"I was lucky to race against time to become a mother," Hien said.

After giving birth to her first child three years ago, Hien’s menstrual cycles gradually became infrequent. She was unable to conceive again. A hospital examination diagnosed her with secondary infertility due to premature ovarian insufficiency of unknown cause, with depleted ovarian reserve. Unwilling to use donated eggs, meaning the child would not be genetically related to her, the couple sought treatment at the Center for Reproductive Assistance, Tam Anh General Hospital TP HCM (IVF Tam Anh TP HCM).

Doctor Le Xuan Nguyen's ultrasound revealed that Hien's ovary contained only one ovarian follicle, and her anti-Mullerian hormone (AMH) ovarian reserve index was depleted at 0,04 ng/mL (the average level for women under 38 years old is approximately 2-6 ng/mL). To enable the patient to conceive using her own eggs, Doctor Nguyen developed a multi-cycle oocyte accumulation protocol.

Over five months, Hien regularly underwent ultrasound examinations at the beginning of her menstrual cycles to monitor follicle development. Two cycles yielded no eggs, leading to treatment cancellation. The remaining three cycles each produced one small ovarian follicle. She received appropriate doses of ovarian stimulation medication to help the follicles mature.

After three egg retrieval and collection procedures, she had a total of three eggs, which were cryopreserved. Following the final retrieval, the patient’s ovaries atrophied and were no longer visible on ultrasound.

Doctor Le Xuan Nguyen and his team performing egg retrieval for the patient. Photo: Tran Trung

Doctor Le Xuan Nguyen and his team performing egg retrieval for the patient. Photo: Tran Trung

Embryologists thawed the eggs, injected the husband’s sperm into the oocyte cytoplasm for fertilization, and cultured two day-5 embryos. Both artificial intelligence software and embryologists graded the embryos as type 3.

"These two precious embryos were the patient's last chance to have her own child," Doctor Nguyen stated, adding that the patient had already entered full menopause.

To increase the chance of successful implantation, Doctor Nguyen performed a hysteroscopy on Hien before embryo transfer. He observed a cesarean section scar and fluid retention in the uterine cavity, which posed a risk of toxicity and could hinder embryo implantation. The doctor aspirated the fluid and prepared the patient’s uterine lining. The first embryo transfer was successful, but it resulted in a biochemical pregnancy. During the second embryo transfer, Hien conceived. Her pregnancy is currently 11 weeks and developing well.

Premature ovarian insufficiency is a condition where the ovaries cease to function before age 40, causing menstrual irregularities, reduced or lost ovulation capacity, and leading to infertility. The causes can include: genetic disorders, autoimmune diseases, effects of chemotherapy or radiation therapy, unhealthy lifestyles, prolonged exposure to harmful chemicals, and more. In some cases, like Hien's, the cause remains undetermined.

According to Doctor Nguyen, each in vitro fertilization (IVF) cycle typically requires 10-15 eggs for fertilization and embryo culture. Women with premature ovarian insufficiency may not produce an optimal number of eggs, reducing the success rate of embryo creation and culture. At IVF Tam Anh, women with premature ovarian insufficiency account for approximately 10% of infertility treatment cases. Multi-cycle egg or embryo accumulation strategies have helped many patients obtain more eggs and embryos compared to traditional techniques. With time-lapse embryo culture technology, patients with 5-7 eggs can culture at least one good embryo to increase the chance of successful implantation.

Doctor Nguyen advises women experiencing signs of premature ovarian insufficiency, such as: menstrual irregularities, amenorrhea, hot flashes, night sweats, vaginal dryness, or decreased libido, to seek early examination and treatment. Those diagnosed with the condition but not yet married should consider egg cryopreservation to preserve their future fertility.

Hoai Thuong

*Patient's name has been changed