Hi Dr Sher,
I am considering pursuing egg freezing in a few months. I had an initial consult with and RE in which my numbers were as follows:
Age: 34 years, 8 months
Day 3 FSH: 8.1MIU/ml
Day 3 AMH: 1.57ng/ml
Antral Follicle Count (AFC) = 13 (6 on one side, 7 on the other)
Cycle length: typically 28 to 34 days
Is such a variance in AFC typical? Are these numbers still indicative of Diminished Ovarian Reserve? If I go through with egg freezing, will one cycle be enough or based on these numbers, do you think I will require multiple egg freezing cycles?
Any help, advice and guidance you can offer me would be very much appreciated.
R.S (nom de plume)
Sounds to me as if you are an excellent candidate for egg freezing. You are young and that likely means that provided the right protocol for stimulation is used your egg quality should be determined by your relative youth. However you do have diminishing ovarian reserve and this means that time is off the essence as your total egg population is probably starting to decline and this can rapidly get worse. My one bit of advice is that the eggs you bank, first be subjected to polar body-1 (PB-1) biopsy to determine their chromosomal integrity.
FYI, while significant enhancements in technology have brought about much improved success rates following freezing (cryopreservation) of embryos, results following egg freezing have been very relatively disappointing.
And there is a lot of misinformation out there. It is not uncommon to see advertisements of a 30-40% birth rate per transfer procedure using embryos derived from previously frozen eggs.. But this statistic is “misleading” because it does not tell the whole story. It fails to address the fact that in the final analysis each egg being frozen and banked will have no more than a 7% chance that it will survive the thaw, be successfully fertilized, and upon being transferred to a recipient uterus will result in a live birth. It also does not reveal that because (even in young women) at best one out of two mature eggs (M2s) eggs are chromosomal abnormal (aneuploid) and “incompetent”; i.e., are incapable of propagating a normal pregnancy (this incidence increases progressively with advancing age). Thus the vast majority of eggs being frozen/banked are in actuality, “incompetent”. This is why most Egg Banks require a commitment on the part of patients, to bank least 15-20 eggs before stopping. It should therefore come as no surprise that recent data shows that the pregnancy rate when eggs used with egg donation are derived from currently operating frozen egg banks, the pregnancy rate following embryo transfer is significantly lower than when fresh (non-frozen) donor eggs are used. That is why our following our governing body, the American Society for Reproductive Medicine (ASRM), currently, still regards egg freezing and banking as being an “experimental approach”.
But all this could be about to change dramatically. We published on the fact that if eggs are selectively frozen, based upon them being chromosomally normal, and such eggs are subsequently used for fertilization and embryo transfer, the pregnancy and birth rate per embryo is several fold higher. In 2007 we were the first to report (RBM-online) on a study where, using metaphase CGH, we were able to selectively freeze (vitrify) and bank only chromosomally normal eggs. We reported on how, upon thawing such pre-vitrified eggs , 90% would survive and that upon fertilization (using ICSI) and then transferring up to two (2) resulting blastocysts), the baby rate baby rate per frozen egg was six times higher and the birth rate per embryo transfer procedure was 60%. To date we have had about 40 babies born using this approach.
So…. the process of selectively vitrifying (freezing) and then banking ONLY “competent” (CGH-normal) represents a real break-through and will likely soon allow women to safely postpone having babies, without fear that the inevitable decline in egg quality which accompanies aging, will deny them having a family they are ready…”Fertility Preservation”. This would also benefit women with existing medical conditions (such as breast cancer, leukemia, lymphoma etc.) which preclude initiation of pregnancy until cured. In such cases treatment (e.g. by radiotherapy or chemotherapy) would otherwise often render these women permanently infertile. The successful cryopreservation and storage of their eggs could avoid denying such women the opportunity of parenthood with their own eggs. Finally, it could lead to genetically competent donor eggs being banked for subsequent purchase (at a comparatively low cost) by women with failing or failed ovaries who wish to have babies.