42-Year-Old Woman’s Successful Twin Pregnancy After Multiple Failed IVFs and Recurrent Pregnancy Loss

At Saraogi Hospital’s IRIS IVF Centre, we regularly treat patients with long-standing infertility and complex medical histories. One such case involved a 42-year-old woman who came to us after multiple failed IVF attempts, recurrent pregnancy losses, and a life-threatening pregnancy complication in the past. With a carefully planned IVF approach and close medical supervision, we were able to help her conceive successfully, and she is now carrying a healthy twin pregnancy. This case study highlights the meticulous planning and multidisciplinary care that made this high-risk IVF journey possible.

A 42-year-old woman and her 38-year-old husband approached us in June 2025 with an extremely challenging obstetric and infertility history. The couple had been married for over 16 years and had undergone multiple fertility treatments over the past decade, with repeated pregnancy losses and serious medical complications.

Their journey included four failed IVF cycles and one natural conception, all ending in miscarriage or fetal loss. The first IVF, performed five years earlier using self-eggs and self-sperm, resulted in an early miscarriage at two months due to absent fetal heart activity. A subsequent IVF attempt using donor eggs and donor sperm progressed until 24–25 weeks, when the patient developed severe hypertension and eclampsia, leading to a stroke (GTCS episode). An emergency preterm cesarean section was performed to save the mother’s life, but the baby could not be saved.

Following this, the patient underwent another IVF cycle using self-eggs and self-sperm, which again ended in an early miscarriage. Around four years ago, she conceived naturally, but this pregnancy also ended at two months due to absent cardiac activity, requiring D&C.

Given this history of recurrent pregnancy loss and intrauterine fetal death, the patient was further evaluated and diagnosed with autoimmune abnormalities, including ANA positivity and antiphospholipid antibody (APLA) positivity, which significantly increased her risk of pregnancy rejection, miscarriage, preeclampsia, and early preterm delivery.

This case presented multiple high-risk factors that required meticulous planning and close monitoring:

• Advanced maternal age

• Four previous failed IVF cycles

• Recurrent early miscarriages

• History of severe preeclampsia and eclampsia

• Stroke during pregnancy

• Autoimmune condition (ANA positive, APLA positive)

• High risk of pregnancy rejection, hypertension, and preterm delivery

Given the complexity of her medical and reproductive history, the case was managed with extreme caution under the guidance of an experienced IVF doctor in Mumbai, Dr. Mohit Saraogi, and a multidisciplinary fertility team. Before proceeding further, a diagnostic hysteroscopy was performed to evaluate the uterine cavity and cervical health carefully, ensuring there were no anatomical or endometrial factors that could further increase the risk of implantation failure or pregnancy loss in this high-risk patient.

A thorough and stepwise evaluation was conducted before initiating treatment. Diagnostic hysteroscopy revealed a healthy, roomy uterine cavity with normal endometrium, ruling out uterine structural causes. Hormonal profiles and routine blood investigations were also within acceptable limits.

Considering the patient’s age and previous outcomes, we decided to proceed with a donor egg and donor sperm IVF cycle, which became her fifth IVF attempt. The embryos were cultured to the blastocyst stage to improve implantation potential, and a single blastocyst transfer was planned to maximize success while allowing better control over pregnancy complications.

The patient conceived successfully in the very first IVF cycle at our center, with strong and reassuring beta-HCG doubling values (1500 to 3000). From the beginning of pregnancy, an intensive medical protocol was initiated to prevent miscarriage and immune-mediated pregnancy rejection. This included:

• High-dose low molecular weight heparin (blood thinners)

• Steroid therapy to control autoimmune activity

• Strict blood pressure monitoring

• Preventive low-dose antihypertensive medication

• Regular fetal and maternal surveillance

A Successful Pregnancy with Some Complications

Early ultrasound confirmed a twin pregnancy, with both babies showing strong cardiac activity and appropriate growth. Given the patient’s history of early preterm delivery, she is receiving additional injections to prevent pregnancy rejection, and a cervical cerclage (stitch) has been planned to reduce the risk of cervical incompetence and premature labor.

The pregnancy is being managed as extremely high risk, with close coordination between fertility specialists, obstetricians, and physicians. Preventive measures for preeclampsia, eclampsia, and autoimmune flare-ups are being continued, and both maternal and fetal health are being monitored very closely.

As of now, the pregnancy is progressing well, offering renewed hope after years of heartbreak and medical challenges.

This case highlights how individualized IVF planning, advanced reproductive techniques, and aggressive medical management can help even the most complex and high-risk patients achieve a successful pregnancy. Women with recurrent IVF failure, autoimmune conditions, and previous pregnancy complications can still have positive outcomes when treated with the right expertise, technology, and long-term care. 

At our center, we strongly believe that no case is beyond hope, and this successful twin pregnancy stands as a testament to what comprehensive fertility care can achieve.