment.
In the second cycle, the change came from addressing each possible critical point simultaneously:
- Nutritional intervention improved metabolic health.
- Endogen helped optimize the endometrium.
- The Implantation Score provided molecular data on the oocytes’ competence.
- PGT-A confirmed which embryos were chromosomally normal.
Together, these tools worked as part of a multi-level strategy: from metabolism to oocyte, from oocyte to embryo, and from embryo to uterus.
When the Problem Isn’t Just One, the Answer Shouldn’t Be Either
This case reinforces an important idea in assisted reproduction: some patients don’t need “more of the same,” but a more comprehensive evaluation of what’s happening at every level of the process.
For those who have experienced failed IVF cycles, this matters a lot. An unsuccessful attempt doesn’t always mean that IVF won’t work. Sometimes, it means that a deeper look is needed, and clinical, scientific, and metabolic decisions need to be better coordinated.
At Ingenes, we believe that the most complex cases deserve equally comprehensive solutions. That’s why we work with an approach that combines clinical experience, applied research, and technologies that allow us to analyze fertility from different angles.
Ingenes: Science That Brings New Opportunities
Fertility doesn’t always depend on a single factor. And when multiple elements interfere simultaneously, finding an answer requires more than just repeating protocols.
This clinical case, published in a peer-reviewed medical journal, shows that when science, personalization, and perseverance align, a new possibility can open up.
If you’ve been through failed attempts or face a complex case, it’s worth knowing that deeper, personalized, and comprehensive approaches exist to study what’s happening and define the next step.
Based on: Rojas-Pérez TG, Reyes-Albarracín Y, Ortiz G, Suárez JJ, Cordero J, Vilchis D, Hernández-Melchor D, López-Bayghen E. Addition of multi-level technologies to evaluate eggs and embryos and improve endometrial quality applied for in vitro fertilization to achieve pregnancy: a case study. Clinical Case Reports, accepted in February 2026.