The ‘freeze-all’ approach to IVF: Increasing the likelihood of pregnancy in older women

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Goral Gandhi, Dr Eric A. Widra, some of the leading experts in reproductive healthcare talk about the new “freeze-all approach” in IVF and how is it different.

No matter what the age, every woman wishes to become a mother at some point in her life. Trying to achieve pregnancy at later life stages might be due to multiple factors, but you are certainly not alone. With the internet filled with success stories about how IVF has helped women in their 30s and 40s become mothers, the utility of the treatment cannot be undermined.

Due to favorable, but often incomplete information about the advanced maternal age, many women believe that there are a few biological contraindications to delaying childbearing. Others delay conception to pursue their goals, unaware that their fertility potential will diminish over time. The relationship between maternal age and fertility is often talked about, but are there risks that potential older mothers should be aware of? Miscarriages and birth defects in the children are main risks, says Dr Goral Gandhi, a notable embryologist who has also contributed majorly in clinical research of IVF and ART.

Talking about the complication and associated risks that come with conceiving at an older age, Dr Goral Gandhi gave us an insight into a novel approach known as the new ‘freeze-all’ approach.

“The benefits of Freeze All strategy are clear. It gives higher success rates than conventional IVF. The increased pregnancy rates in these cycles are due to several factors. First, in stimulated IVF cycles, the endometrial lining is slightly out of phase with the embryo development. Secondly,  the ovaries in these cycles are hyperstimulated and are at an increased risk for ovarian hyperstimulation syndrome (OHSS) should a pregnancy result from the fresh transfer. Freeze-All approach eliminates all this.

Most importantly, for older women, who are at a higher risk of creating chromosomally abnormal embryos, Freeze-All approach enables us embryologists to take a biopsy of few cells form the blastocysts and perform pre-implantation genetic testing on them. Only euploid or chromosomally normal embryos are then transferred back, ” she says.

The ‘freeze-all’ strategy has emerged as a viable alternative to fresh embryo transfer (ET) during in vitro fertilization (IVF) cycles. The process involves the entire set of embryos (and not just cherry-picking the best) transferred in a posterior cycle with a more physiologic endometrium.

Being an effective alternative, the ‘freeze-all’ strategy is, however, not designed for all IVF patients. One of the study’s clinical investigators, Dr Eric A. Widra from Shady Grove Fertility in Washington DC, USA, emphasized that the interest in a ‘freeze-all’ approach to IVF is growing, but not with broad application. “There are several reasons clinics do freeze-all cycles,” he said. “These include patients at high risk for OHSS, patients having a preimplantation genetic diagnosis before embryo transfer, and importantly, those patients who have a premature rise in the concentration of progesterone hormone prior to egg retrieval. Several studies have shown that this rise in progesterone is associated with a lower pregnancy rate after fresh embryo transfer,” added Dr Widra.

The approach seems to be optimal for planning conception from physical and social standpoints. For women of advanced maternal age undergoing in vitro fertilization, this new approach promises to increase the likelihood of a successful IVF cycle.

Last modified: September 30, 2019

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