Personalized In Vitro Fertilization Protocols in Premature Ovarian Insufficiency and Male-Factor Infertility: A Case Series

BACKGROUND The current literature lacks extensive case-based evaluations of primary ovarian insufficiency (POI) in the context of severe male-factor infertility. This case series presents 4 patients with extremely low AMH levels and varied male infertility, aiming to illustrate clinical decision-making and treatment outcomes. Adjunct therapies such as growth hormone (GH), dehydroepiandrosterone (DHEA), Sildenafil, and Pentoxifylline were incorporated to assess protocol effectiveness. CASE REPORT All 4 patients had low AMH levels and male partners with differing degrees of oligoasthenoteratozoospermia (OAT), except 1 with normozoospermia. Intracytoplasmic sperm injection (ICSI) was performed in all cases. The treatment protocols varied: 3 used high-dose gonadotropins (FSH 300-375 IU with LH and GH), while 1 used a minimal stimulation protocol (Clomiphene Citrate + FSH 150 IU). Embryo transfer methods included both fresh and frozen (FET). Two cycles failed to implant, 1 led to a biochemical pregnancy (ß-hCG 9.22 mIU/mL), and 1 progressed to clinical pregnancy (25%), following endometrial receptivity enhancement in the normozoospermic case. Protocol adjustments were made based on ovarian response and sperm quality. All sample collections and treatments were conducted at Hasan Sadikin Hospital. CONCLUSIONS This case series highlights the complexity of managing infertility in patients with POI and coexisting male-factor infertility. Personalized stimulation, strategic sperm optimization, and endometrial preparation were critical. One patient achieved a clinical pregnancy and 1 had a biochemical pregnancy, indicating a 50% biological response. Further studies are needed to evaluate advanced therapies, including ovarian rejuvenation and enhanced sperm selection, in this challenging patient population.