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CGH Testing in IVF: Does Age Matter?

Dr. Geoffrey Sher Recommends

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CGH embryo testing, by accessing all the cell’s chromosomes, accurately diagnoses aneuploidy (an irregular chromosome component), which is the overriding cause of Reproductive Failure). In most cases, it is the egg, rather than the sperm that determines the chromosomal integrity of the embryo. Since the incidence of egg aneuploidy (and therefore also embryo aneuploidy) increases rapidly after age 35 years, the advisability of doing CGH embryo selection for IVF is in large part tied to the age of the egg provider.

The ideal candidate for CGH-embryo selection is an embryo recipient who ends up with numerous (>6) healthy, day-3 (6-9 cell) embryos resulting from fertilization of a younger woman’s eggs (whether her own or donor-derived). The microscopic examination (grading) of embryos cannot accurately determine their ability to make a healthy baby (what we refer to as their “competence”). CGH testing can make this determination much more reliably.

CGH embryo testing is also helpful in younger women, when it is necessary to diagnose the cause of repeated miscarriage, failed IVF, or completely unexplained infertility. In such cases, the embryo is often at the root of the problem (due primarily to egg aneuploidy). Here, embryo CGH can help distinguish between embryo “incompetence” and an implantation problem.

At age 33, about two in five of a woman’s embryos are likely to be “competent”; at 40, about one in six or eight, and at 45 years of age, only about one in every 15-20 eggs/embryos is likely to be CGH normal. This helps explain declining IVF success rates, increasing miscarriages and chromosomal birth defects with advancing age. Thus, the older the woman, the greater the likelihood that CGH testing will reveal that none of her embryos are chromosomally normal.

High aneuploidy rates in women over 39 years of age are the predominant reason we very rarely see triplets or greater (high-order multiples) occurring when these women conceive through IVF using their own eggs. Thus, we can safely transfer more embryos at a time to older women, leaving it up to nature to cull out the defective ones. These higher aneuploidy rates are also the reason that prenatal genetic testing should be done in pregnancies where the woman is in this age group.

Thus, there is a declining need for doing CGH-embryo selection with advancing age of the egg provider. There are, however, a few notable exceptions:

The few women over 40 who are high responders and end up with a large number of embryos.
Women who wish to bank (“stockpile”) their embryos for later use. In such cases we would sequentially perform several stimulation/egg retrieval cycles, without transferring the embryos to the uterus. Instead, we would do CGH and then freeze/bank and store all genetically “competent” blastocysts for future dispensation.
When a severe anatomical or immunologic implantation issue is suspected. In such cases it is often a good idea to defer surgery or intensive immunotherapy until “competent” blastocysts are available.
When the patient elects to do everything possible to optimize the chance of success for every embryo transferred, and/or to minimize the risk of miscarriage and birth defects.

Always bear in mind that CGH testing identifies “competent” embryos. It does not help produce them or improve embryo quality. As a result, it is the birth rate per embryo transferred (and the quality of life after conception) that is vastly improved…not the success rate per egg retrieval performed.

Tags: aneuploidy, Blastocyst Transfer, Comparative Genomic Hybridization, Comparative Genomic Hybridization (CGH), embryo competence, Embryo Grading, embryo quality, IVF Authority

7 Responses to “CGH Testing in IVF: Does Age Matter?”

Marci says:

September 20, 2009 at 5:12 pm

Dr Sher,

I am 35 years old and I just finished IVF with no success. I had 11 eggs retrieved and 8 fertilized. From them 3 were transfered and I was told the quality was not very good. Do you think it makes sense for me to have CGH testing?

Many thanks in advanced for your answer!

Reply
Geoffrey Sher, MD says:

September 20, 2009 at 8:47 pm

Yes indeed…for all the reasons outlined in several blogs on this site.

Go to http://www.haveababy.com and arange nfor us to consult by phone.

Geoff sher

Reply
Hanadi says:

November 10, 2009 at 10:40 am

hello,
I ve already had 6 fresh cycles and 2 fet, failed then they found out that i have immune issues so i had IVIG. I am 38 and my husband is 44 and we live in london. Do you think we need to do CGH? and if so how can we do it and we live in the UK? also my husband is diabetic and i have MS, could it be a reason for us not implanting. i always produce top quality eggs in good number and they go to blast. I am currently having my treatment at ARGC, with Dr. Taranissi, he is trained by Dr Aln Beers. I would really appreciate you advice.
Hanadi

Reply
Geoffrey Sher, MD says:

November 10, 2009 at 12:19 pm

CGH will identify competent embryos for transfer, it won't do anything to improve embryo quality. That requires a very individualized (customized) protocol of stimulation. The most important issue is to carefully identify and then address the immunologic implantation dysfunction (IID)…see elsewhere on this blog.

I would be happy to taklk to you. Go to the top of this page and set up a free medical telephone consultation.

Geoff Sher

Reply
ihsan says:

January 16, 2011 at 4:07 pm

My husband is 33 years old and i am 29 years old we have been trying to get pregnant for 3 years until we lost hope and we seeked medical help that where we found out my husband's sperm has low motility and low morphology 1%. We hve done 4 IUI's without good result then we moved on to IVF with ICSI, 7 egges were retrieved and 6 of them ferilized with good grade(N 8)My doctor decided to transfer only one embryo since is good grade and my age ..I was so happy i got pregnant first try and only with one embryo but our hapiness did not go far..at 3 month i found out that the baby is affected with chromosomes abnormalities after undergone CVS and amnio> the fetus was turner syndrome.. it was davasating news for us i could not get first time …, then I have decided to terminate the pregnancy at 17 weeks..I was told by all doctors this is random error and wont happen again.. My journey is still going with second attemp since we have 5 frozen embryos remaining.. they thawed all of them 2 survived one with grade 6 and one with grade 3.. transfered 2 of them and i got pregnant with one… i was not so excited like first one indeed i so was anxious.. at 3 months i have found out that fetus is down syndrome this time after i had done CVS .. I was about to get crazy why this is hapening to me twice in the raw … decided to terminate the pregnancy again… Now it is been 7 months sine my last pregnancy and i wanted to try again but i so anxious .. I even asked doctor to have PGD done and he said it is not good option for me since you got 2 different chromosomes abnormalities.. Do you thing CGH will be good option for me since it tests for all chromosomes .. But i am not sure if my clinic is having this new technology..I would appreciated your response.. Thank you

Reply
Liza says:

March 28, 2013 at 1:06 pm

I just completed my first IVF cycle. I am 26 and my husband is 31. Although they were able to retrieve 27 follicles (19 of which were mature), 15 fertilized but only 2 made it to the early blastocyst stage. The rest stopped dividing. Would I be a good candidate for CGH testing? Or is there something else that should be done to figure out why the attrition rate is so low? Any advice that you have would be greatly appreciated.
Thank you!

Reply
- Geoffrey Sher says:
  
  March 28, 2013 at 5:54 pm
  
  Hi Lisa,
  
  We would need to talk if I am to help you. In the interim, please go to the home page of this blog, http://www.IVFauthority.com . When you get there, look for a “search bar” in the upper right hand corner. Type the following subjects into the bar, click on it and it will take you to all the relevant articles posted there.
  
  1. “An Individualized Approach to Ovarian stimulation” (posted on November 22nd, 2010)
  
  2. “Ovarian Stimulation in IVF: Why is it important to down-regulate LH?”
  
  3. “Agonist/Antagonist Conversion Protocol”
  
  4. “Factors that affect egg-embryo quality”
  
  7.“A personalized, stepwise approach to IVF at SIRM”; Parts 1 & 2 (posted March, 2012)
  
  Consider calling 800-780-7437 or 702-699-7437 to arrange a Skype consultation (free of charge to those who reside in the United States or Canada) with me so we can discuss your case in detail
  
  Geoff Sher
  
  Geoffrey Sher, M.D.
  Executive Medical Director
  Sher Institutes for Reproductive Medicine (SIRM)- Las Vegas
  
  Geoffrey Sher MD
  Clinical Professor, UNLV
  Executive Medical Director
  Sher Institutes for Reproductive Medicine (SIRM)
  5320 S. Rainbow Blvd. | Las Vegas, NV 89118 | 800-780-7437
  http://www.haveababy.com | Facebook | Twitter | Dr. Sher’s Blog
  “Believe…In a Successful Journey from Infertility to Family”
  
  Reply

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