IVF protocol

Which IVF protocol is best - Agonist or antagonist?

Dr Gleicher, from the Center for Human Reproduction in New York, presented findings at the COGI 2011 infertility research conference suggesting that in his experience, there is no difference between the live birth rates for the two protocols in “normal responders” (women who produce a good number of eggs during the stimulation). In his opinion, given that the antagonist approach doesn’t lead to a lower success rate, and that it is a safer protocol, it should be the first point of call.

Some debate took place, and the main reason to choose the agonist protocol is the ability to plan better, which is helpful if the clinic is small and closed on the weekend for example.

What is the optimal number of embryos for IVF?

Dr Garrido presented the results from the IVF clinic in Valencia for both women using donor eggs and women using their own eggs. They found that for a woman using her own eggs, who is younger than 40 years old, the optimum number of embryos is 25. After this number, there is almost no increase in chance of pregnancy success. If the woman is over 40, the optimum number of embryos is 10.

When a woman is using donor eggs, the results are slightly different. She will reach her maximum chance of pregnancy using 15 embryos.

He quoted another important statistic; if a woman produces 30 eggs through (in several cycles) IVF, then she has a 72% chance of having a baby.

It is important to know that the aim is not to get that many embryos from one cycle; this would be unrealistic and dangerous for the patient. A good cycle would yield 15 eggs for a young woman.

Dr Garrido reminded colleagues of the known negative effect of hormonal stimulation to the embryo and the dramatic consequences of OHSS (Ovarian hyperstimulation syndrome), which rarely result in death of the patient. And finally he warned the audience of the negative effect of COS (controlled ovarian stimulation) on the chromosomal content of the egg. This is clearly highlighted by a new technology used in some clinics: CGH array