Among the areas of focus that we have at New Hope Fertility Center is Poly Cystic Ovary Syndrome or PCOS. Often colleagues and patients alike want to know: how does NHFC manage individuals with PCOS during their IVF process? Let’s look at a case to see how New Hope Managed to successfully treat a difficult and common situation.
This is a 41-year-old Asian woman with primary infertility for more than three years. Before she came to New Hope Fertility Center, she had done medicated IUI three times and two conventional IVF cycles at Florida infertility Clinics. In her first IVF cycle, a total of 26 eggs were retrieved (18 egg maturated, 4 had significant blastocyst formation). Unfortunately, a Fresh Day 5 transfer resulted in a second trimester miscarriage at 19 weeks. During her second IVF cycle, she got total of 41 eggs with three blastocyst formations. She did PGD testing and one normal embryo was transferred, but still with no pregnancy.
At New Hope, she did two Mini-IVF™ cycles and the results are shown in table one
Table 1. Comparison of conventional IVF with Mini-IVF™ stimulation
|Protocol||Total of eggs||Total of blastocysts||Normal Embryos with PGD testing||Embryo transferred||pregnant|
|Con IVF At Florida||16||4||Didn’t do test||One fresh Day 5||19wks miscarriage|
|Con IVF At Florida||41||3||One ( 6 bl tested)||Single frozen embryo||no|
|Mini IVF At NHFC||24||13||2 ( total 13 bl tested)||___||___|
|Mini IVF At NHFC||29||15||6 (total 15 bl tested)||Single frozen embryo||Yes, and graduated at 9 weeks|
After the age of 40, egg quality is significantly decreased. This patient is 41 year old. After two Mini-IVF™ cycles at NHFC, total of 28 blastocysts were harvested and sent for PGD testing with aCGH. 8 blastocysts were found to be chromosomally normal. The yield of normal embryos was about 33% which is pretty good in her age group.
From this you can see that conventional IVF results in low yield of blastocyst formation. It is possible that her eggs may be triggered early (8 immature out of 26 eggs). Or due to her PCOS condition, it may have been hard to balance between the egg quantity and ovarian hyper-stimulation. In her second conventional IVF cycle, amount of injectable medication was increased and total of 41 eggs were retrieved with very low yield of blastocysts formation which is less than 10%. She did one normal frozen embryo transfer without success.
After analyzing her past IVF history, we believed that she was a good candidate for Mini-IVF™ stimulation with PGD testing. Since she has good and decent amount of Antral Follicles, the protocol used was moderate heavy, mini stimulation. For this protocol we limited the medications used to Clomid, Letrozole, Follistim and Ganirelix. These are all oral medications, however, we also use double trigger with a nasal spray (Synarel) and Ovidrel which may help or prevent OHSS and egg maturation. As you can see, our blastocyst formation was more than 50%. It is also surprised to us that her first mini-IVF resulted in 2 normal BL while the last one with 6 BL. This shows that in order to increase the chance to get pregnant, women with advanced age should do more mini cycles instead of one heavy stimulation cycle. She was offered a single embryo transfer with normal PGD testing. Today, she is close to delivery.
From this case, we learned that Mini-IVF™ may be one of best protocols for women with advanced age related miscarriage or PCOS. The range of medication used in Mini-IVF™ is from Ultra Mini-IVF™ to heavy-mini stimulation.