The Most Challenging IVF Case We’ve Ever Seen: Zero Sperm Count and Poor Egg Quality in a Woman in Her Twenties
In today’s article, we’re sharing one of the most difficult IVF cases ever encountered by Dr. Riham Elshal at Tbibty Clinic.
Our aim in sharing this story is to give hope to every woman who is trying to achieve her dream of motherhood and feels anxious or believes her case may be too difficult or hopeless.
We want to reassure you — there is always hope!
Dr. Riham Elshal, Specialist in Obstetrics, Gynecology, Cosmetic Gynecologic Surgery, IVF, and Fertility Challenges, says:
The most difficult case I ever had was with a young couple. The husband was suffering from a very severe issue with his sperm.
It was shocking because the husband was still quite young, yet there were no sperm at all in his semen.
Because their situation was extremely difficult, the andrology specialists had to extract a testicular biopsy directly. We then proceeded to freeze the sample because there was a strong possibility that we wouldn’t be able to retrieve another one in the future.
This step was crucial to preserve any possible chance of conception.
Once we completed the male side of the process, the case moved to the female fertility and IVF team, and we started the treatment protocol.
But the surprise was that things didn’t go smoothly on the wife’s side either.
Watch the video here:
Although the wife was quite young — in her early twenties — after ovarian stimulation, we retrieved 20 eggs.
However, the shock came when we examined the quality of the eggs.
The eggs were of very poor quality, almost “burnt” — meaning completely unviable, as if they had been damaged or severely compromised.
Scientifically, this condition is known as egg fragmentation or degeneration, which is extremely rare at such a young age.
These eggs were nowhere near the level of quality we typically expect from someone in her twenties.
So, imagine this:
A very severe issue with the sperm from the husband, coupled with a serious egg quality issue from the wife.
After all the effort, out of 20 eggs, we only ended up with 3 embryos.
Only one of them was of decent quality (grade 1 or 2), while the other two were very poor quality — they had only undergone early-stage cell division and didn’t reach the developmental stage we typically hope for.
Dr. Riham continues:
When I got the call from the lab telling me that we only had 3 embryos from 20 eggs, it was a huge shock and incredibly disheartening. But I surrendered to God’s will and said: “This is God’s decree.”
Due to the poor quality of the embryos and the insufficient number, I couldn’t freeze any.
So we had no choice but to transfer all three embryos in the same cycle.
At that moment, I prayed to God with all my heart for this case to succeed — because honestly, we might not be able to repeat the process:
• The chances of retrieving sperm from the husband again were almost zero.
• And if the wife, in her twenties, produced eggs of this poor quality — what would happen in the future as she gets older?
Then came the long-awaited day — the pregnancy test day.
The result was incredible and amazing.
Perhaps part of the beauty was that the patient didn’t know the full details of how severe her case was, so she approached the whole process calmly.
I didn’t tell her everything from the start — I just explained simply that we only had three embryos and that her case had some unusual challenges.
But when the result came — it was a positive pregnancy test.
Subhan Allah (Glory be to God), she got pregnant!
Our joy was indescribable — tears, celebration, prayers, and pure astonishment.
We were all crying with happiness.
Everyone on the team was praying for this young woman from the heart — because we all knew what she had been through.
One of the moments closest to my heart was when I said to her:
“Let’s listen to the heartbeat.”
And we listened together, for the first time, to the heartbeat of her baby — a heartbeat full of life, hope, and miracle.
We all said together: “Alhamdulillah (Praise be to God), Allahu Akbar (God is Great).”
Everyone around her was praying for her. One of her relatives even told me:
“Doctor, she’s not just my daughter — she’s my sister and mother at the same time. You’ve comforted our hearts.”
Today, by the grace of God, this young woman is expecting her baby — and we all repeat: