Overcoming Advanced Maternal Age and Complex Infertility Issues – Real Patient Cases

Laura Cooke explores IVF success stories with PGT-A. The accompanying image captures a moment of triumph as a woman fist bumps the air.

At Cyprus IVF Hospital, a leading center for reproductive medicine under the expert guidance of Dr. Serap Kağan, remarkable stories of hope, resilience, and medical triumph unfold regularly. These patient success stories are not just narratives of personal journeys; they are testaments to the advanced capabilities of modern fertility treatments and the profound impact of personalized care.

In the realm of assisted reproductive technology, challenges such as advanced maternal age, recurrent implantation failures, and complex medical histories often stand in the way of the dream of parenthood. However, at Cyprus IVF Hospital, these obstacles are transformed into opportunities for success through innovative treatments, meticulous medical protocols, and a deep understanding of each patient’s unique fertility journey.

The following three patient case studies exemplify the hospital’s commitment to overcoming some of the most daunting challenges in fertility treatment. Each story is unique in its challenges and triumphs, yet all share the common thread of determined pursuit of successful outcomes against significant odds.

First Patient Story

In the realm of reproductive medicine, each patient’s journey is unique, but some stories stand out for their complexity and triumphant outcomes. This is particularly true for the first case, where a 47-year-old patient was treated at Cyprus IVF Hospital, led by the accomplished Dr. Serap Kağan, an OB/GYN & IVF specialist with a rich background spanning almost 30 years. This case not only highlights the challenges associated with advanced maternal age and adenomyosis but also demonstrates the profound impact of tailored medical approaches in the field of IVF.

Background and Previous Challenges

The patient arrived at Cyprus IVF Hospital with a history of reproductive difficulties, including female infertility primarily due to advanced maternal age. Her journey had been marked by recurrent miscarriages and implantation failures, compounded by a diagnosis of adenomyosis. Before her treatment at Cyprus IVF Hospital, she had undergone five IVF attempts at other clinics, all of which ended either in miscarriages or negative results.

A Tailored Medical Approach by Dr. Serap Kağan

Understanding the intricacies of the patient’s medical history, Dr. Kağan embarked on a meticulous treatment plan. The initial step involved a comprehensive evaluation through a Karyotype male analysis and a thrombophilia genetic panel for the patient, which returned normal results. The presence of adenomyosis required a specialized and extended protocol, a challenge that Dr. Kağan was ready to meet.

The treatment began on the 21st day of the patient’s menstrual cycle, with Gonapeptyl 0.1mg injections. This careful synchronization with her cycle was crucial for the success of the subsequent steps. The patient’s readiness for the next phase of treatment was achieved within eight days, a testament to the protocol’s effectiveness.

In preparation for the IVF process, the patient underwent several examinations, including an ECHO, an Effort Test, and consultations with cardiologists and internal medicine physicians. These steps were necessary to comply with the health regulations for patients aged 45 and above.

The IVF Process and Embryo Transfer

A key element of the treatment involved egg donation and IVF. The synchronization between the donor and the patient’s preparation was crucial. From the donor, nine mature eggs were obtained, leading to seven blastocysts by the fifth day. The patient’s endometrium was prepared to an optimal thickness of 8.9 mm, creating a conducive environment for embryo implantation.

A carefully selected single 4AA embryo was transferred. This decision, influenced by the patient’s adenomyosis, was a critical aspect of Dr. Kağan’s strategy.

A Positive Outcome

The patient’s first trial at Cyprus IVF Hospital resulted in a positive pregnancy test. She is now three months pregnant, a significant milestone after her complicated journey.

Cyprus IVF Hospital’s Experience with Similar Cases

Cyprus IVF Hospital has become a renowned center for patients over the age of 45, handling a wide variety of complex infertility cases. More than half of their patients fall into this age group, illustrating the clinic’s expertise and success in addressing such challenging scenarios.

Dr. Serap Kağan’s Insights

Reflecting on the case, Dr. Kağan emphasized the challenges posed by the patient’s previous IVF attempts and miscarriages. The decision to employ an extended protocol and a cautious approach to embryo transfer was pivotal. Dr. Kağan expressed immense joy and satisfaction in witnessing the patient’s success and happiness.

Second Patient Story

Now we come to our second Patient story, about a patient over 50 years old, who finally became a mother thanks to a fertility treatment at Cyprus IVF Hospital.

Patient Background and Previous Attempts

The patient, at the age of 55 with a BMI of 23, had undergone IVF with egg donation four times at other clinics, unfortunately resulting in negative outcomes despite good embryo qualities. Her medical history revealed struggles with advanced maternal age, thyroid issues, and recurrent implantation failures. Her male partner had been diagnosed with azoospermia, attributed to pituitary gland inhibition by androgen substitution with Nebido, a condition he had stopped treating before starting their IVF journey.

Diagnosis and Initial Steps

Upon arriving at Cyprus IVF Hospital, comprehensive diagnostics were conducted. The female patient’s tests indicated a thyroid imbalance, as her TSH was above the limit despite medication. Dr. Serap advised her to consult her doctor to balance her thyroid hormone, underlining the critical role of TSH hormones in conception and pregnancy.

The male partner’s azoospermia was a significant factor in their infertility. Dr. Serap recommended vitamins and supplements to improve sperm quality before starting their protocol.

Protocols and Procedures

Several tests and procedures were conducted to ensure the couple’s readiness for IVF:

  • HSG (Hysterosalpingography): To check the condition of the uterus and fallopian tubes.
  • ECHO (Echocardiography) and Effort Test: Required for patients over 45.
  • Consultations: With cardiologists and internal medicine physicians.
  • Abdomen USG: To further assess internal health.

The couple’s embryos were created and frozen, followed by a frozen transfer protocol involving Estrofem, Aspirin, and folic acid.

Embryo Transfer and Outcome

From 19 eggs collected from the donor, 16 reached the blastocyst stage on Day 5. Pre-implantation Genetic Testing (PGT) for 5 chromosomes was applied to all embryos, revealing that only three were healthy. Two embryos (4AA, 2BB) were transferred in their first trial at Cyprus IVF Hospital.

The patient successfully became pregnant after the first trial and gave birth last year, a remarkable outcome given the complexity of the case.

Dr. Serap’s Insights

Dr. Serap emphasized the importance of TSH hormone levels in fertility treatments. High TSH levels can lead to difficulties in conceiving, increased risk of miscarriage, and complications during pregnancy. Balancing the patient’s TSH level was a critical step before commencing IVF treatment. Additionally, the application of PGT to the embryos was pivotal in ensuring healthy embryo selection, especially considering the history of implantation failures and male infertility factor.

Third Patient Story

In the third and last story, we have a case where the patient had several previous failed IVF attempts before coming to Cyprus IVF Hospital.

Patient History and Previous Attempts

Prior to her treatment at Cyprus IVF Hospital, the patient (age 53) had undergone four IVF attempts at other clinics. In December 2021, she experienced a miscarriage, followed by three more attempts in 2022, all resulting in negative pregnancy tests. With a BMI of 21 and a history of reproductive struggles, she approached Cyprus IVF Hospital with the hope of a successful outcome.

Diagnostic Approach and Preparations

A comprehensive diagnostic process revealed the patient’s challenges: Female infertility due to advanced maternal age, miscarriage, and recurrent implantation failures.

To ensure her readiness for IVF, several tests and procedures were conducted:

  • HSG (Hysterosalpingography): To assess the condition of the uterus and fallopian tubes.
  • ECHO (Echocardiography) and Effort Test: Necessary evaluations for patients over 45.
  • Consultations: With cardiologists and internal medicine physicians.
  • Abdomen USG: An additional step to confirm her internal health status.

IVF Protocol and Embryo Transfer

The team at Cyprus IVF Hospital opted for a fresh transfer protocol, involving medications such as Estrofem, Aspirin, Folic Acid, and Climara forte. The synchronization of the donor’s and the patient’s menstrual cycles was a critical aspect of this approach.

From the donor, 11 eggs were collected, all of which fertilized. Nine reached the blastocyst stage by Day 5, indicating a successful fertilization process.

For the embryo transfer, two high-quality embryos (2 x 4AA) were selected. This decision was made considering the patient’s medical background and previous experiences with IVF.

Outcome and Success

The patient’s first attempt at Cyprus IVF Hospital led to a positive pregnancy test. She later gave birth to twins, a joyous outcome after her long and challenging journey.

Dr. Serap’s Insights

Reflecting on the case, Dr. Serap highlighted the importance of thorough testing and preparation. The patient’s endometrium responded well to the treatment, and the use of Climara forte patches was beneficial. The successful collection and transfer of quality embryos were pivotal in achieving pregnancy. Additionally, Dr. Serap noted the necessity of adjusting progesterone levels post-transfer, a move that was instrumental in supporting the pregnancy, leading to the birth of twins.


This case studies from Cyprus IVF Hospital underscores the effectiveness of personalized and meticulous approaches in IVF treatments, especially in cases involving advanced maternal age and complex infertility issues. The success stories are a testament to the advanced techniques, thorough preparations, and expertise of healthcare professionals in overcoming significant fertility challenges. Finding the best IVF clinic for individuals over 50 requires thorough research into clinics with specialized expertise in advanced maternal age.

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Editorial Team
Fertility Road aims to inform and inspire in a manner which is honest, direct and empathetic. Our worldwide expert writers break down the science and deliver relevant, up-to-date insights into everything related to IVF.

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