Many women are now postponing childbearing , as a result of which they will often seek consultation after 35 . While it’s true that IVF technology is very helpful , it is also equally true that as women get older , their ovarian reserve drops and since this decline in egg quality is irreversible , it is a good idea that they should maximise their chances of getting pregnant before they get too old, because time is at a premium for them .
This is why we suggest that these women explore the possibility of embryo pooling . We suggest that they do as many egg retrievals as is required for us to be able to freeze least 4 top quality blastocysts, before we start transferring them one at a time .
This strategy takes longer , and is more expensive , but is designed to maximise the chances of a live birth , which is the holy grail.
Let me explain the rationale for this .
We know that older women have poor ovarian reserve , but we still have no reliable way of checking the quality of their eggs. The AMH test and the antral follicle count are crude measures, which provide inadequate information. The only way of answering what their chances are of getting pregnant with their own eggs is by doing an IVF cycle !
We recommend that an IVF cycle should be broken up into 2 legs – the first is the egg retrieval , where we freeze and store blastocysts; and the second is the transfer of these frozen embryos into the uterus. This option maximises the chances of getting pregnant , because we can optimise endometrial receptivity to maximise the chance of the frozen blastocysts implanting.
However, when we do an egg retrieval for older women , often we will not get as many eggs and blastocysts as we want . Sometimes, we may end up with only one or two. In that case, our recommendation is that we do not transfer the frozen blastocyst in the next cycle , but do more egg retrievals so that we have enough frozen blastocysts before we actually start transferring them back. This is because even if we wait for the transfer of the embryos, the receptivity of the uterus doesn’t get impacted as the woman gets older ! The uterus is quite resilient and will remain receptive , irrespective of the age of the woman – it’s only the ovarian reserve which takes a beating with age.
This is why it’s important to maximise the number of embryos we make, so that time is no longer a constraint for us . This is why we suggest that we do egg retrievals , and some of these could be back to back if required , and stop only when we have 4 top quality frozen blastocysts.
Now this doesn’t mean that you will definitely get pregnant if you have 4 top quality blastocysts and then transfer them one at a time , but your chances of getting pregnant as a cumulative conception rate over 4 frozen transfers with top quality blastocysts is better than 80% , which should give you peace of mind you did your best ! This strategy maximises your chance of having a singleton healthy baby , and ensure you received the best medical treatment possible, so that you never have any regrets afterwards that you lost the opportunity to have a baby .
None of these protocols are written in stone , and this strategy will help you maximise your chances of having a baby , but at the end of the day it’s you as a patient who needs to make a well informed decision , after weighing the pros and cons of all these approaches.
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