DrJosephDavisDO OP t1_iwxqi3s wrote

Hi @strawberrywine5880,

Many of my patients choose to do genetic testing if embryos (PGT) for several reasons. For patients over 37, the odds of an embryo being genetically abnormal exceeds the odds of a normal embryo and this can mean lower pregnancy rates and a higher miscarriage rate. For others who are younger, especially those with PCOS or unexplained sub fertility, they often have a large number of embryos and use PGT as a tool to identify the chromosomally optimal ones.

Like all tests though, PGT is not 100% accurate. This can mean “normal” embryos may be discarded if the test inaccurately shows they don’t have the right number of chromosomes. There is also additional cost to PGT which is a factor.

Many patients I’ve spoken to have balanced the cost of PGT ($2000 in my practice) with the cost of a failed frozen embryo transfer (also $2000) and given the higher pregnancy rate and lower miscarriage rate with PGT tested embryos have stated they feel the cost is worth the benefit.


DrJosephDavisDO OP t1_iwxpahf wrote

Hi @rosegolddragon,

There are some risks of pregnancy as we approach our later 30s and 40s but a lot depends on your overall health status (such as high blood pressure, etc). The other risks we think of related to pregnancy over 35 are risks of genetic problems in the baby. The risk of having a baby with Down’s Syndrome for example is 1/1000 roughly at age 30 and is closer to 1/350 by age 35 and 1/100 by age 40. An unfortunate corollary to the increased chromosomal abnormalities is an increased chance of miscarriage. These risks related to the baby don’t seem to be reduced with diet or lifestyle but can be tested for using PGT.

If you have other medical conditions like high blood pressure or diabetes, lifestyle and diet can in some cases help reduce the risks associated with those conditions. Hope that helps!


DrJosephDavisDO OP t1_iwxobmf wrote

Good follow up question! See my reply above but yes, hCG worsens OHSS. This is not only from an hCG trigger but also from a fresh transfer that implants and begins making hCG. This is the theory behind using agonist triggers and avoiding fresh transfers when OHSS is suspected.

Unfortunately not all OHSS can be avoided. We can just use certain approaches to lessen the duration of the OHSS and reduce the risk of worsening symptoms.


DrJosephDavisDO OP t1_iwxnynk wrote

Great question. OHSS does get worse shortly after trigger especially with an hCG trigger (vs an agonist trigger). The symptoms peak as you rightly said 3-7 days after trigger. The benefit of freezing embryo rather than fresh transfer is the reduce the severity of the OHSS while it resolves. I typically use agonist triggers and plan to freeze if I see any risks or signs of OHSS. Even in the best of situations however OHSS can still happen. I believe the most important way to address OHSS is to have an open discussion about the signs and symptoms and make a plan with my patient about how to proceed. That being said, I do very few fresh transfers and have seen very few cases of severe OHSS since moving to that approach.


DrJosephDavisDO OP t1_iwwe7n4 wrote

Hi u/Harlan2114

Thanks for the question. The 2 main types of protocols are agonist and antagonist. There is data suggesting longer agonist suppression can help with early follicle growth, but this can also over suppress some follicles. The estrogen priming protocol is a nice blend of suppression with the added advantage of antagonist. I see a lot of patients with a similar situation. If you want to reach out to my office, we could set up a consultation to talk about your specific case. (email contact@caymanIVF.com)


DrJosephDavisDO OP t1_iwwdj4c wrote

Hi u/SongBird2007

I am sorry to hear about your situation. Many medical conditions can have an impact on fertility, and it is often hard to find a balance. PCOS and insulin resistance are both very commonly linked to fertility problems. You ideally want to make sure you are working with a doctor you feel is addressing your needs in a supportive and productive way. Also be sure you are taking time for yourself!


DrJosephDavisDO OP t1_iwwbrdi wrote

Hi u/HaworthiaRYou

Great question. There are many ways to reduce OHSS, one of which is freezing the embryos and planning for an FET. This is a very effective option. In nearly everyone who is experiencing OHSS, the symptoms are gone by the time of your period. That being said, most doctors will still want to assess you before starting the FET cycle just to be sure.


DrJosephDavisDO OP t1_iwwb4vd wrote

ERA (endometrial receptivity assay) for those who aren't familiar is a tool designed to determine the best time of the cycle to transfer a frozen embryo after IVF. The studies on ERA have sown benefit in some patients if they have had multiple failed embryo transfers. In my clinic, I specialize in PGT single embryo transfers. Our current pregnancy rate using PGT is >85% per embryo transfer and as such I haven't found much of an improvement using ERA for my patients. I would recommend anyone considering having an ERA, ask your clinic how much of an improvement they have seen using the ERA so you can make the most informed decision.


DrJosephDavisDO OP t1_iww96ur wrote

You are very welcome u/Lt_Devil_Melon!

Lifestyle choices when you are trying to get pregnant is very important. High on the list of things to avoid are smoking and alcohol for both men and women. Being an optimum weight is also important as both underweight and overweight have been linked to poorer IVF outcomes. Also, if you have any medication conditions (such as diabetes or high blood pressure) you want to make sure your condition is under control prior to starting the process.

Regarding supplements, some studies have found a benefit for women taking Co-enzyme Q10 and DHEA supplements. For men, zinc and antioxidants have also been found to be important for sperm production.

Stress reduction is also important but hard to study scientifically.


DrJosephDavisDO OP t1_iww883w wrote

Hi u/dangerWW,

I am sorry to hear about your sister's situation. The best advances in fertility treatments have been in the field of pre-implantation genetic testing (PGT). Using IVF, embryos can be tested safely for specific genetic conditions and then the unaffected embryos can be selected to have a baby without the condition. This is something many clinics including my own specialize in. Looking at my own clinic's data, we have a >85% pregnancy rate using PGT, so this is a very successful option to consider.


DrJosephDavisDO OP t1_iww7n1v wrote

Hello u/LucilleandCharlie,

Thanks for the question. NOA (non-obstructive azoospermia) is a common cause of sub-fertility. The causes can vary from genetic to hormone issues, chemical exposure and varicocele. This means the treatment options are best tailored to the underlying cause. Some cases can be treated with medication however not all. Even the best treatment may however only lead to a small amount of sperm production, just enough for IVF.

There are some studies looking into stem cell therapy, but this is not commonplace.

An alternative worth considering is donor sperm which may or may not be a direction you are comfortable with.


DrJosephDavisDO OP t1_iww6tb4 wrote

Hi u/MsGoogle,

Thanks for your questions!

Regarding question 1: There are different professional guidelines on how many times a woman can donate her eggs but the most common one is no more than 5 times.

For question 2: Laws and regulations regarding sterilization vary widely between different jurisdictions around the world. The most important thing to bear in mind is sterilization is not intended to be reversable and as such most doctors avoid offering it to younger women especially if they have not had children. As far as advocating for yourself, I would advise working with a doctot that you feel comfortable with and who is willing to listen to your concerns and weigh the pros and cons.


DrJosephDavisDO OP t1_iww4n2a wrote

Hi u/leag63,

Great question. For many couples the best way to start trying is to make sure you are timing things with the woman's menstrual cycle. The easiest way is to plan to time sex every 2-3 days from when her period ends until she expects her next period. If her periods are unpredictable, this is reason to see a doctor rather than try for too long on your own. If she is over 35 it is a good idea to do some fertility tests even if you are planning to try naturally just to make sure all is well.

The basic tests are semen analysis, uterus and tube test (like an HSG), and ovarian reserve testing (such as AMH and ultrasound).

The most common thing people may not know is when to time sex especially when a woman's period is irregular.