Sunday, April 30, 2017

Surrogacy ? or donor egg ?

I just received this email from a patient

My date of birth : 24/7/73 (43 years old)
My partner date of birth : 11/3/76 (41 years old)
Trying to conceive 4 years, since May 2013
One previous pregnancy in June 2013, first month of trying, ended in early miscarriage at 5.5 weeks.

Started IVF in September 2014 and have had 7 failed cycles to date.  Details below:

Cycle 1: October 2014

Gonal F - 600 units
4 eggs retrieved
1 fertilised with icsi
1 top grade 8 cell embryo (no fragmentation) was transferred on Day 3
No pregnancy

Cycle 2: April 2015

Fostimon - 600 units
Early ovulation before egg collection meant I lost at least 1 mature egg, but they still managed to collect 2 eggs
Both fertilised with IVF (we dropped ICSI on Dr's advice as sperm was good quality)
2 top grade embryos were frozen on Day 2 due to my progesterone levels being too high for fresh transfer as a result of early ovulation

FET Cycle: July 2015
The 2 embryos from the above cycle were transferred, both survived the thaw
No pregnancy

Cycle 3: August 2015

Due to early ovulation last time and poor response to stimulation, we opted for a mild/natural cycle
Fostimon/Merional - varied between 75-300 units daily
2 eggs retrieved, fertilised with IVF
2 top grade embryos transferred on Day 2
No pregnancy

Cycle 4: October 2015

Mild/natural cycle
Fostimon/Merional - 75/150 units daily
1 egg retrieved, fertilised with IVF
1 top grade embryo transferred on Day 2
No pregnancy

Cycle 5: February 2016

Mild/natural cycle
Fostimon/Merional - 75/150 units daily
2 eggs retrieved, fertilised with IVF
Both were frozen on day 2 as I wanted to try another cycle in order to batch together 3 or 4 embryos

Cycle 6: August 2016

Mild/natural cycle
Fostimon/Merional - 75/150 units daily
1 egg retrieved, fertilised with IVF
Top grade embryo, was transferred along with the 2 frozen embryos from the previous cycle (1 of these looked very weak after the thaw, but the other looked good, but they still transferred all 3)
No pregnancy

Cycle 7: December 2016

Fostimon/Merional - 600 units
4 eggs retrieved
1 fertilised normally with IVF
1 top grade embryo transferred on Day 3
No pregnancy

I then embarked on a 3-cycle package with a view to freezing and batching any embryos

Cycle 8 : March 2017

Fostimon/Merional - 450/600 units
4 eggs retrieved
3 fertilised with IVF
2, top quality embryos made it to Day 3 and were frozen 
(SO I now have one 7 and one 9 cell Day 3 embryos in the freezer)

Cycle 9: April 2017

Fostimon/Merional - 600 units
6 eggs retrieved
5 fertilised with IVF
5 made it to Day 3 (4 top quality, one lower as it has 50% + fragmentation) and we have for the first time ever decided to try to take them to Day 5 and see if I can produce any blastocysts.
As of today, these embryos are :  3 x 6 cells and 2 x 8 cells (one of the 8 cells is the one with the fragmentation which she thinks is likely to stop growing, and one of the 6 cells is a little elongated in shape but she said it still looks normal)

This brings you up to date as this last cycle is still active - we will know whether they make it to Day 5 by Tuesday.

Over laying all of the above I have had various immune work as I have ulcerative colitis, an auto immune disease, and so have been tested for NK cells/cytokines.

I have tried : Humira, Prednisolone, Intralipids, LIT treatment and also take clexane and aspirin in addition to the progesterone post transfer.

I hope this gives you a lot more information.  As you can see, we have few eggs/embryos per cycle but a very high fertilisation rate, with high grade embryos, but still none of them have led to a pregnancy. 

I am baffled as to whether this is an egg quality issue (I have been told this is probably the case due to my age - but I have been trying since age 39 and am a very fit and healthy person), or if it is a receptivity issue.  That's what makes it difficult to decide whether it's donor eggs (we are not keen on this) or surrogacy with my own eggs that we should be exploring or keep going with my own eggs/womb...any advice you can give is very much appreciated as we are desperate to have a family.
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This is a very common dilemma many patients face, and they are very confused if they should change the uterus ( surrogacy) or change the eggs ( donor egg)

This was my answer.

 I am worried about your advanced age. This suggests you have diminished ovarian reserve, and this would explain your early miscarriage; as well as your repeated failed IVF cycles. Being fit or healthy does not translate into  having genetically fit eggs . As a woman grows older , her eggs accumulate genetic defects, because she does not produce any new eggs.

You can read more about this at http://www.drmalpani.com/knowledge-center/the-infertile-woman/oopause

Surrogacy is an expensive and complex treatment option, which is best reserved for women without a uterus, or whose uterus has been irreparably damaged. Research shows that the reason for failed implantation is much more likely to be genetically abnormal embryos ( because of poor quality eggs), rather than a uterine problem. The soil is passive - it is the seed which is active and is responsible for growth


I agree donor egg IVF is a very hard option to come to terms with, but this would maximise your chances of having a baby

Need help in getting pregnant ? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !




1 comment:

  1. Ailin, Norway12:44 AM

    Thank you for posting this, dr. Malpani.

    ReplyDelete

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