To use frozen eggs or continue naturally @ 43 years old? In a pickle!

[flipflop256]

Hi!
Me and my partner are trying for our second child. I am 43, with first child born 18 months ago. Despite my age, I seem able to get pregnant quite quickly (have fallen pregnant twice since first child born), however both pregnancies resulted in early miscarriage (@ less than 6 weeks). I also had 2 early miscarriages before our first child was born.

I have 28 eggs in storage that were frozen 2.5 years ago. I'm unsure whether we should continue trying naturally or now use these.

Considerations:

• Frozen eggs will be younger (but only by a bit) which may reduce early miscarriage risk versus continuing to try naturally
• I understand that with screening they can "pick" the best embryos for transplantation which could reduce miscarriage risk (but I'm also aware that the act of freezing/defrosting damages eggs which could counteract this)
• I understand that your ability to carry a child in the womb does not decline until you hit about 45 so maybe we are best continually naturally for another year or so and then using the eggs
• Financial cost is not a massive consideration for us - priority is having a second child. At the same time if we could stick with a natural approach and avoid the cost of implantation, I would prefer this
• I am pretty fit and healthy

I am very grateful for any thoughts from people who know more about this than me. Thankyou

I would make an appointment with an IVF doctor and discuss the pros and cons. Then you can make your decision based on accurate information.

What does your doctor say? At 43, I would be doing whatever gives you the best chance of conceiving, so I would use the frozen eggs.

Definitely get expert opinion. Was your first child conceived naturally? Do you have any frozen embryos or just eggs?

Thankyou for the replies. The first child was conceived naturally. Its frozen eggs that I have, not embryos.

When I ask the doctors they dont really give me numbers - they just give vague answers. And obviously all these private providers are incentivised for me to try with them. So I'm unsure what to do. I feel like every month counts but that natural is best if possible.

I'd keep trying naturally until it isn't working for you, or tests show low egg reserves, then move to the frozen eggs. I would even consider normal IVF with embryo screening before resorting to frozen.

The difference of 2.5yrs in terms of egg quality will be less than the drop in success from fresh eggs to frozen.

The odds are better according to the HFEA figures with your frozen embryos than with a fresh round of IVf. Although, you are, of course, not comparing this - you are comparing natural conception with defrosting eggs, not embryos. But it's the closest decent statistical comparison I could muster! I'm not sure it's all that helpful.

How long have you been ttc the second child? Successful conception leading to live births really falls off a statistical cliff at 43, so I wouldn't give natural conception much time at all if it were me. I'd get on with IVF with fresh or frozen eggs. I'd be a bit wary of losing loads of eggs to any sort of genetic testing - it's a waste of money and eggs potentially.

And I'm not sure many drs have as good a grasp of statistics as you would hope!

Given your miscarriage history I would get tests run now by Dr Gorgy or Dr Shehata to check you don’t have obvious immune issues. They may be able to give you some treatment that would improve your chances of keeping a spontaneous pregnancy.

If that all comes back okay, I’d probably bank on 2-3 rounds of fertilisation with your frozen eggs (to avoid a one off “bad sperm day”) and I would lean towards PGT-A testing, again because of your miscarriage history. If you go down this route get your husband checked as well for DNA fragmentation and have him on a good supplement for a few months first.

40 year old eggs are precious when you’re 43 so I’d lay some groundwork first before using them. Successful own egg IVF with 43 year old eggs is possible but mostly unsuccessful (around 5% per round)

I know people swear by these immune drs but there isn't a good evidence base for these interventions - although there is for blood clotting issues, which might be worth treating for regardless (that's what ARGC used to do).

I'd do frozen eggs.

Thankyou all. After the first 2 miscarriages I had tests to investigate if there were any blood clotting or immune issues and all came back negative. We have been trying to conceive the second child for about a year, since my periods came back at 6 months after birth. The challenge we have at the moment is that my periods are still irregular, probably because I am still breastfeeding.

That is really useful advice @Porridgeislife re not doing all the fertilisation at once to avoid a "bad sperm day". It makes complete sense although one IVF provider had actually advised me to defrost all eggs at once (I'm unsure of their reasoning).

It sounds like the evidence is a bit mixed on embryo testing. I know testing can also damage embryos. Grateful for any further insights here.

I am down to 2 breastfeeds a day with first child but trying to wean completely is challenging (she loves boob!). I'm unsure how important this is from the perspective of conceiving. One doctor did tell me that high levels of prolactin can reduce chances of pregnancy embedding but I'm unsure if this is properly evidence based. (If my periods are back, I am ovulating. However, it is true that irregular periods are making conceiving naturally more complicated because of difficulties in predicting ovulation date).

Have you had recent AMH, AFC and FSH testing? These will give you an idea of your current ovarian reserve. Although quality declines fast on average over 40, if you have a higher reserve there's a greater chance of ending up with an egg that's normal.

The average number of eggs that might be ok at 43 is around 10-15%. This manifests as either non fertilisation in the first place or recurrent miscarriage. However, the percentage of chromosomal abnormality by age is not standard across everyone, there is variability - ie. for some people most of their eggs will be kaput by 38. Others may still have some normal ones at 45+. Your successful pregnancy 18 months ago, albeit after 2 miscarriages, probably puts your fertility as above average.

If money is no object you could get a fast sense of your quality level now by doing a round of IVF with fresh embryo genetic testing. It might also be worth seeing how many of your frozen eggs fertilise and develop into blastocysts before making a decision. If you also test them, the c.5% that get damaged are likely to have not been robust enough anyway.

I think at 43 it's all about maximising your chances. So anything that might even marginally increase or decrease your chances of conceiving I'd pay attention to (e.g. stopping breastfeeding, no alcohol etc). It may not make a difference but it might.

Was there a reason you didn't freeze embryos? I don't know anyone who has gone down the frozen egg rather than embryo route so I'm afraid I'm ignorant as to the challenges.

Thankyou! Yes, I did an AMH test a few years and the number was very high (I can't remember exactly) but I also got 28 eggs through one round of extraction (aged 40) so I think my number of eggs is high for my age.

@flipflop256 hello, could I ask how you are getting on and what you decided to do? I am in a similar situation. I’m 43, have a child 18 months old (natural conception) and been trying for 9 months for a second (one miscarriage and one chemical in this time). I have 9 frozen eggs from when I was age 37 so wondering when to start trying with these.

Thanks

Hi! We had another miscarriage (at 9 weeks this time so was more disappointing) so we are now going to move ahead with the frozen eggs. Actually had an Appointment yesterday to kick start things. We will do the PGTA analysis. I think your eggs being 6 Years younger could make quite a difference. Let me know how you get on!

@flipflop256 thanks for replying so quickly, and I’m sorry to hear you had another miscarriage. I am thinking we will try for a few months then look to progress with frozen eggs as well. Will let you know how it goes.
Best of luck with your frozen eggs, I hope you
are successful. One question about the frozen eggs I had which I couldn’t find the answer to online. Do you just defrost a few and fertilise them, or can you defrost them all to be fertilised and then re freeze some as embryos?

This is actually one question I have outstanding as someone said on here you can have "bad sperm days" in which case makes sense not to use all at once. But if that's not the case i think i would just defrost all at once and refreeze the good embyos

@flipflop256 ah ok thanks, I will ask about that too!