Watch the webinar with dr. Bogna Sobkiewicz, Gynecologist & Obstetrician and Małgorzata Wójt, MSc, Head of Embryology Lab at Salve Medica, Poland.
It is a very difficult question because it depends on many factors. The younger women have completely different success rates than older patients. We look at the age of the couple, we look at the quality of the embryos, we look at different things. In Poland only three attempts with own eggs are refunded by the state. We also look at the will of the couple, if they want to try once again with own eggs. We always inform them that sometimes the success rate is very low. But if the couple would like to try again and again with their own gametes, we also do it but we always tell them that the success rate is low.
Yes, of course. However, you have to know that endometriosis may cause some problems and it’s a little bit more difficult to treat endometriosis, especially the adenomyosis. You have to know that it can be a little bit more problematic for you. I agree that it’s important to start with egg retrieval and then cope with the endometrium problem.
We use endometrial scratching for two reasons. The first reason is to check if the cervix is not blocked. This way we can avoid potential problems with inserting the catheter into the uterine cavity. During the transfer, the catheter contains delicate embryos and we want the transfer to be as gentle as possible. The second reason, according to the research, is connected to the fact that after scratching in the consecutive cycle, the cytokine profile in the uterine cavity changes. This, to a small extent, has an impact on the transfer success. But only on the condition that scratching was done in a previous cycle.
We are not the immunologist so we’re not a good persons to ask these questions. There’s also a little bit difference between the natural killer cells in the endometrium or in the blood. It also depends on which natural killer cells we are talking. We all have natural killer cells and, for example, in the endometrium. It is important whether their level is high or low. It’s not enough information for us and as I said at the beginning we are not the immunologists.
Scratching solves two problems. One of them, is the scratch and another is that it allows us to go through the cervix. Sometimes we do the hysteroscopy. When we have the problem to do the scratching with a special catheter to the uterus, we perform hysteroscopy and to find a way where it goes. Sometimes it’s going more to the left, sometimes it’s going more to the right. When we do the hysteroscopy, we can find out how it goes and it allows us to go with the catheter this way. The contractions – when we perform the embryo transfer, we try not to touch the fondues, to do it as smoothly as we can, we use a very delicate catheter because we do not want to have the contractions. We do not want to cause any pain to our patients because we believe that it can diminish the probability of success. We sometimes have to struggle as well. Sometimes we have the problem with the transfer and, even though, we always try to make it a smooth as possible, you should remember that this is medicine and sometimes it’s difficult or even impossible to know something beforehand.
It is difficult to say because we have so many different types of fibroids (myoma). It depends on where they were localized, if they touch or go to the uterine cavity. If the myomas were out of the uterus, they are less important for us, unless they are not very big. But it is also important if during the if the cavity was of the uterus was open or not, if there are any scars on the uterus. There are so many different problems that are important to know. Even though that sometimes we know that there are fibroids or the myomas but there’s another problem as well like low quality of semen, eggs or the embryo. So even if we know that there is a problem with myoma, there can be still another problem that is just difficult to diagnose.
The egg quality – it is difficult sometimes. We know that when you use DHEA 2-3 months before the egg retrieval, it can help a little bit. There are some studies that say that the growth hormone can be a good solution but it’s difficult to use, it’s very expensive, there is no refund in Europe for the growth hormone and it’s a little bit still experimental to use it. Sometimes it is good to use the testosterone but, even though, sometimes when we try to help our patient and we use these solutions, even though the egg quality is slow because of the age or low AMH, it is difficult to help them. Also, it depends on the age of patients because sometimes low AMH in younger patients is better than older patients. The genetics is like that – we are aging and our gametes as well.
I haven’t heard that it helps with recurrent miscarriages I ‘m not sure if it makes sense to take it with the higher than average AMH. We try not to ask our patients to take everything what they can. Patients look for solutions but sometimes they can they do some things that have no studies, are experimental therapies so we do not recommend this.