Case Study: Comprehensive Management of Infertility with IVF, Hormonal Optimization, and Lifestyle Interventions

Abstract

This case study presents a 34-year-old female with primary infertility for four years, associated with irregular menstrual cycles and polycystic ovarian morphology. The patient underwent a comprehensive fertility management plan involving hormonal optimization, in vitro fertilization (IVF), and structured lifestyle interventions. Following controlled ovarian stimulation, embryo culture, and transfer, she achieved a successful singleton pregnancy. This case underscores the importance of individualized fertility assessment, multidisciplinary care, and integration of lifestyle modification with assisted reproductive technologies (ART) to improve reproductive outcomes. It also highlights the role of metabolic and psychosocial factors in optimizing IVF success.

Introduction

Infertility, defined as the inability to conceive after 12 months of unprotected intercourse, affects approximately 10–15% of couples globally. Female infertility may result from ovulatory dysfunction, tubal pathology, endometrial abnormalities, or age-related decline in oocyte quality. Polycystic ovary syndrome (PCOS), obesity, and lifestyle factors contribute significantly to infertility, with anovulation being a common manifestation. Assisted reproductive technologies, including in vitro fertilization (IVF), have become central to the management of such cases.

The success of IVF depends on multiple factors, including ovarian reserve, endocrine balance, sperm quality, uterine receptivity, and patient compliance. Evidence shows that lifestyle optimization, including weight management, stress reduction, and diet modification, improves ART outcomes. This case demonstrates an integrated approach combining hormonal regulation, IVF, and behavioral modification, ensuring optimal fertility outcomes in women with endocrine-related infertility.

Patient Information

Age / Gender: 34-year-old female

Occupation: Software engineer

Marital Status: Married for 6 years

Medical History: Irregular menstrual cycles since adolescence, diagnosed with PCOS 3 years prior

Surgical History: Diagnostic laparoscopy (2020) showing patent fallopian tubes, polycystic ovarian morphology

Family History: Mother with type 2 diabetes mellitus

Social History: Non-smoker, occasional caffeine intake, sedentary lifestyle

Current Medications: None prior to IVF workup

Chief Complaints: Inability to conceive for 4 years, irregular menstrual cycles (35–60 days), mild weight gain, acne

Clinical Findings

Symptoms:

• Oligomenorrhea (menstrual cycles every 45–60 days)

• Mild hirsutism and acne

• Weight gain (~8 kg over 2 years)

Physical Examination:

• BMI: 29.4 kg/m²

• Normal thyroid and breast examination

• No pelvic tenderness on bimanual examination

Timeline

Initial Presentation (January 2023):
Patient presented with primary infertility and menstrual irregularity. Preliminary hormonal evaluation and transvaginal ultrasonography were planned.

Diagnostic Workup (February 2023):

• AMH: 6.8 ng/mL (elevated, suggestive of high ovarian reserve)

• LH/FSH ratio: 3.2:1 (PCOS pattern)

• Prolactin and TSH: Within normal limits

• Transvaginal Ultrasound: Bilateral enlarged ovaries with multiple peripheral follicles

• Semen analysis (partner): Normal

Initial Management (March 2023):
Lifestyle modifications initiated structured diet, moderate exercise (30 mins/day), and stress management via yoga. Metformin 500 mg BID started to improve insulin resistance.

IVF Cycle Initiation (June 2023):
Controlled ovarian stimulation using recombinant FSH with GnRH antagonist protocol. Adequate follicular growth achieved; 12 oocytes retrieved.

Embryo Transfer (July 2023):

Three blastocysts formed; one high-quality embryo transferred, two cryopreserved. Luteal phase supported with vaginal progesterone.

Outcome (August 2023):
Serum β-hCG positive after 14 days. Early ultrasound confirmed viable intrauterine gestation.

Diagnostic Assessment

Hormonal Findings:

• Elevated LH/FSH ratio

• High AMH levels

• Normal prolactin and thyroid profile

Imaging Findings:

• Ultrasound pelvis: Polycystic ovaries, normal endometrial thickness during stimulation

• Hysterosalpingography (prior): Patent tubes, normal uterine cavity

Partner Evaluation:
Normal sperm parameters

Therapeutic Intervention

Step 1 – Hormonal Optimization

• Metformin 500 mg BID for insulin resistance

• Vitamin D and folate supplementation

• Controlled ovarian stimulation with gonadotropins, closely monitored

Step 2 – Assisted Reproductive Technology (IVF)

• Oocyte retrieval after 36-hour trigger with hCG

• Intracytoplasmic sperm injection (ICSI) for fertilization

• Embryo culture to day 5 blastocyst stage

• Single fresh embryo transfer under ultrasound guidance

Step 3 – Lifestyle Modifications

• Calorie-restricted, protein-rich diet guided by nutritionist

• Regular aerobic exercise and yoga for stress reduction

• Sleep hygiene and psychological counseling for anxiety management

• Encouragement of adherence to healthy daily routines to optimize endocrine function

Challenges Faced

• Risk of ovarian hyperstimulation due to high AMH managed with GnRH antagonist protocol

• Emotional stress and anxiety related to prior failed cycles; addressed with counseling and mindfulness strategies

• Difficulty maintaining weight loss; managed via regular follow-up with dietitian and motivational support

Follow-Up and Outcomes

• Successful conception after first IVF cycle

• β-hCG positive; ultrasound confirmed singleton intrauterine pregnancy

• Luteal support continued until 10 weeks gestation

• Regular antenatal follow-up with normal fetal development reported

• Patient adherence to lifestyle recommendations enhanced IVF success

Discussion

This case emphasizes a multimodal infertility management strategy, integrating hormonal correction, assisted reproductive technology (ART), and lifestyle optimization. Polycystic ovary syndrome (PCOS) contributed to anovulation, hyperandrogenism, and metabolic dysfunction, all of which were addressed prior to IVF. Metformin improved insulin sensitivity and reduced hyperinsulinemia, which in turn lowered ovarian androgen production and promoted follicular maturation. Structured exercise and dietary interventions facilitated weight reduction, improved insulin sensitivity further, and enhanced overall metabolic health, which positively influenced ovulatory function and endometrial receptivity. Together, these interventions created a more favorable intrauterine environment for embryo implantation.

Evidence suggests that weight loss of 5–10% in women with PCOS can restore ovulation, normalize menstrual cycles, and improve ART outcomes (Legro et al., NEJM 2007). Individualized gonadotropin dosing, guided by ultrasound and hormone monitoring, and the use of GnRH antagonist protocols minimized the risk of ovarian hyperstimulation syndrome (OHSS), a common complication in high-AMH or polycystic patients. Psychological support and counseling were integral in managing stress and anxiety, which can negatively impact hormonal balance and adherence to treatment protocols. Stress reduction techniques, including mindfulness, yoga, and behavioral therapy, complemented medical interventions by mitigating hypothalamic-pituitary-adrenal axis disturbances.

The successful singleton pregnancy demonstrates that integrated therapy addressing endocrine, metabolic, and psychosocial factors can significantly enhance IVF success. Furthermore, this case highlights the importance of patient education, adherence to lifestyle modifications, and continuous monitoring throughout the IVF cycle. A multidisciplinary approach including reproductive endocrinologists, nutritionists, mental health professionals, and nursing staff ensures individualized care, early identification of complications, and optimized reproductive outcomes. These strategies are particularly relevant in patients with endocrine or metabolic disorders contributing to infertility.

Key Takeaways

• Integrated hormonal optimization, IVF, and lifestyle interventions improve reproductive outcomes.

• Early endocrine evaluation and tailored stimulation protocols prevent complications like OHSS.

• Lifestyle modifications enhance reproductive health and IVF success rates.

• Psychosocial support improves adherence, reduces stress, and supports mental well-being.

Patient’s Perspective

“I had tried multiple treatments without success. With proper guidance, medication, and lifestyle changes, I finally conceived. Continuous support from the team helped me stay motivated and manage stress during the process.”

Conclusion

An integrated approach combining hormonal correction, IVF, and lifestyle modification proved highly effective in this patient with PCOS-related infertility. Addressing metabolic and hormonal imbalances prior to IVF not only enhanced ovarian response and oocyte quality but also improved endometrial receptivity, creating an optimal environment for embryo implantation and successful conception. Comprehensive counseling, tailored pharmacotherapy, and behavioral strategies including diet, exercise, stress management, and adherence monitoring were essential in achieving this outcome. This case reinforces the importance of personalized, evidence-based, and multidisciplinary care, highlighting that fertility success depends not only on advanced reproductive technologies but also on addressing underlying endocrine, metabolic, and psychosocial factors. Early intervention, ongoing support, and patient education play a critical role in ensuring both immediate and long-term reproductive health outcomes, emphasizing the need for a holistic approach in managing complex infertility cases.

References

1. Legro RS et al. (2007). Clomiphene, metformin, or both for infertility in the polycystic ovary syndrome. N Engl J Med.

2. National Institute for Health and Care Excellence (NICE). (2021). Fertility problems: Assessment and treatment.

3. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. (2004). Revised 2003 consensus on diagnostic criteria and long-term health risks related to PCOS. Hum Reprod.

4. Polyzos NP et al. (2018). Optimizing ovarian stimulation in IVF: Individualized approaches. Hum Reprod Update.

5. Practice Committee of ASRM. (2022). Optimizing natural and assisted reproduction outcomes in PCOS. Fertil Steril.

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