CGH EMBRYO SELECTION IN WOMEN POLYCYSTIC OVARIAN SYNDROME (PCOS)

02 Jan
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For a human embryo to be “competent” it must have all 46 chromosomes intact. Microscopic (morphologic) embryo grading methods while improving the ability to identify good quality embryos, are incapable of recognizing its chromosomes and as such are incapable of reliably identifying and selecting “competent” embryos for transfer. The recent introduction of a genetic test known as Comparative Genomic hybridization (CGH, by achieving this objective, is the closest to being a “silver bullet” when it comes to assessing embryo “competency.

At best, 50% of a young woman’s eggs are chromosomally normal and thus capable, upon fertilization , of generating embryos that are “competent” ( most likely to propagate normal babies ). As a woman ages (beyond her early thirties), progressively fewer of her eggs will be chromosomally normal (“competent”) and by 45 years of age, the percentage of competent eggs drops to under 10%. “Competent” eggs, upon being fertilized with healthy sperm will in >80% of cases propagate “competent” embryos

Women with Polycystic Ovary Syndrome (PCOS) tend to be very high responders to fertility drugs, often producing a large number of follicles and eggs. Unfortunately when this happens, a much higher than normal percentage of their eggs tend to have an irregular number of chromosomes (aneuploid) and are thus are incapable of propagating euploid (“competent”) embryos”.

CGH-based embryo selection provides a rational approach to selecting “competent” for transfer to the uterus in women with PCOS.

8 Comments

  • samantha gross says:

    i have a question. i am 44 years old and have been down this roller coaster of a ride since 2004. i have pcos and was treated for infertility with hcg shot and metphormine 1500 mg a day. i got pregnant and at 36 1/2 weeks my daughter was stillborn. it is now 11 years later and my partner developed hodgkins lymphoma. we had his sperm stored and was trying the fertility thing once more. i was told that my blood work didnt even register on a scale. i am at that age poor reserve. i did develope two embryos the last iui we did. no success. they want me to do the donor embryo thing. i have 5 wonderful friends that are willing to help me achieve this goal but i was told that the doctor only would accept them if they were under 40 years old. what are your thoughts about my situation. the donor bank is too expensive and my insurance pays for the donors meds, labs and procedure. but i cant do that unless i have a donor or is it possible to help me in any way of making myself have a better reserve with medication.

    • Geoffrey Sher says:

      My website has changed. The new site is at http://www.sherIVF.com where I host and populate new and updated blog articles . The blog can also be accessed directly by going to http://goo.gl/4hvjoP. I now only respond to posts on this new site.

      To find and follow updated and new blog articles and to post questions or comments, please use this new venue. I promise to respond promptly.

      In the interim, please re-post this question or comment on my new website-blog.

      Geoff Sher

  • piegurl says:

    Hello Dr. Sher-
    I am 43.3 years old. I had a daughter at 40, easily conceived, carried and delivered. We started trying for a sibling at 41.5 and after 12 months had a chemical. I started treatments and respond very well to meds–my AMH is 2, fsh is 7, e2 around 50. My RE said while I don’t have PCOS, I do have borderline insulin resistance and polycystic ovaries, so started me on metformin before IVF #1. We did 11 nights of straight gonal F, 200 iu, and ganirelix antognist. Retrieved 22 eggs, 15 fertilized, 8 made it to blast, we transferred 4 and froze 4. I got pregnant (on my 43rd birthday) but had missed miscarriage at 9 weeks–trisomy 15. We did another round asap, same protocol, 16 eggs, 12 fertilized, 5 made it to blast day 5. We did aCGH of those 5 plus 2/4 frosties (2 didn’t expand post thaw). Results were all 7 abnormal. 4 were complex abnormal, only 1 had only 1 flaw.
    RE says with so many abnormal, chances are very low.
    Do you think a different protocol would be better? Can protocol influence egg quality–I understand it can influence embryo quality, but their is a distinction, correct?
    Do you agree our chances are very low?
    Any hope??
    Thanks so much for being so available–we all appreciate it!

    • Geoffrey Sher says:

      Unfortunately age determines the chance of an egg being chromosomally normal and at 43Y only about 1/12-15 will be normal.Unfortunately that means that resulting embryos will likewise be most likely to be abnormal and incompetent. Unfortunately no protocol of stimulation can change this. That having been said, selective embryo banking of CGH normal blastocysts could represent the only alternative to egg donor IVF.

      Please go to the home page of this blog, http://www.IVFauthority.com n When you get there look for a “search bar” in the upper right hand column. Then type in the following subjects into the bar, click and this will take you to all the relevant articles I 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. “Staggered IVF”

      5.“Embryo Banking”

      6.“Array CGH versus metaphase CGH in IVF patients….’

      7.“Egg Donation”

      Consider calling 800-780-7437 or 702-699-7437 to arrange a Skype consultation with me so we can discuss your case in detail.

      Finally, perhaps you would be interested in accessing my new book (just released). It is the 4th edition (and a re-write) of “In Vitro Fertilization, the ART of Making Babies”. The book is available through “Amazon.com” as a down-load or in book form. It can also be obtained from most bookstores.

      Geoff Sher

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