- Age and Fertility
- CDC Report on Fertility Clinic IVF Success Rates
- Chromosomal Abnormalities in Eggs
- Donor Eggs
- Egg Banking
- Egg Donation
- Egg Donation Cost
- Egg Freezing
- Egg quality
- Embryo freezing
- Embryo implantation
- Fertility Preservation
- Frozen embryo transfer
- IVF Clinic Success Rates
- IVF Cost
- IVF Poor Responders
- IVF success rates
- Low ovarian reserve
- Micro IVF
- Mild IVF
- Mini IVF
- Minimal Stimulation IVF
- Number of IVF Embryos to Transfer
- Oocyte Cryopreservation
- Ovarian Reserve
- Ovarian Reserve Tests
- Preimplantation Genetic Screening
- Single Embryo Transfer
Fertility, IVF and Egg Donation
The Advanced Fertility Center of Chicago is now offering 2 low cost fertility screening packages. These fertility screening tests will allow couples to have important information about their fertility reserve for the future.
- In women these tests measure egg supply for the future, also called “ovarian reserve”
- Ovarian reserve testing is done to estimate the status of the current egg supply
- In men a semen analysis is done to evaluate the sperm
|Partner||Basic Fertility Screening for $90||Fertility Screening including AMH for $110|
|Female||Day 3 FSH||Day 3 FSH|
|Female||Day 3 Estradiol||Day 3 Estradiol|
|Female||Transvaginal ultrasound for antral follicle counts||Transvaginal ultrasound for antral follicle counts|
|Male||Semen analysis||Semen analysis|
Basic Fertility Screening Package
The basic fertility screening package includes two blood tests and a transvaginal ultrasound on the female partner and a semen analysis on the male. The blood tests include day 3 FSH (follicle stimulating hormone) and estradiol hormone levels. These blood tests give us some indication as to whether there could be a low remaining egg supply.
The ultrasound test counts the antral follicles in the ovaries (2-9mm cystic structures) as another gauge of the woman’s ovarian reserve. The total cost for the basic fertility screening package is $90.
Comprehensive Fertility Screening Package
Our more comprehensive fertility screening package includes all of the tests from the basic screening package and adds an anti-mullerian hormone (AMH) blood test. See table above.
AMH levels give us another way to estimate a woman’s ovarian reserve The total cost of the comprehensive fertility screening package is $110. The cost of either one of our fertility screening packages will be credited back toward fertility treatment done in the future at any of our 3 Chicago area offices.
Testing for causes of infertility
It is important to understand that these fertility screening tests do not investigate all of the causes of infertility in men or women. The tests in our fertility screening packages look at egg supply and at the sperm situation which are only two of the many possible reasons for having difficulties conceiving.
A full workup for infertility is indicated in couples after 12 months of trying to get pregnant when the female is under age 35, and after 6 months of trying when she is 35 or older. We also perform full infertility workups as well as fertility treatments such as intrauterine insemination and in vitro fertilization.
Women are delaying childbearing more and more over time
Over the past several decades many women have been waiting progressively longer to start trying to have a family. In the 1960’s and 1970’s it was very uncommon for a woman to have her first child after the age of 30. Obviously, this is now common and many women are waiting until the late 30’s or even early 40’s until they try to get pregnant with the first child.
As women delay their childbearing longer, fertility screening for ovarian reserve becomes more important because it allows a woman to have some knowledge about her remaining egg supply.
A woman’s egg supply declines throughout her lifetime from birth. By the time of menopause there are no eggs left. In general, egg supply is related to a woman’s age. However, there is a lot of variation around the average and some women will lose their eggs faster and have an early menopause (and early loss of fertility) while other women will lose their eggs at a slower rate and have a later than average age of menopause.
A woman’s fertility potential declines many years before she reaches menopause. This is because the quality of the eggs declines significantly with aging – particularly after about age 35 to 37. We do not currently have a good test for a woman’s egg quality. At this time, female age is the best predictor of egg quality that we have.
As more women put off their childbearing until their later reproductive years, some will decide to freeze eggs to try to preserve their fertility. This is becoming much more common in recent years. If low ovarian reserve is found on a fertility screening test, fertility preservation could be a smart option for her to consider if she is not ready to have a child soon.
Summary: Our low cost fertility screening panels
We perform two different low cost fertility screening panels at all 3 of our Chicago area offices. If you are interested in having this testing, please call one of our offices to schedule a visit. The testing requires one visit to the office for the woman and one for the male. The results will be mailed to you approximately 7-10 days after the tests are completed. The cost of either fertility screening package will be credited back toward fertility treatments done in the future at our offices.
Fertility treatment fads and the internet
I’ve been in this field for 20 years and have seen fads come and go. The information exchange and communication between patients and doctors that the internet provides sometimes fosters proliferation of fads driven by rumors – rather than by science.
When I started practicing medicine in the early 1990’s, infertility patients came to the doctor and expected to be told what to do. They wanted some fertility tests done to find the cause for their infertility and then they wanted either intrauterine insemination treatment or in vitro fertilization, IVF to have their baby. There was no internet so couples could not research medical information on their own.
As the internet evolved, couples got more involved in deciding specifics of their infertility care. Most couples now use the internet to educate themselves about fertility testing and treatment options. I think this is great. However, there is a potential downside. It is difficult to separate the wheat from the chaff. There are many worthless tests and treatments promoted and sold on the internet to anyone with a credit card.
When a study comes out and is published in the medical literature regarding a treatment option that might be beneficial the physicians will learn about the new option if it is potentially viable. Then, additional studies will be done to confirm or refute the results from the initial study. Doctors are used to the fact that one study showing a potential benefit from a new treatment option might not stand the test of time and be supported by additional studies done in other clinics.
However, in our news hungry world a study comes out reporting an interesting potential benefit for a new treatment – someone does a press release and it’s picked up on a news wire. Before long, women are discussing it in the infertility forums and on Facebook and in chat rooms as the new treatment option that everybody should be doing.
Coenzyme Q10 and fertility
I want to discuss coenzyme Q10, which is one of the “treatments” that patients are using on their own (often without input from their doctors) in an effort to improve their fertility potential or to increase chances for IVF success. Coenzyme Q10, often referred to as “Co Q10” is a substance that is needed for basic functioning of cells. It is a source of fuel for the mitochondria – which are organelles inside cells that are “power plants” that convert energy for the cell to use.
Interest in coenzyme Q10 as a supplement to improve fertility was sparked when a report from Canada said fertility in mice was improved when the mice were given Co Q10. The mice that were given coenzyme Q 10 before they were given ovarian stimulation made more follicles and better eggs compared to mice that were not given Co Q10. According to the researchers, the Co Q10 seemed to cause the older mice to produce eggs that functioned more like eggs from younger mice.
This study suggests the possibility of a fertility benefit for women with low ovarian reserve. As far as I know, this mouse study has not been repeated and there are not yet published studies of Co Q10 in women having fertility treatments.
Coenzyme Q-10 and egg quality
We all know the chances for pregnancy decline as female age increases after about 30 years old. We know that the decline has a number of causes, but the main problem is a decline in “egg quality”. Egg quality is an important concept involving several critical factors – none of which we can test or measure. One major component of egg quality involves the chromosomal status of the egg. Eggs from older women are more likely to be chromosomally abnormal than eggs from young women.
The human egg is a very large cell. It can be thought of as a big factory with half of the chromosomal complement of a normal human that is sitting and waiting for a sperm to deliver a very small package containing 23 chromosomes (the other half). When a sperm penetrates an egg and releases its package of 23 chromosomes, the switch to the “egg factory” is turned on and embryo development begins.
The process of firing up the factory and starting normal embryo development requires a lot of energy. Mitochondria are very tiny organelles within cells that generate a lot of the energy that cells need. Human eggs have more mitochondria and mitochondrial DNA than any other cell in the body.
What does any of that have to do with egg quality and fertility?
One theory speculates that part of the problem in older eggs is their decreased mitochondrial energy production. Taking that concept a step further, perhaps eggs could function more effectively and efficiently if something could be done to increase the number or health of the mitochondria in the eggs. Maybe the egg could do a better job of maintaining chromosomal normalcy if it had enough energy reserves.
From this came the logic that using dietary supplements of “mitochondrial nutrients” might improve egg quality.
What is coenzyme Q10?
Coenzyme Q 10, which is also known as ubiquinone, is a vitamin-like substance that is present in most cells. It is an antioxidant (meaning it inhibits the oxidation of other molecules). Sometimes, oxidation reactions produce free radicals which can start chain reactions in cells resulting in damage or cell death. So antioxidants can be good when they terminate the chain reactions before there is damage to the cell.
It is not considered a vitamin because all normal tissues in the body make their own CoQ10 so it does not need to be supplied in the diet. It is mainly present in the mitochondria and is a component of the electron transport chain that is involved in generating energy within cells in the form of ATP. The vast majority of the human body’s energy is produced in this way. Therefore, the high Co Q10 concentrations are found in cells with high energy requirements – heart, liver, kidney, etc.
It has been estimated that the average daily intake of Co Q10 is about 3 to 6 mg per day, which mostly comes from meat consumption. The recommended dosage of Co Q10 supplementation varies greatly. The suggested dose is usually between 50 to 600 mg daily in divided doses.
There is controversy as to what the best dose of CoQ10 is for various medical conditions. It is often given at a dose between 100 mg and 300 mg per day. There is some evidence from studies that is safe at a dose of up to (at least) 1200 mg per day.
Should women with fertility problems take Co Q10?
Physicians are trained to practice evidence-based medicine. What that means is that we want well-controlled studies supporting that a treatment is beneficial before we recommend it. In the case of coenzyme Q 10 we can’t justify its use for improving fertility in women based on existing evidence.
On the other hand, there’s no evidence that there is harm from using Co Q10 and it is unlikely that there would be harm since this enzyme is present in every cell in the body and is produced within cells regardless of whether it is present in the diet or not.
So women have read about it and have taken CoQ10 with the idea that they will produce more eggs with ovarian stimulation for IVF and their eggs will get better and perform like younger eggs.
- Even if it doesn’t help, it’s unlikely to hurt – and CoQ10 is not expensive
- Most fertility doctors (including me) are fine with their patients taking Co Q10 if they want to
- Hopefully, a carefully controlled study will be done and published in the medical literature so we will understand more about any potential benefit of Co Q10 for women with fertility problems.
Egg donation has been utilized to help infertile couples since the early 1980s. Donor egg IVF utilization has continued increasing as more couples delay childbearing until their late 30s and 40s. In the United States in 2009 there were over 15,000 cycles using fresh donor eggs reported to SART (Society for Assisted Reproductive Technologies) from their member clinics. Links to the SART and CDC IVF and donor egg success rate reports
Until the last few years all donor eggs cycles were done with fresh eggs retrieved and fertilized the same day with the male partner’s sperm. Over the years egg donation using fresh eggs has become highly successful at some fertility clinics in the US.
Live birth rates with fresh donor eggs are over 70% per fresh transfer procedure at the best egg donation clinics. Success rates at these same donor egg programs using fresh eggs are over 50% for live birth per transfer using a single embryo for transfer. This approach almost totally eliminates the risk for multiple pregnancy.
In recent years the techniques for freezing and thawing eggs have advanced significantly. As a result of these advances, success rates at some frozen donor egg banks has increased from about 10% success in the past to approximately 50% – at least this is what they claim.
Accordingly, business models have developed for frozen donor egg banks. Egg banks sell frozen donor eggs on a per batch or per egg basis. This can make the cost of using frozen eggs seem to be less than the cost of egg donation with fresh eggs. However, there are some significant problems with this approach.
- Uncertain and relatively low success rates – with low success rates the cost per baby is actually higher
- Uncertainty about long-term health issues for the children born from frozen eggs
What are the issues with freezing eggs to preserve fertility?
Can you freeze eggs in an attempt to preserve fertility for a future pregnancy?
- Yes, egg freezing (oocyte cryopreservation) is being done – some women freeze eggs to try to reduce the impact of aging on fertility
- Success rates for IVF with fresh eggs are high in young women
- Success rates for IVF using frozen eggs are generally much lower – but are improving. This technology is rapidly evolving.
There is currently controversy about:
- Who should be offered egg freezing?
- What should women of different ages be told about their chances for having a baby with frozen eggs?
- Are women who freeze eggs well informed about the chances to have a baby in the future with their frozen eggs?
What do recent studies show regarding pregnancy success rates using frozen eggs?
Egg freezing is relatively new
- IVF with fresh eggs has reportedly resulted in the birth of about 3 million babies worldwide
- IVF with frozen eggs has resulted in the birth of about 2000 babies worldwide
- Studies continue to investigate whether the older “slow freezing” technology or the newer method of “vitrifying” eggs will be better
- Studies from the 1990’s to early 2000’s showed pregnancy success rates with frozen eggs of about 2% to 10% (live birth rate per embryo transfer cycle).
- A recent study from an Italian group found similar fertilization and embryo development rates of vitrified versus fresh eggs. Vitrification is a relatively new freezing method.
- This study involved 40 cycles in women (average age 35.5)
- The ongoing pregnancy rate (beyond 12 weeks of pregnancy) with vitrified eggs was 30% per cycle.
- This is a good rate since only 3 eggs can be inseminated under Italian law.
- Study by L Rienzi, et al, Human Reproduction; January 2010
- A 2009 study of 23 IVF cycles using frozen eggs (average age 31.5)
- There were 14 pregnancies, 1 miscarriage and 13 ongoing pregnancies (57% per transfer)
- Study by J Grifo and N Noyes, Fertility and Sterility; May 2009
- There were 14 pregnancies, 1 miscarriage and 13 ongoing pregnancies (57% per transfer)
- A large multicenter Italian study compared IVF using fresh vs. frozen eggs
- Italian IVF clinics tend to have lower success rates because only 3 eggs can be inseminated per cycle (by law)
- They compared 2209 cycles with fresh eggs to 940 cycles with frozen eggs
- The success rate was halved using frozen instead of fresh eggs
- 748 thawing cycles in women less than 39 years old (average age 33.6)
- Live birth rate per transfer with frozen eggs was 13.3% (age < 39)
- 192 thawing cycles in women 39 and older (average age 40.5)
- Live birth rate per transfer with frozen eggs was 8.1% (age 39+)
- Study by A Borini et al, Fertility and Sterility; January 2010
Our society has undergone significant change since the 1960s. Women’s liberation is definitely a good thing. Women can now do pretty much anything that a man can do. However, the one thing that they cannot do is delay childbearing as long as a man can.
Our society has evolved and many women are pursuing advanced educations and career advancement – and delaying childbearing as a result. However, in general women should be more knowledgeable about the impact of delaying childbearing on fertility potential.
Fertility specialists know this is a problem. We commonly see women in their late 30s and early 40s that are very bright and well-educated who are surprised and very disappointed when told that it may be very difficult (or impossible) to get pregnant and have a baby using their own eggs.
I like to use a “garden” analogy when discussing infertility with patients. The uterine lining is the “garden” and the embryos are the “plants”. As women age, the garden is rarely the problem – the plant is often the problem. This is why using donor eggs is so successful regardless of the age of the recipient woman. (continue reading…)
Welcome to the
Richard Sherbahn, MD is a Board Certified Reproductive Endocrinology and Infertility specialist.
Dr. Sherbahn founded the Advanced Fertility Center of Chicago in 1997.
He will post regularly about fertility issues.
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