By Neway Fertility on May 31, 2018
Approximately 10% of women in their reproductive years suffer from premature ovarian aging, meaning that the number of ovarian follicles of the type needed to grow into healthy eggs capable of being fertilized by healthy sperm is decreased. Diagnosing decreased ovarian reserve may be an accidental finding or diagnosed when the patient or couple undergoes fertility testing. Women with this condition face a reproductive challenge as the decreased ovarian reserve is an indicator that they are likely to go into early menopause, precluding their success in having their own biological child. Unfortunately, it is hard to predict just how quickly this group of women will go into menopause and therefore it is imperative as a clinician to diagnose and recommend a course of action in the short term to increase the chance of a successful pregnancy with their own eggs.
Another factor has to be discussed in this context: egg quality. Even in younger women -- age 35 years or less -- about 30% of eggs (oocytes) are abnormal, meaning they either cannot be fertilized or will result in a miscarriage. Chromosomal problems increase with age. On average, a 37 year-old woman has about 40% abnormal oocytes. This number increases to 50% in the average 40 year-old woman, and at age 44 nearly all eggs are abnormal. We do not know exactly why there is an increase in chromosomal abnormalities in the eggs of women as they age. With an in-vitro fertilization (IVF) treatment cycle, a maximum number of eggs are harvested allowing us to increase the chance of identifying a chromosomally normal egg. When there exists a condition of low ovarian reserve and hence few eggs available for harvesting, the chances of a successful pregnancy with IVF goes down quite dramatically even in younger women. This fact complicates the already complex situation these women find themselves in.
At many infertility centers, women diagnosed with decreased ovarian reserve are most often discouraged in their attempt at having their own biological child. The most common recommendation is either egg donation up front or following an aggressive and expensive treatment with high dose injectable medication (gonadotropins) aimed at producing more eggs for use with in vitro fertilization. This treatment is rarely successful in women with low ovarian reserve due to the fact that the number of follicles able to produce mature eggs is so limited. After one or two unsuccessful treatment cycles, further treatment to have her own biological child will not be recommended, often with donor egg being the only option left to consider.
Neway’s heart goes out to these women, who receive this unexpected finding of low ovarian reserve and learn that their chances of conceiving a biological child is extremely curtailed even with IVF, the standard treatment as described previously. In contrast to most infertility centers we are able to offer an innovative treatment to these women which does in fact offer a realistic chance for conceiving with their own eggs. In this clinical scenario, we propose to do repeated natural cycles or cycles stimulated with oral medications, which are milder and significantly less costly than high dose injectables. Besides increasing the odds of pregnancy over a several month period, the cost for the injectables at about $3,000 to $4,000 per cycle goes down to about $40 per cycle. With the oral medication (letrozole or clomiphene), we are often able to get one to three eggs per cycle which will then be fertilized and frozen on day five or six of life, and banked. At this early stage of life, the embryos are known as blastocysts. Over a five-month period of repeated treatment cycles, we would expect to have accumulated 1 to 4 high quality blastocysts which will be transferred in a "frozen cycle" or stored to be transferred at a later date. It is recommended, but optional, to do a pre-implantation genetic screening on these embryos to be more certain of having a successful pregnancy with no chromosomal abnormalities. As opposed to most other treatment centers where immature eggs are discarded, Neway recognizes that immature eggs may be salvaged and matured outside of the body. With sophisticated laboratory conditions, the eggs which are able to be matured can then be used to create blastocysts, not allowing any chance go by for using a woman's own genetic material for reproduction.
With all of these advanced technologies at hand, Neway offers the best hope for a woman with low ovarian reserve to fulfill her dream of a having a biological child.