A Story of Resilience and Expert Care. A Journey Through Loss, Hope, and Renewal
A 40-year-old woman (name withheld for privacy) and her partner presented to Dr. Hossam Elzeiny after four painful years of secondary infertility. Although they had previously conceived their daughter naturally during the COVID-19 lockdown, they had since endured five consecutive first-trimester miscarriages, each conceived through ovulation induction with clomiphene citrate, due to her irregular cycles caused by PCOS.
Despite the repeated losses, the couple had never received a full evaluation. No chromosomal analysis of the miscarried pregnancies (products of conception) had been performed, and no investigations into the underlying causes of miscarriage had been initiated—until they came under Dr. Elzeiny’s care.
A Thorough, Individualized Assessment
Dr. Elzeiny’s comprehensive fertility work-up revealed multiple contributing factors:
- AMH of 75 pmol/L, unusually high for her age and consistent with PCOS
- BMI of 45.79, classifying her as morbidly obese
- A past weight loss of 35 kg after lap band surgery in 2016, with gradual regain over the years
Additional investigations showed:
- Karyotype: Normal female (46,XX)
- HbA1c: 4.6% (no evidence of diabetes)
- TSH: Normal
- Thrombophilia screen: Normal
- Semen analysis: Normal
- Ultrasound: Normal uterine cavity
Dr. Elzeiny identified that chromosomal abnormalities were the most likely cause of recurrent miscarriage, compounded by PCOS-related hormonal imbalances and metabolic impact of obesity. A clear, evidence-based pathway was proposed.
Precision Fertility Treatment with PGT-A
The couple commenced IVF with Preimplantation Genetic Testing for Aneuploidy (PGT-A)—a cutting-edge tool that identifies chromosomally normal embryos before transfer, dramatically improving success rates in women with recurrent pregnancy loss.
Dr. Elzeiny carefully designed a customized ovarian stimulation protocol to achieve optimal egg yield without risking ovarian hyperstimulation syndrome (OHSS). The result: three high-quality euploid embryos.
Given her high BMI and PCOS, a natural or OI-based cycle was ruled out due to the unpredictability and risks of poor or excessive ovarian response. Instead, a frozen embryo transfer (FET) with full hormonal preparation—starting with GnRH agonist downregulation, followed by an artificial hormone replacement cycle—was chosen. This approach provided precision in timing, stabilized the endometrial environment, and mitigated PCOS-related hormonal disruptions.
A Hopeful Pregnancy Begins
On 11 September 2023, a single chromosomally normal embryo was transferred. To optimize implantation and early placental development, a dual progesterone strategy was used—vaginal plus subcutaneous progesterone—to support the lining and modulate the maternal immune response.
- On 21 September, her serum hCG was 246 IU/L, confirming implantation.
- At 7 weeks 5 days, an ultrasound revealed a healthy fetal heartbeat and CRL of 14.2 mm.
- Although she experienced minor brown spotting, a follow-up scan at 8 weeks 4 days confirmed continued healthy development, with a CRL of 20 mm.
Upon request, the couple learned that the embryo transferred was a male—a beautiful balance to their first child, a daughter. (Note: While gender selection is not permitted in Australia, patients may choose to learn the gender post-transfer.)
Successful Outcome Despite High-Risk Pregnancy
The pregnancy was considered high-risk due to morbid obesity and a history of recurrent miscarriage, but it progressed remarkably well under expert monitoring. She developed gestational diabetes, but it was successfully managed through dietary modification alone, without the need for insulin.
At 39 weeks and 1 day, she gave birth to a healthy baby boy, weighing 3430 grams, via elective Caesarean section—a joyful, full-term outcome after years of loss and uncertainty.
Expert Commentary
This case illustrates what is possible when science, skill, and individualized care come together:
- Thorough identification and management of multiple risk factors
- Use of PGT-A to bypass chromosomal errors causing miscarriage
- Skillful handling of egg retrieval and embryo transfer in women with high BMI
- Judicious use of evidence-based investigations only, avoiding unnecessary tests
- Expertise in hormonal and immunological support for implantation
- Transparent communication and compassionate care throughout
This was not just a technical success—it was a life-changing outcome for a couple that had nearly lost hope.
Is This You?
Have you experienced multiple miscarriages? Do you have PCOS, high BMI, or complex fertility issues?
You deserve answers—and results.
Dr. Hossam Elzeiny is one of Australia’s most highly qualified and experienced fertility specialists, uniquely equipped to handle the most challenging reproductive cases with empathy, precision, and success.
Don’t wait. Book your consultation today.
Your journey to parenthood starts with expert care—and the right partner by your side.
