Friday, May 24, 2019

The limitations of IVF and the problem with the biological clock.



 While IVF labs are great at making top-quality blastocysts, the problem is that the chance of a blastocyst from a 40 year old woman getting pregnant is less as compared to that of a 25 year old woman, even though the morphological grade and the quality of these blastocysts is identical.
This means that if we have top quality blastocysts , and one is from a 25 year old and the other is from a 40 year old, and they look exactly the same, the fact still remains that the 25 year old's top quality blastocyst has a better chance of implanting and becoming a baby as compared to the 40 year old's.
Now, this is one of the frustrations doctors have with modern reproductive medicine - we really don't have a good answer as to why this is so .
One problem is that the energy powerhouse of the eggs - the mitochondria in the cytoplasm, which drive embryo division after fertilisation - start malfunctioning as the eggs age. The problem is that we can't test for this.
Also, we know that as eggs get older, they will have more genetic errors,  as a result of which the embryos from these will also have more genetic errors, and many of these are lethal.
The problem is that we can't prevent this - and neither can we test for them , because PGS only allows us to screen for chromosomal abnormalities.
This is one of the biological limitations IVF specialists and older women need to learn to live with.

What to find an IVF clinic which respects your time and intelligence ?
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Thursday, May 23, 2019

IVF clinics - quantity vs quality.



A lot of IVF clinics take pride in the large number of cycles which they do . Their focus is on their turnover, because they are profit making corporates, who need to maximise their ROI for their investors.
While is great for the management because this maximizes their revenue, it may not be good for each individual patient they treat. They use an assembly line approach, where every patient is treated as a widget, and the focus is on maximising throughput by using a "one-size-fits-all" approach.
Our focus as a boutique clinic is very different ! We make sure that we spend a lot of time and energy on each individual patient , to try to maximize their chances of getting pregnant.
What this means is that we treat each individual egg as an individual patient, and grow every follicle with love and care. Every egg is treated with respect , so that even if you have only immature eggs , we mature them in vitro , so that they can become embryos, and we can grow these to blastocysts.
The advantage of this is that we maximize each individual patient's chances of getting pregnant. Yes, this means we can't do as many cycles as a lot of very busy clinics can do, because we don't have any assistants. However, our pregnancy rates for patients are far better , because we focus so much energy on each of them.

What to find an IVF clinic which respects your time and intelligence ?






Saturday, May 18, 2019

The story of an embryo !

We retrieved 4 oocyte cumlus complexes from 4 follicles for this older woman with a very low AMH level
All the 4 eggs were mature ( M2) and we did ICSI for all of them
However, only 1 fertilised
This divided well until Day 4, by which point it had formed a morule
However, the blastocyst on Day 5 was of poor quality

This photo-essay emphasises how much biological variability there is in egg and embryo quality, which is why it is so hard for us to predict the outcome of any IVF cycle 

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