IVF with donor eggs with PGS – what is the correlation between the cost of the treatment, the outcome, the success rates, and the time frame. Our expert, Dr Natalia Szlarb
is talking about PGS diagnostics with IVF with donor eggs and possible outcomes of various treatment options. If you are interested in the topic, watch the video above which is the recording of this live event and check the Q&A session for the doctor’s answers to participants’ questions.
In 2018 Dr Szlarb was a guest speaker during our webinar on “Process of IVF with donor oocytes abroad”.
Dr Szlarb begins her presentation by bringing all of us to speed with the context – the sociocultural climate established by the social revolution of the 1960s encourages women to postpone their parenthood in order to focus on their education, career and other aspects of their lives. The problem, however, is that human biology isn’t designed for that; as women grow older, their chances of conceiving naturally diminish. Egg quality and ovarian reserves go down, making natural pregnancy less likely.
Modern reproductive science agrees that biologically speaking, women are designed to have children before the age of 35. Following that point, the chances of getting pregnant using our own eggs experience a sharp drop, bottoming out at around 44 years of age. All is not grim, however – modern medicine offers us a way out through egg donation. Egg quality is the biggest deciding factor in IVF treatments: poor eggs often result in genetically abnormal embryos. By using eggs of younger donors, this issue is entirely mitigated. Research shows that pregnancy rates for women who undergo egg donation programs are not negatively affected by age – which provides older women, or those afflicted with ovarian issues, with a chance at motherhood. It’s not the only method, however. Your own eggs still may give you a fighting chance.
There is a range of tests that can be done, determining patients’ ovarian reserves, establishing a medical background and judging their fertility status. Most patients still have enough reproductive capacity in them that they don’t need to resort to egg donation straight away. After stimulating the ovaries into producing more eggs, embryos are generated and held for five days to allow them to reach the blastocyst stage. Not every embryo will reach that stage, which already tells us which ones have the highest chance of resulting in a pregnancy. However, there is still more to be done – PGT-A testing (or PGS, as it used to be known) is a genetic test which allows embryologists to screen for chromosomally abnormal embryos; by weeding those out, the patient is left with the embryo – or embryos – which have the highest chance of success.
The numbers presented by Dr Szlarb reaffirm that this is the correct approach.
The average IVF pregnancy rates for women over the age of 35 oscillate around 18% without PGT-A testing. With testing, however, the pregnancy rates shoot up to over 80%.
As we said, however, not all patients have the ovarian reserve to produce enough high-quality eggs to even have multiple embryos in the blastocyst stage per cycle. As women grow older, the chances of those eggs being genetically abnormal also grow higher, which often results in failed IVF cycles or failed pregnancies. This is where egg donation programs come into play – they’re an efficient, pragmatic and safe solution. According to data, 93% of patients experience successful pregnancies by the third egg donation cycle.
Safety is a major concern for patients who are considering such an approach. Dr Szlarb reassures us that egg donation has been tightly regulated by Spanish law since 1988. Donors go through various medical and psychological screenings, as well as phenotype analysis, to make sure that the donor matches the recipient as closely as possible on the genetic level, and that a child produced through this method will most closely resemble you and your partner. Following that, the patient fills out a phenotype questionnaire, where you describe yourselves and your background; this helps to narrow down the pool of donors to those who most closely match your answers. Finally, doctors then compare photographs of you and your potential donors, selecting around four of those who look the most like you. Finally, based on their schedules, a donation is arranged as quickly as feasible.
As you can see, the process is heavily regulated, but that’s not all; Spanish law obligates clinics to perform a lot of low-level genetics work on the donors to make sure they aren’t carriers of any diseases that could be passed on to the child or that could be a danger to a patient who experiences immunological issues; in that case, it’s almost as tightly regulated as liver or kidney transplants. Simply put, the process is heavily regulated to ensure the safety of all parties involved.
Following the donor selection and the fertilization of eggs, embryos are then developed to the blastocyst stage. As we mentioned earlier, this takes five days. On day five the embryos are frozen to allow for genetic testing; if the patient opts out of testing, there are still non-invasive monitoring methods, such as the time-lapse technology, which allows embryologists to select the embryo with the best cell division rates to be implanted. Freezing embryos for testing doesn’t affect the success rates – quite the opposite, in fact.
Embryos aren’t the only ones to enjoy regular testing, however. The patient undergoes a uterine lining biopsy in order to determine the best time for implantation. This increases the chance of a successful pregnancy during the first transfer. This issue will be discussed during a future webinar, so stay tuned!