# Addition of Multi‐Level Technologies to Evaluate Eggs and Embryos and Improve Endometrial Quality Applied for In Vitro Fertilization to Achieve Pregnancy: A Case Study

## TL;DR

This case study shows how combining advanced embryo selection and endometrial improvement techniques can lead to a successful pregnancy in a couple with infertility.

## Contribution

The study demonstrates a novel integrated clinical approach combining molecular diagnosis and regenerative strategies for IVF success.

## Key findings

- Combining PGTA, cumulus cell analysis, PRP, and dietary intervention led to a successful pregnancy.
- A low-carb diet improved insulin resistance and endometrial receptivity within two weeks.
- PRP application enhanced endometrial quality and supported embryo implantation.

## Abstract

Preimplantation genetic testing for aneuploidies (PGTA) diagnoses chromosomal abnormalities and can be complemented by cumulus cell transcriptional analysis to assess egg and ovarian quality and development during embryo culture. In addition to selecting the best available embryo, intrauterine administration of platelet‐rich plasma (PRP) and correction of insulin resistance (IR) through nutritional intervention can improve endometrial quality. This case report examines the potential feasibility of combining in vitro fertilization (IVF) with four techniques to achieve a viable pregnancy. A couple with a prior successful IVF pregnancy was seeking a second pregnancy. The patient was diagnosed with polycystic ovary syndrome (BMI = 24.5 kg/m2), whereas her partner had teratozoospermia. For the first IVF cycle, using PGTA, we confirmed that only euploid embryos were transferred. A hysteroscopic examination confirmed a lack of endometrial competence, and treatment with autologous intrauterine PRP improved endometrial receptivity; however, after a single‐embryo transfer, the embryo did not implant. The patient underwent a nutritional intervention to improve insulin resistance with a low‐carb dietary intervention (carbohydrates < 50 g/day, protein 1.5 g/day) that reduced insulin resistance after 2 weeks. For the next IVF cycle, the low‐carb dietary intervention was continued, along with another PRP application, and the cumula cells transcriptional analysis was performed in addition to PGTA, identifying two optimal euploid embryos. This time, embryo implantation occurred (β‐hCG: 362.0 mIU/mL). The pregnancy ended at 39 weeks, with a healthy male baby (length: 53 cm; weight: 3465 g; Apgar 8/9). In conclusion, using molecular techniques for embryo selection (cumula analysis and PGTA) and interventions to improve endometrial function (PRP and a dietary intervention) are an effective strategy that strengthens IVF and increases the likelihood of achieving a viable pregnancy.

Personalized regenerative strategies coupled with a systematic molecular diagnosis are a powerful combination to improve endometrial quality and embryo selection for achieving pregnancy in multi‐causal infertile patients using their ova.

This integrated clinical approach optimizes the reproductive cycle in several steps, starting with nutrition (A): restricting carbohydrates and inducing ketosis to reduce inflammation and improve insulin sensitivity, which benefits follicular development. Clinicians then assess metabolic priming success by measuring the PVL index in granulosa cell via qRT‐PCR (B), providing insight into oocyte health. After fertilization, embryos undergo PGT‐A analysis (C) to check for chromosomal abnormalities, selecting only normal (euploid) embryos for transfer. Finally, Platelet‐Rich Plasma (D) is applied to the endometrium, delivering growth factors that enhance uterine tissue and vascularity, creating an optimal environment for implantation.