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 !

 

How we perform Embryo Transfer under Ultrasound Guidance?

Saiprasad Gundeti, Chief Embryologist, Malpani Infertility Clinic

Embryo transfer is the final and the most crucial Step in IVF .

For our patients, we routinely perform embryo transfers on day 5 at the Blastocyst stage.

Safe Placement of Embryos in the ideal Location in the uterus is crucial.

We perform all our Embryo Transfer procedures under ultrasound guidance.

Ultrasound guided embryo transfer is the most efficient technique. It aids to track the catheter during embryo transfer and helps placing the Embryo in the desired location in the Uterine Cavity.

Better results are seen, when the Embryos are place roughly 1 cm away from the Fundus i.e. between mid of cavity and Fundus.

Steps Involved in Embryo Transfer -

1) Blastocysts (Day 5 Embryos) are selected and segregated for Embryo transfer. The blastocyst (s) is shifted to Embryo Transfer Dish containing Culture Medium or Embryo Glue.

2) The Embryologist loads the Blastocyst (s) into the Embryo Transfer Catheter under         

     stereozoom microscope. 

    - When we load  the embryo/blastocysts into the catheter, they are sandwiched between 2    

       air  bubbles.

     - we aspirate bit of culture media, followed by an air bubble, then Embryos with  minimal   

        amount of  culture media followed by another air bubble and finally bit of culture medium.

3) The catheter loaded with embryos are handed over to the surgeon, who passes it through

      the cervical opening into the uterine cavity.

4) Abdominal Ultrasound is used to track the catheter tip entering into the cavity.

5) when the catheter tip reaches the ideal location which is between fundus and mid of uterine cavity.

6) After few seconds of wait for stability,  the surgeon slowly pushes the embryo into the cavity.

7) few second of wait and then the catheter is slowly withdrawn by the surgeon and handed over to the embryologist.

8) The Embryologist checks the catheter under microscope by flushing it with some culture media to confirm  that the Embryos are safely placed in the uterine cavity and that the catheter is clean.

During Embryo transfer, in the abdominal Ulrasound it's not the catheter or the embryo which is visible in the USG, But the 2 air bubbles present in the catheter on both sides of the Embryo which are visible, make it easier for us to track the catheter and place the embryos at the desired place, which is roughly 1 cm away from the fundus.

The Embryo transfer catheter is made of soft polyurethane material that is non-toxic to the Embryos and most of the Catheters are not Echogenic (Ultrasound waves cannot be reflected back) which means it cannot be identified under ultrasound.

Similarly Culture Media is also not Echodense, to be able to get identified under ultrasound.

The  Air Bubbles are Echodense and easily identified under ultrasound.

Hence when we track the catheter in the uterus during the Embryo Transfer, it’s the Air bubbles which are seen in the ultrasound while the catheter going inside and post the Embryo placement in the cavity.

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!

Which are the best days to have sex to get pregnant ?

 

Which are the best days to have sex to get pregnant ?

A  woman can only get pregnant during a few days of her cycle because eggs and sperm only live for a short amount of time.

Sperm live for about 4 days, and eggs can only be fertilised for about 24 hours (one day) after they are released from the ovary.

For fertilisation to happen, eggs and sperm must meet at the right time. This is how an embryo is made.

So how do you calculate your fertile days ?

Your menstrual cycle begins on day 1 of your period ( when the flow of your bleeding starts) and ends on day 1 of your next period. If a cycle lasts between 21 and 35 days, that's considered normal. They can be different for each woman and each cycle.

If your menstrual cycles are different lengths, as they are for most women, you can figure out how long they are on average.

The length of a woman's period can change from one month to the next. Periods don't always come every month. Taking the length of three menstrual cycles and averaging them can help you figure out when you're most likely to be ovulating.

If you add up the number of days in three cycles and divide by three, you get the average length of a cycle.

When you know how long your cycle lasts on average, you can figure out when you ovulate.

About 14 days before your next  period is due to start, you will ovulate.

• If your average period lasts 28 days, you ovulate around day 14. Days 12, 13, and 14 are your most fertile days.

• If your average period lasts 35 days, ovulation happens around day 21, and your most fertile days are days 19, 20, and 21.

If your cycle is shorter, say 21 days, you ovulate around day 7, and days 5, 6, and 7 are your most fertile days.

The three days before and including the day you ovulate are when you are most likely to get pregnant.

After you ovulate, you become infertile, because the cervical mucus dries up and does not allow the sperm to enter the uterus.

Some women have very unpredictable cycles or find it hard to figure out the average length of their cycles. This can make it hard to know when you're going to ovulate. If it's too hard, having sex every two to three days takes care of everything and makes it more likely that you'll get pregnant.

 Is your most fertile day Day 14?

You may have heard that you ovulate on day 14 of your cycle. So, many people have sex on day 11, 12, or 13 because they think that will give them the best chance of getting pregnant. But ovulation doesn't always happen on day 14. Normal ovulation can happen anywhere between day 10 and day 20. If your periods are not regular, ovulation can happen even later. So, you can't always say that day 14 is your most fertile.

Is IVF the most effective treatment for infertile couples ?

 IVF, or in vitro fertilization or test tube baby, is the most effective treatment option for infertile couples. The great thing about IVF is that treatment protocols have become standardized. And equally importantly, it allows us to solve any problem no matter what it is because we can bypass problems by doing IVF, which means what's not happening in the bedroom whether because the tubes are blocked or the sperms aren't good enough we can actually do it in the IVF laboratory.

But we also need to remember that IVF is not just a treatment option; it also provides us with very valuable diagnostic information and prognostic information. And let me explain a little bit about what I mean as far as diagnostic information goes, it tells us exactly how well the woman is capable of responding to a superovulation protocol.

We know that as women get older, their ovarian reserve drops, which is why we measure their AMH level, and their antral follicle count, but these are static measures, and the proof of the pudding is in the eating. So you can only know what the responses are by doing an IVF cycle, which means you'll have patients with an AMH level who still respond very well to a superovulation protocol.

And this is the information we can only get by actually doing an IVF treatment cycle. And more importantly, because IVF treatment cycles are dynamic, if the ovarian response to one particular standard superovulation protocol is not very good, we can change it for the next cycle. Equally importantly just like it allows us to dynamically assess ovarian response in the sense not only how many eggs do we get how mature the eggs are, but how many are fertilized did they form good quality embryos or not which is invaluable information.

Because it helps us tell the patient what to do differently next time. And that's why not only is it therapeutic as well as diagnostic, it's also prognostic because we can tell the patient, "Look, you know, we don't think your ovary response was good or that your embryo quality wasn't very good because the egg quality wasn't very good." So next time, if changing the protocol doesn't work, we might want to consider donor eggs.

This then becomes a well-informed decision based on valuable data, which only an IVF cycle can provide, but you're making well-informed decisions, and that's true for sperms as well, so for example, the only way of finding out if sperm are capable of fertilizing an egg is by actually doing IVF. Most patients don't know this, and most doctors won't tell you this, but the correlation between a semen analysis report sperm count, sperm motility with actual sperm fertilizing ability is very poor, which means you'll have men with low sperm counts whose sperms fertilize their wives' eggs in the lab, and conversely, there are people whose count looks perfect and whose motility looks good whose sperms don't this is why an IVF cycle can actually allow us to assess sperm fertilizing ability.

Lots of clinics don't want to take the risk of total fertilization failure, which is why they won't do IVF, and they'll straight away do exceed, which means we will definitely get fertilization but we won't be able to assess whether the sperms were capable of fertilizing the eggs or not, and that's sometimes a trade-off, and it's something you need to discuss with your doctor so you can make a well-informed decision. So please don't underestimate the power of an IVF cycle.

It maximizes your chance of having a baby. It also clearly tells you why perhaps you weren't getting into your bedroom pregnant for so many years, And equally importantly, it gives you much more valuable information as to what you can do for the future to maximize your chance of getting pregnant.

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!

How to get pregnant fast !

Can you do anything to get pregnant quickly? Definitely! The best way to get pregnant is to have sex at least once every other day while you are fertile. But know that not every couple will get pregnant quickly, even if they do everything right. But you can make your chances better.

Some people get pregnant after a month or two of trying. But, for most, it takes longer. Keep in mind that it could take months to get pregnant, and that one in ten couples will have trouble getting pregnant. There is help out there, which is good news.

It's important to remember that these tips might not work for everyone, especially if you have problems with your fertility that have been going on for a long time. Pregnancy isn't something that can be planned exactly, which is sad. Don't blame yourself if you can't get pregnant as quickly as you'd like. Instead, keep trying. Most couples will get pregnant within a year if they keep trying.

1. Stop using birth control!

If you want to get pregnant, it makes sense that you should stop using birth control. Your fertility may need time to come back, especially if you have had an IUCD inserted. Talk to your doctor about when you can start trying to get pregnant so you know what to expect.

2. Have a lot of sex

Having sex often for a whole month can help you get pregnant. Every other day or every two days is a good amount.

You could try to have sex every day , but most people will get tired of it, and it's not really necessary. If you have sex three to four times a week, you are more likely to have sex on your most fertile days, which increases your chances of getting pregnant. If you wait and only time sex at ovulation and you get the timing wrong, you may lose that month.

Having sex often also makes sperm healthier. If you are healthier, you are more likely to get pregnant.

Normal personal lubricants like KY Jelly are bad for sperm, which is something you should know. Your own cervical fluid is the best thing to help you get pregnant. But if this is a problem for you, there are options that are good for sperm, like liquid paraffin.

3. Find out when you ovulate.

The two days before you ovulate are when you are most likely to get pregnant. You can find out which days these are in a number of ways, such as by looking for fertile mucus in your cervix. 

You might have an easier time if you use ovulation kits or monitors.

4. When to seek help. 

See your doctor if you don't get pregnant in six months (if you're over 35) or a year (if you're younger than 35).

Getting help doesn't mean you're giving up; it just means you're brave enough to find out why you can't get pregnant and what you can do about it. Some of the things that cause infertility get worse over time. If you get help when you need it, it might help you get pregnant faster.

What you should know while you are undergoing IVF treatment ?

 The good news about IVF is that, because it's been around for so many years, treatment protocols have become very standardized. which means most IVF clinics will know exactly what to do for the patients who come to them, which is great because patients are no longer being used to skinny pigs Not that they were ever used to skinny pigs, but there was a lot of uncertainty involved, a lot of which has now disappeared. So we know pretty much how to treat any patient who comes to us. 

Having said this, there is a certain degree of trial and error involved in every IVF cycle because, even though we use a standardized treatment protocol, not every patient is standardized, and every patient is going to respond differently to any protocol we use. Now we will categorize patients, for example, based on their age or based on their AMH levels or their antral follicle counts, or what we think will reserve isn't even based on their response to previous IVF cycles.

 But having said all this, no matter how many tweaks you make or how many well-informed decisions you make, the proof of the pudding is in the eating, and it's only by actually doing the IVF cycle that you will learn what went well and equally what didn't go well. Conceptually, I tell patients to think of IVF as a series of hurdles; you need to cross all the hurdles to reach the finish line; you need to grow the follicles; we need to get the eggs out, we need to check the eggs are mature; the embryologist needs to fertilize the eggs; we need to make good quality blastocysts, and they need to implant. Some things are in the doctor's hands, some things are in the patient's hands, and of course, a lot of it is in nature's hands, and we really can't control the implantation process.

This is why we do a certain amount of tweaking, and this is why monitoring during an IVF cycle is so important. Is the patient responding the way we expect it to respond, or is there something that is going on that is not what we'd expected? We can cause correct based on these studies or levels based on follicular scans based on what we think the ovarian responses are, and this is valuable information, and that's why we tell patients, it's so important that you know in advance what your IVF doctor is going to do for you. This is why we have standard treatment templates and standard treatment protocols. So ask your doctor what the protocol is for the treatment.

They should give it to you in advance, even before starting the cycle, so that there are no unexpected surprises; you know exactly what's going to happen; you're in control of your life and if things are going the way you expected that's great. Equally, this will tell you if things aren't going the way we expected, we need to make some changes, so you can have an intelligent discussion with your doctor and ask them what changes they're going to make and why, and sometimes we can make these changes during the IVF cycle itself. So for example, when we start the superovulation, it usually takes about five days of gonal F or HMG injections or FSH.

 We can check ovarian response by doing an ultrasound scan and checking the E2 level, and if it's not okay, that's a moment of truth during that IVF cycle. We can sometimes bump up the doors or sometimes we need to make certain changes in the protocol, like adding different drugs, and if we can't make those changes in that IVF cycle, we're sometimes forced to cancel the cycle. But that's still valuable information because we can use this information to improve the treatment protocol for the next IVF cycle, and that's why you, as a patient, need to be well informed as to what the treatment plan is going to be. You need to know what's going to happen next and what the expected response is. If things aren't going according to plan, your doctor should be able to explain to you what he's going to do, and armed with this information, your anxiety and stress levels will be much less because you are in control of what's happening.

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!