A 43-year-old woman break through the predicament by IVF 3.0 Plus.
7/31/2019 06:22:00 AM
She's 47 years old this year. Only left one chromosomally normal blastocyst.
With great confidence and last transfer hope, her blood test for pregnancy is...
Written by Dr. Hsing-Hua Lai.
What will you do if you still want to
become a mother when you are 43 years old? There are two options. One is as
fast as high speed rail, you can hold your child after one year; the other
takes 3 years of trying and cost 1.5-2 times of money. Most of people will
choose first option without a doubt. However, her choice was different. It was
not because of she want to cut off
her nose to spite her face. Neither was she rich. It's because she didn't
want to undergo oocyte donor program.
How hard
is it to become a mother for a 43-year-old woman through IVF? According to a paper
from 2012's Human Reproduction, a top European medical journal, the statistic showed that a 43-year-old woman need 120 oocytes to accomplish this goal. And under our
experience, only 1/7 of the pretty blastocysts from appearance will be euploid
(chromosomal normal) after PGS
test. The pregnancy rate of transfer
one euploid blastocyst is around 60-70%. Therefore it is better to collect at
least 2 euploid blastocysts before transfer. But the question is, how do you
collect 120 oocytes at this age? It is also very hard to collect two chromosomal
normal blastocysts. Because her AMH was below 0.13. The average number
of oocytes picked up every time would be 1-2. And she needed 42 oocytes to make
it!
Jesus! How long would it take? She needed a lot
of courage and determination to make this choice.
We used mild stimulation and natural cycle for
her oocyte retrieval
treatment. Because the quality was more important that number in her case. If we
used strong stimulation, the number of oocyte might be greater but the quality
might be disappointed. This kind of treatment design also helped her to save
the medication fee for NTD$ 40,000-50,000 each time.
It took her one year to
undergo 10 times of oocyte retrievals. 13 oocytes became 5 blastocysts after
embryo culturing. There were 6 times that the oocytes couldn't reach the stage
of blastocyst, no blastocyst could be transferred or be preserved. This kind of
outcome is the fear why a lot of fertillity center are afraid of culturing to
the stage of blastocyst. Because it is more challengeable.
Appearance will lie.
Pretty blastocysts from the appearance is not equal to chromosomal normal. There were
clients who waited expectantly after 15 days of transfer one "pretty
blastocyst" but failed. When they asked doctors, the replies always came
with a "Maybe". Maybe because of chromosomal abnormal, wrong
transfer timing, autoimmune factors, inflammation...etc. Without finding out
the truth, these answers could not help next implantation. It was like
gambling, which brought more defeats until we give up trying.
The time after
implantation until pregnancy test is the most pressuring. If the embryo is chromosomal
abnormal, it is basically an invalid medical behavior. Why don't we choose
a right embryo and transfer it at the right time?
She was lucky! 13 oocytes became 5 blastocysts. And the
best part was there were two chromosomal normal blastocysts! This outcome apparently broke the medical reports and our past
experiences!
When she was 45 years old, she tried to
transfer one euploid blastocyst but failed. At that time, there was no
examination to get the right implantation timing precisely. Global physicians can only use their experience
to guess that all women were same. The implantation time was 120 hours after
using progesterone. But the question is that is this
really the right time for every women?
According to latest research, there are 30% of people
have different timing. The implantation window might be 132 hours, 144 hours,
108 hours or even 96 hours. Which means 1/3 of women are exceptions.
How stupid is it to use the formula for every women!
Since 2016, we start to do ERA (Endometrial receptivity
Array). She accepted the examination after resting for one year and nine month.
The result showed that her best timing to do implantation was after taking progesterone 144 hours. And this might be the main
reason for her fail last time. With only one normal blastocyst left, she
underwent the implantation when she was 47 years old. Fortunately, the
pregnancy test was positive. Her βHCG was 2637. And finally gave birth to a
healthy baby girl on Oct. 5th, 2018. After 4 years of hardworking, she finally
got to hold her baby in her arms.
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WhatsApp：A 47 year-old woman, how did she make a pair of boy and girl twins?
7/29/2019 12:36:00 AM
Frankly, I won’t encourage people who are older than 43 to try IVF with their own eggs. The reason is low successful rate accompanied with plenty of cost and time. Using donated eggs would definitely be the first choice for them. However, the question is, “Could you accept it?”. If the answer is negative, what is your plan B? I usually ask my clients in dilemma, “Are you sure that you are determine to do this?”. Only if the answer is positive, I will agree to start this last journey before their last stop – oocyte recipient program.
To make a commitment to my clients, I’ll try calculating the estimated oocytes number need per baby for my younger clients. However, for clients over 40, I will precisely let them know how much oocytes they might need for 1-2 blastocysts with no chromosomal abnormality. In the meantime, I will ask them to set up a stop loss point, which is the spirit of PP-IVF (personalized-precision IVF).
C’est la vie! Who would know that a woman with such a beauty would only meet her Mr. Right in her early forty? At this point, she finally realized an important truth. She should have done the oocyte cryopreservation when she was younger.
IVF 3.0+ is the only choice for her right now. It cost her 1.5 years for 23 oocyte retrievals and 44 oocytes. In the end, she got 6 blastocysts with great appearance (graded above BB). However, the result of PGS showed that 5 were abnormal and 1 has no signal.
What could we do with this situation? We have no choice but take the rest 5 blastocyst, which are not qualified for biopsy, and the blastocyst with a no signal result to do the 2 times transfer.
As you might be curious, how could she do the oocyte retrieval for 23 times in a year? Indeed, to speed up the collection of oocytes, she often need to do the operation twice a month. We call this the D-OPU, which is an innovative protocol for clients with AMH lower than 0.8.
With such a hard work, how can she give up on ERA? The result of ERA indicate that her window of implantation is 132 hours, which is different from most women. With the reference of ERA, we have a success on the first transfer. Unfortunately, the development of embryos did not proceed. The cause of this failure might be the high probability of chromosomal abnormality. They decideded to transfer last 3 blastocysts for the second time transfer. After about 15 days, it turns out the level of beta-HCG is 2635! Although the index of HCG is quite inspiring, we still don’t know the chromosome of the baby is normal or not. Until she has done the Amniocentesis, I finally rest assured and realized that she might be “the oldest pregnant woman with boy and girl twins” in Taiwan. She also broke the record of Stork Fertility Center in 2011: 47-year old IVF with own eggs. I’m extremely grateful for the hard work of our embryologists, the God’s will. Most important of all, her determination and the help from her friend who introduce her to Stork Fertility Center.
There are full of stories behind every lucky pregnancies. Rewind the history of this patient, there are too many “what if?” questions in it. What if she didn’t hesitate to freeze her eggs when she were younger? What if she didn’t meet her helping friend? What if the blastocysts without doing PGS are all chromosomal abnormal? What if we perform biopsy on unqualified blastocysts, and it end up leading to miscarriage? What if she didn’t do the ERA? If she insisted doing transfer on the wrong time, efforts of 23 operations might vanish.
What is the “unseen” question behind every “what if”?
How long and how much would it cost for clients over 43 years old to have a baby? How do we get the answer of this question? My answer is, “You have to ask the correct question.”. The reason is that you can only find a way out in correct direction. People frequently ask, “Where can I find the cheapest IVF treatment? ”. The reality is that it’s not possible to do a skin-deep comparison on professional things. There are too many “unseen” factors under the table. My clients who are considered good-lucked ask the key question in another way, “What is the cheapest way to bring back a baby?”. The difference is on the denominator, the times for the treatment and the number of baby respectively. Asking the right question, both the doctor and the clients are on the same page. With the same goal, we can determine to bring a baby back.