Low AMH, implantation failure & miscarriage – the latest advances in treatment and support
Can ovarian rejuvenation treatment help?
The answer is – quite possibly.
Watch our expert webinar session with Dr Uliana Dorofeyeva, IVF Specialist at the world-leading International Fertility Group (IFG).
Supporting low AMH, implantation failure and miscarriage
Get the expert perspective, as she covers:
- The low AMH and miscarriage connection
- A look into the current standard of care
We also chat through all things ovarian rejuvenation treatment, including;
- Ovarian rejuvenation updates
- Who might be a candidate for ovarian rejuvenation
- The IFG approach, and what’s offered
If you’re looking into ovarian rejuvenation to support your fertility journey, or just looking for a second opinion – connect with IFG to chat through your options today.
Transcript
Eloise Edington
Hello, welcome, and thanks to those who are joining. We are delighted to be welcoming our guest today, Dr. Uliana, from IFG, who is an absolute IVF specialist. She will be talking to us this evening all about low AMH, implantation failure, miscarriage, and the latest advances in technology, treatment, and support to help people on their journey to becoming parents. Welcome, and please introduce yourself.
Dr Uliana Dorofeyeva
Hello everyone, good afternoon, good evening! I know you might be watching from different locations.
Thank you for the kind introduction. I am an IVF specialist, and I’ve been treating patients all over the globe since 2008. I am Ukrainian; however, I have now moved to Europe and practice in Europe and the UK as a consultant. It is my great pleasure to be an invited guest for this webinar, speaking about this very interesting topic: innovative solutions for advanced maternal age, diminished ovarian reserve, low AMH, miscarriages, and repeated implantation failures.
It’s my pleasure to spend another hour together with you. I’ve prepared some information as a presentation, but you are fully welcome to ask additional questions during the Q&A session afterward. If you need a more specific consultation, information, second opinion, or clarification about something I mentioned, I am fully open to further discussions and consultations. Thank you so much!
Eloise Edington
Great, well, thank you for that introduction. We are very fortunate to have you with us today. Thank you so much.
Dr Uliana Dorofeyeva
As I understand, I can continue now with the slides I’ve prepared. These are specifically related to the topics of low AMH, implantation failure, and miscarriages. They also cover innovations in fertility care and opportunities that are quite innovative, maybe new, or limited in some countries due to regulations. Unfortunately, patients still need to travel to receive certain kinds of treatment that may be regulated, limited, or very expensive in specific countries.
These treatments include options such as oocyte donation, mitochondrial donation, which is a unique and innovative technique, surrogacy, and more. We’ll cover these topics in detail. For women, every hour we are spending means we are losing some follicles. I mention this because, during presentations like this, I often emphasize that while men continuously produce sperm, women are losing their potential to produce eggs over time.
Our biological clock is always ticking. This is why it’s so important to be informed and make proper decisions at the right time. The “right time” is whenever you decide to become a parent, whether you started this journey long ago or just recently. The key is optimizing timing and using the most effective technologies and techniques.
Regarding our ovarian resource, the number of antral follicles is determined during the seventh month of antenatal development. While still in the uterus, a female fetus already has the total number of follicles she will use in her lifetime. These follicles begin to be used at puberty and continue until menopause. During this time, women have around 400–500 menstrual cycles. In each cycle, one leading follicle is triggered to develop by follicle-stimulating hormone (FSH).
Nature knows we only need one follicle. However, each month, multiple follicles are ready to grow, but only one becomes dominant, while the rest undergo a process called atresia, where they are lost. This is why we emphasize that if you are considering freezing your eggs, you should do so as soon as possible. The earlier you freeze them, the higher the efficiency.
Every month, we have a new pool of follicles. If we don’t use this pool, we lose it, and the next month brings a completely new one. For patients undergoing stimulation, this cycle allows for stimulation in subsequent months, particularly for advanced maternal age. In younger patients, rest periods between cycles help the ovaries recover. Stimulation, when done safely under professional supervision, poses no risks.
Globally, statistics show that the average age of first delivery is increasing by two years every decade. By 2100, the average age of first delivery could surpass 50 years. People are living longer, prioritizing other aspects of life, and often making family-building decisions later.
This brings us to technological advancements. IVF is constantly evolving, and new developments emerge every year. As professionals, we must stay updated, ensure safety, maintain ethical standards, and pioneer advancements that help patients.
Age is not the only factor to consider. Ovarian reserve is another critical parameter. Regarding the ovarian reserve, or the opportunity for the patient to reduce her own oocytes: there is a parameter, one of those which is quite reliable and very secure.
This parameter is anti-Müllerian hormone (AMH). We can measure AMH on any day of the menstrual cycle, as there is very low variability during the cycle. This makes it easy to use. Once you decide to measure it, you can do so without issue. The value of AMH correlates with the number of antral follicles available in the small preantral, large preantral, and antral follicle stages.
We have different stages in the development of follicles in our ovaries, which originate during antenatal development. This follicular pool is constantly developing. Folliculogenesis, the process of follicle development, spans approximately 270 days. This timeline is significant when considering lifestyle factors and their impact on the health and quality of oocytes. Actions taken today can affect the quality of oocytes produced five to six months later.
AMH will not show the number of follicles in the very early stages of development. However, it provides insight into the follicles expected to mature in the near future. High levels of AMH generally correlate with a high number of antral follicles that are responsive to gonadotropins. For IVF doctors, AMH is a crucial parameter. Without AMH, planning stimulation protocols would be challenging.
By combining AMH levels with antral follicle counts, patient age, and BMI, professionals can decide on the most effective stimulation protocol. Generally, higher AMH levels indicate a higher chance of multiple follicle development. We often say that an AMH level of 0.1 correlates with one potential oocyte for retrieval. Even with low AMH levels, such as 0.1, there is potential to stimulate some oocytes, but selecting the appropriate protocol and managing patient expectations are essential.
As patients age, AMH levels decline more rapidly. For individuals under 30, the decline is slower. However, after age 35—and especially after 40—the decline accelerates significantly. For example, an AMH level of 0.3 or 0.5 in a patient’s 40s could drop by half within a year. This underscores the importance of timing in patients of advanced maternal age or those with diminished ovarian reserve.
Aging not only reduces the number of antral follicles but also diminishes oocyte quality. Inside each oocyte are critical cellular components. Fertilization occurs within the oocyte, which houses the maternal genetic material, while the sperm contributes only its genetic material. The environment, biochemical processes, and metabolic activities required for embryo development are derived from the oocyte. As oocyte quality declines, mitochondrial dysfunction becomes a critical concern.
Declining mitochondrial function results in lower IVF success rates, reduced fertilization, and higher rates of abnormalities. Success rates correlate strongly with patient age due to oocyte quality. That’s why we feel free to say that now it’s like not 35 but maybe 38, but still, we cannot stop this process because this is a very physiologic, natural process.
However, if you’re using donor oocytes, and this used to be a gold standard for successful treatment, very effective and very short in terms of time for the patients who are not able to produce oocytes anymore or who were not able to produce high-quality embryos or genetically healthy embryos. So oocyte donation is a very effective alternative that gives really stable and high success rates. Oocyte donation should never be less than 50% successful. This is without genetically tested oocytes. If we are doing PGT-A tested embryos, the working percentage should be around 70% and higher, of course, that will depend on the implantation potential. We will talk later about the fact of what is important in terms of the implantation potential.
Also, the fact is that aneuploidy rates increase with age. There is data that is globally shared and known, that over 40% for patients who are over 40 years old, sorry, the statistically expectations in terms of the abnormalities in the blastocyst are over 70%. That’s why this is so important for advanced maternal age that the clinics will recommend doing genetic testing for the embryos because this is part of the success, not only in terms of improving the clinical pregnancy rate but also declining limiting the risks of the miscarriages um on the way after the implantation happens. That’s why we recommend testing embryos as well.
If we are talking about alternatives, and this is what I shared at the very beginning about innovative alternatives for the oocyte donation because once we are using oocyte donation, we are getting 50% of the embryo related to the donor. So, there is no genetic information coming from the patient as the female patient, there is a genetic relation to the male partner and a genetic relation to the donor.
That’s why this is a psychologically quite complicated treatment to be accepted by the individual woman. Um, however, there is a technology which is called mitochondrial donation. In this case, if how this works, this is the technology in case the patient still can produce her own oocytes, however, the quality of her oocytes was very low, we were not able to get blastocysts or we were testing blastocysts and all blastocysts came back as aneuploid. However, still she is producing her genetic material. For the mitochondrial donation from the patient, we need only the spindle. This is the nucleus which consists of the genetic information about the female, and we are stimulating a donor at the same time.
Still, we need to do the synchronization for these processes, and we are taking the nucleus on the same day, we are bringing, we enucleate the donor egg, we are taking the nucleus from the donor egg and throwing this away, we are putting the nucleus from the patient into the donor egg, making fertilization and letting the nuclei, both from the female and male, develop inside of the donor egg cell environment.
By this, we are exchanging the overall environment for the genetic material to be fertilized because the mitosis should happen and then the further development. What we understood from the technologies, and why there were mistakes on the abnormalities as genetic abnormalities at the end of the development, was because the environment was not optimal, there was a lack of energy potential, and there were changes in the biochemical and the metabolic processes in this environment. That’s why genetic conditions were also changing, so either embryos stopped their development or they were coming back as aneuploid.
That’s why this is really successful treatment for those patients who are still producing their own eggs but they are not ready to consider oocyte donation due to the fact of being nonrelated to their baby but they want to have their genetically related child.
Another opportunity or what we are doing together or before the preparation of our patients for the mitochondrial donation or just to increase their chances of producing a higher number and higher quality of the oocytes, this is the rejuvenation technique. We have been doing PRP rejuvenation since already maybe six to seven years, and we still believe that this works, again, this is very individual, and we need to consult every patient individually in terms of what is the expectations specifically for her, taking into account her antimullerian hormone count, previous outcomes for the stimulation, volume of the ovary, and so on.
However, in terms of rejuvenation for our facility is the stem cell. For over a year, we’ve been using Mesenchymal stem cells and exosomes, either together with PRP or individually. PRP is no longer commonly practiced, mostly for patients who’ve had it before the stem cells and exosomes offer a second level of rejuvenation. They differ in their mechanism of action as PRP simply increases blood flow and rejuvenates the injected tissue. Stem cells, however, introduce potential new tissue cohorts, leading to the development and production of more follicles. While data is limited, this technology is highly effective and increasingly used for advanced maternal age.
Mitochondrial health is crucial for embryo development. A low mitochondrial battery leads to poor embryo quality and prognosis. We address this by exchanging the battery, as seen with the Oocyte under a specialized microscope. We examine the spindle’s location and characteristics, preparing for biopsy and specific procedures performed by embryologists.
There are two types of mitochondrial donation: spindle transfer and pronuclear transfer. Spindle transfer occurs on day zero, immediately after egg collection. The spindle from the patient’s egg is transferred to a donor egg. Pronuclear transfer happens on day one, after fertilization. The pronuclei from the patient’s fertilized egg are transferred to a donor egg.
Mitochondrial donation is an innovative technology, though still experimental. The first baby was born 45 years ago, and now over six million children have been born globally. Due to aging and environmental factors, the need for IVF is growing. This technology offers hope to those seeking alternatives.
Our group has over 30 babies born, with the first already six years old. Initially, we kept the technology confidential, but we’ve now published our data. While pioneering this technology isn’t easy, it’s proven effective for mitochondrial disease carriers. For advanced maternal age, the reason is different, but the process remains the same.
Recent regulatory changes in the UK and Australia have opened doors for this technology, especially for mitochondrial disease carriers. However, for advanced maternal age, treatments are often conducted in countries like Albania, which allow experimental techniques.
Implantation failure and miscarriages are often linked to genetic factors, particularly in embryos that haven’t been genetically tested. To address this, we recommend genetic testing to ensure embryo health. Other factors include anatomical issues, endocrine disorders, and autoimmune diseases.
Autoimmune diseases are a very interesting topic. Also, there is a part of the professional society who don’t believe in autoimmune infertility. Even we were discussing the fact that we used to call this “not known infertility” that we couldn’t detect because of the infertility. However, this is the cohort of the autoimmune diseases. And that’s why we need to check the natural killer cell levels and the white blood cell count and use the immunological protocols for the preparation of our procedures. Which also we do and we believe that this can be treated and this can be solved and should be solved.
The lifestyle, diets, and the environment, of course, this is something that depends much more on us. However, some environmental factors, unfortunately, we cannot change. So we need to understand what are the issues, specifically for the specific patient. For many patients we have multiple causes, we cannot focus or stop on the first cause that we detected, because that can be also an issue with the anatomical causes, endocrine, and autoimmune. We need to solve all of them before we will proceed with the further transfer.
That’s why we always say to our patients that while treating infertility, we need to solve two problems or get into two goals. The first goal is to have a healthy embryo, a healthy embryo in our understanding, and this is what we believe is a euploid blastocyst. We cannot say that just a day three embryo if we expect this to be a healthy embryo. No, we have the technology to prove that this embryo is a healthy embryo and this is genetic testing, which is totally safe once it is done in the proper laboratory by the proper conditions with the well-experienced embryologist. There is 100% of a survival rate.
Vitrification is a very effective procedure that patients should not be scared of, freezing and storing their embryos, because if this is a healthy embryo, this embryo will survive multiple times and this embryo will be implanted successfully if everything was done properly. The same about biopsy. The biopsy is a very safe procedure while we are taking very few cells from the cytoplasmic part of the embryo. We are not touching part of the embryo-like the inner cell mass. And from the cytoplasmic part, we are getting tissue which will be forming the placenta and other organs, helping to develop the pregnancy. But still, these tissues they are having the same genetic material as the overall embryo and they will be informative in terms of providing information about the genotype of this embryo. So this is safe and that’s why it’s recommended to be performed.
Causes of the implantation, in terms of the first goal, achieve this is the healthy embryo, and the second goal, is to answer all the questions related to the potential implantation failure. Just which I mentioned here, including also the window of implantation, including the microbiome, including the status of the endometrial in terms of the receptivity and the not proper technology of the transfer of course as well. This is very important and then achieving the clinical pregnancy, proper luteal phase support, which is as well needs to be controlled. So all this plays a role and all this needs to be carefully controlled and monitored.
As a conclusion, different treatment options may be recommended in IVF to achieve the goal of parenthood. As we said, there is an option of just IVF treatment. However, we need to consider what is the age of the patients and what are the prognostic factors on the overall success. If we do just the regular IVF, we can recommend doing oocyte donation, which is still a gold standard and widely recommended. It’s not very easy to be treated using oocyte donation, unfortunately.
In some countries, we still have a waiting list, which is a huge waiting list. In some countries, this is very expensive. That’s why still patients consider traveling abroad to those countries where there is an immediate availability of the donors and quite reasonable costs. So as you probably may know, I’m also a Clinical Director of Ovagen. So we are running an egg bank and we, our goal is to help as many patients as possible. So we use donor oocytes for treatment of our patients but also sending them to the different destinations, including the UK, just to help individuals and to help clinics to help their patients and the individuals there. So a second opinion is always recommended due to the specific limits in the countries. This is very true while a clinician is practicing under the specific law and the regulations and the laws in terms of the IVF, they are very strict in some countries and they are not really patient-friendly.
However, this development, we cannot stop. Like we understand the second point of this micromanipulation on the embryo is that we are so close to the factors of cloning and others which are not really ethical. That’s why this cannot be widely practiced or allowed because this needs to be done in good hands and for the well-being of the patients and the overall humans.
That’s why there is some regulatory issue about this, but the technologies are here and we need to talk about them and patients need to be aware of options. After they are aware and after they consider everything, they have the role to make a decision, their own informed decision. The most effective treatment for patients in advanced maternal age is oocyte donation. However, experimental treatments available in IVF are effective and they may be accepted widely in the future. We will be really glad if this happens and we will solve the issue of the advanced maternal age and living longer.
We will be living longer, and healthier, and we will be able to build our families also later as well. So there was a very important last point. If you are listening to this webinar and you haven’t tried all the mentioned above, you should still keep trying and we will be happy to help you in this journey. Thank you so much, and I am ready for your questions.
Eloise Edington
Thank you. That was very, very thorough and informative. So I’m sure everyone felt the same. So what tests would you routinely offer for someone who has had recurrent miscarriage?
Dr Uliana Dorofeyeva
So the reason of the recurrent miscarriage, if this is not an embryonic reason, so first I would recommend testing the embryos to be sure that we are transferring euploid embryos. That would be that can be the very first answer. If we are sure that we are testing high-quality embryos but still we are losing the pregnancies, we need to do an immunological panel. We need to do thrombophilia and the autoimmune, like Hashimoto’s disease tests and the endocrine profile. So that will be something that will be the most relevant for the recurrent miscarriage.
Eloise Edington
And how soon after having a miscarriage should someone have these investigations done?
Dr Uliana Dorofeyeva
In terms of the histological evaluation of the tissue as the abortion, this is recommended to do like immediately after. Also, this can be a solution or the specific answer about what was the reason for this specific pregnancy to be lost. Either again, that was a genetic factor or not.
So if this was a genetic factor, most likely there is nothing else connected with the body of the mom in terms of being able to implant and develop this pregnancy further. But if that was a fetus which was tested as an absolutely healthy fetus but this fetus was lost, the immunological treatment and all other investigations can be done immediately after this information is received.
Eloise Edington
Miscarriages are normally due to the genetic makeup of the embryo rather than the uterus itself, is that right?
Dr Uliana Dorofeyeva
The genetic factors can be easily tested and can be controlled. So we would say yes or no if we have done a histological evaluation or we tested or if we haven’t done the evaluation, so we cannot be sure whether this is still related to the genetic factor or not. So then the uterine abnormalities, mostly we know them. So this is not something that is developed rapidly. So if we understand that this is happening and the recurrent miscarriages are happening due to the fact of the abnormality in the uterus, if they cannot be corrected surgically, unfortunately, we need to consider surrogacy.
If they can be treated or fixed, then it’s recommended to do the surgery and then, after all, continue with the implantations further. If this is autoimmune, which is the biggest question mark for sure still right now, because we can test for many, many conditions in terms of the immune system activity. However, we can still have no answer sometimes.
This is happening because the question is what we are testing and how we are testing, either we are testing periphery, meaning the blood, or we are testing endometrium, and the specificity of these tests, which are quite expensive, frankly speaking. However, the solution for this is and the mechanism of action, so, what is happening with the immune system while we are having an implantation?
Our immune system is our friend, so her goal is to protect us from something that is considered to be an enemy, like the virus, bacteria, or anything that may be wrong or that may cause a problem for our body. The immune system doesn’t know what is the embryo, because the embryo is half not related to the body, it’s related to someone who is a husband, partner, or whoever, but immunologically this is totally different cell which immunologically considered to be an enemy. So there is a very active cell in the immune system which is called a natural killer cell, which is the name is very sane about what this cell is doing. The cell is activated in order to destroy this embryo which is considered to be an enemy.
So, this is the paradox, quite often this paradox is happening for patients who have very aggressive or very effective immune systems. More effective immune systems have higher levels of natural killer cells. We are having, and if they are too high, they will be destroying the embryo. That’s why we need to test.
If we find the reason, we need to follow the immune protocols, which as well they are different. That can be just the medications that we are taking orally, like prednisolone or prachaline, for example, or that can be intravenous infusions of the intravenous immunoglobulins, which are coming as factors which are proteins coming from the donor blood. Then they are considered to be the enemies, and they are taking these natural killer cells from the central organs to the periphery. While these natural killers are busy fighting with the proteins from the IVIG, the implantation, positive implantation, is happening because central organs are free from the natural killer cells.
So this is the mechanism that usually works and works quite successfully if there is an indication for the IVIG. Again, this treatment is quite expensive, but this is an effective one. And if there isn’t a clinical indication, this is helpful for some patients. We need to repeat IVIG because this medication is valid for 28 days. And then even if the implantation happens, the pregnancy is not strong enough until we end the first trimester of the pregnancy, while the placenta is fully functioning and supporting the developing fetus.
So for some patients, there is a need to repeat this. Usually, how we do this for our patients, we have, like we are also with reproductive immunology, so we can recommend the type of protocol and treat our patients. But if they are coming from abroad, usually we are happy to cooperate with the local reproductive immunologist who is helping patients while preparing during the preparation and after the embryo transfer, controlling and supporting the development of the pregnancy.
Eloise Edington
Thank you for that. Is it best to test immunological issues via a biopsy of the womb or the blood? If your blood immunological tests are normal, should someone consider immunological testing via a biopsy of the womb?
Dr Uliana Dorofeyeva
The biopsy is more relevant. That’s true, and we will answer more questions. But also, some specific factors of the immune causes, we will not be able to receive even through a biopsy. So there are some tests that are preferable to be done by peripheral blood, by just controlling the blood. But still, an individual biopsy is the preferable option, of course.
Eloise Edington
And what can someone do to help increase AMH after failed cycles? Is there anything?
Dr Uliana Dorofeyeva
So this is a very interesting question regarding the increase of AMH. As I said, there is very low cycle variability for the AMH. However it is happening, and I have seen cases with showing the AMH like one in January and then 2.1 in April.
So these cases are happening. There is no specific cause that can impact this, the answer can be about the partially the supplements and the lifestyle. So this all works. We cannot say that this is the magic pill and that there is a proper algorithm of what to do in order to increase your AMH. Professionally, like doctors, we are more explaining this with the cycle variability and this fluctuation or the changes of the AMH are not that significant usually.
So, it was low, but it was, it’s started to be a little bit higher than it was before. So this does not impact the cycle outcomes, I would say that while stimulating a lot of patients with the AMH which are quite low, it’s sometimes the findings while we are starting the stimulation are more optimistic when we check this patient just with the AMH, meaning there is still a potential as I said, the AMH is coming from the early preantral and antral follicles, but still there is a potential of some other follicles to come in and to be gonadotropin sensitive and to grow finally.
So I would say not AMH is the most important, but the cycle outcome is important. AMH is just the factor that shows us, saying this is the red light. We have it low. You need to do something immediately. This is like a sign, please do.
But then what to do and how to do this is already a decision of the reproductive doctor, gynecologist, or whoever is working with the patient.
Eloise Edington
Thank you for that. You mentioned sort of the difference between ovarian rejuvenation and PRP, and that ovarian rejuvenation is being used more frequently now.
What is the age limit for ovarian rejuvenation treatment?
Dr Uliana Dorofeyeva
That’s a very good question because, in some countries, we don’t have an age limit, like it’s not written that there is an upper age limit. For example, some countries are still treating patients over 50. Just the clinical decision is what is the level, like should it be 52 due to the somatic health issues and the ethical issues as well, or 54 or 56? But of course, most of those patients over 50, are preparing them just for the embryo donation or the oocyte donation. Mostly because we need to consider what is the status of their ovaries and what is the potential of their response.
Every patient is so individual that we need to talk about statistics, but still, every case will be very individual. I have several because we relatively not working such a long time for again the mitochondrial donation processes, but we have several patients, the oldest being 51, who are still able to produce their healthy and nice quality oocytes, of course, one or a maximum of two per cycle, and not in every cycle, but this depends on the condition of the patient. Mostly those patients who are still responding well in their 45, 46, or even 42, and so on, were PCOS patients before while they were younger, meaning they had a higher reserve compared to the normal gonadotropin patients. That’s why they preserved this reserve. They had just a higher total number of the follicles that were higher.
We had patients producing 12 eggs, at 45, in just one round of the stimulation with a relatively simple protocol, because the protocol also plays a role, of course. So that’s why about ovarian rejuvenation, since we see that the patient is producing, is responding to the stimulation, and we are having follicles that are gonadotropin sensitive, meaning that still there is a potential for small follicles to be in the ovaries, because it’s not stopping rapidly and the sporadic ovulations are happening even while we are in the perimenopause, while the menstruation is not regular anymore.
So that’s why this is the level of the ethical question, and we consult all our patients. And this is true also that I had to say or recommend to the patients, please stop because this is not effective to continue anymore. We have done everything we could, and that was independent to the age of the patient. That was not only for patients over 45, that was also for patients less than 45. And we need to say the only option is the oocyte donation here and now. But, it’s very individual. We have successful pregnancies in 45, 46, 47, are not single. So this is happening if we have the reserve.
So we need to understand what are the inclusion criteria and the factors we are starting with, and then consider what will be the risks and the timing during which we can give time to us as a professional team and to the patient still to work on their stimulation. But what is important, I can say as well, is that patients need to prioritize their IVF over everything else, because once they are in their advanced maternal age, their stimulations are not that well planned, they are not that easily predictable as it is for the young patients and for normal responders.
We can easily plan a patient in one group during the specific time or dates when she is available to fly. But this is true for the good responders or those who have relatively high AMH, relatively high. I would say it’s over 0.5. But those who have much lower, need to be available to fly, to travel, to do the hormones, to do the scans as soon as this is needed and as frequently as this is needed. In this case, that will work.
Eloise Edington
Thank you for that. What have you been having miscarriages with donor eggs?
Dr Uliana Dorofeyeva
Yeah, that’s a good question. This may happen, of course, this means that the miscarriage is related or the reason for the miscarriage is related to the body of the woman who is carrying the pregnancy. It’s not related to the donor egg. If this embryo was tested, because it’s also not true that all donor eggs are coming or embryos coming from the donor eggs are coming euploid.
We’ve been doing a lot of investigations, for example, we have genetically tested oocytes. And while why we decided to do this option because we tested almost 2,000 oocytes from young and healthy women donors. And our cohort donors are between 19 to 30. We are not even including donors in their 32, 35, and so on. So they are their upper age is 30. While having a morphological assessment of the oocyte and after that artificial intelligence, because we are using an AI for the morphological selection for the oocyte, and after doing the biopsy of the oocyte, because not only the embryo can be genetically tested, but also the oocyte can be genetically tested, as a result for this group of the young population, we have got 14% of eggs coming back as genetically abnormal, even they looked okay morphologically and they had a high score according to the AI.
So this is the natural selection as well. Not every egg, even if it looks perfect, is genetically healthy. So that’s why and of course, like 14, that was the overall. And if we graded between 19 to 30, the highest level, closer to 14, was between 28 to 30. So we expected over 30, this number to be even higher, like 15 or 20 or so on.
But any clinic or any egg bank is genetically testing the oocytes, they just do a morphological assessment and that’s all. This means we cannot be sure that 100% of the embryos we are getting, even using donor oocytes, are all 100% genetically tested. And while there is an embryo development, there is also a role of the sperm. That’s why we need to test the embryo. So we cannot be sure that if an embryo developed until day five, this is a healthy embryo. No, still, this can be genetically healthy or non-healthy. So that’s why this is so important. This means that if the miscarriage happened, while that was a donor egg embryo, a high-quality embryo, and this was confirmed, we need to look for the causes, either abnormality in the uterus. If there is none, so we need to think about thrombophilia. If there is none, we need to think about endocrine dysfunctions. If the TSH was tested and was normal, we need to think about autoimmune conditions and the immune system response, which is already a little bit more complicated. Leading to many, many questions that need to be answered.
Eloise Edington
Okay, thank you. And lastly, would ovarian rejuvenation treatment help endometriosis patients with low AMH?
Dr Uliana Dorofeyeva
Endometriosis is, as we all know, a very complicated disease. And the spread of endometriosis is the risk while we are injecting the needle into the ovaries. If you’re having, if this is one endometrioma clearly located and we understand that there is no risk, of course, we would consider doing ovarian rejuvenation. But if there are multiple or this is like a stage three, four, and the patient had surgeries before and so on, so I would not consider this as a, like this is a very individual case, let’s say. So we have had patients for whom we have done rejuvenation with endometriosis because we are helping to rejuvenate the tissue which is healthy ovarian tissue. If we have an ovary and we have an endometrioma, so this is a localized process, but there is another part of the tissue in the ovary that is healthy or let’s say relatively healthy. But still, there is no cause of the endometrioma there. So if we are injecting the rejuvenation liquid, let’s say, because this can be either PRP or the mesenchymal stem cells or the exosomes in this tissue, which is relatively healthy, still, we can improve the process of the blood flow there and rejuvenate this issue. But, we need to compare the risks and the benefits for this category of patients.
Eloise Edington
Great, really, really useful to know. Thank you so much. Everything you have explained this evening has been very thorough and the latest advances in tech. We are very fortunate to have your expertise today. So thank you once again. And thank you to those who have joined. Please do get in touch with the team at the International Fertility Group, IFG, who would be very happy to help you personally.
Dr Uliana Dorofeyeva
Absolutely. Thank you so much. And thank you all for your time and for arranging this great event.
Eloise Edington
Absolutely. Lovely to see you. Thank you. Bye bye.
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