Thursday, November 07, 2013

Embryo banking for patients with poor ovarian reserve

Patients with poor ovarian reserve ( oopause or DOR or diminished ovarian reserve)  have always been heart sink patients for IVF specialists. They are difficult to manage, because IVF success rates in this group are usually poor.  This is because they grow few eggs and we usually end up with few embryos  - many of which are of poor quality.

A “new option” which a lot of doctors seem to be offering today is that of doing many IVF cycles back-to-back, so that they can collect many eggs over 3-4 cycles; freezing the embryos; running genetic tests ( CCS or comprehensive chromosomal screening) on them; and then transferring the genetically normal embryos in one cycle. This called Staggered IVF with Embryo Banking.

They call this procedure embryo banking or embryo stockpiling ; and offer it as a solution for patients who grow few eggs. It seems to be a very logical and attractive solution – after all, if the problem is that we cannot make enough embryos in one cycle, then doesn’t it make sense to do multiple cycles to overcome this problem ?

This procedure is being marketed very cleverly and aggressively, using lots of clever acronyms.

However, it’s a sad fact of life that biology does not over-rule mathematics . The problem with these women is not just poor egg quantity – the underlying problem is poor egg quality as well. Accumulating many poor quality eggs over time to create lots of embryos makes little biological sense.

After all, if an embryo is going to become a baby, it will, even if you transfer it one embryo at a time. On the other hand, if it’s a poor quality embryo which is not going to implant, then transferring many of them as one time will not help at all. After all, if the oranges are sour, the juice will also be sour, whether you use 1 orange or 10 oranges !

I believe that you have a good-quality embryo, you should transfer this, providing your uterine lining is receptive. Freezing all the embryos and doing multiple cycles just so that you can get many embryos makes no sense to me – it just adds to the cost, without improving success rates.

Before concluding that this is a reasonable approach for patients with poor ovarian reserve, IVF clinics need to do trials to prove this hypothesis. If you don't mind being a guinea pig and are happy to volunteer for the clinical research, that's fine !


2 comments:

  1. Nice read! I like the suggestions.

    ReplyDelete
  2. Anonymous9:26 PM

    exactly. don't need quantity.

    ReplyDelete

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