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The Depressing “8 accidents” of IVF Treatment

What is the most depressing part of IVF? For younger women with abundant ovarian reserve, the process would be smoother. Usually, 1-2 times oocyte retrievals are highly possible to create a baby. However, for women over age 38, there might be numerous obstacles.

Age> 38 and AMH< 2 are 2 indicators of “Diminished ovarian reserve”. 
The following situations are “8 accidents” we concluded from our previous experience.

Bad response
For example: We saw 5 small follicles on D1-3 of the patients’ period. However, the number of follicles decrease after stimulation. The primary reason of this situation is the bad quality of follicles which are not able to proceed developing.
Earlier ovulation
The ovulation should occur at 36-40 hr after trigger. However, if the ovulation occur earlier then we expect, we might not be able to extract the oocytes when operation performing.
Empty follicle
Usually, there would be an oocyte inside a follicle. However, in some cases, there might be no oocyte in the follicle, which we called a “empty follicle”.
Low good oocytes rate
The good oocytes rate for women under age 35 is over 70%. For women over age 40, the good oocytes rate is lower than 50%. Even worse, some of the oocytes might be defective for insemination.
Low fertilization rate
The overall fertilization rate is about 70%. However, for some cases, the fertilization might be lower than we expect.
Abnormal fertilization
The fertilization might turn out to be 3PN or other abnormality.
Not dividing
95% of the fertilized eggs would go on cell division. However, some of them might not undergo cell division.
Stop developing
The normal embryos will divide in 15-17 hours. The embryo should acquire 6-8 cells after 3-day culture. However, the embryo might stop developing during the culture, which will end up no embryo for further transfer or freezing.

How to prevent these 8 accidents?
Bad response
Planning the PP-IVF (Personal Precision IVF), such as mild stimulation, natural cycle or D-OPU.
Earlier ovulation
The time point of trigger is different depends on the age. For women under age 40, we only trigger when the follicles are bigger than 17 mm. For women age under 40, we would adjust the trigger at 15-17 mm follicles size. Since the follicles walls of older women are less flexible (might rupture when the size is 20 mm), we can use the prostate gland inhibitor (anal suppositories) to prevent the rupture at 8-14 hrs prior to the oocyte retrieval.
Empty follicle
There might be truly no oocytes in the follicles. Otherwise, the time point and the method of trigger might also the reasons of empty follicles. In this case, we can try adjusting the time or the gesture of the trigger.
Low good oocytes rate
The oocytes would be observed by embryologist after the operation. Those defective oocytes are neither predictable nor not able to undergo fertilization. What we can do is to keep collecting more oocytes with good quality.
Low fertilization rate
The low fertilization rate is related to the quality of sperm and oocyte. The quality of the oocytes is depending on the age, when is unalterable. What we can try is using microscopy with higher resolution (6300X IMSI) to choose sperms with better quality.
Abnormal fertilization
Usually, for those who have fewer oocytes, ICSI is used as the first priority method of fertilization. The cause of this situation are mostly the chromosomal abnormality of the oocytes. What we can do is to keep collecting more oocytes with good quality.
Not developing
The cause of this situation is more related to the quality of the oocyte. What we can do is to keep collecting more oocytes with good quality.
Stop developing
From the genetic aspect, the better embryos have higher possibility to keep developing. The abnormal embryos would be naturally eliminated and often stop developing at D3-4 of the culture. What we can do is to keep collecting more embryos with good quality.

Under which circumstances should I consider using oocytes from younger donor?
According to our statics, for women at age 43, it might take 120 oocytes to successfully bring back a baby. The live birth rate each oocyte retrieval and transfer is only 3.5%. Under these conditions, do you still have the courage to keep going? If the answer is uncertain, maybe you can start considering the oocytes recipient program. 
We suggest women with the following conditions to consider using oocytes from the donor:
1.      Women older than 43 years old.
2.      Continuously getting empty follicles for 3 times oocytes retrievals.
3.      Continuously getting 0 oocytes for 3 times oocytes retrievals.
4.      Continuously having 0 embryos for further transfer for 3 times.

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1 comment:

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