Genetic abnormalities lower success rates of IVF for older women — Dr Abayomi Ajayi

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Nigerian couples that wish to undergo IVF have been advised to start early in order to maximize the successful outcomes of the procedure.

“If you need IVF, start early because your success rate is better when you are younger,” according to a fertility specialist, Dr. Abayomi Ajayi, who however regretted that IVF often fails for specific reasons related more to the patients than the process itself. Ajayi, who is the Managing Director, Nordica Fertility Centre, Lagos, while speaking during a webinar entitled:

“Why IVF fails”, noted that IVF had better success rates when couples are younger, even as he noted that the odds are low for women aged over 35 as a result of genetically abnormal eggs. He argued that for successful IVF outcomes, a woman would need enough number of genetically normal embryos.

“So being younger increases your chances,” he said. “If you are not yet married or you are not ready to bear children, you can freeze your eggs, and this increases the possibility of genetically viable eggs and subsequently genetically viable embryos. Noting that IVF is technology, he warned that couples should be wary of cheap and quick-fix approaches to resolving infertility issues.

“When you start looking for the cheapest interventions, these cannot be the best. IVF is a technology and it is not cheap. We know that we do not manufacture anything in this part of the world, so you have to be careful if an IVF cycle is too cheap because you might be in for a wrong intervention. On the importance of lifestyle, Ajayi observed that losing weight is very important towards successful conception. “You must be of the ideal body weight, once your Body Mass Index, BMI, is over 30, your success rate decreases. In Nordica, if your BMI is high, it is a ready sign that your case would be problematic and there is no magic that the doctor can perform. The same applies if you smoke, and have high caffeine and alcohol consumption. All these are not good for IVF outcomes,” he asserted. Further, Ajayi stated:

“Counseling is important, although people often think it is religious counseling we are talking about, it is the counseling that is not to advise you, rather it is to listen to you and help you generate possible solutions.

According to the fertility specialist, “no responsible IVF clinic can guarantee success. What we can guarantee is safety, sincerity, and confidentiality. The only thing that can be done is that we can work with you to achieve success when you too play your own part and make the right decisions.

“For instance, I see so many 48-year-old women who want to use their own eggs, but from clinical evidence, we know that if you are using your eggs, your success rates are much lower with age. When you are older you need multiple transfers and this increases the number of genetically viable.” Why IVF often fails Further, Ajayi said most of the failure of IVF takes place during the implantation process. “To understand why IVF often fails, we need to go back to the basics. Reproduction has two phases, fertilisation, and implantation. We know that fertilisation is the coming together of the sperm and the egg and the success is determined by the quality of the resultant embryo. The embryo will need to implant into the endometrium or the lining of the uterus, so the two phases must be successful. “In IVF, which is fertilisation outside the body, when the lab is working well, there is about a 75 percent fertilisation rate, but most of this failure takes place during implantation. Most of the time the failure of IVF is from implantation and it has to do with the embryo and the endometrium which should be uniform. “We see patients saying that they were made to do unnecessary hysteroscopy but the fact is that if the endometrium is not uniform, then whatever we put in there is a waste of time.

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So when you are above 35 and have done some surgeries, we want to be sure that your uterus is still regular as the structure of the endometrium should be, and to ensure that it functions to take up the embryo. “When we qualify the embryo, we want good quality, genetically normal embryos, not just embryos, this is where the problem comes in. If the egg and sperm are not genetically normal, there is a problem.”

Ajayi said while some persons claim that they have to grade A embryos, what those only means is that the embryos are of good quality but may not be genetically normal, since the embryologist cannot know if the genes are normal by just looking “The problem with implantation is often during the process of development of the embryo, it comes in during cell division and there is an abnormal number of chromosomes in the cells, this is called aneuploidy.

It is the greatest problem that makes embryos not to take in the uterus,
“The embryos may be good, the embryologist cannot know if the embryos are genetically normal. Sometimes during the division of cells of the embryo, there are abnormal genes and that is aneuploidy. This is the greatest problem for embryos to fail or for a miscarriage to occur, and we also have abnormal cells,” he asserted.

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