Dear Dr. Ramirez,
I am a 36 year old from Georgia. I have primary amenorrhea POF (premature ovarian failure). In short always had POF (now called POI) and never had a period on my own. I guess I have streak ovaries so pregnancy naturally will never be an option. I can’t afford IVF with donor egg so my last chance is going to be embryo adoption with IVF. I currently go to an infertility center in Florida. They checked my cervix and womb and did a test transfer and all looks good. I was sent home with a list of donors and told to pick 4 or 5 for when I return. I am left trying to pick donors and am nervous of finding a good one. Most have 2 embryos left some have one. Is there any advice on picking a donor?
1. I am type A+ blood. Does the embryo blood type matter at all?
2. The embryos are frozen and some are 10-15 years old does the length frozen shorten my chances?
3. What is meant by 2 day 3 embryo, 6 day 2 embryo, (i know the number of embryo but what is the day mean and is it important)
Any suggestions on making this choice successful? I only have one shot to make this work. Any supplements anything would be helpful…. Being a primary POFer makes having POF strange even in a room full of people with the same condition, most of the specialists have seen POFers, just not Primary POFers… Thanks, M. from Georgia
Hello M. from the U.S. (Georgia),
So it sounds like you are going to do a “Frozen embryo transfer” using donated embryos. It is a good option for someone with POF. The questions you ask should rightfully be directed to your clinic and it is their responsibility to explain EVERYTHING, but let me help you out.
1. Blood type does not make any difference.
2. The length of time that the embryos have been frozen does not necessarily impact the chances but that depends on the quality of the freezing technique. If the technique was not good a the time, then it is possible that the embryos would not survive the thaw. Since you are having to purchase these embryos, you need to ask the clinic what their frozen embryo transfer rate was at the time that the embryos were frozen. That will give you an idea of how well their freezing technique was and would be the percent chance of pregnancy you will have.
3. In terms of embryo age, it works like this:
- Day of retrieval – Day#0 Fertilization
- First day post-retrieval – Day#1
- Second day after retrieval – Day#2 This is the day that some clinics will freeze because the number of cells in embryo are less.
- Third day post-retrieval – Day#3 This is the day that most clinics will transfer the embryo. The best embryos are 6-8 cells. Depending on the age of the egg (age of the egg donor), the number transferred will be limited to 2 or 3.
- Fifth day post-retrieval – Day #5 embryo has usually developed into a blastocyst, which is the stage that embryos are when they reach the uterus naturally. Many clinics are now moving to transferring at Blastocyst stage if possible, to help screen out weaker embryos. Only 1-2 embryos are usually transferred at this stage.
Getting a “primary” POF pregnant vs. a “secondary” POF patient is not any different. The chances would be the same as would the treatment technique. In terms of other things to add, that will be totally up to your doctor’s preferences. There are many different protocol variations, and what I use may not necessarily be the same as what your doctor recommends. I do use other supplemental medications and acupuncture to try to optimize the chances for success. Some medications I suggest are low dose aspirin (81mg), Medrol (methyl prednisolone), estrogen, progesterone and low dose heparin (in some cases). You’ll need to discuss these with your doctor. Unfortunately, because IVF only helps with 7 of the 10 natural steps to achieve a pregnancy, it cannot be 100% and frozen pregnancy rates are generally lower than fresh because often, the frozen embryos are the second best embryos for a patient. In terms of which embryos to choose, you want to choose the BEST ones based on how they look: Blastocyst > Day#3 Embryo > Day#2 Embryo; If D#3 embryo, try for an 8 cell embryo. In terms of grade, Grade 1>2>3. I would NOT accept a grade 3 embryo at any division stage.
Good luck with your transfer and I hope that this cycle will be a successful one for you!
Edward J. Ramirez, M.D.