One of the most common fertility issues many women face today is related to their ovarian reserve that does not allow them to conceive using their own eggs and is blocking them from reaching their dream of having a child. When we mention that a woman has a diminished ovarian reserve (DOR), we mean that her ovaries have lost the high reproductive potential they had some years ago and no longer produce enough viable eggs that could be fertilised. It is a condition that comes with aging, but can also occur after a disease or injury.
So, does a low ovarian reserve instantly mean that a woman can no longer wish of starting a family ? Absolutely not. At least, not in our clinic and not on Dr. Firdevs’ watch. Among the methods we use, Tandem Cycle Treatment is one we definitely recommend.
What is Tandem Cycle Treatment ?
It is a fertility treatment that increases the chances of women with low ovarian reserve to get pregnant. Now, you may wonder “IVF does the same, too”, and you will be probably right. However, the difference with Tandem Cycle Treatment is that it provides the patient with an alternative option; to have donor eggs as a backup egg reserve and save the money they might spend on a second IVF treatment if she is not able to conceive using her own eggs. This means that if the patient’s eggs are not considered of high quality, we still can help her get pregnant by using eggs from a young and healthy donor.
Before we mention anything else about Tandem Cycle Treatment, it should be noted that the patient also has a saying in the selection of the egg donor. This means that you get to actually pick the donor you find most suitable per your requirements. So, you can receive eggs from a donor that bears particular physical features, such as the same hair/eye/skin colour as yours, a specific educational background or occupation, and much more. Once we get all the information from you, Dr. Firdevs will find the best match for you.
All the donors in our extensive donor database undergo exhausting tests to ensure they are 100% healthy. This means they are also screened for genetic disorders and hereditary diseases. Finally, they get tested every 3 months to make sure they remain healthy. That aside, all donors in our donor bank have previous donation history with proven pregnancies, so you have nothing to worry about.
Is Tandem Cycle Treatment Only for Women with DOR ?
No. Although it is a method that gives impressive success rates to women with low ovarian reserve, it is also a treatment we use to help women with elevated FHS levels to get pregnant.
What Does it Mean if you Have Increased FSH Levels ?
Follicle Stimulating Hormone (FSH) is a hormone released by the brain to help stimulate the growth and development of eggs in the ovaries. Then, the developing eggs release estrogen, which is another hormone that hinders FSH. If there are not many viable follicles (egg sacks that contain immature eggs or also known as oocytes) in the reserve (meaning, there are not many eggs that could be successfully fertilised), the level of the released estrogen is low. At that point, the brain responds to the low estrogen levels by releasing more FSH to boost the development of follicles. So, high levels of FSH is a strong indicator of low ovarian reserve and can be measured on day 3 of the menstrual cycle.
The only problem with the results of this blood test is that we can never be sure we will get consistent results. This is because the FSH levels vary from month to month, which is why Dr. Firdevs prefers to rely on a combination of FSH and AMH results before treating a patient for low ovarian reserve.
What is AMH ?
It is another method to help us get a better idea of the state of a patient’s ovarian reserve. The Anti-Mullerian Hormone (AMH) is also a hormone produced by the developing follicles. Results from measuring AMH gives us a clearer insight per the remaining eggs in the patient’s ovaries and the state of the ovarian reserve.
AMH levels get lower over time. This is why women in their 40s usually have low AMH results, although there are exceptions. For instance, we have treated women as young as 25 years of age with diminished ovarian reserve which was the outcome of cancer treatment and other environmental factors. The analysis of the AMH results allows us to determine the urgency of the case and how the patient will respond to the fertility treatment.
Should You Be Worried if You Have Low AMH and/or FSH ?
Low AMH (and FSH)exhibits no symptoms and does not always mean that a woman cannot conceive or is infertile. The woman may still have menstrual cycles, only scarcer than before and/or notice differences in the amount of blood per cycle. Nevertheless, she may still be able to get pregnant using her own eggs. So, both FSH and AMH are simply indicators of a low ovarian reserve. The only concern is when low AMH levels go hand in hand with advanced age because, in this case, the chances of egg mutations is significantly high, which, in turns, can result in abnormal fertilisation and miscarriage.
How Can Tandem IVF Treatment Increase Pregnancy Rates ?
The standard medication protocol for women with low AMH in most fertility clinics around the world includes the distribution of high doses of stimulation medications. Although it might produce some results, it also increases the risk of having eggs with chromosomal abnormalities, which, of course, cannot be fertilised to produce healthy, viable embryos. That aside, increased doses of stimulation drugs also affect the lining of the womb and make it an unfriendly environment to implant an egg in.
Tandem IVF treatment gives us the advantage to use significantly lower doses of medication and collect a few but good quality eggs. We really do not focus on quantity at that time. Our only concern is that there are enough viable eggs to use for the fertilisation process and Tandem IVF ensures us of that. Also, according to research, to get high-quality eggs that can result in healthy embryos we need to use the most natural approaches possible. For that reason, we use the eggs the body selects itself naturally first, before stepping into another option.
The great news, though, is that patients are provided with a threefold of options: (1) to use their own eggs, (2) use donor eggs, and (3) use both their own and donor eggs. Most of our patients prefer to start with their own eggs and suggest we freeze donor eggs, just in case. In short, Tandem IVF treatments gives women with low ovarian reserve (but not a totally exhausted reserve) the chance to get pregnant using their own eggs while having a backup plan available (donor eggs) in case something goes south or when the possibility of conceiving that way is either totally absent or extremely low.
The Process of a Tandem Cycle
It is like combining ICSI and standard IVF. This means that the patient is assessed and tested for fertility so Dr. Firdevs can recommend the best medication and treatment protocol. Regarding the steps involved in the process of a Tandem Cycle, they are summarised below.
- You get ovulation-inducing medications for a few days, until 35 hours before ovulation.
- At 35 hours before ovulation, you are administered ovulation-regulation drugs and we require sperm sample from your male partner.
- We collect your eggs and combine both your own and the donor eggs with your partner’s sperm. The fertilisation process takes place in our stellar laboratories that are equipped with the most advanced tools and assisted reproductive technology.
- We monitor the fertilised eggs for 3-5 days.
- After the passing of 3 to 5 days (depending on the case), our embryologist gives you a brief about the quality of all embryos and how many of them have advanced into healthy embryos. This is when you need to decide if you will use your own or the donor’s eggs, based on the information you will get from the embryologist.
- The chosen embryos are transferred and implanted into the uterus. You also get to decide how many of the viable embryos you want to be implanted. However, Dr. Firdevs suggests we do not go for more than 3, to avoid multiple pregnancy, unless, of course, you want to have more than one baby.
Everybody at the Cyprus IVF Clinic agrees that it is our job is to provide every couple facing fertility problems with the best option to help solve their issue and turn their dream of starting a family into their reality the soonest possible. For that reason, we will never stop trying to get the best of the latest in assisted reproduction and ensure every woman has equal chances of conceiving despite her fertility issues.