Implant after harvest or harvest again? 38 y/o

[Nonoichi]

Hi, thanks in advance! My wife is 38 y/o and we just went through the egg harvesting process. We got 4 eggs, 1 is frozen in the early stage of fertilisation, and 1 is Grade 5 A B and is now frozen, we are waiting on the other two. What I'd like to know is if people think it would be a good idea to immediately implant the eggs, or try to harvest more as the quality of the eggs decrease with time. We live in Japan where doctors are motivated by money rather than caring for patients best interests, so their advice is to be taken with a pinch of salt. And it is extremely expensive, we don't want to mess it up. Any advice is gratefully received! Thanks!

[BBHH1]

Just to confirm you have frozen embryos and not eggs right?

Fresh embryo transfers are more effective. So if you can afford, you could do another round with fresh transfer and have the frozen ones as back up. Good luck!

[Nonoichi in reply to BBHH1]

Yes, one of which is early stage, and the other in the blastocyst stage. A staggered implant is recommended (I believe), but it much more expensive as it requires two procedures, but is more effective we've been told.

[IVFat40]

Just to add in to the mix, my clinic (in the UK) have shared with me that for them frozen embryo transfers have a slightly higher success rate.

[BBHH1 in reply to IVFat40]

Maybe for young woman who produce many embryos. That may be your clinics population....

When there are 2 or less high quality embryos (not total, high quality), waiting until day 5 decreases chances of life birth. Around 10% of blastocysts embryos can be lost in freeze-thaw process and 70% of day 3 embryos.

Doctors can have different opinions so up to us to pick and choose 😊

[Gatarra in reply to BBHH1]

That’s interesting - I am about to have fresh transfer on Friday and they were not really sure what to do with me until the last moment as I have low amh / low follicles and was on 2nd batched cycle of 3. I was also told frozen has higher success rates - because it is more natural - I guess because your body has time to recover from stimulation . I was worried fresh might not be the best option but trusted my doctors . Interesting that such a large number don’t survive the thaw so now I’m happy with this decision !

[BBHH1 in reply to Gatarra]

The rationale for doing frozen is that you focus on the meds to get the follicles in one cycle and on preparing the endometrium for implantation in another one. On the fresh you need to do both at the same time which can be tricky. But they manage well it’s good. Good luck!

[Jumpppy in reply to IVFat40]

All the research I've read Frozen has higher success rates for all ages as they can control the endometrial environment better (e.g. progesterone isn't too high over riding the uterus). If an embryo is OK quality it should thaw fine no matter what day it is. If a clinic is good you should have successful thaw rates in the high 90s (there's research on this too). Most prefer fresh transfer because it is less expensive based on how many clinics price cycles (e.g. fresh transfer is included in cycle price, but FET is an "extra.") If you can there are a lot of benefits to banking and then putting back later.

[BBHH1 in reply to Jumpppy]

That’s not true for woman older than 40, with dimished ovarian reserve and that only produce 1 or 2 embryos or even less. The problem is the vast majority of research published, even when they say it includes older woman with dimished ovarian reserve actually means they include woman between 35-40 and with mildly dimished ovarian reserve. If you look carefully at the ages and FSH and AMH and antral follicle count you will see that.

It is true like I mentioned in the other comment that is hard to prepare the follicles and the endometrium at the same time, but if done well is the best approach for this older population with moderate to severe dimished ovarian reserve.

[Jumpppy in reply to BBHH1]

Interesting that it is different for >40. Just for my own edification, did you mean Embryos or blasts? I can imagine if you are in the 1-2 embryo position it is different that the poster's (wife's) position and it could be a different answer.