We guarantee you a baby this spring!

Who can benefit from PGS

Clinical data shows that if embryo is  chosen for transfer on the basis of morphology only, the clinical pregnancy rates are 50% in the age of 30 and go down to 20% in the age of 41

Aneuploidy in embryos seems to be the major reason of implantation failure and early miscarriage.

1 in 4 good in morphology blastocysts is aneuploid in the age of 30, and 3 in 4 good morphology blastocysts are aneuploid in the age of 41. [Ata, Munne al 2012 – 875 cycles, 4600 embryos]
Hence the higher the age of an egg the higher the risk to pick up an aneuploid embryo for transfer if choice is based on morphology alone.
If only 1 in 4 blastocysts is aneuploid in the age of 30, with 75% chance an euploid embryo will be chosen for transfer on the basis of morphology alone.

If 3 in four good morphology blastocysts are aneuploid in the age of 41, with only 25% chance an euploid embryo will be chosen for transfer on the basis of morphology alone.

What would happen if we knew which embryos are aneuploid before choosing the one for transfer?

We would have got the same pregnancy rates in all patients groups (groups of patients), because major factors of implantation failure and pregnancy loss would have been excluded!

The clinical data confirms this hypothesis!

PGS for 23 chromosome pairs eliminates negative effect of maternal age on implantation (if there are embryos found which show no abnormality and can be transferred in the uterus)!

In conclusion: The higher the age of the egg used to create pregnancy, the higher risk of it being abnormal, the higher risk to pick up an abnormal embryo for transfer based only on embryo morphology. Hence the higher the age of an egg used to create pregnancy the higher the benefit from  using PGS for 23 chromosome pairs prior to embryo transfer. PGS for 23 chromosome pairs eliminates negative effect of maternal age on implantation!

 

Women of advanced reproductive age (35+)

  • at the age 30-35  30-40% of blastocysts are aneuploid
  • at the age of 40-42  70-80% blastocysts are aneuploid [Fragouli et al., 2012]

Hence women of advanced reproductive age benefit significantly from PGS for 23 chromosome pairs.

To find at least one euploid embryo available for transfer among the studied group, we need to have a minimal necessary amount of blastocysts for study. The higher the age of an egg - the higher percentage of abnormal embryos - the more embryos need to be studied to find at least one euploid embryo.

A huge study has been done to calculate how many embryos are required to study for a certain female age.

Embryo Banking for Small Cohort Cases 

 

# day 5

embryos

 

% patients with normal embryos
(% normal embryos)

egg donors

<35
years old

35-39
years old

40-42
years old

>42
years old

1-3

99%
69%

95%
68%

79%
49%

61%
34%

37%
17%

4-6

100%
77%

100%
73%

97%
52%

81%
31%

67%
13%

7-10

100%
62%

100%
58%

100%
48%

97%
27%

95%
22%

>10

100%
67%

100%
59%

100%
51%

100%
41%

100%
17%

[Ata, Munne et al. (2012) Reprod Biomed Online (875 cycles, 4600 embryos)]

For example

  • if you are 35-39, half of your blastocysts are genetically abnormal. To have a good chance to find at least one genetically normal embryo usable for transfer we have to test not less than 2 blastocysts. (Please see the table above: in the age 35-39 there is a chance of 79% to find at least one euploid blastocysts if we test 1-3 blastocysts)
  • if you are 41,  ¾ of your blastocysts are abnormal. To have a good chance to find at least one genetically normal embryo usable for transfer we have to test not less than 4 blastocysts. (Please see the table above: in the age 40-42 there is a chance of 81% to find at least one euploid blastocysts if we test 4-6 blastocysts)

But if you are 40+ and produce only 1-2 good quality blastocysts at a time?

Does it make any sense to transfer them in your egg collection cycle, gathering negative pregnancy tests, fatigue and frustration? To put yourself at a risk of miscarriage, which will steal many months of your life (time)?

Does it make more sense to test them to find out that they are abnormal which would result in having no embryo transfer at all?
We have a third and the best proposal to you: Why don’t we arrange your personal embryo banking? Collect 5 or more blastocysts from more than one egg pick-up and perform testing for 23 chromosome pairs for all of them!

And then to perform transfer of viable genetically normal embryo instead of several transfers of untested embryos?

 

Embryo banking

In the age of 40 only 1 in 4 blastocysts is euploid. If you are above 39 and produce less than 3 blastocysts in one IVF cycle, the risk that all of them are abnormal and no embryo transfer takes place is high. Hence you will benefit from embryo banking.

You can undergo 2 or 3 egg collections within 3-6 months to produce statistically sufficient for your age amount of blastocysts to find euploid ones. In every cycle embryos which grow to (the) blastocyst stage will be biopsied and frozen immediately after biopsy. After we manage to biopsy and cryopreserve a good amount of blastocysts, statistically sufficient for your age to find euploid ones we will test all the 23 chromosomes on the samples collected and stored after the biopsy. Then we will inform you if there were any euploid embryos found. If so, we will see you soon again for the frozen embryo transfer of your euploid embryo(s).

Let us have an example

A 41 year old patient  (1/4 of blastocysts euploid) has gone through 3  stimulations and egg collections in 3 successive menstrual cycles. Three egg collections together have produced 5 blastocysts which were biopsied  and frozen via vitrification on day 5 after each egg collection( embryo banking). The biopsied samples were stored and then screened for 23 chromosome pairs. Only one out of 5 blastocysts appeared to be euploid, was transferred in the uterus in the frozen-thawed cycle and resulted in live birth.

What is the benefit of Embryo banking?

  • Helps to make PGS not only diagnostic method but also an en effective way to increase IVF success in patients of advanced reproductive age and/or low follicular reserve
  • Embryo banking and CGH will help you to avoid gathering negative pregnancy tests
  • To perform transfer of viable genetically normal embryo instead of several transfers of untested embryos
  • To avoid possible consequences of miscarriage of a genetically abnormal embryo

Conclusion: Embryo banking helps to make PGS not only a diagnostic method but also an effective way to increase success rates of your IVF treatment

What would have happened to this 41 patient if she has gone “traditional way” without PGS?

41 year old patient  (1/4 of blastocysts euploid) has gone through ovarian stimulation and egg collection and finally has got just two blastocysts. She got pregnant and lost her pregnancy at 12 weeks due to embryo’s aneuploidy. After a break of 2-3 months she has made a new attempt of stimulation and egg collection and the transfer of two blastocysts was possible again. She did not get pregnant. Two months later a third attempt has been done which has resulted in transfer of only one blastocyst and no pregnancy. Almost a year has passed and now she is 42 facing the need for a new IVF cycle with significantly lower chances.
If she had done PGS  for 23 chromosome pairs with these 5 embryos we would have found that all of them are abnormal.  She might have chosen to immediately go on to the 4-th stimulation and egg collection to produce more embryos or might have decided to look into alternatives (egg donation).

If you would like to discuss improving your IVF success or have questions please give us a call or e-mail us

Unsuccessful IVFs and or repeated miscarriage

If you have already been through several unsuccessful IVFs and/or have a history of recurrent miscarriage (2 or more miscarriages) can PGS provide you with realistic chance to improve your IVF success?

Sure, the clinical data comprehensively shows that especially patients in your situation benefit from using PGS. Patients with recurrent implantation failure and/or recurrent miscarriage history are known to produce a high percentage of genetically abnormal embryos. Aneuploidy of embryos is confirmed to be the major reason of implantation failure and early miscarriage. Genetic testing of your embryos prior to embryo transfer helps to exclude those with genetic abnormality and not to use them for embryo transfer, which would have resulted in implantation failure or miscarriage.

The challenge in many patients with a history of unsuccessful IVF and/or recurrent miscarriage is presented by combination of 2 poor prognostic factors:

  • the high proportion of abnormal embryos expected due to age and/or medical history
  • the low amount of embryos created after one egg collection available for genetic screening (due to low follicular reserve or poor embryo quality).

Confirmation that all embryos produced by you are genetically abnormal and cannot create a viable pregnancy will of course save you from unnecessary hopes for a positive pregnancy test or from freezing of non-usable embryos, it may help you to review alternatives such as egg donation, but it will not increase your success rates.

Why don’t we arrange your personal embryo banking? Collect 5 or more blastocysts from more than one egg pick-up and perform testing for 23 chromosome pairs for all of them!

And then perform transfer of viable genetically normal embryo instead of several transfers of untested embryos?

Let us have an example

After having 3 unsuccessful  IVFs a patient  has gone through 3  stimulations and egg collections in 3 successive menstrual cycles. Three egg collections together have produced 5 blastocysts which were biopsied  and frozen via vitrification on day 5 after each egg collection(embryo banking). The biopsied samples were stored and then screened for 23 chromosome pairs. Only one out of 5 blastocysts appeared to be euploid, was transferred in the uterus in the frozen-thawed cycle and resulted in live birth.

 

Embryo banking

What is the benefit of Embryo banking?

  • Helps to make PGS not only diagnostic method but also an en effective way to increase IVF success in patients of advanced reproductive age and/or low follicular reserve
  • Embryo banking and CGH will help you to avoid gathering negative pregnancy tests
  • To perform transfer of viable genetically normal embryo instead of several transfers of untested embryos
  • To avoid possible consequences of miscarriage of a genetically abnormal embryo

Conclusion: Embryo banking helps to make PGS not only a diagnostic method, but also an effective way to increase you IVF chances, especially after several failed cycles.

What would have happened to this patient with a history of unsuccessful IVFs had she gone “traditional way” without PGS again?

After having 3 unsuccessful IVFs a patient might have gone through ovarian stimulation and egg collection again to get two blastocysts. She might have got pregnant and lost her pregnancy at 12 weeks due to embryo’s aneuploidy. After a break of 2-3 months she has made a new attempt of stimulation and egg collection and the transfer of two blastocysts was possible again. She did not get pregnant. Two months later a third attempt has been done which has resulted in transfer of only one blastocyst and no pregnancy.
If she had done PGD for 23 chromosome pairs with these 5 embryos we would have found that all of them are abnormal. She might have chosen to immediately go on to the next stimulation and egg collection to produce more embryos or might have decided to look into alternatives (egg donation).

If you would like to discuss improving your IVF success or have questions please give us a call or e-mail us

Younger patients and donor egg recipients

Younger patients who produce a good amount of eggs and embryos as well as donor egg recipients using individual egg donor can use PGS for 23 chromosome pairs to obtain the same live birth rates with one genetically tested euploid embryo as it could have been with two untested embryos.

Why transferring two “very good looking” embryos is dangerous for young patients or donor egg recipients?

Because every second pregnant woman will have twin pregnancy after transfer of two high good in morphology  embryos on day 5. Sadly twin pregnancies result in late miscarriage or very early delivery 5-6 times more often than singleton pregnancies. It seems like human body is designed to produce one healthy baby at a time…

Is one euploid embryo really enough?

Does transfer of one euploid embryo provides higher success rates in comparison to transfer of two untested embryos?

Interested in PGS treatment at AVA-Peter?

We are happy to call you at your convenience
Request a call Phone consultation is free of charge and non-obliging
E-mail us your questions! We are happy to answer them within 24 hours! Ask us a question

A blog by Tone Bråten family counsellor

A blog — to help you on your journey to become parents!

Our patients tell their stories



  • Willeke and Mario from Netherlands come to AVA-Peter for egg donation treatment… Enjoy this touching and sincere documentary by Jorien van Nes