Poor ovarian reserve due to low AMH, poor quality of embryo during IVF cycle, multiple failed IVF cycles and the decision of using Donor Eggs. This never gets easy.
The reality is when patients in their late thirties visit Fertility Clinics and eventually initiate their IVF Cycle, their choices are limited to start with. In late thirties 50% of women present with very low AMH and lower number of antral follicles on their ultrasound, meaning their ovaries are running out of their oocyte pool or ovarian reserve. Unfortunately, there is nothing much that can be done yet to improve the existing ovarian reserve since women are born with a fixed number of eggs or oocytes in their ovaries, and till date it is not possible to increase this number with medication.
How many cycles of IVF should I consider if I have low AMH value ?
Depends on the value of AMH as well as the number of antral follicles as seen on the ultrasound. In case the first IVF cycle has resulted in enough oocytes to form one embryo, it is worth trying again to see if a more rigorous stimulation protocol may result in more oocytes to form more than one embryo.
At times it makes sense to pool embryos in cases of very poor ovarian reserve and advanced maternal age instead of transferring one embryo and waiting for an uneventful pregnancy.
Can any medication improve AMH value ?
Unfortunately not.
One may try ovarian rejuvenation therapy using autologous PRP, which in some studies have shown to improve the AMH value within 6 months post therapy. However ovarian rejuvenation is not a guaranteed treatment for low ovarian reserve or low AMH and ovarian PRP is still in experimental stage.
How many months gaps is needed between two IVF cycles ?
No gap is required between two IVF cycles. In fact in a single menstrual cycle, a new protocol known as duostim protocol can be done and two oocyte retrievals can be planned – one in the first half and the second in the latter half of the menstrual cycle. Duo stim is usually reserved for those who have diminished ovarian reserve and low AMH levels.
In short, no gap is needed or recommended between two IVF cycles. However if patients want they can space their IVF cycles by few months after discussing with the IVF Specialist.
How many maximum cycle of IVF should I undergo ?
No such number has been recommended by any IVF or Reproductive medicine body. It usually takes upto 3 Embryo Transfer cycles or ET cycles to attain 95 % success rates. As long as the embryo quality and endometrium of uterus is normal, you should just keep on trying. On the other hand, if any abnormality in quality of egg, sperm or embryo is observed, you need to take a step back and revisit the decision together with your IVF specialist.
What are the side effects of multiple IVF Cycles?
Multiple IVF cycles lead to a lot of stress, anxiety and a feeling of despair. It has an impact on the mental health of a couple as well as significant financial implications since IVF is an expensive type of treatment. As far as other long term side effects are concerned, there are multiple studies which have ruled out any major long term side effects of multiple IVF cycles.
Will I gain weight due to multiple IVF cycles ?
If you maintain a strict diet, ensure adequate water intake and exercise routinely, you will not gain weight. Some hormones like progesterone do cause water retention and bloating, symptoms which usually go away one the hormone levels fall.
The problem which is more commonly seen is that women undergoing IVF cycles maintain their normal diet and at times even consume more calories than what they normally do – but on the other hand they restrict their physical activities. This causes an imbalance between intake and expenditure of calories leading to calorie retention and weight gain. Hence weight gain during IVF cycle is not because of IVF medication but actually because of a change in life style.
Do multiple IVF cycles cause cancer ?
Multiple cycles do not cause cancer. There are many studies which have proven that the incidence of cancer in women who have undergone more than 3 IVF cycles is the same as those who have not undergone any treatment for infertility.
There have been numerous studies performed worldwide to understand the relationship between IVF stimulation drugs and Cancer (Ovarian, cervical and breast cancer), however a review in 2019 did conclude that there is no definitive relationship between the IVF drugs and cancer.
Do I need to take any medicine before starting IVF cycles ?
Certain Multivitamin, antioxidants and micronutrients improve quality and fertilization rates of eggs and sperm for both men and women hence if prescribed by your doctor, you should take them before starting an IVF Cycle. Such medication is usually prescribed in cases of patients who have low AMH or poor ovarian reserve, abnormal sperm report and known Vitamin deficiencies.
If IVF cycle fails to form any good quality embryo, should I consider donor eggs in next cycle?
If a good quality embryo does not form in the IVF cycle it could be because of egg quality or sperm quality. Therefore reason for poor embryo quality should be assessed first and then option of oocyte donation or egg donation should be explored. Best would be to discuss with the reproductive medicine specialist and embryologist and then decide whether to opt for donor eggs or not. Since no two oocyte or egg in a woman’s body are same, it might make sense to try at least two ovarian stimulation cycles, before considering oocyte donors.
Does donor egg guarantee good quality embryo ?
If the reason for poor embryo formation in a self IVF cycle has been determined as poor quality of eggs, then the only two options are either trying with self egg again or opting for Donor oocytes or donor eggs.
The donor eggs usually are from healthy young females who tend to produce good quality eggs, this leads to better quality of embryo. But in case the sperm is of poor quality or poor morphology, embryo quality may be poor despite of good quality of donor eggs.
What are the chances of success in IVF with own eggs after age 35 ?
After 35, if AMH levels are low and AFC is also low, chances of success are less than 20 %. However if AMH and AFC levels are normal, chance of success can be as high as 60 % with good quality blastocyst transfer.
What are the chances of success in IVF with own eggs after age 40?
After age of 40, chance of success in IVF is less than 10 % because of diminished ovarian reserve.
What is the success rate of IVF with donor eggs ?
Success rate of IVF with donor oocytes, normal sperm and normal uterus is as high as 60-70 % with good quality blastocysts.
For this, sperm and uterus have to be normal.
Cumulative pregnancy rate for 3 cycles of Embryo Transfer can be as high as 93 % in such cases.
Will we be able to meet the egg donor ?
As per the previous ART law in India, identity of the donor used to be kept anonymous. However as per the latest ART act 2021, patients can bring their own donors hence anonymity is not maintained any more. But if patient is selecting donor profile from an ART bank, then the bank needs to maintain anonymity of both parties.
Will the donor know that her eggs have been donated to us ?
Recipient and donor identity cannot be revealed as per ART law in India.
Will the donor be tested for all genetic diseases ?
Donors are tested for certain disorders and diseases, as laid down in the ART law. All genetic diseases can not be diagnosed and many diseases in the child are de-novo – meaning they are new disorders, not inherited from egg or sperm.
What happens if we do not form good embryos even with donor eggs in an IVF cycle ?
This can happen at times. It is mainly due to sub optimal oocyte quality in a particular cycle or problems with sperms. If this happens, your IVF specialist will discuss this with you and include embryology feedback and offer you a solution. At Indore Infertility Clinic, we personally try another IVF cycle at reduced costs if all other parameters are normal.
What is the cost of IVF with Donor eggs in Indore ?
Currently the cost of IVF with donor eggs in Indore is 1.75-2 Lacs. This may change (increase) in the times to come as there are many additional provisions for safety of the process and donor health like medical insurance for donor etc. in the new ART Bill 2022.
