05.01.2015

Ivf long protocol over 40

We are willing to take on the most difficult cases with lower prognosis, so long as we feel there is a chance for pregnancy. The success of this approach depends not only on a novel endocrine stimulation protocol, but also upon a flawless method of embryo freezing such as our vitrification system, and the highest level laboratory air purification system to give the eggs from older women the best possible environment in which to develop.
Another example: A 41 year old nurse married to a 39 year old physician had already gone through three conventional IVF cycles elsewhere with PGD and no success. A great example of the superiority of mini-IVF for older women is a 43 year old who had gone through 5 previous conventional high dose stimulation IVF cycles since she was 40 years old. A very determined 45 year old woman underwent four cycles of mini-IVF stimulation for IVF resulting on a total of 14 frozen stored embryos, because she knew how low her chance was for pregnancy per embryo with her own 45 year old eggs. A dramatic example of mini-IVF for women over 40 is a typical case of what we call secondary infertility, where the couple was able to conceive and deliver a healthy baby when they were younger, but now find themselves infertile in their attempt to have another child a few years later. In fact the remarkable successes with some of these older women resulting from the mini-IVF protocol are causing us to be cautious about how many embryos we transfer at one time even when older eggs are involved. Finally, although GnRH antagonists block LH release within hours of being administered, initiating treatment with such medications 6-7 days after starting ovarian stimulation comes too late to protect eggs early on in the stimulation cycle, when they are coming “out of the starting gates”, from over-exposure to testosterone. Women over 38 years of age often have very few eggs, respond poorly to conventional ovarian stimulation, and because of lower pregnancy rates, are often just cancelled by IVF clinics for fear that such cases will lower their reportable statistics. For them the news is even harsher when an IVF clinic tells them they will need to use donor eggs. One 44 year old woman who was turned down by many IVF centers unless she agreed to use donor eggs, underwent two mini-IVF cycles at our center in which we were able to retrieve 4 eggs each time, resulting remarkably in 4 embryos each time, which were frozen by vitrification and stored for eventual transfer.
Firstly, it is hard to overstate how crucial is the purity of air quality in the lab as well as in the operating room.


But with this mini-IVF approach of storing up vitrified embryos month by month in older women, we have a remarkable pregnancy rate even in women over 42 years of age of over 50%, and this year thus far 67%.
Most IVF centers will turn these women down if they do not agree to donor eggs, or else string them along with tests and meager treatments that are doomed to fail, until they finally agree to donor eggs. The advantage of mini-IVF is that we can get better quality embryos at a much lower cost per cycle, store them up safely with vitrification, and spend less than the conventional IVF cycles would cost. Many IVF programs just have a small local pool of egg donors, which we feel is not a favorable approach.
She uses most of them up throughout her reproductive life and when the number of remaining eggs falls below a “critical threshold” her reproductive potential declines over a period of six or eight years whereupon it ceases completely. Also, such patients usually require huge doses of expensive drugs that can add another $6,000 or $7,000 to the already high cost of conventional IVF, bringing total costs to as much as $18,000 or more per cycle. We placed her on a program of mini-IVF back to back cycles to store up embryos by vitrification over the next year. These cases of women over 46 getting pregnant with their own eggs are unusual, but it is nonetheless quite possible if donor eggs are not an option for them.
We have been offering donor egg IVF for over 24 years, and therefore have had a chance to follow these children and their parents for a almost a quarter century. Accordingly, there is no longer any need to administer fertility drugs that contain LH or hCG, especially not to women that are likely to have ovarian hyperthecosis. It takes advantage of your own natural FSH elevation with an ingeniously simple protocol that strives for smaller numbers of better quality eggs. Their local IVF center laughed at them; but because they were physicians, they knew not to give up hope.


She went through a total of 6 cycles of IVF just to store up embryos, retrieving only a few eggs at a time, and eventually storing up 10 embryos. Both the children and the parents are well adjusted and completely happy with their lives as a result of the donor egg IVF. It follows that when conducting controlled ovarian hyperstimulation (COH) in such cases, the protocols must strike a balance between optimizing follicle growth and development while avoiding excessive ovarian LH-induced testosterone production. It also makes little sense to me in such cases to use protocols such as the GnRHa-flare protocol that result in excessive pituitary gland release of LH early on in the stimulation cycle, when the eggs are at their most vulnerable to high local levels of testosterone. Instead of massive doses of expensive hormones to try to blast out a few poor quality eggs, it more naturally teases out of the older ovaries their best quality eggs with a carefully devised protocol of minimal stimulation.
Both were physicians, only 34 years old, and had been told by several IVF centers they had visited that she had only a few follicles left, was about to go into early premature menopause, and was not a candidate for IVF with her own eggs.
So this time, again with mini-IVF, we actually got 6 eggs and 5 good quality embryos, giving them two more children, even at age 43, when every other center would automatically turn them down because the results are normally so poor with conventional IVF in women over 40.
Secondly, the very clever Japanese approach to minimal stimulation allows us to retrieve just as many (or few) eggs from older women as more expensive massive dosing conventional stimulation protocols, but better quality eggs and at a lower cost.



After having a baby what now
18 weeks pregnant


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