IVF in Older Women Using Their Own Eggs - Embryo Banking Offers an Excellent Option

Until recently, for many infertile older women and those with diminished ovarian reserve (DOR) who wanted to have a baby, IVF using donated eggs offered the only realistic option. Many who were unwilling to use donor eggs often nonetheless attempted IVF (often repeatedly) with their own eggs, only rarely succeeding in having a baby. The recent introduction of selectively banking genetically tested, “competent” embryos over several IVF cycles and subsequently (in a later cycle) transferring only those found to be chromosomally normal, could offer many such women/couples a realistic alternative to IVF with egg donation, while offering them an opportunity to have their own genetic offspring.

It is mainly the chromosomal integrity of the egg, rather than the sperm that determines whether the embryo will be “competent” (i.e. have the potential to develop into a normal baby). It is the age of the woman that most profoundly impacts the likelihood that the mature egg will have a full contingent of chromosomes (a “euploid” egg), necessary to achieve embryo “competency.” By way of example, up until about 35 years of age, fewer than 50% of a woman’s mature eggs will be euploid, and thus upon fertilization, more than half will have an irregular chromosome component (i.e. “aneuploid”) and thus be “incompetent.”

Incompetent embryos either will fail to develop normally, fail to attach (implant) in the uterine lining, miscarry, or even result in a chromosomally abnormal baby (e.g. Down syndrome). As a woman ages beyond her mid-30’s the incidence of egg/embryo aneuploidy increases such that by the time she reaches her mid forties, more than 90% of her eggs/embryos will be aneuploid and incompetent.

To make matters worse, the older the woman, the closer she gets to the time that her ovaries run out of eggs and she stops ovulating and menstruating (i.e. menopause). The 6-8 years prior to menopause (i.e. the climacteric or pre-menopause) which is characterized by 1) diminishing ovarian reserve (DOR) with an associated progressive reduction in the number of available number of mature eggs at the time of egg retrieval, and 2) building resistance to fertility drugs.

To complicate matters further, it becomes ever more difficult in the face of DOR, to protect developing eggs during stimulation with fertility drugs in the hope of minimizing the incidence of egg/embryo aneuploidy. This is why, unless a very customized and individualized approach to ovarian stimulation is used in older women and those with DOR, the incidence of egg/embryo aneuploidy may even approach 100%. It also serves to explain why IVF success rates plummet with diminishing ovarian reserve and with advancing age, and why the relentlessly ticking biological clock often creates in them a profound sense of urgency and even desperation to have a baby before their time runs out.

Confronted with the reality that advancing age and diminishing ovarian reserve will inevitably reduce the likelihood of an IVF pregnancy, as well as increasing the risk of miscarriage, in all probability, come at considerable emotional and financial cost, many such women often choose to undergo IVF using the eggs derived from a younger egg donor.

Embryo banking offers many older women an those with DOR a realistic and cost-efficient alternative to IVF with Egg Donation: The recent introduction of Embryo Banking at SIRM now offers an alternative to egg donation for many older women, as well as those with prematurely diminishing ovarian reserve (DOR) who otherwise would have a very small chance of having a baby with their own eggs. This is provided, of course, that they still have an ability to produce some ovarian follicles in response to fertility drugs.

Embryo banking involves a process whereby several blastocysts are accumulated (stockpiled) over two or more IVF cycles. After each such cycle, the embryos are biopsied for CGH analysis, taken to the blastocyst stage of development and then vitrified (ultra-rapidly frozen and banked). All biopsy specimens accumulated over several such cycles are held for as long as it takes to complete the scheduled IVF egg retrieval cycles, whereupon they are collectively dispatched for a single CGH analysis (to reduce testing costs). When the results return, the “incompetent” (CGH-abnormal) embryos are discarded while the “competent” ones are stored (cryobanked) for a subsequent embryo transfer. With this method, the transfer of even a single “competent” embryo is capable of achieving almost a 70% chance of a viable pregnancy, regardless of the age of the woman.