Elevated FSH is telling you that the ovaries require more hormonal pushing let’s say to work. It is a sign of the ovaries not working well. The good news here is your age, as you’re 30 years old as the eggs are probably going to be of good quality. You mentioned that you have a high FSH, I don’t know if that’s been repeated more than once or it was just one reading, you need to be very careful which day of the cycle you are doing that because it might be elevated because you’re not doing it on the proper date. Let’s say you have a high FSH that means that the ovaries are showing some kind of resistance to the hormones that’s why the hormones are elevated, they are trying to compensate this resistance.
We need to know more things, we need to know at 30 how many eggs you have, I mean we know that maybe there is some resistance to the hormones, but how many you have, so you need to do other tests to check your ovarian reserve. I don’t know if you have done something called anti-mullerian hormone (AMH). You also need to do an ultrasound to see how many follicles you have, your antral follicle count. We also need to know what is the sperm quality as well, so if your partner’s semen is acceptable, you have an acceptable ovarian reserve, and you are 30 years old, your chances with an IVF cycle are very high. I mean that’s the first thing we will look when somebody comes to the clinic at this age of the woman because that’s going to determine the success rate, that’s an important factor. Of course, you need to do other tests, you need to check the male factor, but I will definitely go for an IVF cycle, especially if you’ve been trying to conceive for 3.5 years, that’s becoming a long time. I wouldn’t go for example to other treatments like insemination it is not worth it after 3 years, the success rate is not higher.
In regards to the add-ons, one that I definitely would recommend is to transfer the embryos on day-5, not transfer them on day-3, so when you do an IVF, and you retrieve the eggs, and you fertilize them, we watch the embryos, and we can watch them during 3 days and transfer them on day-3 or transfer them on day-5, ideally, we recommend to go to day-5 because on day -3 you might have embryos that look similar, but if you give them 2 days more you will have more information of the quality of these embryos, which one is growing well and which one is not growing well. It’s not that by keeping them for 2 days longer, we are making them better, what we are doing is we are choosing better. For example, you have an embryo on day-3, and it looks good, and on day-5 it kind of stopped growing. At least you didn’t transfer that embryo on day-3 because it wouldn’t give you a pregnancy. We’re putting these embryos through a very tough selection but at least this way, we select only the strong ones. So I would recommend Embryoscope, if you don’t have it, the embryologist have to open the lid and checks the embryos, is giving them a score, 24 hours later, he’s going to do the same again, but if you have the EmbryoScope, you don’t have to do that. Not opening the lid means that the temperature and the oxidative stress of the embryos are not affected, the embryos grow better, so that’s the first advantage.
A second advantage is that because it’s creating a video, you might have 2 embryos on day-5 and they look pretty much the same, and you wonder which one to choose, you want to transfer the best one in fresh if possible, so if you watch the development of the embryos on the video, you might decide that this one has been growing more steadily and is better than the other, so you are selecting better, so that’s the two advantages. Apart from that, there is the option of having the Embryomobile, which means that these images we are seeing, the patient can see from the mobile, that’s another thing that is nice, it gives reassurance, it decreases anxiety on patients, but in terms of success rate, the first two things are very important.
Other add-ons depend on each particular case. For example, we do ICSI because we know it increases the fertilization rate, why are we not using IMSI, the powerful microscopes, because not everybody needs that, we don’t want to do things that patients don’t need. If a patient has a very bad sperm with very bad morphology, he might require an IMSI, but we won’t indicate that, so we have to individualize.