Sometimes we encounter patients who have gone through many treatments already without success, and when we look at their medical history, we see that they haven’t been diagnosed properly. If you don’t have a proper diagnosis, you won’t have proper treatment. If the quantity of the eggs is affected, it’s important to adapt the medication properly so we can get as many eggs as possible. We always need to offer medication according to age, BMI, we need to take into account previous treatments, etc.Another issue can be with the quality of the eggs, which is generally due to age. In this case, apart from medication, it’s necessary to look at the genetic information of the embryos as they can be impacted by a woman’s age. In such a case, PGT-A testing might be indicated to make sure that only the euploid embryo is transferred. Sometimes, additional techniques, such as assisted hatching might be beneficial. Some embryos might have a hard shell due to age, and it might be hard for them to get out of the shell and implant, and assisted hatching can be helpful. There are some cases in which we might need to do microsurgical fragment removal, it’s when the embryos might have little fragments between the cells and when they are removed, the embryo has a bit better quality and might implant, which increases the success rates. If all the previous treatments with own eggs fail, the last treatment option that is recommended is egg donation. There are various egg donors available, and the egg donation programs at Institut Marques have been very successful. Again, the egg donation process needs to be individualized, all patients need to be informed about the process, and egg donor selection, it might be possible that the couple would prefer to have the eggs sent abroad or need a specific donor, etc. There is also a possibility that infertility is due to male factors, and again, a proper diagnosis is required. Sometimes, a normal sperm analysis is not enough and might be crucial to look for the genetic quality of the sperm with the FISH test or do a DNA fragmentation test. Many times patients don’t know the reason they haven’t been successful, but it turns out, they haven’t been properly evaluated. Lifestyle changes may be enough, other times, we need to perform PGT-A or select sperm with the IMSI method. Another method that is often used is EmbryoScope which helps with embryo selection. Instead of having to open the incubator with the embryos, they are monitored thanks to a small camera inside, and the embryologist can see how they develop every day. The other advantage is that a video of embryo development is created, and for example, if you have 2 embryos that look similar, it is easier to select the best-looking embryo by looking at the video. Other issues include uterine problems, such as chronic inflammation of the lining or infection, and even though you have great embryos, they might not implant. This has to be treated before any embryo transfer is performed. There is a broad range of options available, from sperm donation to ROPA or embryo donation. One-size-fits-all is never a good approach, all treatments have to be individualized both medically and personally.