ACFS strongly believes that chromosome testing alone is not the sole reason for our significantly improved success rates. Although, it is overwhelmingly the most important component, without the "best" eggs, an excellent embryo/blastocyst culture system, an excellent freeze-thaw program (vitrification), excellent trophectoderm biopsy techniques using laser and uterine transfer techniques, the team at ACFS does not think that they would get the same results.
ACFS strongly believes that every woman is genetically pre-determined to make a certain amount of eggs on each stimulation cycle. Because of age, reproductive function gets hammered, mainly because of chromosome abnormalities, not because ACFS cannot get you good day 5 blastocysts. That is why it is important to be aggressive in COH (controlled ovarian hyperstimulation) to get the most and best number of eggs possible; because only some embryos will make it to blastocysts, then only some will be chromosomally normal.
If not stimulated appropriately/aggressively you may still get a lot of eggs but they may be of poor quality producing "poor" quality embryos that may or may not develop to the blastocyst stage. Even if they develop into a blastocyst (day 5 embryo) they may be "incompetent" and not implant and/or have a higher risk of miscarriage (not related to being chromosomally abnormal). Alternately, if not stimulated appropriately, you will get fewer eggs than you are genetically pre-determined to make; and they may also be of decreased quality, either not fertilizing and/or producing poor quality embryos that do not implant. ACFS believes that understimulation is one of the most important factors in why a woman has an unsuccessful IVF cycle.
There is of course the concern about OHSS or ovarian hyperstimulation syndrome. In its severe form, you can be hospitalized and are "very" sick. OHSS can be avoided by not getting the patient pregnant; in other words, cryopreserve or freeze (vitrification) all the embryos, and later transfer than in a subsequent cycle. Also, by not transferring the embryos the woman can be placed on medications that will significantly abate the symptoms of OHSS. Because of the fear of OHSS, some clinics back off stimulation, or will "coast" the patient or increase the amount of medication if not responding well. ACFS respectfully disagrees with this approach and feels that these cycles should be canceled rather than trying to "rescue" the cycle and re-stimulate in a subsequent cycle.
This thinking may support ACFS speculation that "conservative" stimulation protocols may lead to aneuploidy or chromosome abnormalities. And supports ACFS thinking about not under-stimulating patients and maximizing their genetic potential, whatever it is.
Also, ACFS data shows that pregnancy rates are decreased if you transfer embryos back in a fresh physiologically overstimulated cycle. You may then ask, " then don't physiologically overstimulate me". The problem is if you are not mildly "overstimulated", you may not make the "best" quality eggs/embryos.
But then you may ask, "is a frozen or cryopreserved cycle as good as a fresh cycle?" In the ACFS experience, a frozen cycle is better than a fresh cycle. Why? For three reasons. First, you do not want to put embryos back in a "physiologically" overstimulated cycle (having adverse effects on endometrial receptivity and endometrial DNA patterns); second, only the "best of the best" embryos survive the freeze-thaw process; and third, it significantly decreases (or can eliminate) the risk of OHSS. This is based on the assumption that your ART laboratory operates at a high level of excellence. ACFS was not able to say this 5-6 years ago, but if your embryos were not able to reach the blastocyst stage (day 5) in the ACFS-ART laboratory culture system, then they would not have made it in you if they were transferred. The same is true of frozen embryos, if they do not survive the freeze/thaw process (vitrification) at ACFS then they would not have survived in a fresh transfer. Some clinics disagree with these conclusions but the overall experience at ACFS is quite the opposite. Recent reports in the literature (ESHRE, July 2012) support ACFS conclusions. Initial meta-analysis on this subject indicates that the chance of a clinical pregnancy is approximately 30% higher when all the embryos are frozen or cryopreserved (vitrification) for later transfer than with fresh embryo transfer. We have not done a day 3-embryo transfer for the last 4-5 years; and as shown from our data above, we feel very comfortable with our freeze/thaw (or vitrification) program which is a very critical part of doing PGS-chromosome testing.
This also works out quite well because if you are doing chromosome testing, the embryos are cultured out to day 5 or the blastocyst stage, than biopsied. Since you do not get the results in time to do a fresh transfer, all the embryos are cryopreserved and transferred in a subsequent cycle (FET-frozen embryo transfer); thus avoiding transferring them back in a "physiologically" overstimulated cycle and also avoiding the risk of OHSS. Two very important advantages.
Our Scottsdale Fertility Clinic Location
8426 E Shea Blvd.
Scottsdale, Arizona 85260
Phone: (480) 860-4792
New Patient Referrals Fax: 480-946-9914
Routine Fax: 480-860-6819
Monday - Friday: 8:00 AM - 5:00 PM
Saturday – Sunday: Closed
If you're traveling north via the Loop 101 Pima Freeway towards our clinic, please be aware of significant delays, especially near the Shea Blvd. exit. We recommend allowing extra travel time to ensure you arrive relaxed and on time for your appointment. Your timely arrival helps us provide the best care for you and others. Stay safe and plan ahead!