Successful Delivery After Severe PCOS and High AMH: A Grade B Embryo Success Story
A 29-year-old woman and her 36-year-old husband, married for seven years, came to Saraogi Hospital with primary infertility spanning their entire marriage. She had tried a few cycles of follicular monitoring elsewhere without success, and her periods were markedly irregular, arriving only once every 80 to 90 days, and only with medically induced withdrawal bleeding. An ultrasound and a very high AMH of 11 confirmed severe polycystic ovaries, with around 20 follicles on each side. Two IUI cycles failed before the couple moved to IVF, and despite a long stimulation and a large number of oocytes retrieved, the resulting embryos were not high grade. Her first transfer, using a Grade A embryo, failed. Her second, using Grade B embryos, succeeded. She was later delivered at 35 weeks by emergency caesarean section for severe preeclampsia and went on to develop HELLP syndrome after delivery, but both mother and baby recovered well.
PATIENT PROFILE
| Age | 29 years (wife), 36 years (husband) |
| Gender | Female |
| Presenting Complaint | Primary infertility for seven years, very irregular menstrual cycles, prior failed follicular monitoring cycles |
| Diagnosis | Severe PCOS with high AMH (11), bilateral polycystic ovaries |
| Date of Procedure | IVF cycle through to delivery at 35 weeks |
| Outcome | Healthy baby boy delivered via emergency caesarean section, complicated by severe preeclampsia and HELLP syndrome |
THE PROBLEM
This couple had been married for seven years, and had been trying to conceive for all of it. A few cycles of follicular monitoring elsewhere had not worked. Her periods were unusually irregular, coming only once every 80 to 90 days, and even then only with the help of a withdrawal bleed rather than occurring on their own. Flow was typically light, but on the occasions when it came very late, it turned heavy, which had led to one dilation and curettage procedure elsewhere; that report came back normal.
An ultrasound at Saraogi Hospital showed a healthy uterus and lining, but both ovaries showed severe polycystic changes, with around 20 follicles visible on each side. Her AMH was found to be very high at 11, which, together with the ultrasound findings, confirmed a diagnosis of severe PCOS, a condition officially renamed PMOS (Polyendocrine Metabolic Ovarian Syndrome) in a 2026 global consensus process, though it is still widely referred to by its older name. A high AMH is a marker in its own right; it typically signals poorer oocyte quality and a higher chance of failed fertilization or miscarriage, even when there are plenty of eggs to work with. The husband’s semen reports were normal, and an HSG showed bilateral spill, confirming both fallopian tubes were healthy.
CONSULTATION AND TREATMENT PLAN
WHAT WAS ASSESSED DURING THE CONSULTATION
- Ultrasound showing a normal uterus and endometrial lining, with severe bilateral polycystic ovaries (around 20 follicles per side)
- Hormone testing, including an AMH of 11, confirming severe PCOS alongside the ultrasound findings
- Husband’s semen analysis, found to be normal
- HSG showing bilateral tubal spill, confirming both tubes were open
- History of one prior dilation and curettage for heavy delayed bleeding, with a normal report
WHY THIS TREATMENT APPROACH WAS CHOSEN
Given the combination of severe PCOS and confirmed tubal patency, IUI was attempted first as a less invasive option, with a trigger injection given each cycle to prompt egg rupture. When both IUI cycles failed, the couple proceeded to IVF. Because severe PCOS typically means a longer, more carefully monitored stimulation and a real risk of poor oocyte and embryo quality despite a high follicle count, expectations were set accordingly from the outset, and a dual trigger approach was used at the point of egg maturation, appropriate for a high follicle count case like this one.
PROCEDURE ILLUSTRATION
The patient underwent ovarian stimulation, egg retrieval, fertilisation, and embryo transfer, the standard IVF sequence, adapted here for the specific challenges of severe PCOS: a very high follicle count, but oocyte and embryo quality that needed to be worked with carefully rather than assumed. The illustration below outlines this sequence, from the dense follicular pattern typical of severe PCOS through to the embryo grading and transfer stage.
PROCEDURE DETAILS
- Two IUI cycles attempted first, each with a trigger injection for egg rupture; both cycles failed
- Ovarian stimulation for IVF required 14 injections, a longer protocol reflecting the severity of the PCOS
- A dual trigger was given ahead of the egg pickup
- Over 40 antral follicles were seen on scan; around 25 mature oocytes were retrieved at pickup
- Egg and embryo quality were lower than average, as anticipated in severe PCOS
- Three embryo straws were formed and stored at day 3: one Grade A, one Grade B, and one Grade BC
- First embryo transfer performed in January 2026 using the Grade A embryo; the cycle failed
- Blood tests repeated after the failed cycle showed a mild sugar abnormality, consistent with PCOS; metformin 500 mg twice daily was started
- Second embryo transfer performed using the Grade B embryos, with a favourable endometrial lining; the patient conceived
- Beta hCG rose well on repeat testing, and a foetal heartbeat was confirmed; the pregnancy then progressed without incident until the third trimester
- At 35 weeks, blood pressure rose sharply to 200/140 with altered sensorium, epigastric pain, and other signs of impending eclampsia
- Emergency caesarean section performed for severe preeclampsia; a healthy baby boy weighing 1.8 kg was delivered
- Baby required two days of CPAP support in the NICU before discharge
- Mother’s platelet count dropped after delivery, consistent with HELLP syndrome; she recovered well with supportive care
PROCEDURE FACTS
| Procedure | IVF with Dual Trigger for Severe PCOS, Followed by Embryo Transfer |
| Oocytes Retrieved | Approximately 25 mature oocytes from over 40 antral follicles |
| Embryos Generated | 3 embryo straws at day 3 (1 Grade A, 1 Grade B, 1 Grade BC) |
| Embryo Used for Successful Transfer | Grade B |
| Gestation at Delivery | 35 weeks |
| Baby Outcome | Healthy baby boy, 1.8 kg, 2 days of CPAP support, discharged well |
OUTCOMES AT A GLANCE
| Conception | Achieved on the second embryo transfer, using Grade B embryos |
| Diagnosis Managed | Severe PCOS with AMH of 11, managed through tailored stimulation and metformin |
| Pregnancy Course | Uneventful until the third trimester |
| Delivery | Emergency caesarean at 35 weeks for severe preeclampsia |
| Maternal Complication | HELLP syndrome post-delivery, recovered with supportive care |
| Baby Outcome | Healthy baby boy, brief NICU stay, discharged well |
Delivery and Recovery
The pregnancy itself was uneventful after conception, with a good beta hCG rise and a confirmed heartbeat. At 35 weeks, the patient developed severe preeclampsia, with blood pressure reaching 200/140, along with altered sensorium and epigastric pain, both warning signs of impending eclampsia. An emergency caesarean section was performed, delivering a healthy baby boy. After delivery, the mother’s platelet count dropped, consistent with HELLP syndrome, a recognised complication that can follow severe preeclampsia. She was managed with supportive care and recovered well. The baby needed two days of CPAP support in the NICU as a precaution before being discharged in good health.
RECOVERY TIMELINE
| IUI Cycles | Two cycles attempted with trigger injections; both failed |
| IVF Stimulation | 14 injections, dual trigger, egg pickup with 25 mature oocytes retrieved |
| January 2026 | First embryo transfer (Grade A embryo); cycle failed |
| Post-Failure Workup | Mild sugar abnormality identified; metformin started |
| Second Transfer | Grade B embryos transferred; patient conceived |
| Early Pregnancy | Beta hCG rising well; heartbeat confirmed |
| 35 Weeks | Severe preeclampsia; emergency caesarean section; healthy baby boy delivered |
| Post-Delivery | HELLP syndrome identified and managed; mother and baby both discharged well |
Disclaimer: This case study is for informational purposes only and does not constitute medical advice. Individual results may vary. Consult a qualified fertility specialist before undergoing any procedure. Patient identity withheld per confidentiality guidelines.
Why Choose Dr. Mohit R. Saraogi for Severe PCOS and High-Risk IVF Pregnancies
Dr. Mohit R. Saraogi has treated patients with severe PCOS, very high AMH, and complicated IVF pregnancies at Saraogi Hospital and IRIS IVF Centre. Cases like this one, where a high follicle count did not translate into high embryo grades, call for realistic counselling from the outset and a willingness to work with the embryos available rather than waiting for an ideal one. That same attentiveness carried through into the pregnancy itself, where early recognition of severe preeclampsia and prompt delivery made the difference in a case that could otherwise have become far more serious.
Severe PCOS brings its own set of challenges: long stimulations, unpredictable egg and embryo quality, and a higher risk pregnancy once conception is achieved. Each of these is manageable with the right monitoring at every stage.
If you have been diagnosed with severe PCOS, a very high AMH, or have concerns about embryo quality during IVF, Dr. Mohit R. Saraogi and the team at Saraogi Hospital and IRIS IVF Centre can help you understand your options. See more real outcomes on our IVF Success Stories page, or book an appointment today.
Helpful Answers
Frequently asked questions
A few of the questions we hear most often. Have something else in mind? Talk to us →
Can severe PCOS succeed with IVF despite poor egg quality?
Yes. Severe PCOS often means a longer stimulation and oocytes that do not all mature well, but a high number of eggs retrieved still gives more chances to form a viable embryo. In this case, out of 25 oocytes and lower than average embryo quality, a Grade B embryo went on to result in a healthy pregnancy and delivery.
What is the success rate of a Grade B embryo compared to Grade A?
Grade A embryos are generally associated with slightly higher implantation rates, but Grade B embryos are also considered viable and regularly result in successful pregnancies. Embryo grading reflects appearance under the microscope on a given day, not a guaranteed outcome, so a Grade B embryo can and does succeed, as seen in this case.
Why did the first IVF transfer fail despite using a higher grade embryo?
IVF success depends on more than embryo grade alone. Factors such as endometrial lining quality, timing, and underlying conditions like a PCOS related sugar imbalance can all affect implantation. In this case, a mild sugar abnormality was identified and treated with metformin before the second, successful transfer.
Is preeclampsia more common in IVF pregnancies with PCOS?
Women with PCOS do carry a somewhat higher risk of pregnancy complications such as preeclampsia, partly linked to underlying metabolic factors. Close blood pressure monitoring through pregnancy, especially in the third trimester, helps catch and manage this early, as it did in this case.
What does HELLP syndrome mean after delivery?
HELLP syndrome is a complication that can follow severe preeclampsia, marked by a drop in platelet count along with liver related changes. It is managed with supportive care and close monitoring, and most patients, including in this case, recover well.