Achieving pregnancy at a late reproductive age in a patient with a history of multiple failed in vitro fertilization attempts
Background. As a woman gets older, her ovarian reserve is diminished, her egg quality is worse, the number of concomitant somatic diseases and reproductive tract pathologies increases. This causes a substantial reduction in her likelihood of conception not only spontaneously, but also with the use of assisted reproductive technology (ART). On this basis, reproductologists’ efforts are aimed at searching for new methods to overcome infertility in older reproductive-aged patients.Kirienko K.V., Osina E.A., Apryshko V.P., Voloshanenko V.V., Yakovenko S.A.
Case report. This paper reviews a clinical case of ART singlet pregnancy and birth of a baby to an older married couple (a 42-year-old woman and her 54-year-old husband) after 13 failed IVF attempts. Implementation of the 14th IVF program using the female patient’s own eggs and her husband’s sperm after auxiliary zygote activation with calcium ionophore A23187 and co-culture of embryos on the feeder layer could obtain two embryos, the transfer of which led to the onset of a singlet pregnancy and birth of a baby. At 39 weeks’ gestation, the patient delivered spontaneously a healthy girl weighing 3190 g.
Conclusion. An individual approach to choosing methodological solutions (by an embryologist) and therapy (by a reproductlogist and an andrologist) for a specific infertile couple contributes to the achievement of pregnancy and childbirth in older couples with multiple failed IVF attempts.
Keywords
infertility
late reproductive age
ovarian reserve depletion
multiple failed IVF attempts
pregnancy
clinical case
References
- Российская ассоциация репродукции человека. Регистр ВРТ, отчет за 2018. [Russian Association for Human Reproduction. ART Register, Report 2018 (in Russian)]. Available at: http://www.rahr.ru/d_registr_otchet/RegistrART2018.pdf
- Боярский К.Ю., Гайдуков С.Н., Чинчаладзе А.С. Факторы, определяющие овариальный резерв. Акушерство и женское бесплодие. 2009; 2: 65-9. [Boyarsky K.Yu., Gaidukov S.N., Chinchaladze A.S. Factors which can predict ovarian reserve. Akusherstvo i Zhenskoe besplodie/Obstetrics and Female Infertility. 2009; 2: 65-9. (in Russian)].
- Назаренко Т.А., Мишиева Н.Г. Бесплодие и возраст. М.: МЕДпресс-информ; 2014: 7-22. [Nazarenko T.A., Mishieva N.G. Infertility and age. M.: MEDpress-inform. 2014. S. 7-22. (in Russian)].
- Esteves S.C., Carvalho J.F., Martinhago C.D., Melo A.A., Bento F.C., Humaidan P. et al. Estimation of age-dependent decrease in blastocyst euploidy by next generation sequencing: development of a novel prediction model. Panminerva Med. 2019; 61(1): 3-10. https://dx.doi.org/10.23736/S0031-0808.18.03507-3.
- Gardner D.K., Lane M., Stevens J., Schlenker T., Schoolcraft W.B. Blastocyst score affects implantation and pragnancy outcome: towards a single blastocyst transfer. Fertil. Steril. 2000; 73(6): 1155-8. https://dx.doi.org/10.1016/S0015-0282(00)00518-5.
- Malchau S.S., Henningsen A.A., Loft A., Rasmussen S., Forman J., Nyboe Andersen A. et al. The long-term prognosis for live birth in couples initiating fertility treatments. Hum. Reprod. 2017; 32(7): 1439-49. https://dx.doi.org/10.1093/humrep/dex096.
- Haahr T., Esteves S.C., Humaidan P. Poor definition of poor-ovarian response results in misleading clinical recommendations. Hum. Reprod. 2018; 33(5): 979-80. https://dx.doi.org/10.1093/humrep/dey059.
- Sunkara S.K., Rittenberg V., Raine-Fenning N., Bhattacharya S., Zamora J., Coomarasamy A. Association between the number of eggs and live birth in IVF treatment: an analysis of 400 135 treatment cycles. Hum. Reprod. 2011; 26(7): 1768-74. https://dx.doi.org/10.1093/humrep/der106.
- Klinkert E.R., Broekmans F.J., Looman C.W., Te Velde E.R. A poor response in the first in vitro fertilization cycle is not necessarily related to a poor prognosis in subsequent cycles. Fertil. Steril. 2004; 81(5): 1247-53. https://dx.doi.org/10.1016/j.fertnstert.2003.10.030.
- Wallace W.H., Kelsey T.W. Human ovarian reserve from conception to the menopause. PLoS One. 2010; 5(1): e8772. https://dx.doi.org/10.1371/journal.pone.0008772.
- Ata B., Kaplan B., Danzer H., Glassner M., Opsahl M., Tan S.L. et al. Array CGH analysis shows that aneuploidy is not related to the number of embryos generated. Reprod. Biomed. Online. 2012; 24(6): 614-20. https://dx.doi.org/10.1016/j.rbmo.2012.02.009.
- Franasiak J.M., Forman E.J., Hong K.H., Werner M.D., Upham K.M., Treff N.R. et al. The nature of aneuploidy with increasing age of the female partner: a review of 15,169 consecutive trophectoderm biopsies evaluated with comprehensive chromosomal screening. Fertil. Steril. 2014;101(3): 656-63. https://dx.doi.org/10.1016/j.fertnstert.2013.11.004.
- Borges E., de Almeida Ferreira Braga., de Sousa Bonetti., Iaconelli A., Franco J.G. Artificial oocyte activation with calcium ionophore A23187 in intracytoplasmic sperm injection cycles using surgically retrieved spermatozoa. Fertil. Steril. 2009; 92(1): 131-6. https://dx.doi.org/10.1016/j.fertnstert.2008.04.046.
- Barmat L.I., Liu H.C., Spandorfer S.D., Kowalik A., Mele C., Xu K. et al. Autologous endometrial co-culture in patients with repeated failures of implantation after in vitro fertilization-embryo transfer. J. Assist. Reprod. Genet. 1999; 16(3): 121-7. https://dx.doi.org/10.1023/a:1022575630105.
- Mercader A., Garcia-Velasco J.A., Escudero E., Remohí J., Pellicer A., Simón C. Clinical experience and perinatal outcome of blastocyst transfer after coculture of human embryos with human endometrial epithelial cells: a 5-year follow-up study. Fertil. Steril. 2003; 80(5): 1162-8. https://dx.doi.org/10.1016/s0015-0282(03)01178-6.
- Dominguez F., Gadea B., Mercader A., Esteban F.J., Pellicer A., Simón C. Embryologic outcome and secretome profile of implanted blastocysts obtained after coculture in human endometrial epithelial cells versus the sequential system. Fertil. Steril. 2010; 93(3): 774-82. https://dx.doi.org/10.1016/j.fertnstert.2008.10.019.
- Ménézo Y. Cryopreservation of IVF embryos: which stage? Eur. J. Obstet. Gynecol. Reprod .Biol. 2004; 113(Suppl. 1): S28-32. https://dx.doi.org/10.1016/j.ejogrb.2003.11.007.
- Ménézo Y.J.R. Blastocyst freezing. Eur. J. Obstet. Gynecol. Reprod. Biol. 2004; 115(Suppl. 1): S12-5. https://dx.doi.org/10.1016/j.ejogrb.2004.01.007.
- Ménézo Y.J., Chouteau J., Torelló J., Girard A., Veiga A. Birth weight and sex ratio after transfer at the blastocyst stage in humans. Fertil. Steril. 1999; 72(2): 221-4. https://dx.doi.org/10.1016/s0015-0282(99)00256-3.
- Ménézo Y., Veiga A., Pouly J.L. Assisted reproductive technology (ART) in humans: facts and uncertainties. Theriogenology. 2000; 53(2): 599-610. https://dx.doi.org/10.1016/s0093-691x(99)00260-5.
- Ménézo Y., Sakkas D. Monozygotic twinning: is it related to apoptosis in the embryo? Hum. Reprod. 2002; 17(1): 247-8. https://dx.doi.org/10.1093/humrep/17.1.247.
- Cassuto G., Chavrier M., Menezo Y. Culture conditions and not prolonged culture time are responsible for monozygotic twinning in human in vitro fertilization. Fertil. Steril. 2003; 80(2): 462-3. https://dx.doi.org/10.1016/s0015-0282(03)00599-5.
- Guérin P., Ménézo Y. Hypotaurine and taurine in gamete and embryo environments: de novo synthesis via the cysteine sulfinic acid pathway in oviduct cells. Zygote. 1995; 3(4): 333-43. https://dx.doi.org/10.1017/s0967199400002768.
- Guérin P., El Mouatassim S., Ménézo Y. Oxidative stress and protection against reactive oxygen species in the pre-implantation embryo and its surroundings. Hum. Reprod. Update 2001; 7(2): 175-89. https://dx.doi.org/10.1093/humupd/7.2.175.
- Janny L., Ménézo Y.J. Maternal age effect on early human embryonic development and blastocyst formation. Mol. Reprod. Dev. 1996; 45(1): 31-7. https://dx.doi.org/10.1002/(SICI)1098-2795(199609)45:1<31::AID-MRD4>3.0.CO;2-T.
- Ménézo Y.J., Sakkas D., Janny L. Co-culture of human embryo: factor affecting human blastocyst formation in vitro. Microsc. Res. Tech. 1995; 32(1): 50-6. https://dx.doi.org/10.1002/jemt.1070320105.
- Kattal N., Cohen J., Barmat L.I. Role of coculture in human in vitro fertilization: a meta-analysis. Fertil. Steril. 2008; 90(4): 1069-76. https://dx.doi.org/10.1016/j.fertnstert.2007.07.1349.
Received 07.12.2020
Accepted 15.06.2021
About the Authors
Konstantin V. Kirienko, PhD, Leading Embryologist, Altravita IVF clinic. Tel.: +7(967)167-79-23. E-mail: kkiriyenko@rambler.ru. ORCID: 0000-0001-8713-6231;eLibrary SPIN: 3719-8680. 4A, Nagornaya str., 117186, Moscow, Russia.
Ekaterina A. Osina, MD, PhD, reproductologist, obstetrician-gynecologist, Altravita IVF clinic. Tel.: +7(903)686-75-24. E-mail: ossina@mail.ru.
4A, Nagornaya str., 117186, Moscow, Russia.
Valentina P. Apryshko, PhD, Head of Embryology Department, Altravita IVF clinic. Tel.: +7(910)409-28-13. E-mail: supermycolog@mail.ru.
4A, Nagornaya str., 117186, Moscow, Russia.
Vladimir V. Voloshanenko, embryologist, Altravita IVF clinic. Tel.: +7(985)078-05-53. E-mail: veston.campbel@yandex.ru. 4A, Nagornaya str., 117186, Moscow, Russia.
Sergey A. Yakovenko, PhD, G.M., Altravita IVF clinic; researcher, M.V. Lomonosov Moscow State University, Faculty of Physics, Biophisics Department.
Tel.: +7(903)790-90-18. E-mail: altravita@mail.ru. 4A, Nagornaya str., 117186, Moscow, Russia; 1/2 Leninskie gory, 119991, Moscow, Russia.
For citation: Kirienko K.V., Osina E.A., Apryshko V.P., Voloshanenko V.V., Yakovenko S.A. Achieving pregnancy at a late reproductive age in a patient with a history of multiple failed in vitro fertilization attempts.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2021; 7: 202-209 (in Russian)
https://dx.doi.org/10.18565/aig.2021.7.202-209
Similar Articles
