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.

Preimplantation genetic testing for aneuploidies (PGTA) diagnoses chromosomal abnormalities and can be complemented by cumulus cell transcriptional analysis to assess egg and ovarian quality and development during embryo culture. In addition to selecting the best available embryo, intrauterine administration of platelet-rich plasma (PRP) and correction of insulin resistance (IR) through nutritional intervention can improve endometrial quality. This case report examines the potential feasibility of combining in vitro fertilization (IVF) with four techniques to achieve a viable pregnancy. A couple with a prior successful IVF pregnancy was seeking a second pregnancy. The patient was diagnosed with polycystic ovary syndrome (BMI = 24.5 kg/m2), whereas her partner had teratozoospermia. For the first IVF cycle, using PGTA, we confirmed that only euploid embryos were transferred. A hysteroscopic examination confirmed a lack of endometrial competence, and treatment with autologous intrauterine PRP improved endometrial receptivity; however, after a single-embryo transfer, the embryo did not implant. The patient underwent a nutritional intervention to improve insulin resistance with a low-carb dietary intervention (carbohydrates < 50 g/day, protein 1.5 g/day) that reduced insulin resistance after 2 weeks. For the next IVF cycle, the low-carb dietary intervention was continued, along with another PRP application, and the cumula cells transcriptional analysis was performed in addition to PGTA, identifying two optimal euploid embryos. This time, embryo implantation occurred (β-hCG: 362.0 mIU/mL). The pregnancy ended at 39 weeks, with a healthy male baby (length: 53 cm; weight: 3465 g; Apgar 8/9). In conclusion, using molecular techniques for embryo selection (cumula analysis and PGTA) and interventions to improve endometrial function (PRP and a dietary intervention) are an effective strategy that strengthens IVF and increases the likelihood of achieving a viable pregnancy.