Infertility affects 15% of couples in reproductive age worldwide. In women in particular, infertility can be caused by various abnormalities, with polycystic ovary syndrome (PCOS) being the most common. Currently, there are many assisted reproductive techniques (ART) available to combat the burden of infertility. However, positive results are not guaranteed. The administration of inositol has been shown to increase positive reproductive outcomes in women undergoing ART. Here we present a series of clinical cases in which women with a history of infertility and previously failed ART, supplemented with a specific 3.6:1 MYO:DCI ratio, antioxidants, vitamins, and minerals for a period of 1 to 3 months before undergoing in vitro fertilization (IVF). In this series of case reports, we provide preliminary evidence that supplementation with a specific 3.6:1 MYO to DCI ratio, as well as antioxidants, vitamins, and minerals may contribute positively to female fertility in women undergoing IVF, with a history of primary or secondary infertility and previously failed ART.

This case report illustrates that in vitro fertilization (IVF) may be a potential risk factor for pregnancy-associated osteoporosis (PAO), highlighting the need for awareness and monitoring of bone health in women undergoing IVF treatments. PAO is a rare disease resulting from an imbalance of calcium in the body during pregnancy and lactation and presenting with fragility fractures. PAO occurs in late pregnancy or early postpartum period. A 28-year-old woman who conceived through IVF experienced severe back pain 2 days after delivery. Magnetic resonance imaging of the spine showed wedge-shaped fractures of T9-T12 vertebrae. Bone mineral density (BMD) was low on dual-energy x-ray absorptiometry. The laboratory tests were within the normal range. Based on the clinical manifestations, osteoporotic spine fracture, results of BMD, and exclusion of other causes of osteoporosis, the patient was diagnosed with PAO. Considering the deleterious effect of treatment with gonadotropin-releasing hormone and repeated superovulation on bone, we hypothesized that IVF may be an etiological factor for PAO.

An adnexal pregnancy after tubal clamping is a very rare entity. Very few such cases have been reported in the past. Here, we discuss a case of such an occurrence. A 35-year-old female with third gravida and a history of two abortions with secondary infertility conceived via in vitro fertilization was admitted to the ward for observation with a history of amenorrhea of one and a half months and a known case of hypothyroidism. The ultrasonography showed left ectopic adnexal pregnancy that was managed conservatively. With a previous history of left ectopic pregnancy, the patient was managed with exploratory laparotomy with left partial salpingectomy. This case is used to illustrate the need to gather a complete medical history and take ectopic pregnancy into account in women who are of reproductive age and have a history of ectopic pregnancies.

We present the case of a 42-year-old (gravida 2, abortion 2 (G2A2)) infertile woman who visited an infertility clinic with her husband (aged 42 years). She had been married for eight years and had two abortions during this time. After the second abortion, dilatation and curettage (D&C) was done at her hometown hospital. This is a case of secondary infertility. Before coming to our center, she visited another center for infertility treatment, where in vitro fertilization (IVF) was done using self-oocyte, but intracytoplasmic sperm injection (ICSI) was not done. Unfortunately, the treatment did not succeed. On hysteroscopy, adhesions were found in the cavity, which were possibly formed due to the D&C procedure performed for past abortions. This condition is known as Asherman\'s syndrome. Hence, hystero-adhesiolysis was done on January 20, 2021. Her latest report showed an anti-Mullerian hormone (AMH) value of 0.252 ng/dL, which was very low. Low AMH was indicative of low ovarian reserve. Her follicle-stimulating hormone (FSH) was 23 mIU/mL, which was too high, suggestive of poor egg quality. The antral follicular count was assessed through transvaginal ultrasound; the total count was three (one on the right, and two on the left). Ovum pick-up was done on March 15, 2021. Only one oocyte was retrieved from the patient (MI grade). The husband\'s sperm count was 12 million/mL with low motility, which is known as oligoasthenozoospermia; hence, ICSI was performed. However, the embryo could not be formed. Therefore, on April 1, 2021, oocytes were retrieved from the donor, and ICSI was done using the semen sample of the husband. On April 6, 2021, two embryos at the day six stage were transferred to the patient\'s uterus. Before the embryo transfer, tablet estrogen 2 mg was administered thrice daily. This was started from day two of menses till day 14th. After 14 days, the patient was given a progesterone injection for six days daily. After embryo transfer, tablet estrogen 2 mg was given thrice daily, and tablet progesterone 2 mg twice daily was given as support. After 14 days of embryo transfer, a beta-human chorionic gonadotrophic hormone (βhCG) test was done. Her βhCG was positive, and the couple was delighted. Diagnostic challenges occurred due to previous abortions, previous failure of IVF, history of hypothyroidism, AMH value of 0.252 ng/dL, and presence of adhesions. This is a case of secondary infertility with cavity adhesions with low AMH and low antral follicular count. The outcome was favorable at our fertility clinic. Because the patient is a known case of hypothyroidism, levothyroxine tablets were also prescribed.

BACKGROUND: The molecular basis of McCune Albright syndrome (MAS) is a recurrent GNAS Postzygotic gain of function sporadic mutation, resulting in a mosaic disease. Most of girls present precocious puberty, caused by the development of recurrent ovarian cysts with autonomous Hyperestrogenic stimulation. After menarche, the majority of patients with ovarian GNAS mutation have menstrual disturbances and infertility.
OBJECTIVE: We wanted to focus on the fertility of MAS females and propose an appropriate management, by a detailed case report and an exhaustive review of the literature on fertility and pregnancy in MAS females.
RESULTS: We present the case of a 29-year-old MAS female, who had previously undergone a unilateral ovariectomy and was managed by in vitro fertilization (IVF). Eight oocytes with many morphological abnormalities were retrieved. The GNAS mutation was found at a low frequency in follicular cells. The ovarian histopathological examination showed developing follicles of all stages, strongly expressing AMH by immunohistochemistry. In addition, AMH was high (45.5 pmol/L) and the AMH / AFC ratio (5.69 pmol/L per follicle) was much higher than in PCOS and control groups (2.16, and 1.34 respectively).
CONCLUSIONS: Ovarian and endometrial involvement can be responsible for infertility in MAS women. IVF and oophorectomy may be useful in management. The genetic characterization of the different tissues may have a prognostic utility. Moreover, we suggest that the AMH could be a marker of the ovarian activity in MAS. Further studies are needed to clarify the potential oocyte abnormalities and the risk of miscarriages in order to guide genetic counseling.

Oocyte quality could be negatively affected by many factors including smoking, alcohol consumption, obesity, woman\'s age, endometriosis and controlled ovarian stimulation (COS), during assisted reproductive technology (ART), in addition to genetic factors, such as hormone receptor polymorphisms, for example. We know that the increase in the reactive oxygen species (ROS) due to systemic disorders causes biochemical and morphological changes to the oocytes, interfering with their quality. The oocyte dysmorphism can be expressed through intra and/or extra cytoplasmic changes. In general, the size and number of oocytes\' morphological abnormalities are directly related to preimplantation development failure. This case report is based on four in vitro fertilization (IVF) cycles performed by a patient with oocyte dysmorphism in all oocytes captured. The literature review on this topic aims to relate the characteristics of the oocytes, presented in the case report, with research results about the quality and morphology of the oocytes.

In this report, we present an unusual case of a couple who achieved a successful pregnancy by ICSI with a single oocyte collected. The cumulus-oocyte-complex (COC) was retrieved at 36.5 hours post trigger, and was found to be at metaphase II, when sperm injection was performed at around 39 hours post trigger. At 18 hours post injection, the single oocyte was fertilized, developed to four-cell embryo on day 2, and 8-cell grade on day 3, when it was relocated in the uterine cavity. The pregnancy yielded a positive β-hCG result. The scan performed at seven weeks, revealed the presence of one amniotic sac with a fetal heartbeat. The ongoing pregnancy has been eventless at 24 weeks of gestation.

In this report, we present a case of a couple who obtained a live birth with a single oocyte fertilized by intracytoplasmic sperm injection. The oocyte was collected at 36 h post trigger and was found to be at metaphase II when sperm injection was performed. At 18 h post injection, the oocyte was found to be fertilized with two clear pronuclei. The embryo divided and generated a four-cell embryo on day 2, which was replaced to the uterine cavity. Pregnancy test gave a positive β-human chorionic gonadotropin result, the scan performed at 7 weeks, revealed the presence of one amniotic sac with fetal heartbeat. Healthy live birth was obtained after 39 weeks of gestation.

In this report we present an unusual case of a couple who achieved a twin pregnancy by intracytoplasmic sperm injection (ICSI) with a single immature oocyte retrieved. The oocyte was at metaphase I at 39 h post human chorionic gonadotrophin (hCG) administration, which is our standard ICSI time. Extended culture allowed the extrusion of the polar body, and sperm injection was performed at 43 h post-trigger. The fertilized egg underwent embryo biopsy on day 3 and preimplantation genetic assessment for three chromosomes (X, Y and 21). The embryo remained in culture until day 5. Later, the biopsy results reported a transferable embryo, which was replaced to the uterine cavity at blastocyst stage. Pregnancy test gave a positive β-hCG result, and the 6 weeks\' scan, performed to confirm the fetal heart, revealed the presence of one amniotic sac and two fetal heartbeats, which currently have been so far eventless and smooth, ongoing at 18 weeks of gestation.

In this report, we present a case of a couple who obtained a live birth with a single oocyte fertilized by ICSI. Two oocytes were collected at 35.5 hours (h) post trigger and both were at metaphase II when sperm injection was performed (38 h). At 18 h post injection, one oocyte was fertilized, developed to the blastocyst stage and underwent to trophectoderm biopsy for preimplantation genetic testing on day 5. Following biopsy, the blastocyst was vitrified and 4 h after warming procedure, the euploid blastocyst was replaced to the uterine cavity. Healthy live birth was obtained after 39 weeks of gestation.