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Pooled IVF with PGS

Pooled IVF refers to doing 2 or more ovarian stimulations with egg retrieval, ICSI, and early embryo cryopreservation. By banking cryopreserved embryos from more than one IVF stimulation cycle we have enough to biopsy and perform pre-implantation genetic screening (PGS) which identifies healthy chromosomally normal (i.e. euploid) embryos. It is less expensive than doing 2 or 3 separate IVF procedures with PGS, and reduces the risk of having all abnormal (i.e., aneuploid) embryos on a given cycle, especially with older patients.

The number of chromosomally abnormal embryos increases with age.  It is higher than many people expect.  The data below shows the remarkable percentage of chromosomally abnormal embryos that look ‘good’ and are suitable for embryo transfer or cryopreservation yet may never result in an ongoing pregnancy or may result in a pregnancy that might miscarry if they are aneuploid.
 

Approximate Aneupolidy Rates for Embryos biopsied on day 3 and day 5
Day 3 Biopsy Results:
Age Group % Eupoloid (normal) % Aneuploid (abnormal)
    <30 40 60
30 - 34 35 65
35 - 40 25 75
    <40 10 90
Day 5 Biopsy Results:
Age Group % Eupoloid (normal) % Aneuploid (abnormal)
    <30 70 30
30 - 34 65 35
35 - 40 50 50
    <40 30 70

With day 3 embryo transfers only 25% of embryos in women between 35 and 40 years of age are normal and in women >40 years only 10% are normal. It is no wonder that so many patients do not get pregnant >40 years of age. When we do day 5 embryo transfers, the healthier and more chromosomally normal embryos self-select out, so we see 50% normal in the 35-40 year old age group and 30 % in the > 40 year old group. Still, most embryos are abnormal in the older age group.

As you can see, pooling the cycles increases the chance to have normal embryos for transfer. How many times have we had patients with ‘beautiful embryos’ not get pregnant? There is no doubt that many were chromosomally abnormal. In patients with multiple IVF failures, we often try and evaluate factors related to recurrent pregnancy loss, yet many of the embryos may have chromosome abnormalities that result in failed cycles. What if they are all abnormal? Try another stimulation protocol? Consider egg donation?

Cost

The average cost of an IVF cycle in the US with PGS is more than $17,000. Two cycles could easily cost more than $35,000 and three more than $50,000. By pooling the cycles, we can reduce the cost substantially by basically doing a single culture of the fertilized eggs followed by biopsy of all acceptable embryos and transferring on a frozen embryo transfer cycle, which may have better implantation rates regardless.

The information below shows potentially how this could be more cost effective than simply doing cycle after cycle. We have significantly discounted the fee for the egg retrieval and facility to $1500 per procedure. The cost will vary somewhat as stimulation protocol medication cost with blood work and ultrasounds may vary from patient to patient. Also, some patients may have insurance coverage for all or part of the procedure.

  1 cycle 2 cycle
Meds 2500 5000
US/BW 1800 3600
Ret/Facility 1500 3000
Anes 560 1120
ICSI 850 1700
Freeze 600 1200
   Total 7810 15620

 

Thaw and culture cycle:
Thaw/FET 1850
Meds/US 700
Emb Bx 1500
PGS lab 1950
   Total 6000

We feel that for certain patients, pooled IVF may be a cost effective way to conceive and eliminate the heartbreak of multiple failed IVF failures with out explanation. The day 5 trophectoderm biopsy is safer for the embryo as it removes only future placental cells, not the inner cell mass of the embryo, that becomes the future baby. Studies show improved pregnancy rates with the day 5 biopsy.

Please feel free to email us with any questions at: jdonahuemd@ivf-indiana.com

 

 

 

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