Recent questions from patients asked during live online events
Is there any difference in success rates if we implant adoption embryos (healthy sperm and the egg of a 25-year-old woman with proven fertility) in a woman aged 43 or 40. Does the age of the recipient make a difference in the success rate? If not, what is the success rate in terms of percent HCG and live birth?
First of all, the age of the recipient doesn’t make a difference. You could be 43 or you could be 50. Your likelihood of success is going to depend on the fertility of the donor or the woman that created the embryo. Women’s fertility begins to drop significantly at age 34, which is why donors are preferably between the ages of 21 and 28 and a repeat donor up to the age of 33, before her fertility starts to decline significantly. The success rate is going to be equivalent to the age of the donor so if you happen to be in a country that keeps statistic as to the age of the donor, you can look up the likelihood of success for women in that age group. Typically, it’s very high. Women in this age group are very fertile, and your likelihood of success is really great.
What are the risks to the embryo with genetic testing for sex selection?
They may be a slight risk because of the biopsy procedure. There may be a negative impact on embryo development and also issues during the pregnancy; the risk of miscarriage or a biochemical pregnancy may be increased. But, with day-5 embryo biopsy, trophectoderm biopsy, these risks are very low.
You say that you recommend genetic tests in women that are over 35, but is there an age where DGP or PGS becomes obligatory?
Sometimes we do genetic testing for patients as young as 27 – for example, if they have had three or four failed cycles in their home countries, as a specialist I need to know why those cycles failed. While genetic testing is never truly obligatory, we strongly recommend them in cases such as this, because it’s pointless to attempt a process that has already failed several times – something has to change, and DGP and PGS allow us to give you a different way forward.
Is it good idea to do chromosome/embryo testing like PGS for embryos from donor eggs?
That’s our specialty. We are in favour of PGS testing, but not to egg recipients, unless they have two failed attempts at other centres. Then we have to determine if it is the embryo or the uterus that does not allow implantation. Since in oocyte donation, the chance of having a good euploid embryo is very high and the cost is about EUR 2,000 for embryos to be tested, we do not advise PGS for oocyte donation program unless the patient has had multiple failures. In such a case then we have to find out if the reason lies in the embryo itself or the endometrium. Our own experience is that even with thin endometrium, we can have, for example, twin pregnancy in a patient 4.9 mm of endometrium. It may take a little bit more trials but in the end we can succeed. Nature created the uterus in such a way that it can overcome all the difficulties. It is the oocyte that really matters and very rarely endometrium.
Do you transfer one or two embryos during the embryo adoption treatment? Do you transfer embryos created from donor sperm or donor eggs?
We can transfer either one or two embryos; we select two or three embryos for transfer and the patient can choose whether she receives one or two at once.
How many of these (egg donation IVF procedures) are actual births? For patients over 30 and in general?
We have to differentiate two things. The biochemical pregnancy rate means a positive pregnancy test, and then there is a clinical pregnancy and live birth. If you see the biochemical pregnancy rate, you have to subtract 10-15 %, which is the miscarriage rate, to give you the live birth rate. If I say that we have a biochemical pregnancy rate of 70%, automatically, I say that we have a 60% live birth rate per transfer. That’s why we are interested in having at least three embryos out of the egg donation cycle. The first transfer is always fresh, except if you do PGS, the second and third transfers are frozen. If you have a miscarriage after the first transfer, we do the second one, then we try to improve your endometrium. Then we try to work on your immunology. After two transfers over 70 % of all the patients have children at home. If we do three consecutive transfers, your accumulated pregnancy rate live birth rate at IVF Spain last year was over 80%. After four transfers it is over 90%.
You mentioned that you have donors from Africa and China as well. Do you also provide sperm donation as well?
Yes for both questions. We cooperate with agencies in South Africa, Asia, China, in different parts of the world, because our patients come from all over the world. We need to have those options available. Mostly those donors are called travelling donors. We do not have them available immediately in Ukraine, but by communicating with the agencies we plan the treatment cycles for them and they come for fresh stimulation. They start the stimulation in their home country and then they come for the egg collection, and the patient comes as well. The final step of the IVF treatment takes place in our clinic. We also do sperm donation as well, from Ukrainian and international donors as well.
My NK cells test was done via blood test. Is this okay, or is a biopsy better?
When it comes to NK cells, it’s important to remember that the blood is not going to be the environment in which the embryo’s going to live – that would be the uterus. As such, in order to get a full assessment I would recommend also performing an endometrial biopsy in order to confirm that the alterations found in the blood can also be found in the uterus.
Will you recommend to have 1 or 2 embryos transferred in the first implantation? What are the risks of transferring 2 embryos when you’re over 40?
Blastocyst culture, genetically normal embryos, single embryo transfer – it’s a key answer. The embryo selection is so sensitive that the implantation rate of this kind of embryos is over 70%. As I say, through genetic pre-testing of embryos I erase your age. I bring you to pregnancy rates of somebody who’s twenty-thirty years old. If I transferred two genetically normal embryos at the same time, I’d do a selective double embryo transfer, your twin rate is more than 50%. I would like to avoid that because twin pregnancies are always high-risk pregnancies for you. Your cervix can dilate. You can stay in bed till the end of pregnancy and I have to do the C-section. So these are the reasons why we recommend single embryo transfer. If you’re over 40 and your embryos are not tested genetically, you have to be aware that the euploid rate is 10%. So we can discuss double your transfer but with blastocyst culture, I’d still prefer a single one.
We had a one-time failure to implant, and second-time donor cycle – no implantation. I previously had a big fibroid removed. What investigation would you recommend – age 44?
Well definitely, I recommend hysteroscopy – definitely that because you need to see how the uterine cavity is after the myomectomy after the fibroids have been removed, so that will also help you to know if there is any problem in the uterus, and to solve this problem. If there is nothing in the uterine cavity is completely normal, then you should have done what we call endometrial scratching, and that would increase the chances of you getting pregnant. But again, was this embryo a good quality embryo? Was the sperm good? Were the eggs good, from a young donor? And you had good embryos? If the answer is yes, the embryo was perfect, then a hysteroscopy will definitely help you, and I wish you the best next time.
I think we shouldn’t change our lifestyle too much during the 2week wait (of course, no smoking, no alcohol). It might be too stressful for me! The embryo transfer has happened and I think we should focus on our emotions and well-being. What’s your opinion?
100% and, you know what, sometimes I’ve seen people who think to themselves, ‘I have to do acupuncture or I have to do this or that…’ and it turns out that the 2-week wait ends up being more stressful than any other time of the journey because of all these ‘have-to-dos’. That’s why I emphasize so much to do things that give you a sense of pleasure—whatever you would actually enjoy doing—and don’t do something just because you have to. Indeed, focus on your emotions and on your own well-being. There’s nothing that we’re going to do regarding your lifestyle during the 2-week wait that will specifically make a difference. I would say lifestyle and environmental factors matter more about the quality of the eggs and the sperm. So, it’s all about the three months before egg collection or the three months before sperm collection—that’s how long it takes for the sperm or the egg to actually have better quality or poorer quality. Lifestyle and environmental factors matter more during that period than in the 2-week wait. But, of course, like you said—no smoking, alcohol, extreme exercise, bathtubs or anything like that. Those are things that your doctor will tell you about as well but focus 100% on your well-being.
Does PCOS affect the embryo implantation and is it important to keep up with a low sugar diet after the embryo transfer?
Generally, the implantation rate is not considered lower when glucose metabolism is controlled correctly. However, if a woman having PCOS does not have good glucose metabolism and she is overweight, then yes – we can say there is a decreased implantation rate for her. In such cases, before the embryo transfer, we need to have the pre-treatment for overweight or glucose abnormalities disorders.
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