Gynecology, Obstetrics and IVF Specialist Prof. Dr. Deniz Ulaş gave important information about the subject.
What should be the ideal number of eggs in IVF treatment?
Emphasizing that one of the most difficult patient groups in IVF treatment is women with low ovarian reserve. Dr. Deniz Ulaş stated that the number and quality of eggs in women started to decrease at the age of 32, there was a decrease again at the age of 35 and a dramatic decrease was observed at the age of 38.
With women entering the business life, women want to have children later in recent years. Considering the women who apply for IVF treatment, the majority are over the age of 35. In other words, after the ovarian reserve decreases, they decide to have children and apply for IVF treatment.
The higher the number and quality of eggs in IVF treatment, the higher the chance of pregnancy. The number of eggs collected in IVF treatment is between 8 and 15, which increases the chance of pregnancy. If the number of eggs collected is below 8, it means low ovarian reserve. If the number of eggs collected is more than 15, it is considered an over-response.
In some studies, the number of eggs between 5-15 is considered as the ideal number in IVF treatment. Egg quality is as important as the number of eggs in the success of IVF treatment. Eggs collected in IVF must be at the metaphase 2 (M2) stage. Because only M2 oocytes can be fertilized by sperm. The more M2 eggs, the higher the chances of a woman conceiving.
Why is the Number of Eggs Important in IVF Treatment?
In the natural cycle, if 1 egg develops from a woman every month, it cracks and encounters sperm, pregnancy occurs. The aim of vaccination treatment is to develop 1 or 2 eggs. But the more eggs there are in IVF treatment, the higher the chance of pregnancy. For this reason, the doses of egg-enhancing drugs given in IVF treatment are higher.
The higher the number of embryos obtained in IVF treatment, the better the chance to choose among these embryos. This will increase the chance of pregnancy.
In addition, studies have shown that; The chance of pregnancy is higher in day 5 embryo (Blastocyst) transfer compared to Day 3 transfer. Because healthy and high quality embryos can survive until the 5th day. In order to transfer embryos on the 5th day, there must be a certain number of embryos so that the best among them can be selected by natural selection.
In some cases, embryos should be screened genetically. Indications for preimplantation genetic screening (PGD) include familial inherited disease, history of previous childbearing with anomalies, and advanced maternal age. In order to conduct genetic research on embryos, there must be more than 5 embryos so that healthy embryos can be selected.
If there are a large number of embryos, the remaining healthy embryos can be frozen after the transfer is made. Thus, even if there is no pregnancy, frozen embryos can be thawed and transferred again in other months. Each transfer will also increase the chances of pregnancy.
It is also undesirable to develop a large number of eggs in IVF treatment. Excessive response to medications is most common in women with polycystic ovary syndrome (PCOS). Therefore, the drug dosage in PCOS should be adjusted very carefully.
If the patient over-responds to egg-forming drugs, this condition is medically called ovarian hyperstimulation syndrome (OHSS). OHSS is an undesirable condition from in vitro fertilization. When looking at, the higher the number of eggs collected, the higher the chance of success, but if OHSS develops, the hormonal microenvironment reduces the chance of the embryo to adhere to the uterus. In addition, OHSS is a complication that puts the life of the woman at risk or even death.
If a patient who develops OHSS and becomes pregnant, the picture gets worse. Because the BHCG hormone produced during pregnancy aggravates OHSS. Therefore, in a patient who develops or is predicted to develop OHSS, all eggs should be collected, microinjection should be performed, but all embryos should be frozen. Embryo transfer should be made in a more physiological hormonal environment after 1-2 months. In this way, both the chance of pregnancy is increased and the woman’s life is not put at risk.
Stating that how a woman will respond to IVF treatment and how many eggs will develop can be predicted in advance, Prof. Dr. Deniz Ulaş stated that it can be understood that the ovarian reserve is good or bad by performing an egg count with ultrasound before treatment and by looking at the AMH value in the blood. “Determining the patient-specific treatment protocol by looking at these tests ensures the ideal number of eggs to be collected and the patient can be informed in advance about possible negative consequences,” he said.