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Pregnancy Rates in Women 43+ Doubles with Early Retrieval

CHR’s research found that retrieving eggs early in an IVF cycle, when they are still in the 14-18 mm range, vastly improves egg/embryo quality and pregnancy rates for women over 43. (In a typical protocol, eggs are retrieved when the follicles are about 21 mm.) Dr. Norbert Gleicher, CHR’s Medical Director, explains why egg quality is better and pregnancy rates higher when eggs are retrieved earlier in women over 43 who are undergoing IVF cycles.

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In a paper CHR investigators published in 2015 in a prestigious endocrinology journal, we demonstrated that in older women, and by that I mean women with mean age of 44 and with all being above age 43, in those women, early egg retrieval doubled pregnancy chances. This is remarkable because pregnancy chances in such women at our center are already quite good, again, considering their very advanced ages. Those pregnancy chances usually run at around roughly 7-10%. Live birth chances, indeed, in those patient populations over the last few years at CHR have been steady at around 7%. With early retrieval, those chances almost doubled.

We start treating these patients, not only once they enter the IVF cycle as most other centers do, but long before that. We learned a number of years ago that ovaries of older patients need to be prepared, so that by the time they enter an IVF cycle, they can maximally  perform. This preparation at our center means that we are trying to raise the androgen levels of these patients because it is now very well known that the intra-ovarian testosterone levels are of crucial importance for normal follicle growth. An older women usually has low testosterone levels, and so they need to be raised before, weeks to months before the patient starts here IVF cycles, so that these follicles over these weeks and months that have been maturing are exposed to an ovarian environment with appropriate testosterone levels. We also prepare patients during this time period with CoQ10, which is an enzyme and an antioxidant. The purpose of COQ10 is again to maximize egg quality.

That’s not all of it. Once we stimulate the patient in her IVF cycle, she gets the kind of stimulation that is very different from the kind of stimulation that a young woman receives. We for example do not give them anything that could suppress their ovaries–no birth control pills, no agonist, no antagonist. The patient starts stimulating straight on the 2nd day of her period, with any of these agents given in parallel. We can do this because we’ve learned over the last few years that older women need to be retrieved early. In other words, their eggs have to be removed form their follicles at earlier stages than in younger women. That means, while in routine IVF cycles in younger women, we, like most of our colleagues, give hCG for ovulation induction at lead follicle sizes of 19-22 mm, in older ovaries, we have now demonstrated in multiple studies, that hCG needs to be given at 16-18 mm.

While it is important to note that this requires that these patients are still able to produce eggs and embryos, and a significant proportion of women at that age will not be able to do that. For those women, who have the ability to still produce eggs and embryos, it demonstrates that we are steadily improving outcomes, and it’s worthwhile giving them a chance to try to conceive with their own eggs, rather than sending them right away to egg donation.