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The HIER Egg Retrieval Method Helped a 48-Year-Old Patient Get Pregnant at CHR

In this video, Dr. Gleicher discusses CHR’s HIER (highly individualized egg retrieval) method, which is helping more women age 43+ getting pregnant with their own eggs.

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I want to talk to you today about what we here at CHR consider our last really important discovery and we call this our HIER process. H-I-E-R. Standing for highly individualized egg retrieval. Let me give you a little bit of history how all of this started. Our IVF program as most of you already know serves a very negatively selected patient population. Over 90% of our patients come to us after they have usually failed multiple IVF cycles at other IVF services. We also have the oldest patient population of any IVF center in the US. You can check on that in in the national reporting programs.

Yet our patients experience surprisingly good pregnancy rates, but only up to age 43. Meaning that up to age 43, we saw what one would expect, which is a slow decline in pregnancy chances as women get older and then after age 43 until about two or three years ago, we saw a precipitous drop. Basically, very, very few women conceived at CHR after age 43. And so one day about three years ago, we started asking ourselves “why is that?” Why is it that we are seeing this slow, progression in declining rates, but suddenly at age 43 something happens and we decided there must be a reason and we decided that the reason must be within the follicle where the egg is maturing, because most of pregnancy chance comes from the egg. 95 percent of the pregnancy chance that an embryo gives you comes from the egg, not from the sperm. Only five percent roughly comes from the sperm and so consequently, we started an investigation of what we call the follicular environment by molecular biological means, In other words we checked out, what is happening inside the follicles before we retrieve eggs in women above age 43 that makes our outcomes so different than under 43 or even in younger controls like young healthy egg donors.

This study conducted about three years ago was then published in a very prominent endocrinology journal because we had pretty remarkable and very obvious results. We were able to demonstrate that the whole metabolism inside the follicular micro environment speeds up as women get older and therefore, as a consequence, if we wait in older women above age 43 as long as we were used to in younger women before taking out the eggs from this environment, we would get, what we jokingly call here, hard-boiled eggs rather than soft-boiled eggs and once you have hard-boiled eggs, the medical term is atretic eggs, there’s nothing you can do with them. And so once we understood what is going on inside the follicles, the next question was so what do we do about this and what we decided to do is to simply take the eggs out of this increasingly hostile environment before it turns faster and that meant that in women above age 43, we started planning egg retrieval much earlier instead of giving ovulation induction at lead follicle sizes 18, 19, to 22 millimeters where we usually do it and most or practically all other IVF centers do it.

We now decided that in women above age 43, we’ll do it at 16 millimeters. 16 to 18 millimeters and low and behold, what we found is that we ended up with more embryos that we could transfer and even more importantly, we increased significantly our clinical pregnancy rates and so since then with these early retrievals, we don’t see this sudden drop any longer after age 43 and we now suddenly have significantly more pregnancies not only at age 43, but at age 44, 45, 46, even age 47, almost 48.

Indeed, we recently as you may remember if you’re watching us regularly reported what is probably the oldest woman ever to conceive with IVF with use of her own eggs having her daughter. And she and her daughter and her husband came last week to visit us here at the center. She has one hell of a cute girl So this concept of here of highly individualized timing of egg retrievals has really radically changed our practice pattern here at CHR probably more so than it would anywhere else because so many of our patients are really older. But what we, since our publication, have also discovered is that the same speeding up of the biology of the follicle that we observed in older women above age 43 also happens just somewhat slighter degrees, but still to a significant degree in younger women with premature ovarian aging. And so we started in those women also to retrieve eggs earlier and so this has dramatically changed the practice at CHR.

You may not have heard about it yet because it is just getting out into the literature and it takes usually years before something new that has been discovered comes down to the general practice level of the of the average and practitioners, but we here at CHR are absolutely convinced that HIER will be the next big change in IVF practice, especially in those centers who are still treating older women and our results over the last years since we are practicing here show that many women who are being automatically shipped off into egg donation really still can have quite a significant chance with their own eggs if their eggs are retrieved in an individualized and well-timed way.