IVF Outcome Comparisons Between Fresh Embryo Transfers and Embryo Banking Cycles With Subsequent Thawed Transfers Vary Between Good-, Intermediate- and Poor-prognosis Patients

Never investigated before in poor prognosis patients, we here determined how in vitro fertilization (IVF) outcomes after fresh embryo transfers compare to frozen-thawed transfers after embryo banking. Using data from our center’s anonymized electronic research data bank, we in a retrospective controlled observational study investigated IVF cycle outcomes of poor-prognosis infertility patients, utilizing autologous eggs, while utilizing donor-egg recipient cycles as controls for covariables. To accomplish statistically valid comparisons, 4 different pairings of 1st IVF cycles were utilized: (i) 127 fresh vs. 193 frozen donor recipient cycles; (ii) 741 autologous fresh unselected non-donor IVF cycles vs. 217 autologous frozen non-donor IVF cycles; (iii) 143 favorably selected autologous non-donor IVF cycles vs. the same 217 frozen autologous cycles non-donor; and (iv) 598 selected average and poor-prognosis autologous non-donor cycles vs. the same 217 frozen autologous non-donor cycles. Main outcome measures were pregnancies and live births. Even within poor-prognosis patients, patient selection to significant degrees impacted how fresh and frozen-thawed IVF cycles compared. Though embryo banking with delayed embryo transfer in best-prognosis patients marginally improved IVF outcomes, in unselected patients it had no effect on outcomes, while in poor-prognosis patients it adversely affected IVF outcomes. Unexpectedly, the study also discovered a previously unreported effect of recipient-age on miscarriage risk in donor-egg recipient cycles, which apparently is independent of age-associated increases in chromosomal abnormalities and, therefore, must have other causes. This study suggests that in poor-prognosis patient banking cycles should be considered contraindicated, in intermediate-prognosis patients they do not appear to change outcomes and, therefore, do not warrant additional costs from thaw cycles, leaving only good-prognosis patients as potential candidates for such a strategy.

Case reports for embryo banking: for women who want their own

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".