03 August 2025
: Case report 
Personalized In Vitro Fertilization Protocols in Premature Ovarian Insufficiency and Male-Factor Infertility: A Case Series
Unusual clinical course, Challenging differential diagnosis, Unusual or unexpected effect of treatment, Diagnostic / therapeutic accidents, Educational Purpose (only if useful for a systematic review or synthesis)
Agus Heriyanto ABCDEF 1*, Dian Tjahyadi ABCD 1, Anita Rachmawati ABCD 1, Ayu Insafi Mulyantari
E 1
DOI: 10.12659/AJCR.947396
Am J Case Rep 2025; 26:e947396
Table 1 Summary of the 4 cases.
| Case | Age | AMH (ng/ml) | Previous IVF attempt | Stimulation protocol | Adjuvants | Embryo stage and transfer | Semen analysis |
|---|---|---|---|---|---|---|---|
| 1 | 30 | 0.247 | Yes | Agonist protocol with Follitropin delta (FSH 300 IU) + LH 75 IU | GH 9 mg from D6 | Fresh Transfer of 2 blastocysts on Day 5 | Diagnosis: OATSperm source: EjaculatedConcentration: 2.005 million/mlMotility: poor motility (12%)Normal morphology: 1% |
| 2 | 29 | 0.08 | No | FSH 375 IU + LH 75 IU, increased LH to 150 IU on D8 | GH 9 mg on D6, Thromboaspilet, LMWH, Progynova | Frozen storage of 3 blastocysts on Day 5 | Diagnosis: OATSperm source: Ejaculated (frozen)Concentration: 1.04 million/ml (post washing) |
| 3 | 39 | 0.19 | No | Agonist protocol with FSH 375 IU + LH 75 IU | GH 9 mg on D6, Thromboaspilet, LMWH, Progynova | Fresh Transfer of 1 blastocyst on Day 5 | Diagnosis: severe OATSperm source: TESENo motile sperm |
| 4 | 36 | 0.17 | Yes | Clomiphene Citrate 2x50 mg + FSH 150 IU + DHEA 1x1 | Intravaginal Sildenafil, Pentoxifylline, Enoxaparin | Frozen storage of 7 cleavage -stage embryos (Day 3), then FET | Diagnosis: OATSperm source: EjaculatedConcentration: 51.0 million/mlMotility: 46%Normal morphology: 6% |
| 1 | Micronized Progesterone 800 mg | Negative β-hCG | Standardized protocol; fresh transfer avoids freeze-thaw stress | Poor outcome; very low AMH; semen quality compromised | |||
| 2 | Micronized Progesterone 800 mgProgynova 4 mgThromboaspilet 2×80 mgLMWH 6000 U | Negative β-hCG | High gonadotropin dose possibly enhanced response; embryo cryopreservation allows cycle optimization | No implantation; very low AMH; aggressive medication; anticoagulants indicate thrombophilia risk | |||
| 3 | Micronized Progesterone 800 mgProgynova 4 mgThromboaspilet 2×80 mg MWH 6000 U | β-hCG 9.22 mIU/ml | TESE allowed sperm retrieval; fresh transfer attempted | Marginal implantation; high medication load; severely compromised sperm | |||
| 4 | Intravaginal Sildenafil 2×25 mgPentoxifylline 2×100 mgEnoxaparin 0.4 mg | β-hCG 296 mIU/ml, Intrauterine pregnancy detected | Mild stimulation; better sperm quality; successful pregnancy | Less conventional stimulation; embryos frozen at earlier stage (Day 3) | |||