Dr Maria Arqué, International Medical Director at Fertty International is talking about fertility preservation and egg freezing options.
The AFC means antral follicle count, so when we’re doing a transvaginal scan, we can count how many follicles we have, as I’ve explained before the follicles are the ones that are containing the eggs, and when we’re doing that test, we usually try to do it once you just got your period, which is the best moment in which we can do the antral follicle count that gives us an idea about how many eggs more or less can we expect that is going to grow with one cycle of stimulation. It gives us complementary information on the AMH, which is the blood test that we will use for also assessing your ovarian reserve.
There is not a test to check for chromosomal issues of the oocytes. We can do that when we’re freezing embryos because at the end of the day, and that’s what’s important, so what we can do, is before deciding which embryos are worth being transferred, once we have fertilized the eggs with sperm, and we have them at the stage of the blastocyst, we can do a biopsy of those embryos. We can do the karyotype and see which of those are worth being transferred and are chromosomally normal, but currently, there’s no test to check directly which eggs are chromosomally normal. That would be great because that would be a way to have a clear idea of the realistic chances of those eggs being worth using in the future. Regardless of that, I just want to point out as well that even though the egg is mature and it’s chromosomally normal, that’s not a 100% guarantee that you’re going to get a blastocyst and you’re going to get a healthy pregnancy.
This is a very tricky question. If we’re looking at the best quality of the eggs obviously your eggs are going to be better at 25, than when you are 30 or 35. Usually, we don’t recommend to freeze your eggs when you are very young, we’re seeing that f.e. women that are 18 or 19, we’ve seen that a lot with egg donors that there is some kind of eggs that are not mature, the process of maturation is not exactly the best sometimes, not always but it happens. I would not consider egg freezing unless you’re doing that for oncology purposes or because you have a medical issue. Having said that, obviously, your eggs are going to be of better quality at 22 than at 30, but when you’re 22 you still have a lot of time to think about when you want to have children and what are your options. I think that probably what I would recommend is that from a very early age since you start going to the gynaecologist, usually it’s when you start having intercourse or when you are 18, and you start having Pap smears and regular checkups, I think that’s something that should be checked is the ovarian reserve. If we know what is the patient’s ovarian reserve, at least we can Warn patients and say, if you are not planning to have babies soon, most likely in the future you might struggle, so maybe in your case, we should be doing the fertility preservation. Obviously, all women who have already some infertility issues or some gynaecological problems like endometriosis, PCOS or other problems, I think that they should have a chat with their gynaecologist or with a fertility specialist even when they are young to assess all the options and how those pathologies can affect their fertility in the future.
I’d say that as I pointed out before our goal would be to get around 16-20 frozen eggs in Total, so obviously before you’re 35 ideally. In the terms, of how often can we do the cycles, probably I would do stimulation one cycle after the other unless you’re feeling unwell. Because we’re seeing that we’re having exactly the same results, we can even stimulate during the luteal phase and do something that is called DuoStim, we can do one cycle after the other without having to Lose more time which is something that for some patients is more convenient. I’d say that the number of cycles that leads us to have at least 15-20 frozen eggs.
First of all, even though for a lot of time we thought that male age was not that important when we were about to do fertility treatments, we have currently more data saying that sperm quality also declines with age. There is a more important decline after the age of 40, and there is a slightly higher risk of having chromosomal abnormalities on the embryos after 40. So this is something that we have to count for, even though you had 3 boys before and I assume they are healthy, so that’s reassuring as well. Regarding the egg donor and the number of blastocysts to expect, it will mainly depend on how many mature eggs will be guaranteed by the clinic that you’re using. Usually, there’s a minimum number of mature eggs guarantee, and it is around 8 eggs from the donor, so you should be expecting to have at least 2 blastocysts more or less. Sometimes, there might be donors that we don’t know why we end up having poorer results, but I’d say that a minimum of 2 blastocysts should be the normal thing.