Firstly, yes, keep on banking the embryos. Just make sure that these are good quality blastocysts. I would encourage that. When we feel that we’re confident with the outcome, the question is your age, we would need a good number of embryos, and again that depends on whether these embryos are PGT-A tested or not. On the other hand, do not delay the embryo transfer too much. Although the success rate depends on the quality of the blastocysts, unless we’ve done genetic scanning, we’re not sure of the quality of the blastocyst. Unfortunately, the rate of chromosomal abnormality and DNA anomaly of the embryos at your age could be as high as 50 or 60%.
In regard to the polyp, absolutely, yes. Go ahead and remove it but do it soon before you do the embryo transfer, don’t delay this too much because we’re always a little worried about polyps in women over the age of 40. The chance of malignancy and cancer is extremely low, but it is not 0, so it is not just for reproductive reasons, it’s also for your own health. I would strongly suggest having a hysteroscopy.
When it comes to your family history, my team and I are very sensitive, a breast assessment is one of our obligatory tests to have a formal breast assessment before. Our Breast specialist in our team happens to be my wife, and she has threatened to divorce me if she ever found out that we did IVF on anyone without a formal breast assessment. I’m also very sensitive about breast cancer because I lost my mother to breast cancer, and this is the reason I became a doctor, unfortunately, breast cancer is very common. The rate in western societies could be as high as 1 in 7, 8 women. Whether it’s associated with IVF or not, there’s good evidence now to recommend that there’s no association. In other words, there’s no causative association that IVF cause breast cancer. However, if someone has a small lump and that lump is undiagnosed, and if that person undergoes IVF, this lump will grow, but it will also remain undetected during pregnancy and breastfeeding. I’m very sad to share with you the fact that in my unit, we pick up 2 to 3 cases of breast cancer before IVF through our screening program. Have a very thorough breast exam. I know that the European scenario is that in the majority of the European countries, official breast screening offered free doesn’t start before the age of 40 or before the age of 45 in some countries that doesn’t mean that this is justifiable because, unfortunately, about 50% of breast cancers occur in women under the age of 40.
Make sure you have your breasts properly checked, and when I say properly, I mean check it with mammography or ultrasound or both. Breast self-examination, even medical examination, would not be showing enough before starting IVF. Breast cancer and family history is a very long discussion. However, the definition of family history of breast cancer is that if you have 1 or 2 relatives who develop breast cancer at a younger age, younger than 50 or 45, and the majority of breast cancers are not genetically linked, so in other words, they’re not associated with the genetics. The BRCA gene is associated with high-risk breast cancer, so have your own doctor give you a risk assessment. Your grandmother or aunt who developed breast cancer at the age of 60 does not count as a family history. Having said that, have a formal assessment of your risk for breast cancer based on your family history, other associated factors like alcohol and smoking, previous possible issues on breasts, and please make sure that you have a recent accurate breast assessment before starting IVF.