A 32-year-old woman with a recurrent ovarian tumour delivered a healthy baby after undergoing fertility-preservation treatment and in-vitro fertilisation (IVF) despite having very low ovarian reserve following two previous surgeries.

The woman was diagnosed with a borderline seromucinous ovarian tumour with microinvasion at the age of 30. Fifteen months later, an MRI revealed a large cyst in the left ovary, prompting a second surgery. The tumour recurred in the same ovary within three months.

Consequently, the woman was referred to Milann Fertility and Birthing Hospital in Bengaluru. She wished to have a child using her own eggs, even as specialists assessed the risks associated with the condition and the limited ovarian tissue remaining.

At Milann hospital, scans showed a complex cyst in the left ovary and only two visible follicles, which contain eggs. Her right ovary could not be visualised, and her anti-Müllerian hormone (AMH) level was 0.6 ng/ml, indicating very low ovarian reserve.

The case was managed by a multidisciplinary team that planned treatment to address the recurrent tumour while preserving the possibility of pregnancy. Although removal of both ovaries and fallopian tubes, along with the omentum, was recommended as definitive treatment, the couple wanted to explore the possibility of having a genetically related child.

The team adopted a two-stage approach, first removing the affected ovarian tissue while preserving access to the remaining tissue, and then proceeding with fertility treatment. Testing confirmed a borderline tumour with microinvasion but found no evidence of spread into surrounding tissues.

To limit hormonal exposure, the team used a low-oestrogen stimulation protocol for IVF. The first embryo transfer did not result in pregnancy. Further evaluation suggested chronic endometritis, or inflammation of the uterine lining, which was treated with anti-biotics followed by pro-biotics.

For the next attempt, the team opted for a natural-cycle frozen embryo transfer to avoid additional hormonal stimulation. A single high-quality embryo was transferred, and a pregnancy test 14 days later was positive. An ultrasound at seven weeks confirmed a singleton pregnancy. The woman continued oncological surveillance alongside pregnancy care and, subsequently, delivered a healthy baby.

“Our priority was to preserve her fertility while minimising hormonal exposure. A personalised IVF approach and natural-cycle embryo transfer helped us achieve pregnancy,” said T. Shilpa Reddy, consultant in Reproductive Medicine and Gynaecology at the hospital.