Case reports for embryo banking: for women who want their own
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20193072Keywords:
Embryo banking, Gamete donation, In-vitro fertilization, Oocyte accumulation, Ovum donation, own, Poor/low ovarian reserve, Preimplantation genetic screening, Ray of hope, VitrificationAbstract
Out of the many challenges in management of female factor infertility, poor responders and low response to stimulation in aged and even younger women, seems to be a common problem. It is very difficult to offer one particular management strategy or treatment protocol for optimum outcome in this group of women of poor responders. In a low resource set up, IVF (In vitro Fertilization) specialist doctors usually face a challenge in treating women with poor/ low ovarian reserve as ovum / gamete donation is considered as a taboo in various sections of society even today. Hence women insist on having an offspring of "their own" and vehemently deny ovum / gamete donations. In this article we discuss 2 cases of poor ovarian reserve retrospectively, who underwent multiple cycles of controlled ovarian hyperstimulation for embryo banking and ultimately achieved pregnancy. Both patients achieved pregnancy with the method of embryo banking. Embryo banking should be considered and discussed. Various articles have discussed the advantages and disadvantages of embryo banking or even oocytes accumulation. The advantages of this technique is patients with poor/low ovarian reserve get a chance to be pregnant with their own oocytes and also have a chance for vitrification of residual embryos. Another advantage in such patients is that the embryos can undergo PGS (Preimplantation Genetic Screening) techniques in cases of suspected genetic disorders. The disadvantage in a low resource set up like India is the cost of the treatment. Nevertheless, embryo banking and accumulation of oocytes should be given as an option for treatment of poor/ low ovarian reserve and could be considered as a ray of hope for all future mothers hoping for a child of "their own".
References
Sadeghi MR. Oocytes/Embryos Banking: a vague hope for poor responder women. J Reprod Infertil. 2018;19(3):123-4.
Papathanasiou A, Searle BJ, King NM, Bhattacharya S. Trends in ‘poor responder’research: lessons learned from RCTs in assisted conception. Hum Reprod Update. 2016;22(3):306-19.
Drakakis P, Loutradis D, Kallianidis K, Liapi A, Milingos S, Makrigiannakis A, et al. Small doses of LH activity are needed early in ovarian stimulation for better quality oocytes in IVF-ET. Eur J Obstet Gynecol Reprod Biol. 2005;121(1):77-80.
Ferraretti AP, Gianaroli L, Magli MC, D'angelo A, Farfalli V, Montanaro N. Exogenous luteinizing hormone in controlled ovarian hyperstimulation for assisted reproduction techniques. Fertil Steril. 2004;82(6):1521-6.
Bosdou JK, Venetis CA, Kolibianakis EM, Toulis KA, Goulis DG, Zepiridis L, et al. The use of androgens or androgen-modulating agents in poor responders undergoing in vitro fertilization: a systematic review and meta-analysis. Hum Reprod Update. 2012;18(2):127-45.
Ng EH, Lau EY, Yeung WS, Ho PC. HMG is as good as recombinant human FSH in terms of oocyte and embryo quality: a prospective randomized trial. Hum Reprod. 2001;16(2):319-25.
Westergaard LG, Erb K, Laursen SB, Rex S, Rasmussen PE. Human menopausal gonadotropin versus recombinant follicle-stimulating hormone in normogonadotropic women down-regulated with a gonadotropin-releasing hormone agonist who were undergoing in vitro fertilization and intracytoplasmic sperm injection: a prospective randomized study. Fertil Steril. 2001;76(3):543-9.
Gordon UD, Harrison RF, Fawzy M, Hennelly B, Gordon AC. A randomized prospective assessor-blind evaluation of luteinizing hormone dosage and in vitro fertilization outcome. Fertil Steril. 2001;75(2):324-31.
De Placido G, Mollo A, Alviggi C, Strina I, Varricchio MT, Ranieri A, et al. Rescue of IVF cycles by HMG in pituitary down-regulated normogonadotrophic young women characterized by a poor initial response to recombinant FSH. Hum Reprod. 2001;16(9):1875-9.
Eskandar M, Jaroudi K, Jambi A, Archibong EI, Coskun S, Sobande AA. Is recombinant follicle-stimulating hormone more effective in IVF poor responders than human menopausal gonadotrophins?. Med Sci Monitor. 2004;10(1):PI6-9.
Gougeon A. Regulation of ovarian follicular development in primates: facts and hypotheses. Endocrine Rev. 1996;17(2):121-55.
Rombauts L, Suikkari AM, MacLachlan V, Trounson AO, Healy DL. Recruitment of follicles by recombinant human follicle-stimulating hormone commencing in the luteal phase of the ovarian cycle. Fertil Steril. 1998 Apr 1;69(4):665-9.
Kwon H, Choi DH, Kim EK, Kim EH, Lee SE. Accumulation of Vitrified Embryos Followed by Frozen Embryo Transfer in Poor Ovarian Responders According to Bologna Criteria. Gynecol Obstet (Sunnyvale). 2015;5(10):1000331.
Cobo A, Garrido N, Crespo J, José R, Pellicer A. Accumulation of oocytes: a new strategy for managing low-responder patients. Reprod Biomed Online. 2012;24(4):424-32.
Schoolcraft WB, Surrey ES, Minjarez DA, Stevens JM, Gardner DK. Management of poor responders: can outcomes be improved with a novel gonadotropin-releasing hormone antagonist/letrozole protocol?. Fertil Sterility. 2008;89(1):151-6.
Surrey ES, Schoolcraft WB. Evaluating strategies for improving ovarian response of the poor responder undergoing assisted reproductive techniques. Fertil Steril. 2000;73(4):667-76.
Cedars MI. Assisted reproductive technology: moving forward or just moving?. Fertil Steril. 2016;105(3):588-9.
Pierson RA, Ginther OJ. Ultrasonographic appearance of the bovine uterus during the estrous cycle. J Am Vet Med Assoc. 1987;190(8):995-1001.
Ubaldi FM, Capalbo A, Vaiarelli A, Cimadomo D, Colamaria S, Alviggi C, et al. Follicular versus luteal phase ovarian stimulation during the same menstrual cycle (DuoStim) in a reduced ovarian reserve population results in a similar euploid blastocyst formation rate: new insight in ovarian reserve exploitation. Fertility and sterility. 2016;105(6):1488-95.
Kawamura K, Cheng Y, Suzuki N, Deguchi M, Sato Y, Takae S, et al. Hippo signaling disruption and Akt stimulation of ovarian follicles for infertility treatment. Proc Natl Acad Sci USA. 2013;110(43):17474-9.