The Depressing “8 accidents” of IVF Treatment
11/29/2019 02:46:00 AM
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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Hey,
ReplyDeleteI noticed your Article. I just loved it.
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Cheers,
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