This case report describes the fertility journey of a 26-year-old female with secondary infertility, a history of pelvic surgery, and a confirmed heterozygous Factor V Leiden mutation. Despite low ovarian reserve (AMH 0.741 ng/mL), recurrent endometrial polyps, and multiple failed assisted reproductive attempts, pregnancy was ultimately achieved through a tailored IVF protocol with intracytoplasmic sperm injection (ICSI). Genetic testing via PCR confirmed the presence of Factor V Leiden mutation, which contributed to recurrent implantation failure. Anticoagulation and careful hematological monitoring were integrated into management. Remarkably, the patient later conceived spontaneously, though the second pregnancy was complicated by vasa previa. Both pregnancies resulted in successful deliveries via cesarean section. This case highlights the importance of thrombophilia screening in women with recurrent implantation failure and supports individualized reproductive and pregnancy care strategies in complex infertility cases.