This document discusses embryo development and factors that influence IVF outcomes. It summarizes key stages of embryo development from fertilization through blastocyst formation. It identifies the woman's age, controlled ovarian stimulation protocol, and embryology laboratory as factors governing embryo aneuploidy and IVF success. The document provides details on different ovarian stimulation protocols and considerations for individual patient factors like ovarian reserve, previous response, and risk of over or underresponse.
16. Factors in IVF that Govern
Embryo Aneuploidy
Woman’s age
Protocol for controlled ovarian stimulation
(COS)
Embryology Laboratory
17. Determining the Best Protocol for
Controlled Ovarian Stimulation
1. Age
2. Ovarian Reserve (FSH/AMH/inhibin-B)
3. Previous Response to COS
18. Orchestration of Follicle/Egg Development
IN THE STROMA:
LH promotes production by stroma/theca of male hormone
(androgen)
IN THE FOLLICLE:
FSH converts testosterone to estradiol
THE EGG IS THE CONDUCTOR OF FOLLICLE EVENTS
20. Role of Ovarian Male Hormones (Androgens)
A small amount testosterone is essential for
follicle and egg development
Excessive testosterone is a cause of poor
follicle and egg development.
21. Who is Most Vulnerable
to Excessive Androgens?
Older Women
Women with ovarian Lesions (cysts,
endometriomas & tumors)
Women with polycystic Ovarian Syndrome
(PCOS)
22. Effects of Excessive Androgens
Poor-follicle development (premature luteinization,
“empty” follicles)
Poor- egg/embryo quality (increased aneuploidy)
Poor- endometrial development
Poor-endometrial development and implantation rate
Poor -IVF Success
23. What leads to Increased Exposure to
Androgens?
HIGH LH
Age
Ovarian resistance / failure
PCOS
INAPPROPRIATE OVARIAN
STIMULATION PROTOCOLS
“Flare protocols”
Clomiphene
Menotropins
OVARIAN LESIONS
Endometriomas
Functional cysts
Tumors
ANDROGEN ADMINISTRATION
Testosterone
DHEA?
24. How to Limit Exposure to Androgens
Limit exposure to exogenous LH
Use purified FSH
Treat ovarian lesions pre-COS
Endometriomas
Cysts
Suppress endogenous LH pre-COS
Use “long” GnRH agonist / antagonist protocols (esp.
in DOR and PCOS)
Avoid “flare” protocols (esp. in DOR & PCOS)
Avoid Clomid/Femara
41. Triggering Ovulation 36 Hrs. Prior to ER
hCGu 10,000 IU (Pregnyl/Profasi/Novarel)
hCGr (Ovidrel), if used ideally should be 500mcg.
Criteria:
2 lead follicles at least 18mm in diameter
1/2 of total number of follicle at least 15mm in
diameter
Endometrial lining at least >9mm with trilaminar
pattern
42. Thank You!
If you would like to schedule a
consultation with Dr. Sher,
please call 1-800-780-7437
Read Dr. Sher’s Blog at:
www.IVFauthority.com
SIRM Website: www.haveababy.com