IVF after the age of 40 & Gender selections

Question: I am current 40 years-old and would like to know what is my chance of getting pregnant with IVF. Can I choose the gender of my baby when I go through an IVF

Dr Helena’s Answer:

One of the biggest single determining factor for IVF success is the woman’s age. Before the age of 35, the IVF success rate is around 60-80%. After the age of 35, the success rate drops to 40-60%. The success rates of IVF drop drastically after the age of 40 to about 20-30% and then 1-2% after 45.

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The reason for this is because as women aged, the number of follicles produce each menstrual cycle drop drastically. The quality of eggs also deteriorate as we age. As we aged, the division of chromosomes in our ovaries can become more imperfect, resulting production of eggs with faulty sets of chromosomes, leading to increase number of abnormal eggs and henceforth abnormal embryos.Therefore, women over the age of 40 has a lower rate of pregnancy with each individual IVF cycle, compare to their younger counterparts

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This is a macroscopic view of the general population of women after the age of 40. However, an individual’s success rates is also dependent of her body condition, her ovarian reserves and her uterus receptivity. No two women at the age of 40 is exactly the same. A healthy 40 year-old woman with good ovarian reserves is more likely to produce good number of good quality embryos. Her counterpart who smokes and drinks, eats badly and have poor ovarian reserves is more likely to fail her IVF attempts.

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Recently, advances in Pre-implantation Screening (PGS) tests allowed us to biopsy embryos at blastocyst stage to select embryos which is normal in chromosomal make-up before embryo transfer. This test is extremely useful in determining which embryo is more likely to get our patients pregnant. However, like all the tests in this world, it comes with its problems as well. First and foremost, PGS is still expensive, and this test can only be done on embryos created from IVF, which then increase the cost of the IVF cycle. If the embryos tested showed that all the embryos are abnormal, there is no way we can change or treat these embryos and make them chromosomally normal. And therefore, some patients may end up not having any embryos which is suitable for transfer after an IVF with PGS. However, if this is the scenario, the couple can then move on quickly to another cycle of IVF to collect more embryos for PGS, hence, shortening the time required to find the ‘right’ embryo to achieve pregnancy.

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Although this technology is able to reveal the gender of the embryo, one must realize that the use of such technology to perform gender selection in STRICTLY Prohibited in this country and also most countries in this world. It is important to note that IVF and PGS are technologies to help couples to achieve a healthy pregnancy and must not be misuse for ones’ whims and fancies. Science and technology should be use sensibly to maintain and restore nature’s balances and any manipulation as such can potentially tip off the balance and create potential disasters to mankind.

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What you should know about PGD & PGS

PGD

What you should know about PGD & PGS

If you and your partner have been struggling with fertility issues and are seriously considering In-Vitro Fertilisation or IVF, the consideration of whether you should be undergoing PGD and PGS on top of an IVF can be quite daunting. This is because, in normal IVF procedures, the best embryos are selected based on their appearance and morphology only. Therefore, the genetic content of those embryos or any chromosomal abnormality cannot be detected. However, by undergoing PGD and PGS, you will be able to screen your embryos for any potential genetic and chromosomal issues.  However, before we jump into the band wagon of having PGS or PGD, there are a few things we need to consider.

 

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What is PGS?
PGS stands for Pre-implantation Genetic Screening. In PGS, a cell is taken from an embryo  which was created following an IVF procedure, so that it can be tested for chromosomal abnormalities before the embryo is transferred to the womb. This test will be able to tell us whether the embryo has normal sets of chromosomes. However, it will not be able to tell us whether this embryo has a genetic problem or not.

It is important to note that not all the patients going through an IVF required a PGS. You may want to consider it if:

  • You are of advanced maternal age, whereby embryos may show greater levels of chromosomal abnormalities.
  • You have had recurrent miscarriages.
  • You have had repeated IVF failure.
  • Either of you has a chromosome rearrangement.

The PGS procedure involves:
1. You will undergo a normal IVF treatment and your eggs will be collected and fertilised.
2. An embryo is grown in the laboratory for a few days.
3. An embryologist will perform a biopsy and remove a few cells, usually on day 3 or 5.
4. All 24 chromosomes are analysed (22 non-sex chromosomes and two sex chromosomes X & Y).
5. If the embryo is normal, it will be transferred into your womb.
6. Any remaining unaffected embryos can be frozen for later use.
7. Affected embryos will be allowed to perish.

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What is PGD?
PGD is an abbreviation for Preimplantation Genetic Diagnosis. In PGD, a cell is taken from an IVF embryo so that it can be tested for a specific genetic condition before the embryo is transferred to the womb. It can be used to test for any genetic condition that is known to be caused by a specific gene.

At present, PGD is used to screen for more than 250 genetic conditions, such as Huntington’s disease, Cystic fibrosis, Thalassaemia, Duchenne muscular dystrophy and Fragile-XPDG to name but a few. Therefore, PGD enables individuals with an inheritable genetic condition to avoid passing it on to their children. The PGD process is more tidious and challenging compared to PGS. It is used to test for a specific genetic disease which is known to your family, i.e. you or your partner is confirmed a carrier of a specific gene at a certain point of the chromosome. You need to bear in mind that by performing a PGD, it does not mean that screening of ALL genetic diseases are performed at the same time. This is because human beings have millions of gene and it is impossible to screen ALL of the genes in one go.

However, not all IVF patients need to undergo PGD. You may want to consider it, or your specialist may recommend it to you if:

• You or your partner (or both) are carriers of single gene mutations.
• You ended a previous pregnancy due to a serious genetic condition.
• You have a child with a serious genetic condition.
• Either of you has a family history of a serious genetic condition or chromosome problems.

The PGD procedure involves

1. You will undergo a normal IVF treatment and your eggs will be collected and fertilised.
2. An embryo is grown in the laboratory for a few days, until it has divided into around 8 cells.
3. An embryologist will remove one or two of the cells from the embryo.
4. The cells are tested to see if the embryo has a gene that causes a genetic condition.
5. If the embryo is free of any genetic condition, it is transferred to the womb.
6. Any remaining unaffected embryos can be frozen for later use.
7. Affected embryos will be allowed to perish.

Since PGD and PGS help detect genetic conditions and chromosomal abnormalities, they help IVF patients to decide if they wish to continue with pregnancy.

The Pros and Cons of PGD and PGS
Before you decide on undergoing PGD or PGS, your fertility consultant will explain their pros and cons to you, which include:

Pros

  • They can detect an inherited chromosomal or genetic issues and help prevent passing chromosomal or genetic diseases to the next generations
  • They are a form of early detection of chromosomal or genetic problems before the embryo is transferred back into the uterus.
  • They help increase a couple’s chances of conceiving a healthy child.
  • It allows older women to still have viable children.

Cons

  • There is a risk that embryos may be traumatized or destroyed due to damage during the biopsy process.
  • There is always a possibility of an undetected disease, as no form of testing can guarantee 100% accuracy
  • The test is expensive
  • You may not have any embryos to transfer after the IVF & PGD/PGS , which is frustrating for patients because after investing time, money & effort, the result can be disappointing
  • There is no guarantee that an embryo which had been screened will definitely get implanted after being transferred into the uterus. Therefore, there is no guarantee that a PGS/PGD embryo will give you a life birth.

If you and your partner are interested in or have any concerns about PGD and PGS, be sure to speak to your fertility specialist to address concerns, inquiries and options.

MOTHERHOOD ON HOLD- NEW STRAITS TIME

Our Monash IVF Group Chief Executive Officer, Mr James Thiedeman & Fertility Specialist Dr Helena Lim Yun Hsuen (KL Fertility Centre/ Monash IVF, KL) spoke to New Straits Times on Egg Freezing and the technology involved.

 

KL Fertility - NST (23.12.2014)