Vladimiro Silva, PharmD
Embryologist, CEO, Founder & IVF Lab Director at Ferticentro, Ferticentro
Category:
Low Ovarian Reserve, Success Stories
Starting from the beginning, normally, I would prefer day-5 embryos because it’s preferable. I always tell patients is that this extended culture will not improve the embryo quality, but it will give us more information about that embryo. If we are not doing invasive procedures like PGT-A, we can at least observe the embryos with video time-lapse and understand if they have normal development. Multiple algorithms can help us understand whether the embryo is a good prognosis or not. The more information we have about the embryo, the better. I would say that day-5 is preferable over day-3. If you tell me that you want to maximize the odds of every single embryo, the less we manipulate the embryo, the better, and so in that sense day-3 is also a respectable option. At our clinic, at Ferticentro, we usually go to day-5 because we prefer to be sure that the embryo is capable of forming a blastocyst. In some cases, when patients say they just want to give their embryo the best possible chance and the best incubator in the world is the human uterus. Therefore, it’s a personal decision if you want to maximize the odds, you should transfer them as soon as possible to lower the manipulation in the lab. If you want to be as informed and certain as possible, then definitely day-5.
The second question is: how many embryos should I accumulate to have a pregnancy chance at my age? It depends on a lot of factors, your AMH is very low, so probably, in theory, we will be talking about 5 to 10 per cent of pregnancy, so in theory, it should be around 10 to 15 embryos, but this is statistics. It depends on luck, we are working with a low number of eggs. Statistics are an indication, but when we are discussing an individual patient’s case, statistics are not that important. My advice would be to do 3 maybe 4 ovarian stimulations, that’s already a lot to protect your health. Then, if you want to be as sure as possible, possibly refreeze all the embryos, take them out to day-5. Do an embryo biopsy to do a PGT-A to see if the embryos are viable or not, and just transfer the viable euploid embryos. If you don’t want to test her embryos in terms of genetics, we can just take them to day-5, see which embryos form a blastocyst, and transfer those. If you don’t want to do that as well and you just want to maximize the accumulated pregnancy odds, then you should transfer 1 or 2 embryos at the same time. In our clinic, our policy is always the same, just one embryo. Why is that? Over the age of 40, having twins can represent a lot of risks. However, in this particular case, since the AMH is low and the probability of pregnancy is also low, it’s not shocking to transfer 2 embryos at once to maximize the odds of getting pregnant. In that particular embryo transfer, 2 embryos seem like a sensible approach. If we’re working with day-3 embryos, I would probably say, transfer 2 embryos. If we’re working with blastocysts, maybe just one, if we were working with PGT-A, tested blastocysts just one.It will depend on the clinic system of embryo classification. In principle, day 3 embryos should have 8 cells, so in the theory, the potential is not the same, but this is another reason for taking them to day-5. If the embryos are not perfect, if they have some fragmentation and not the right number of cells, it would be preferable to know a little more about them. I would take them to the blastocyst stage.
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