Successful fertility outcome in a couple with recurrent implantation failure and testicular cancer survivor: A case report.

A couple of Indo-American descent, presented to our clinic with a history of primary infertility and repeated IVF implantation failure. Male was a testicular cancer survivor who had erectile dysfunction and azoospermia. Female partner had polycystic ovarian syndrome (PCOD). She had three unsuccessful attempts of embryo transfer at another fertility clinic. At our clinic, she underwent controlled ovarian stimulation, COH started from day two period with rFSH (follicle stimulating hormone) followed by HMG (human menopausal gondadotropin) with antagonist protocol followed by preimplantation genetic screening of embryos. Subsequently, she began HRT (hormone replacement Therapy) protocol for ERA cycle from day 2, where she also underwent hysteroscopy on day 7. After five days of progesterone supplementation, she underwent endometrial biopsy for ERA (endometrial receptivity assay). Frozen embryo transfer cycle was started with the same HRT protocol used in her previous ERA cycle. Post embryo transfer, immunotherapy with steroids and fortnightly intralipids was given. Pregnancy test was positive with a BHCG value of 290 mIU/mL. and she delivered naturally after 39 completed weeks of gestation. A stepwise personalized treatment approach maximizes the chances of a successful outcome in presence of both male and female factors. Frozen or fresh sperms for ICSI with PGS along with hysteroscopy, ERA and under cover of immune modulation yielded positive results.