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Embryo pooling is an advanced Assisted Reproductive Technology (ART) procedure. It is performed before Preimplantation Genetic Screening (PGS) and also contributes in enhancing IVF success rate. Embryo pooling is recommended to the women who are above 40 age and have failed in their IVF cycles.
Let’s Discuss in More Details About Embryo Pooling:
- What is Embryo Pooling?
- Who needs Embryo Pooling?
- How Does Embryo Pooling Enhance IVF Success Rate?
- The procedure of Embryo Pooling?
- Cost Involved in Embryo Pooling?
- When Not to Go for Embryo Pooling?
Embryo Pooling or ACCU-VIT Protocol is one of the greatest revelations in reproductive medicine. ACCU-VIT literally stands for Accumulation of embryos and vitrification. This procedure is nothing but an improvement of a normal IVF cycle. Under this procedure, a woman goes through multiple ovulation or superovulation. Her eggs are collected over a period of time, fertilized in the embryo form and then vitrified. After receiving a good amount of healthy embryos, they are transferred to the woman’s uterus which is scientifically proven to better the chances of pregnancy with IVF. (1)
Embryo pooling is suggested/ recommended to women under the following circumstances (2):
- Women with low ovarian reserve (poor responders)
- Women with previous multiple IVF failures
- Women above the age of 40
- Women with previous OHSS and PCOS patients (Hyper-responders)
Embryo pooling is a relatively new yet effective process to enhance the success rate of IVF. Women with advancing age, low ovarian reserve or repeated IVF failure are the ones who get benefited with it. Failed implantation is a major problem that is encountered frequently. Creating high-quality embryos is something that we have mastered yet once these are transferred in the uterus, doctors can’t assure implantation. The main reason behind the dependency on implantation to achieve a pregnancy is the fact that implantation is a biological process that cannot be influenced externally hence doctors have no control over it. After implantation, it is impossible to track the changes or developments happening inside of the uterus, which is why it is difficult to establish an exact reason behind a failed implantation. (3)
To this, embryo pooling has emerged out as a possible solution. Under this process, a number of high-quality embryos (at blastocyst stage) are produced in a span of 2 to 4 IVF cycles. These are then cryopreserved after being checked for quality through Pre Genetic Screening (PGS). The frozen embryos are then transferred one by one during a time period. This Frozen Embryo Transfer (FET) can be done during a natural cycle or even during the one where estrogen is given to make endometrium ready for implantation. (4)
This may appear like a costly, tiresome and lengthy procedure to follow but it has its own advantages in enhancing the chances of pregnancy. The most important reason behind this is that the chances of implantation for a superior quality embryo during a fresh IVF cycle are lower when compared to that of a natural cycle. The process of superovulation to which the patient is subjected to in an IVF cycle requires hormonal injections. During this process, the complete focus is given to the generation of multiple high-quality eggs while their effect on the endometrium is not considered which could also mean decreased endometrial receptivity. The reduced levels of endometrial receptivity may not get detected in an ultrasound, which may look perfect otherwise. Freezing of embryos is one way of avoiding this issue when instead of being transferred in a fresh cycle, they are transferred in a frozen thaw cycle, one at a time. This cycle would have all the focus on the endometrial receptivity and implantation. It is to be noted that with the help of proper vitrification process, the chances of success can get as good as 100%.
The process is advantageous for women in their late 30s or early 40s also called advanced maternal age so that they can have as many numbers of good quality embryos as possible and later on get them transferred.
The Embryo Pooling or pooled IVF is a process when the patient will undergo 2 or more ovarian stimulation. In easy terms, we can say that the superior quality of blastocyst culture will generate in 2-4 cycles, and then they are frozen. Then over a period of time, the blastocyst culture will transfer in either a natural cycle IVF or by the process in which using estrogen, the endometrium will prepare. (8) The process of Embryo Pooling is as follows:
- During Embryo Pooling, all the embryos are frozen at the early embryonic development.
- After the embryos have reached the desired stage, the frozen embryos will be taken and will be grown together with the other embryos.
- Embryo pooling process is done before Preimplantation Genetic Screening (PGS) by pooling the cryopreserved embryos from two or more IVF stimulation cycle. (9)
- There are enough to cycle and to perform Preimplantation Genetic Screening (PGS) which identifies normal embryos with healthy chromosomes i.e. Euploids. During this step, patients undergo 1 IVF cycle, as all the embryos will be frozen at the early ovulation stage. Subsequently, the patient will undergo another IVF cycle.
- The frozen embryos will be taken and combined with the fresh embryos. After that, the Preimplantation Genetic Screening (PGS) will be done. The embryos will be made ready for the blastocyst stage. (10)
- Pooled Embryo process is comparatively cheap and this will reduce the risk of having Aneuploids i.e. abnormal embryos.
As the age advances, the number of aneuploids increases and it is much higher than people might expect. Embryo Pooling increases the chances of having normal embryos evidently. Women between the age of 35 - 40 years, only 25% of embryo transfer will be normal. If the woman is above 40 years, then the normal embryo transfer will reduce to 10% if it is a 3-day embryo transfer. If a 5-day embryo transfer is done then the Euploids will select themselves out and the normal embryos will be 50% among 35-40 years of women and 30% normal when the age exceeds above 40. This is the reason why women do not get pregnant naturally after the age of 40. With this process, the survival rate of the embryo is 100% and none of the frozen embryones is a waste.
In-Virto Fertilization (IVF) and Pooled In-Virto Fertilization are very much different. In IVF, the embryo is fertilized and is transferred directly. On the other hand, in Pooled IVF or Pooled Embryo process, a number of embryos are frozen and are transferred by the IVF procedure. One by one the embryo is prepared for the blastocysts transfer till the time the desired results are achieved. (6) (7)
Pooled Embryo is slightly expensive and effective than the standard IVF. The average cost of a regular IVF in India is around Rs. 2,00,000; this may or may not include the multiple visits to the doctor. While on the other hand, if we pool the embryos then the cost of the procedure is quite high. Pooling Embryos is cost-effective as the work is done upon a single culture of fertilized eggs, after that, all the normal and acceptable embryos will undergo Preimplantation Genetic Screening (PGS). The embryos will be transferred to the frozen embryo transfer cycle and that will ensure better implantation rates. The estimated cost of the Pooling Embryo cycle is about Rs. 3,00,000 per cycle. The cost of other additional procedures varies from patient to patient.
Pooled Embryo cycle significantly increases the chances of having a baby for the women who are in the 30-40 year age group. The couples do not have to undergo the trauma of multiple IVF failures. Although the process is time-consuming than the standard IVF, the success rate is high.
As discussed earlier, Embryo Pooling is a technology that specifically helps women with advanced maternal age (35 to 40 years), low AMH reserve, or repeated IVF failures due to unknown causes. If you are below 35 years, have no history of IVF failure or have sufficient ovarian reserve then there is no need for you to opt for embryo pooling unless suggested by the doctor. (5)
Failed implantation due to anonymous reasons has been a concern since the introduction of IVF. Constant research and development have introduced Embryo Pooling technique as a recent addition in the list of Assisted Reproductive Technology (ART) treatments that can now successfully handle the major implantation issues faced by women with increasing age and other related factors.
SOURCES AND REFERENCES:
- ^ Embryo Pooling | NCBI Ncbi.nlm.nih.gov, 09 August 2019
- ^ Who needs Embryo Pooling | Semantic Scholar Semanticscholar.org, 09 August 2019
- ^ Freezing Embryos Does Not Boost IVF Success Rate Newscientist.com, 09 August 2019
- ^ Frozen Embryo Transfer (FET) Procedure | Verywell Family Verywellfamily.com, 09 August 2019
- ^ How Much Does IVF Really Cost? | Verywell Family Verywellfamily.com, 09 August 2019
- ^ In Vitro Fertilization | Mayo Clinic Mayoclinic.org, 09 August 2019
- ^ IVF Procedure | Medical News Today Medicalnewstoday.com, 09 August 2019
- ^ Blastocyst | Wikipedia En.wikipedia.org, 09 August 2019
- ^ Preimplantation Genetic Diagnosis | Wikipedia En.wikipedia.org, 09 August 2019
- ^ Embryo Freezing: What Is the Process and Who Benefits? Medicalnewstoday.com, 09 August 2019
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