In this session, Dr. Yanina Samoilovich, Obstetrician-Gynecologist, Fertility Specialist at International Centre for Reproductive Medicine (ICRM), St. Petersburg, Russia has been talking about all the factors that can impact your IVF success like age, sperm and egg quality, uterine and genetic
The advanced maternal age is supposed to be a very difficult case for infertility treatment, and it’s important to know how many follicles you have on the ultrasound picture. It’s also important to know what is your medical history. It’s hard to say that 41 is the end of fertility, and every woman is different. For someone, it could be 41, for example, some days ago, I had a patient who is 43, and she delivered a baby by herself with no donor eggs, so no, I can’t say that 41 is considered to be the end.
It also depends on your previous medical history. If you had a lot of attempts with your own eggs and it all failed, maybe it’s useless to go ahead with your own eggs, and if you don’t have any good quality embryos with your own eggs as well. If it’s your first time and you haven’t tried with your own eggs before, you can try it if you are 40 to 42. I believe that the oldest age when you can try with your own eggs is 43-44, but again it depends on a particular case.
You must understand that supplements are vitamins and other different substances. There are not many of them that can increase the quality of sperm or eggs. Folic acid is a proven vitamin that both partners have to take, but different antioxidants like CoQ10 can also be helpful. There are a lot of various supplements that doctors can advise nowadays. I’m not sure it can do some harm to you. Unfortunately, the most important factor here is your age if we’re talking about women, so if you are at an advanced age, there are no supplements that can help, the age is the best prognosis factor. Regarding sperm quality, it’s important to remember that urologists can prescribe antioxidants that can increase sperm quality, but the lifestyle can do much more for man. Healthy diet and avoidance of cigarettes and alcohol, taking any supplements, etc.
The blood type is not as important as the Rhesus (Rh) factor, so if the donor has a negative Rh factor, the surrogate mother should have the same. The blood type doesn’t matter. Regarding epigenetics, it’s better to ask genetic specialists about it. Now, we are only at the beginning of understanding this epigenetics process. I’m afraid I can’t tell you a lot about it.
It’s supposed to be treated, but it depends on the kind of fibroid. If it’s submucosal fibroid, it definitely should be removed before an IVF cycle, before embryo transfer, and it doesn’t depend on its size, it should be removed. If we have intramuscular myoma, it depends on its size. Here in Russia, it’s legal not to remove it if it doesn’t deform the uterus cavity and if it’s not more than 4 or 5 centimeters. We should treat it, but it depends on the kind of fibroid.
Endometriosis is a chronic disease, unfortunately, and it’s important to know how many follicles you have now in your eggs and if it diminished or not. It’s also important to know what treatment of endometriosis you had after your operation. It’s better to have a complicated treatment, not only a standard operation but a complex treatment with drugs. Talking about your uterine lining, you can use high doses of estrogens, but we also know that it doesn’t always help and some other factors help, for example, in our center, we try to use platelet-rich plasma injections, and we use it twice in a frozen embryo transfer, and it is safe to use. This plasma can stimulate proliferation and regeneration by growth factors and cytokines that are inside this plasma, and we can’t say that it’s an approved method and it always helps, but it’s better than doing nothing. We have to do something when we want to improve the endometrial lining.
After the egg collection, you must feel well, and you can’t feel dizzy. It usually takes about 30 minutes to 1 hour, and then you can go home.
Except for the supplements you’re already taking, we can recommend vitamin D, 4 000 IU per day, but that’s all and continue with a healthy lifestyle. I’m not fond of prescribing a lot of supplements. I want to authorize things with proven data.
I’m not sure about honey, but there are a lot of different data about it. Concerning zinc, we can see that our urologists prescribe it for men, so zinc, selenium, and folic acid are very useful for sperm quality and quantity.
I think that every laboratory has its own reference. For us, vitamin D should be more than 30-40 units in blood, but I’m not sure if your laboratory has the same reference meaning, it depends.
If we’re talking about the natural cycle, we are not fond of prescribing a high dose, we should be prescribing a dose from 75 to 150 units of FSH when there is a low ovarian reserve. If we’re talking about lower values, not only about a natural cycle. If we’re talking about a natural cycle, we shouldn’t prescribe anything, that’s why it’s called the natural cycle. In the usual IVF, we should use the middle dose of FSH, which is from 150 to 225 units.
No, it’s better not to exercise after the embryo transfer, but you shouldn’t stay in bed either. You should go ahead with your regular life, and you should work, you can maybe swim or do yoga, but not heavy exercises when you had the embryo transfer. Before embryo transfer, you should do regular exercise, as it will improve your blood flow in your pelvic.
Definitely, yes. We often see that women who are overweight or who is obese needs more FSH dose. Sometimes, we can see that there is no growth of follicles, and we should use more and more, and we should increase the FSH dose, and even then, it can be useless even if we increase it. Those kinds of patients should lose their weight, and as I have already said, the optimal BMI should be from 20 to 24, and you can easily calculate it with different calculators online.
Unfortunately, I don’t think so. If you have more follicles in your right follicle, so let it be, and your AMH level is quite okay, it can easily be treated with IVF, and you can get a lot of oocytes from your one ovary. What matters is the whole amount of your oocytes, and I don’t think that you have to do something to encourage more activity of your left ovary.
Low AMH is considered to be less than 1.4 ng/ml here in Russia. Keep in mind that it depends on the laboratory too. It depends on the age of a patient and the level of FSH hormone. If the FSH hormone level is quite high, so more than 12 or 15, we have to use a high dose to make follicles in ovaries grow. If we use a low dose of FSH here, our ovaries won’t produce any follicles. I would try the middle dose of FSH in your case, about 200 units of FSH, maybe gonadotropin with LH activity, but again, I don’t know about your previous story attempts, etc., so I can advise that only looking at these numbers.
We tend to use LH for people of advanced age, so at the age of 35. We also use it when we had some failures using only FSH in previous attempts, and there are a lot of data that LH for women of advanced age can have some benefits when it comes to the egg quality.
It’s better to lose weight and then do IVF, but if you are 42, you don’t have enough time. Don’t waste a lot of time losing weight, just do IVF, as you are.
If we’re talking about donor eggs, the maximum age in our clinic is 54.
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