Answer from: Raúl Olivares, MD
Without any doubt, the more eggs we have, the better chances for the patient. I know that for some years, we’ve been told that at some point, the extra oocytes that we can get from a cycle may not be of the same quality compared to if we just get 7-8 eggs.
However, I think that current evidence is strong enough to confirm that this is not true. The more oocytes we get, the more embryos we’re going to have, the higher the chances to get that optimal embryo. If we don’t get that, the higher chances that the patients can get pregnant after the first or second cryotransfer without having to go through a new IVF or stimulation again.
When we do IVF, we’re always aiming at trying to get as many eggs as we can.
Answer from: Anna Voskuilen, MD
This is a question that we hear a lot. Actually, I always say the same thing. Because fertility is related to age and the quality of the eggs, everything is related to the number of eggs. We depend, of course, on the eggs that we have. It’s the same thing. The more eggs we have the better options we have to find the good egg and the good embryo that we’re looking for.
What do we do to try to have a good number of eggs? We stimulate the ovaries with hormones that we give, an external medication that we give. And we try to get the maximum number of follicles that we can. This, of course, depends on the ovarian reserve that the patient has because this is something that we cannot change.
Every month we work with what we. We cannot change that. The thing is that we give a certain dose of hormones to try to boost all the possible follicles, but always within a safe level for the patient. For example, when we want to do everything personalized, we depend on the age of the patient, on the height and the weight of the patient, and on the ovarian reserve of the patient, all these factors. We take these factors into consideration to know what dose to give to every patient. For example, we avoid problems like ovarian hyperstimulation syndrome, which is related to a high ovarian reserve in a high ovarian response. So that’s the reason we always try to do everything personalized, but the general idea is the more eggs we have the better options we have.
Answer from: Aleksandr Darii, PhD
IVF cycles or protocols are based on hormone therapy. The task is to grow the optimal number of follicles in the ovaries to obtain eggs. A woman has one dominant follicle in the natural cycle, using hormonal therapy; this increases to between 5 and 20. For successful fertilisation, we need as many follicles as possible. The gold standard is 8 to 16 oocytes; the embryologist will work the best with this number of oocytes. The chance of hyperstimulation syndrome is small. According to statistics, women under 35 years old need 9 oocytes to get a singleton pregnancy. Women aged between 35 and 37 years of age require about 12 oocytes. Women under 42 years of age need 16 oocytes, and after 42 years of age, an average of 100 oocytes. During the maturation of oocytes, the woman is regularly examined; if there is no growth, the protocol is interrupted.
Answer from: Alina Horbenko, MD
It all depends on the woman’s reproductive potential. In a woman’s natural cycle, one or two follicles mature. In stimulated cycles this can be 5, 10, 15, and sometimes 20 follicles respectively and cells. A large number of our cells increases the chance of obtaining quality embryos. When choosing a dose of medication for stimulation, we focus on age, body weight, and AMH level. The higher the AMH and the number of control follicles in the patient’s ovaries, the stronger the predicted response to stimulation.
Typically, ovarian stimulation lasts 10 or 14 days. When the maturity criteria of the follicles are reached, the day of oocyte retrieval is assigned, ultrasonic puncture of the follicles. Immediately after the fertility specialist has punctured all mature follicles, their material is passed to embryologists.
However, not all of the resulting oocytes are capable of producing embryos. Some of them may be immature or defective. Therefore, the number of cells is one of the most important factors. By the fifth day of cultivation, we receive information about the number of blastocyst embryos and if they are suitable for transfer into the uterus.