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Anna Blázquez, MD
Head of Medical Research, Eugin Clinic
Category:
Low Ovarian Reserve, Success Rates, Success Stories
DHEA won’t increase the risk for cysts or polyps, but we don’t usually recommend it to our patients because there’s no scientific benefit of taking this medication to increase the ovarian reserve or even to increase the quality of the eggs. However, it won’t do any harm. If you want to take it, you can. We don’t think that it could increase the results substantially.
It depends a lot on the clinic because some clinics only do day-5 transfers, but as you have seen in my cases, we have done a lot of day-2, -3 embryo transfers. That’s because we know that between day-2 or day-3 until day-5, an embryo inside an incubator might not survive. An incubator is not the natural environment for the embryo, it’s the uterus.
We know that day-5 is a better stage to transfer the embryos because the implantation rate is higher. However, if there is a risk and from day-2 until day-5, we might lose some embryos putting them in a uterus can give us a very healthy baby. We decide if we take the risk for them to arrive until day-5, depending on the number of embryos we have.
If we have a lot of embryos, let’s say around 4 embryos or more, we take the risk to arrive until day-5 because maybe we will only get 1 at the end, but this embryo has a high potential of pregnancy. Usually, if we have 3 or 4 embryos or a lower number, we prefer to be conservative, and we transfer the embryos on day-2, -3 because we don’t want to lose a healthy embryo.
The embryologists are the ones that give us the recommendation depending on the number of embryos and on the quality of those embryos, and if we have 3 very good quality embryos, we can take the risk of arriving until day-5.
We are maybe a little conservative, but it’s true that maybe the patient will have more failed transfers, and it’s difficult to cope with, but we prefer not to lose any good embryo in the lab. That’s why if we have 3 embryos or fewer, we always do the transfer on day-3.
The best option in your case is egg donation, that’s true, because in the best scenario, maybe you can try with some strategy and a modified natural cycle or even with testosterone. I think the best response that we can have in your case is possibly one egg, so we can try with an embryo transfer, but the effectiveness after 3 failed different cycles with no embryos to transfer, with different strategies, different doses, the best option is egg donation.
Egg donation is a change of mind, some patients prefer to try all the options they have before changing to egg donation, which depends a little on you. If you are tired of negative results, if you can cope with more cycles and possibly bad results, then as you are 38, we can try. I would suggest trying a different strategy to see if we can have at least 1 egg, knowing that possibly only one egg might be obtained. If you are looking for the most effective treatment, it’s for sure egg donation.
At 49, we always do an egg donation or double donation depending on if the patient is in a relationship or not, but with egg donation, the chances of getting pregnant are around 60% at the first attempt. In cases, we don’t have a pregnancy in the first attempt, and a patient needs a second cycle, 85% of patients get pregnant, and in the number of cases that need a third egg donation cycle, 90% of patients get pregnant, so those are the chances of getting pregnant.
It all depends a little on if you have any basal pathology and if you have any uterine malformation, but if everything is okay, your chances are more than around 60-65% of getting pregnant in the first attempt.
No, if you have menopause, it’s impossible. In those cases, even in younger patients with early menopause, the only option is to go through an egg donation. If it’s menopause, that means one year or more without your cycles.
Accumulating embryos is an option that many patients want to try to have more options because if we have more embryos, we have more chances of having 1 embryo that can implant. It’s a good strategy in your case. I don’t know why they have always done modified natural cycles, maybe because of your ovarian reserve.
Even with trying other strategies, only 1 egg can be achieved, but, of course, you are 41, and you are not in menopause, so we can try different strategies to see if instead of 1, 2 or 3 eggs can be retrieved. Possibly 2 embryos can be obtained and frozen. It’s a good strategy, Gonal F with Menopur.
Don’t worry about those 4 cycles, it’s not going to increase cancer risk, but, indeed, Clomid is used for milder stimulation, so in your case, I will suggest stopping with Clomid and trying with gonadotropins, I think it’s the best treatment in your case.
Unfortunately, no, there isn’t any kind of treatment that could improve AMH levels, there’s no treatment to improve ovarian reserve. There are some experimental therapies, but they have not been shown or proved to be used in clinical practice. After 2 years of trying naturally without success, I would suggest starting with medical treatment. I don’t know your AMH level, but if it’s low and you’ll be trying for 2 more years, it will decrease even more, and then maybe it will be late to do a treatment.
The international medical association says that when a patient is 35 or younger after one year of trying without success, they should start treatment. If the patient is older than 35, they should go to a doctor to study and try to diagnose the cause of infertility. In your case, yes, I would suggest starting a fertility treatment.
Perhaps, we can. There’s always a chance of doing another cycle, but to recommend another cycle, I would need more information about these previous cycles because what we don’t recommend is to do the same things after 4 failed cycles. We can do something else to try to improve the results. If there’s nothing else that we can do, then we skip to an egg donation.
I need more information about these previous cycles, if there’s something that could improve the ovarian response or the egg quality, then I would suggest it. You are 39, and you have a chance of getting pregnant, so if there’s something that can improve the response, I would suggest doing another cycle with your own eggs, but again I need more information about the previous cycles.
It’s different if you have an empty follicle syndrome because you had a low number of follicles growing, and they weren’t able to recover any eggs from these 1 or 2 follicles, or if you had a very good amount of follicles, and no egg was recovered. Some strategies can improve or try to avoid this empty follicle syndrome. One of them is changing the gonadotropin and using a dual trigger.
\We do the ovulation trigger with two different medications, and we program the ovum to pick up a little earlier than in the first attempt. That’s the strategy that we use when a patient has had an empty follicle syndrome, but it’s not the same to have an empty follicle syndrome if a patient has a low ovarian response to the medication or if it’s after unexpected empty follicle syndrome.
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