IVF over 38. Treatment options, chances, risks

It’s true that normally we do not have a waiting list but when physical characteristics are a little bit more difficult to find within our donors, it may take a little more time. In this case, we’re talking about 2-3 months until the transfer.

With egg donation treatment, success rates won’t change even if you are over 45 years old. But here we have to take into account other risks that could occur during the pregnancy – because of the age. We have to very carefully consider such risks as hypertension, preeclampsia or diabetes. So normally we would have to do a lot of tests to see that there are no further risks for that person in particular.

Right. Obviously, if you do not have menopause and you still have periods, we have to have eggs leftover – and obviously follicles, too. It may happen that although in one cycle you don’t see any follicles, you can see one or two if you do the scan in the next cycle. The idea is always to compare AFC with anti-Müllerian hormone (AMH) to have more information.

Firstly, we have to see the morphology of the embryo to see the chances of pregnancy. It means that if the quality the embryos is not good, they won’t be used for the transfer – because we don’t think they can achieve a pregnancy. Other tests that we can do are PGS and a biopsy to see the chromosomes. Nowadays, there are no more tests that we can do. With embryo quality in the blastocysts stage and PGS, we can have maximum information right now.

I’d say the question is controversial. It depends on the patient obviously. Normally, when we try the first, second or even third cycle, the idea is to achieve as many eggs as we can. So normally we put the maximum dose of gonadotropins. But it is true that when we’ve done several treatments and the response is always the same – meaning 2 eggs each time – we can maybe reduce the dose a little bit so it is more comfortable for the patient, as well as cheaper. Obviously, I prefer to do a mild stimulation to achieve 2 eggs rather than do a natural cycle and nearly always achieve only one egg.

This is a very interesting question. In each country, the law is quite different. In Spain, the law – for the moment – says that donation should always be anonymous. So there is no option for donors at all to have contact with their offspring – or for the offspring to have contact with the donor. There are different opinions but we think that donation works quite well in our country because of this. Normally, donors do not have an interest in getting in touch with the offspring after their donation. They don’t even ask about pregnancies achieved – we give them this information but they don’t ask about it. So we – for the moment – could never help in this connection. I do not know if the law could change within time – this is something we never know. However, most professionals, who work with egg and sperm donation in our country, think that the fact that this procedure is anonymous helps us have more donors. It also refers to patients. I think that the majority of recipients will also prefer not to have contact with the donor in the future.

Obviously, the issue is controversial. We could talk about this topic all night. Some people think it’s fair, others think it’s not. Some people say it’s not right for the offspring not to know where they come from. However, not all the people who undergo this type of treatment will always tell their offspring that they come from egg or sperm donation. For the moment, this is how we do it in Spain and it has been like that since egg and sperm donation started in our country.

It is true that it is not mathematical. Normally, it obviously goes down with age. But we cannot control absolutely everything. We’ve seen that the same patient, doing two treatments with exactly the same medication month after month, could have different results each time. The number of mature eggs depends on quality. We’ll have to see what medication you used there. I normally work with nanograms per millilitre, so I would have to change your result into nanogram to see if it’s good. I think it’s nearly 2 ng/ml – which is still good at the age of 38.

It means that the more IVF attempts there are, the greater the chances you have. It does not mean that, for example, if you do the first attempt, you will have like 50% of chances and with the second attempt – 70% in total. It means that if you did two attempts, you can achieve better pregnancy rates – just because you tried two times to be pregnant with IVF and the embryo transfer. It does not mean that within treatments, chances are greater. Your chances will be more or less the same with each transfer – but as you do more transfers, in the end, you will have more possibilities of getting pregnant.

I do not think it is something mandatory. It depends on your obstetrician, the risks, your health situation or the size of the baby. But if the delivery starts and everything goes smoothly, then why not? We can have a vagina delivery. However, it’s true that caesarean rates increase with age as well. It results from the fact that it is simply more difficult to have a vagina delivery and there are more risks related to going through all the procedures and stages of delivery.

Yes, it’s true. Normally, when we do PGD, we can get 3 types of results: an aneuploid embryo (which won’t be transferred as the possibility of having a healthy child is 0%), a euploid embryo (when the chromosomes are correct and the embryo could always be transferred) and a mosaic embryo. Let’s say that mosaicism is like the ‘middle’ result. Geneticists see that some of the cells are chromosomally normal and some others are not. Within mosaicism, there are lots of types. So we have to see what type of mosaicism we have – meaning if lots of cells are affected or not. Is it a simple or more complicated mosaicism? Additionally, it’s important what type of a problem a chromosome has. Sometimes, mosaicism affects only one chromosome – other times, it could affect two or more. Depending on this, there is a very complicated classification. Normally, a gynaecologist will be helped by geneticists to know a little bit more about the options of that mosaic embryo. And normally, they would give you the probability of getting pregnant, the probability of having a miscarriage and finally, the probability of having a normal, healthy pregnancy and baby. All this information will be given to a patient and a patient will finally decide whether they want to transfer the embryo or not. This is, of course, an option only when we don’t have healthy (euploid) embryos. If there are only mosaic embryos, then we would have to decide together if the patient wants the transfer or not.

This is a very difficult question to answer precisely. There are so many types of mosaic embryos. Genetic experts should give you percentages depending on the type of mosaicism. Normally, the best ones to transfer would be those that have only one chromosome affected. There are chromosomes that could have a worse prognosis than others, such as, for example, chromosome 21 – which is the one that produces Down syndrome. It has worse – let’s say – the percentage of a healthy baby than others. But it is very difficult for me right now to give you exact details in each chromosome. Normally, we have to look at the type of mosaicism and the chromosome affected so that we can give you more information. But if you do get mosaic embryos, don’t worry about that. The specialists will give you as much information as they can so that you can finally decide whether to do the transfer or not.

Unfortunately, I’m not the person to explain prices here. But do not worry, we will get in touch with you regarding this question. I assume you know there are different costs, depending on packages and we can explain the meaning of those to you later. My colleagues can contact you and give you all the information.

Yes, we do. We’ve done lots of treatments with black people until now. It’s true that it’s sometimes more difficult to find donors with black skin but we have them. We even have a bank of frozen eggs from black donors that you could use in the future if it is impossible for you to find a fresh donor. So normally we have no problems with that.

What we normally do right now is to give you treatment with analogs during 3 months before the transfer. In this way, we try to diminish the situation of adenomyosis before doing the endometrial preparation. So it’s like a 3-month hormonal pause with this treatment. We’ve done it with several patients and it worked good with them. Of course, we cannot say that this treatment works for 100% of the time but it does work some of the time with patients who have adenomyosis.

Obviously, sperm is also important. It’s true that men’s age is not going to affect the chances of pregnancy as much as women’s age but sometimes we also have to take these factors into account. So what can we do if – let’s say – a man is older than 45-50 years old? We can do other tests regarding the sperm, such as DNA fragmentation – this is something that could be more affected within time. We could see if we could increase the chances of pregnancy when DNA fragmentation is not good. We could use other techniques at the lab for sperm selection to improve our results. But generally, the sperm quality or age shouldn’t affect egg donation treatment so much.

I understand this question completely but it’s difficult to answer. It’s true that nowadays we don’t have yet the key to that. We’re looking at different treatments to try to improve egg quality and ovarian reserve as these are the problems we have with so many patients every day. So we’re trying different options but it’s still only investigation. I cannot tell you about any treatment that is really used clinically nowadays. But I hope that we will have more options for this in the future.

Firstly, we should see more information on sperm count. We should check DNA fragmentation – is it only single-stranded DNA fragmentation or are we talking about double-stranded fragmentation? If we have enough sperm quantity – even if the morphology is poor – we could use techniques to improve the outcome by choosing less fragmented or not fragmented spermatozoa for ICSI (sperm microinjection).

I heard about studies done with the speed of the sperm and the outcomes. I can’t say if this is true because I don’t know if it is really scientifically proven. But I think that in IVF there shouldn’t be any differences because we’re selecting the sperm that moves and has good morphology. We’re not looking at the sperm speed normally. So here the results should be 50-50 when talking about sex outcomes.

Yes, we have donors of either African or Caribbean descent. We always look at your physical characteristics and we ask where you come from. It does not mean that the donor has to be from exactly the same place as you but obviously, we try to match you both as best as we can – taking the origins into account.