Why you should freeze all your embryos when doing IVF

 

The reason freeze-all IVF cycles have become so popular is because it increases pregnancy rates , by allowing patients to have their cake and eat it too.

In the past . we would do only fresh cycles and fresh transfers , which means the embryos were transferred back in the same cycle in which the egg collection was done.

The reason for this was that the technology for freezing embryos wasn't very good , and many embryos would die during the freezing and thawing process. Today, however, we are very confident about offering this option routinely to all our patients , thanks to the technology of vitrification or flash freezing , where the survival rate of frozen embryos after thawing is 100% in good labs .

This strategy has lots of advantages .

For one thing, we can transfer only one embryo at a time , because we can store the rest safely. This improves the cumulative conception rate without incurring the risk of a multiple pregnancy , which often ends up as a preterm birth because the uterus wasn’t designed to hold more than one baby at a time !

This means that patients can have as many babies as they want - but one at a time , which is the right way to have babies , because twin pregnancies have a much higher risk of preterm births, and these premature babies often end up with multiple complications ( and also run up a huge bill during their NICU stay).

We can also optimise our superovulation strategy during the fresh cycle, and help the patient to grow many eggs, so we get lots of embryos. Because we are not doing a fresh transfer, the risk of OHSS( ovarian hyperstimulation syndrome, which can be a life-threatening complication) ) is nearly zero, and we can go ahead and freeze all the embryos. This is why, when we do a fresh cycle, our focus is on helping you to grow many eggs. However, the price we pay for this is that endometrial receptivity is compromised,  which is why the pregnancy rate in a fresh cycle is not very good , and this is the reason we prefer not transferring fresh embryos.

On the other hand , when we freeze all the embryos and then transfer them in the next cycle after thawing them one as a time, we can focus only on growing the endometrium in the thaw cycle, so that it’s receptivity is optimal. During this cycle, we don’t need to grow eggs, which is why this thaw cycle is much easier and less expensive, because no injections are needed.

This combined option ( freeze all embryos at the blastocyst stage in the fresh cycle and then thaw them and transfer them one at a time) increases pregnancy rates,  because it allows us to grow lots of embryos, and transferring them one at a time reduces the risk of multiple pregnancies and increases live birth rates. You should ensure that all your embryos are frozen only on Day 5; and that the clinic has a full-time embryologist, who will provide you with photos of your embryos, both before freezing them, and after thawing them

How to improve your chances of IVF success

There are several factors that can affect the success of in vitro fertilization (IVF), and the specific steps you can take to improve your chances will depend on your individual situation.

Some general tips for increasing your chances of success with IVF include:

Optimizing your overall health: Maintaining a healthy weight, eating a balanced diet, and being well-informed about the treatment will help you reduce your stress levels. These can all improve your chances of successful IVF.

Choosing an experienced fertility clinic: The success rates of different fertility clinics can vary, so it's important to choose one with a good track record. Find a clinic which does only blastocyst transfers and provides embryo photos routinely to all their patients. 

You can see what embryos should look like at www.drmalpani.com/knowledge-center/ivf/embryos

Read more at https://blog.drmalpani.com/2021/03/how-to-check-on-your-ivf-doctor-so-you.html

Timing your treatment: Your fertility specialist will be able to advise you on the best time to undergo IVF based on your individual situation. Don't wait until you are too old, because your egg quality declines with age, and poor ovarian reserve is the commonest reason for IVF failure today, when the IVF is done in a good clinic.

Sticking to the treatment plan: It's important to follow your fertility specialist's instructions and attend all scheduled appointments to increase your chances of success.

It's also worth keeping in mind that IVF is not always successful, and you may need to try more than once to achieve a successful pregnancy. It can be helpful to discuss your options and expectations with your fertility specialist.

You can download the IVF Comic Book free at www.drmalpani.com/IVFComicBook 

How can you know if your frozen embryos are alive after thawing and are ready to be transferred?

Saiprasad Gundeti, Chief Embryologist, Malpani Infertility Clinic

In IVF treatment, we freeze/ cryopreserve your spare Embryos after your Embryo Transfer to store them as a backup in case your first cycle is unsuccessful, or we freeze all of your Embryos owing to the risk of ovarian Hyperstimulation Syndrome (OHSS) or if the lining is not optimal .

For subsequent frozen embryo transfer cycles, your frozen embryos must be thawed prior to transfer.

Patients typically have lots of questions and are concerned about the viability of their embryos upon thawing.

How can one know if the embryos have survived post thawing and are ready to be transferred?

At Malpani Infertility Clinic, we culture fresh embryos till day 5 and transfer or freeze embryos at the blastocyst stage for all of our patients.

You can see what embryos should look like at www.drmalpani.com/knowledge-center/ivf/embryos

This allows us to select the best embryos for transfer and freezing, increasing your chances of becoming pregnant.

When we freeze Blastocysts on Day 5/Day 6, we put Laser Pulse between the Trophectoderm Cells to artificially collapse them. This reduces the amount of water that must be replaced during vitrification, as well as the duration that embryos are exposed to Vitrification solutions (cryoprotectants), hence decreasing the toxicity of cryoprotectants.

Therefore, when we vitrify (freeze) your Blastocyst, it will be in a collapsed (reduced) state.

For Frozen Embryo Transfer (FET), when we thaw your frozen blastocyst prior to the transfer, it will be in a collapsed state; however, after a few hours of incubation, the thawed blastocyst re-expands.

The re expansion of the blastocyst provides confidence that it has survived and is ready for transfer.

We at Malpani Infertility Clinic often thaw blastocysts three hours ahead of the transfer, which provides sufficient incubation time and re-expansion of the blastocyst prior to transfer. 

We routinely show our patients their embryos before transferring them and explain how their embryos recovered after freezing and thawing, which makes them happy and gives them confidence that their embryos have recovered well from the freezing process and are ready for transfer.         

Need help in making the right decision ?

Please send me your medical details by filling in the form at www.drmalpani.com/malpaniform.htm so that I can guide you better !

Why do bad IVF clinics refuse to give embryo photos routinely to all their patients ?

There are 3 important reasons you should demand photos of your embryos from your IVF clinic

1. This is a global best practice , which all leading IVF clinics all over the world follow , because this allows them to document that they generated top quality embryos. This is invaluable diagnostic and prognostic information as well ! If they did produce top quality blastocysts for you, then you know that your chances of getting pregnant over a period of time are excellent , and you just need to be patient ! However, if you don't have any photographs , this is valuable information that was wasted because of the lack of photos. If your clinic refuses to provide photographs , you have to ask yourself why they are hiding information from you ! All modern IVF labs have cameras attached to their microscopes,  and taking photographs does not harm the embryos at all , which is why we good clinics do this routinely for all their patients.

2. This practise is good for the patient because it proves to them that they received top quality medical care . The fact that the doctor made top quality blastocysts for them increases their trust and confidence in him. Much more importantly, they have peace of mind knowing that they have received the best possible medical care , and didn't leave any stone unturned in their quest for a baby. The outcome maybe uncertain, but embryo photos prove the process was carried out properly !

3. It's also good for the doctor to provide embryo photographs , because good doctors take pride in the high quality of care they provide . If they can provide photos of top quality blastocysts, this confirms that they are competent professionals who are doing a good job for their patients . This is great for the doctor’s reputation as well, because patients will often get a second opinion when their IVF cycle fails, and if the new specialist can see that the first doctor created top quality blastocysts, they can vouch for the fact that good quality medical care was provided , irrespective of the final outcome.

You can see what embryos should look like at www.drmalpani.com/knowledge-center/ivf/embryos

Why Batch IVF has a lower pregnancy rate

 

Now that every gynecologist wants to become an IVF specialist ( because this is considered to be high-profile and profitable) , many gynecologists have started doing IVF in their own clinics. However, because they don't have either the confidence , expertise, competence or experience of doing this, they need to hire an IVF specialist to do the actual medical treatment for their patients.

This is why they do batched IVF . They cycle a group of patients together - usually 5 to 25, depending on how greedy they are. The medical experts who do the IVF treatment then fly down for 1-2 days to actually do the procedures. The gynecologists claims that the success rate for batch IVF is as good as regular IVF, and that this option is much more convenient for patients . who don't need to travel and much less expensive as well. Most patients are also happy with this option , because they prefer taking treatment from a trusted local doctor .

However, the reality is that this is a bad idea because the success rate of batched IVF is terrible, and there are many reasons for this .

For one thing , these gynecologists are not IVF specialists, and are doing this just in order make more money . They often end up having to take shortcuts,  which compromise pregnancy rates.

For example , they are not able to do Day 5 transfers , because the embryologist has left , and they end up transferring many Day 2 and Day 3 embryos, to try to compensate for this. They aren’t able to freeze embryos, because the embryologist is too busy doing ICSI, and doesn't have the time to do this. They end up doing too many cases in one day , because the travelling embryologist and IVF specialist want to maximize their income , which means they have to complete one pick up and transfer in about 10 minutes. The scope for mix-ups and mistakes is much higher in this chaotic setting. All patients end up having their pickups and transfers done on the same day , even if they aren’t medically ready. The doctor is not able to customise the treatment protocol for each patient , because they have to use the same treatment plan for every patient, based on what the IVF specialist tells them . This expert is remote, and has never seen the patient , and really doesn't care about what happens to you.

This is also why the documentation in these clinics is so poor, because the staff doesn't have the time or the energy to take photos of the embryos.

The medical equipment is also not maintained properly, because it is used for only a few days in a month, as a result of which the lab often isn’t able to create good quality embryos, but it’s easy to pass the buck, and the IVF specialist blames the local gynecologist, who blames the specialist, but it’s the poor patient who ends up suffering.

Finally, many of the “extra” eggs and embryos created during these batches are “donated” to other patients, without their permission, knowledge or consent ! This has now become illegal under the new ART Act, but this practice continues merrily nevertheless !

Should you freeze your eggs ?

 

Many young women freeze their eggs as an insurance policy , because it allows them to delay having children until they are ready to have a baby.

Some are unsure if it’s right for them as egg freezing is expensive and invasive. Determining whether freezing your eggs is worth the expense can be tricky.

So, should you freeze your eggs? Ultimately, it’s your decision, but here’s what we do know.

Step-By-Step Egg Freezing

Here is what the journey looks like:

1. Go to a fertility clinic for a set of fertility tests to test your ovarian reserve. These include an AMH level ( read more at http://www.drmalpani.com/knowledge-center/infertility-testing/amh) and an antral follicle count ( read more at http://www.drmalpani.com/knowledge-center/articles/afc)
2. Hormone stimulation – daily hormone injections for about 7-10 days to stimulate the production of eggs in the ovaries. You self-inject using a small needle at home, usually into the thigh or tummy. These are safe and effective, because they are natural hormones, and get excreted promptly in the urine.
3. Monitoring – your ovaries are monitored throughout the hormone stimulation, using transvaginal ultrasound to check the development of eggs and time the collection procedure. You need to come to the clinic about 3-4 times
4. Egg Collection – A probe is inserted into the vagina, with a needle piercing through the vaginal wall and into the ovary to "suck out" eggs from the ovary. This is painless because it’s done under anesthesia and takes a few minutes. The eggs are then cryogenically frozen using vitrification technology.

Does It Work?

You’re probably wondering, how likely is egg collection and freezing to be successful? This depends. The age at which you freeze (the younger the better), the number of eggs you freeze, and the expertise of the clinic are all factors that impact how likely you are to have a baby if you need to use your frozen eggs in future. One thing is for certain, it’s not a guarantee.

Is It Worth It?

Some women who have frozen their eggs can go on to conceive naturally. However, despite not needing to use them, the vast majority of women reported having no regrets over their decision to freeze and nearly everyone said they would recommend it to a friend because the peace of mind it provides is invaluable,

 It’s an incredibly personal decision and no one can tell you what is right for you – you need to decide for yourself !

 

 

 

How getting older affects fertility and pregnancy: Having a baby after 35

When are women most fertile during their life?

The best time for a woman to have children is between her late teens and late 20s. Fertility, or the ability to have children, starts to go down after age 30. When you reach the middle of your 30s, this decline speeds up. By the time a woman is 45, her fertility has dropped so much that it is unlikely that she will get pregnant on her own.

Why does fertility decline as you get older ? This is because  a woman has a set number of eggs in her ovaries at birth, and she does not produce any new eggs in her lifetime. As a woman gets older, she has less eggs because her eggs start running out with each menstrual cycle. Also, older women are more likely to have eggs that have chromosomes that aren't right because they have aged.  Also, as women get older, they are more likely to get diseases like fibroids and endometriosis that can make it hard for them to get pregnant. Incidentally , a man’s fertility is not affected by his age because his testes constantly produce fresh young new sperm throughout his lifetime.

How are the odds of getting pregnant in your bedroom affected by your age ?

For healthy couples in their 20s and early 30s, about 1 in 4 women will get pregnant during a single menstrual cycle. This is called fecundity.  By age 40, about one in ten women will get pregnant each time they have their period.

Women who have babies later in life are more likely to have problems during their pregnancy .

For example, people over 40 are more likely to have high blood pressure. Preeclampsia is more likely to happen if a woman has high blood pressure before she gets pregnant. But studies also show that even if an older woman is in good health, she still has a higher risk of having complications during her pregnancy, which is considered to be high-risk because of her advanced age.

The risk of birth defects increases as a woman gets older.

 In general, the chance of having a baby with an abnormal number of chromosomes is low. But as a woman gets older, she is more likely to have a child with missing, broken, or extra chromosomes. Down syndrome (also called trisomy 21) is the most common problem with chromosomes that happens when women have babies later in life. The chances of having a child with Down syndrome is 1 in 1,480 at age 20, 1 in 940 at age 30, 1 in 353, at age 35, 1 in 85 at age 40, and 1 in 35 at age 45.

What can you do if you are worried about babies being born with problems?

Prenatal screening tests are done after you get pregnant and can figure out how likely it is that your baby will have a certain birth defect or genetic disorder.  Screening tests can also be done before you get pregnant, to check if you are a carrier of genetic diseases

Creating a reproductive life pan

All women should think about whether or not they want children and, if so, when they would like to have them. If you want to have kids someday, your plan can be as simple as saying, "I want to finish school and save more money before having kids," or "I want to have kids when I'm in my 20s, when my chances of having a healthy pregnancy are best." If you want to get pregnant soon, you should try to be as healthy as possible before you get pregnant. Take steps to stop drinking, smoking, and using drugs. You should also start taking folic acid, which is found in prenatal vitamins, to help prevent neural tube defects (NTDs).

What is prepregnancy planning ?

This is a visit to your ob-gyn that helps you plan for a pregnancy. During this appointment, your gynaecologist should review your medical history, the medical history of your family, any previous pregnancies, and any medicines you take. You should also check your immunizations to make sure you have all of the recommended shots, such as rubella.

How can you protect your fertility ?

At the moment, there is no medical method that can guarantee that a person will stay fertile. If you are married and know you want to have kids later in life, but don’t want to have a baby right now, you can do IVF and  freeze your embryos when you are young. This allows you to have your cake and eat it too, because you can transfer these healthy embryos into your uterus when you are ready to become a mom.

Another option is to freeze your eggs if you aren’t married. Social egg freezing has become very popular, and you should think of it as being an insurance policy if you want to postpone child-bearing for a few years.

How to get a 100% pregnancy rate in IVF

A 100% IVF success rate is the Holy Grail for all IVF doctors and patients , because it would make everyone's life so much easier !

The reason this is never going to happen is that human reproduction is not efficient. We know that about 50% of top-quality blastocysts will have genetic defects, which is why they will not implant , and we can’t either prevent this or diagnose it, because current preimplantation genetic testing ( PGT) is very flawed and inaccurate.

This is fact of life that both doctors, as well as well-informed patients, need to  come to terms with . They understand that they need to be patient until they get pregnant , and it’s impossible to predict in advance which blastocyst will become a baby.

However , many doctors are quite unethical and fool their patients by giving them an HCG injection routinely after the embryo transfer . Now this HCG hormone will appear in the blood and get excreted in their urine , which means both the Urine Pregnancy Test and the blood HCG test will be positive . The clueless patient will be ecstatic that the treatment was successful and that they are finally pregnant . They will give the credit to their doctor , and it is only when the HCG levels start dropping that they realise that they have been taken for a ride. It’s a handful of bad clinics that do this and end up giving all IVF specialists a bad reputation

How many IVF embryos should I pool ?

We are now routinely pooling embryos for many patients who want to postpone having a baby. These are usually young women , who don't want to have a baby right now because they want to pursue a career, but understand that babies born from the eggs of older moms have a higher risk of being abnormal; and older women , who understand that time is at a premium for them , which is why they need to generate as many embryos as possible , before they can think about transferring them .

As a woman gets older, it’s her ovarian reserve which drops , while her uterine receptivity remains the same , no matter what her age .

The tricky question is - how many embryos should they store , before they start transferring them. Now, if the implantation rate was 100% and they wanted 2 babies born a few years apart to complete their family, then we would need to freeze just 2 blastocysts, and transfer them one at a time.

Sadly, we know that about 50% of top-quality blastocysts will have genetic defects , and will not implant . Sadly, we do not have the technology to either prevent this or diagnose it, because PGT ( preimplantation genetic testing ) is unreliable and flawed, and generates incorrect information .

This is why we tell patients that if they want to have one baby, they should plan to store at least 4 top-quality blastocysts, because the cumulative conception rate is more than 80% if you transfer these 4, one at a time , over 4 cycles . This way, not only have you stacked the odds in your favour , you also have peace of mind that you have done your best !