Age has a profound impact on women’s ability to get pregnant, both naturally or with IVF using her own eggs. Even in egg donation programs, it is an important factor, because patients are usually older, so there’s a higher probability of any uterine problems. This means that implantation rates increase and abortion risk decrease.
The situation differs if donor eggs are used in IVF treatment. Here, the age of the egg is crucial. The age of the potential mother is less important.
Because of this, all clinics make every effort to ensure that donors are in the best state of health. They have to pass medical tests, screenings and psychological evaluations what is clearly defined in the regulations of every clinic.
If you’re interested in the details, watch three experts explaining in details what is the approach and additional techniques used in connection to IVF with donor eggs in clinics, they represent:
• Robert Najdecki, Assisting Nature
• Dr Ruth Sanchez, Reproduction Unit of Clinic Vistahermosa
• Dr Aldo Isaac Meneses Rios, UR Ciudad de Mexico
Is there any correlation between age of the woman and IVF with donor eggs success rates?
3on1 #IVFpodcasts give you different perspectives on a specific topic.
Below 3 answers recorded with 3 IVF experts. Enjoy watching!
Answer from Dr Najdecki
The success of any given assisted reproductive treatment depends on various factors, in particular when dealing with female factor infertility, age is a crucial determinant of the outcome. With increasing age, the oocyte quality tends to decline, especially after the age of 35. The oocyte quality is directly related to the quality of embryos formed and thus the chances of a positive result.
However, younger women don’t always have a good ovarian reserve, despite their age. In such cases, AMH levels are low, and often no oocytes can be retrieved. The enrolment of such a woman facing premature ovarian failure into an oocyte donation programme, can sometimes be the only way to achieve a much desired pregnancy. Last but not least, the alternative of oocyte donation can appeal to women with some kind of genetic defect, abnormal karyotype or genetic disease. Being an oocyte acceptor is not an easy decision.
Recipients are often wary of the donor’s health status and subsequently oocyte quality. Thankfully, oocyte banks only accept physically and mentally fit donors who pass numerous medical tests, screenings and psychological evaluations.The donor’s medical history is thoroughly screened and the donor’s health state is excessively tested by medical tests, according to Greek legislation. Besides standard genetic testing, which includes karyotype, alpha and beta thalassemia, cystic fibrosis, fragile eggs, there are many additional genetic tests which may be requested by the couple. We for instance, offer our patients a variety of integrated genetic panels and packages including tests for many monogenetic disorders.
We strongly support the PGS (preimplantation genetic screening) strategy for all reproductive patients, offering them prenatal genetic testing of all cultured blastocysts with the use of next-generation sequencing. The average implantation rate for embryo transfer of euploid blastocysts is over 60%. But how does the acceptor patient’s age affect IVF with donor eggs success rate? An oocyte donation programme aims to offer oocytes of the optimal quality for the optimal results. The age of the recipient doesn’t affect the outcome of the donation programme, as the only factor affecting the oocyte quality is the age and the status of the donor. the only parameters that should be taken into account regarding the acceptor and the impact of the result of the embryo transfer, are the endometrium receptivity and any anatomical defects that could jeopardise the result. It is of paramount importance that the acceptor has a normal menstrual cycle either naturally, or under hormone replacement agents. To avoid any anatomical shortcomings, a hysteroscopy examination is essential.
We recommend hysteroscopy before embryo transfer to all our reproductive patients. During hysteroscopy, the uterine cavity is carefully examined. Non-ultrasound visible pathologies such as small polyps are excised, and grade 1 or 2 septa corrected. Our data shows that one layer scratching during hysteroscopy plays a catalyst role in the implantation process, increasing the probability of pregnancy up to 5%. After scratching, a waiting period of 2 cycles shows the highest implantation success rate. Proper endometrial preparation is fundamental in the process of achieving a pregnancy, and must be as follows.
The first day of the cycle is regarded as the first day of the substitution protocol. On day 1, estradiol and progesterone levels are checked and a transvaginal ultrasound scan is performed to confirm that the protocol can be initiated. During this protocol, at least 2 further ultrasound scans and serum hormone levels are performed. Progesterone level monitoring is crucial as a premature rise can jeopardise the cycle, leading to its cancellation. Target endometrial lining thickness is over 8mm, and progesterone under 1nanogram/ml are the basic conditions for a happy ending.
Embryo transfer can be performed either in the fresh cycle or FRET cycle (frozen embryo cycle). In the first case, the acceptor and donor are synchronised so that the embryo transfer can be performed in the cycle in which the retrieval and fertilisation of the oocyte are done. In the latter case, FRET cycle, previously cryopreserved blastocysts are transferred after thawing into the appropriately prepared acceptor uterus.
In Assisting Nature, the estimated pregnancy rate for embryo transfer was 62% for the year 2017. In both cases, when all the embryos from a single oocyte pickup have been transferred, the new index cumulative pregnancy rate is used. Cumulative rates are indicators of the success of an IVF cycle. The ratio regarded as cumulative is the number of pregnancies achieved over the total number of embryo transfers derived from a single oocyte pickup. In the case of the acceptors, the cumulative rate results from the embryo transfer that were formed from a single donation cycle.
In Assisting Nature during 2017, the cumulative pregnancy rate was as high as 75%. But, the most important IVF success determinant is the take home baby rate. Following oocyte donation at our centre, the estimated cumulative live birth rate was 64%. Bringing it all together, the age of the recipient doesn’t affect the outcome for the donation programme as the only factor affecting the oocyte quality is the age and the status of the donor. Proper endometrial preparation is fundamental in achieving a pregnancy. We strongly recommend uterus cavity hysteroscopic evaluation before embryo transfer and endometrial one layer scissor scratching.
Answer from Dr Sanchez
Since oocytes are donated, the oocyte age, which is very important for the success rate, is already guaranteed. By law, donors must be under 35 years old, although in our centre, the vast majority of donors are under 30. As to whether the age of the recipient of gametes has any influence, in principle, unless there is a uterine pathology, it shouldn’t influence the pregnancy rate. It should be noted that patients who come to egg donation are usually older than 40 years old, and at these ages, the probability of having a uterine problem, for example types of myomas, adenomyosis and so on, is higher, and can influence a lower implantation rate and a higher risk of abortion.
Answer from Dr Rios
The oocyte age is the main factor for the success rate. As part of our quality control, we guarantee the age of the egg donor to be between 20-30 years of age and to have a proven motherhood. With this range of age, we reduce the possibility to obtain unemployed eggs. So, this way of selection reduces the rate of miscarriage and increases the rate of ongoing pregnancy.
Otherwise, the age of the recipient of gametes should not influence the pregnancy rate, unless there is a uterine pathology.
It should be noted that patients who come to egg donation are usually older than 40 years old, and that at these ages, the probability of having a uterine problem, for example types of myomas, adenomyosis and so on, is higher, and can influence a lower implantation rate and a higher risk of abortion.