The question
Hello Dr. Sher
I am 39, childless and I'm currently undergoing IVF in Portugal. I have had 4 miscarriages in the past (2 clinical and 2 chemicals). On my last scan, my AFC was 15. My AMH is 1.24.
I would like to make and store as many embryos as possible in back-to-back retrievals, as we will be doing PGTA testing on the embryos and I know many of them will be abnormal.
However, in Portugal, as soon as you have a fertilised egg, you are legally not allowed to retrieve more eggs.
This means if I do back to back retrievals, we have to freeze the eggs from the first round and then fertilise them with the eggs harvested from the second round. If we do three retrievals, we have to freeze the eggs from the first 2 rounds and then fertilise them with the eggs retrieved from the 3 round, and so on and so forth. We can do as many retrievals as we like, but as soon as any batch is fertilised, we're not allowed to do more.
Our options are:
1.) Collect as many eggs as we can from 2 or 3 or 4 rounds, but with the risk that we lose some in the freezing and thawing process. Pro is that we can collect more eggs to fertilise in one shot and hopefully this results in more embryos.
2.) Fertilise the eggs from the first round to reduce risk of egg loss. But that means we have to go through the entire process: fertilise, wait for day 5 embryos, PGTA testing and also transfer (if we make it that far). Only once all the embryos have been used or have failed, can we retrieve again. Given the attrition rate, it seems unlikely the first round will produce anything.
Currently, I am leaning towards collecting as many eggs as possible in 3 to 4 rounds. But a lot of people are saying that egg freezing at my age is too risky - that the eggs are too fragile.
What is your opinion on this? Thanks so much
Answer from Dr. Geoffrey Sher
I concur. I would collect as many eggs as possible in advance.
"Empowering Choices: Embryo Banking vs. Egg Banking for Fertility Preservation"
Geoffrey Sher MD
It's crucial for women to make informed decisions about preserving their fertility. Delaying trying to conceive, relying on egg freezing, or assuming the biological clock can be paused are misconceptions. As women age, egg quality declines, affecting the chance of a successful, healthy pregnancy.
Let's break down the key points:
- Age and Egg Quality: As women progress past their mid-thirties, the quality of their eggs declines rapidly. This impacts conception rates, leading to higher miscarriage and chromosomal abnormalities like Down syndrome.
- Comparing Chances:
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- At 30, the natural conception rate is around 15-20%, with a 10-15% miscarriage rate and a 1:1000 chance of Down syndrome.
- At 45, natural conception drops to 1-2%, with a 50-60% miscarriage rate and a 1:40 chance of Down syndrome.
- IVF and Age:
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- IVF success rates are better at younger ages, with a 50-60% conception rate for 30-year-olds and a 3-5% chance for 45-year-olds.
- However, IVF doesn't eliminate the increased risk of miscarriage or chromosomal abnormalities as women age.
- IVF Realities:
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- The success of IVF dramatically decreases with age, making informed decisions crucial.
Preimplantation Genetic Screening (PGS)/Preimplantation Genetic Testing for aneuploidy (PGT-A) is a breakthrough in fertility treatment, aiding the selection of the most viable embryos for a successful pregnancy. By analyzing all chromosomes, it significantly boosts the success rates of IVF. PGS/PGT-A not only increases the chance of a healthy baby per embryo transfer but also reduces the risks of miscarriages and chromosomal birth defects, regardless of the woman's age.
Who Benefits from PGS/PGT-A?
PGS/PGT-A) has revolutionized embryo evaluation, especially for those facing unexplained IVF failure, infertility, recurrent pregnancy loss (RPL), and older women with diminished ovarian reserve (DOR).
Empowering Older Women: Embryo Banking
PGS/PGT-A is especially beneficial for women over 39 years of age and those with DOR, as it allows the storage (banking) of healthy embryos over multiple cycles, countering the ticking biological clock.. Selective banking of PGS-normal embryos over multiple cycles is a game-changer. It minimizes the impact of age on egg quality, giving these women a chance to make the most of their remaining time to conceive a healthy baby.
Egg Freezing: Factors to Consider
Eggs are vulnerable cells, and freezing a single egg is less effective than freezing a multi-cellular embryo. Additionally, a significant portion of eggs (especially in older women) have chromosomal abnormalities. This makes egg freezing less efficient and embryo freezing, far more successful, especially when selectively freezing PGS/PGT-A-normal blastocysts.
Choosing the Right Path
Importantly, considering the decline in reproductive potential with age, it's essential for women and couples to explore their fertility options before the age of 35. An aggressive approach, like moving to assisted reproduction and IVF can significantly improve outcomes. For younger women (<35y) who have normal egg reserves, especially those who are not married, have not as yet settled on la “permanent” male partner or a do not feel secure with their existing male partner fathering a child with them might preferentially choose egg freezing . Conversely, women who are comfortable with a designated male partner, older women and those who have DOR might rather select embryo banking.
In the choice between egg and embryo freezing, caution is advised. Current methods for egg selection lack chromosomal analysis. Conversely the performance of PGSGT-A allows for identification of the healthiest embryos for subsequent FET..
Either way, “timing” is a very important consideration.
By understanding these options, you can make an informed decision to maximize your chances of a healthy, happy family. Remember, knowledge is power in the journey to parenthood.
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Herewith are online links to 2 E-books recently co-authored with my partner at SFS-NY (Drew Tortoriello MD)....... for your reading pleasure:
- From In Vitro Fertilization to Family: A Journey with Sher Fertility Solutions (SFS) ; http://sherfertilitysolutions.com/sher-fertility-solutions-ebook.pdf
- Recurrent Pregnancy Loss and Unexplained IVF Failure: The Immunologic Link ;https://drive.google.com/file/d/1iYKz-EkAjMqwMa1ZcufIloRdxnAfDH8L/view
I invite you to visit my very recently launched “Podcast”, “HAVE A BABY” on RUMBLE; https://rumble.com/c/c-3304480
If you are interested in having an online consultation with me, please contact my assistant, Patti Converse at 702-533-2691 or email her at concierge@sherivf.com\
General information only, not medical advice for your own situation. For that, book a consultation.