Endocrine infertility: a case of successful pregnancy without IVF

A 26-year-old woman came for consultation with a reproductive specialist.
The patient couldn’t conceive for a year despite regular unprotected intercourse.

Her husband had been diagnosed with primary infertility and asthenozoospermia (low sperm motility).

Sexual activity began at 20. It’s her first marriage.

No one in the family has faced such an issue.

External genitalia are normal, with female-type hair distribution. Cervix is conical, with a slit-like external os.

Hormonal analysis showed normal levels: anti-Müllerian hormone — 6.0 ng/ml, follicle-stimulating hormone — 7.2 mIU/ml.

Ultrasound findings (on the 14th day of the cycle):
• Uterus in anteflexed position (normal), size — 48 × 36 × 40 mm, with clear and smooth contours;
• Myometrium homogeneous, endometrial thickness — 11 mm;
• Cervix — 35 × 22 mm, unremarkable;
• Right ovary — 39 × 28 × 35 mm with antral follicles ranging from 3 to 6 mm (12–14 in number);
• Left ovary — 37 × 28 × 32 mm with antral follicles ranging from 3 to 8 mm (14–16 in number).
No signs of infection were found.

Endocrine infertility.

Considering ultrasound results, as there was no dominant follicle, ovulation stimulation was planned.

She was prescribed Clomiphene 50 mg twice daily from the 5th day of the cycle for 5 days.

The first Clomiphene stimulation attempt was ineffective: no dominant follicle was observed.

The dosage was increased to 100 mg for the second attempt, also without success.

During the third attempt, the dosage was further increased by 50 mg. On the 11th day of the cycle, a dominant follicle appeared in the right ovary, with an endometrial thickness of 10 mm.

As her husband had asthenozoospermia, on the 14th day of the cycle (the most favorable for conception), his sperm was introduced into the uterine cavity. The patient was also prescribed progesterone 200 mg twice daily to support the luteal phase. On the 5th day of delayed menstruation, the patient took a pregnancy test, which showed a negative result.

In a repeat attempt with Clomiphene 150 mg, a dominant follicle grew to 20 mm. Sperm was introduced on the 15th day of the cycle, followed by progesterone intake. On the 5th day of delayed menstruation, the patient took another pregnancy test, which was positive.

Further diagnostics confirmed the positive result:
• Human chorionic gonadotropin beta subunit (beta-hCG) — 1420 mIU/ml;
• A gestational sac measuring 8 mm was detected in the uterine cavity, corresponding to 6 weeks of pregnancy.

In recent times, IVF programs are becoming more accessible, some even covered by health insurance. However, IVF is not the only way to achieve pregnancy. There are gentler methods of assisted reproductive technology.

Seeking timely medical help can solve infertility issues through ovulation stimulation and intrauterine sperm injection. The key is to trust your doctor and follow their recommendations. Don’t lose hope if pregnancy doesn’t occur on the first attempt. Your doctor will adjust the medication dosage or suggest alternatives, and you will reach your goal.