Increasing your odds of IVF/PGD- Being your own advocate
This is not a post about supplements and vitamins. This is a post about educating yourself and being your own advocate when it comes to IVF with PGD for Gender Selection. IVF with PGD is a very expensive way to have a baby for someone that can conceive on their own so as with any large purchase, you should do your research and be your own advocate!
You may be new to High Tech(HT) and think that IVF with PGD is easy since you have conceived rather quickly with your natural pregnancies. HT can be a relatively straightforward process but it is never easy. Nearly everyone in this community is fertile and had no issues conceiving yet IVF is a challenge for most. So what do you need to know to be your own advocate and increase your odds?
1. Understand how age may affect your outcome. There are many factors involved with IVF but age is by far the biggest predictor for success. 65% of eggs are abnormal in women in their twenties, about 70% in the 30s, 80% plus in the early 40s and more than 90% in mid-40s. There is a site in the US that tracks clinic outcomes called SART and a Percentage of Cycles resulting in live births bracket for everyone in the US that used IVF with their own eggs for 2013 is as follows-
Under 35- 40%
35-37 - 31.4%
38-40 - 21.1%
41-42- 11.1%
>42 - 4.4%
You can see the decline from mid 30's to over 40. It is significant. Many of us come to HT later in our reproductive years because we have had one or more children already when we were younger. You cannot change your age of course but you can go into a cycle with the understanding that the clinic you choose and the protocol you are put on will directly impact your outcome and your doctor needs to take your age into consideration when discussing the probability of success with you.
Those numbers may be significantly less that what you first assumed about IVF. A less than 50% chance is never good when assessing risk so what factors can help us?
Those numbers do not take fully tested embryos into consideration. Fact- most IVF failures are due to abnormal embryos. The majority of transfers are done with untested embryos. A big difference with the gender selection community is we are using full 24-chromosome(23 plus X and Y) testing on our embryos. This can dramatically increase our chances and at minimum get us over the 50% success rate. Some clinics that perform a lot of PGD quote 80-90% live birth rates from fully tested embryos. You can check with each clinic individually and inquire about their specific results.
So, if our chances can increase that dramatically, why wouldn't this work for everyone? The older we get, the greater the percentage of abnormal embryos our bodies will make so making it to transfer can prove to be the biggest obstacle to overcome with a gender selection cycle. Not only do we need a healthy embryo, we need a healthy embryo of the desired gender. Statistically, men make X and Y 50/50 so our embryos turn out to be 50/50 XX and XY. Once you are in your 30's, if you start with 10 fertilized embryos, by the time testing day rolls around during an IVF cycle, most of our members have less than 4 embryos to test. If you figure half are abnormal, you are left with 2 embryos and then it comes down to the gender split so you can see how your numbers can be reduced rapidly.
2. Pretesting and Protocol
Your pretesting will dictate which protocol a doctor recommends for you. Most doctors have a “favorite” or a go-to protocol. For some it is long-lupron or antagonist for someone they expect to have a normal response and then there is micro-dose flare Lupron or estrogen priming for poor responders. Your doctor should choose the protocol that hopefully will work best for you. How do they do this? Your age and pretesting results.
Pretesting is an assessment of your ovarian reserve. There are tests such as FSH, Inhibin B(A level of greater than 45 is ideal, 35-45 is borderline and under 35 is indicative of a diminished ovarian reserve), AMH and antral follicle count. All of those give you a snapshot of your ovarian reserve. Ideally, you want a FSH under 10, an AMH over 1.0 and an AFC of 12-15+. If any of the numbers are not in the ideal range, you may need a more aggressive protocol and a higher dose of meds.
3. Clinic Choice
Research your clinic. Check out Sart.org for their stats. Don’t believe any clinic that says they take the “harder cases”. Infertility is hard for everyone and I have never heard of any clinic turning away someone that needs help to conceive. All of the cases are hard! If someone is struggling to conceive on their own, it’s a difficult case, period. Try to choose a clinic with the highest live birth rate that you can. Try to choose a clinic that is familiar with PGD and uses day 5 aCGH testing. The good clinics really don’t use FISH testing anymore because it never improved the pregnancy rate so why bother. Try to choose a clinic that recommends that you only need to transfer ONE embryo at a time. Anyone that recommends two or more embryos does so because they are not that good at what they do. One fully tested embryo is all you should need to transfer.
Be wary of a menopur only cycle. Too much LH is bad for just about everyone. If you have PCOS, you should avoid LH and use FSH only. Too much LH increases your testosterone level even more and it makes bad eggs. Do not worry too much about OHSS unless your ovaries have PCOS, PC-looking ovaries or 15-20 follicles on each side and then you can worry about it. OHSS can definitely happen but doctors that are not that familiar with elective IVF for gender selection sometimes think “fertile women” will get it just because they can conceive babies naturally with no issues. OHSS is rare for the fertile crowd.
4. OHW(One hit wonders) are rare
If you are in your 20’s with normal pretesting, you should be a OHW. IVF for Gender Selection should, should, work the first try for someone in her 20’s with normal pretesting. It won’t always work of course, but that’s who has the highest chance of being a OHW. If you are anywhere outside of that shoebox, it is hard to be a OHW. The more boxes you can check(young side of 30’s, normal pretesting, good clinic, etc), the higher your chances. Understand that the first try, the first protocol your doctor prescribes to be precise, is a best guess and that is all we can expect from them. It should be an EDUCATED guess- one that considers your age and pretesting, but it IS just a guess. If the first try does not work, it does not mean that IVF cannot work for you. It definitely does not mean that something is wrong with your natural fertility! It just means you need to try again with a different protocol! IVF is very far from an exact science and sometimes it is trial and error to get it right. Our natural fertility and IVF fertility really have little to do with one another if you do not have trouble conceiving on your own.
Lastly, speak up. The number of eggs likely to be produced can be ascertained by doing an antral follicle count at the beginning of your IVF cycle and the quality is tied to the woman's age and the protocol of stimulation. Ask questions if something doesn’t seem right or if you do not understand what you are doing. Your doctor wants you to succeed! He or she is on your side and you should voice your opinion if something doesn’t seem right. You can always post your questions in our forum and we have lots of members here that will give you their opinions of course!
Have another question? Send me an email at info@genderdreaming.com or post a new thread and I will answer it!
