How to Choose Which Type of IVF is Right for You: Fresh, Frozen, PGT or Not
Advancements in frozen embryo transfers are expanding options for individuals seeking IVF solutions. In determining whether to do fresh or frozen, age becomes a dominant factor. Louis Weckstein, MD, RE, explains the difference between the two, as well as why pre-implantation genetic testing (PGT) is an important consideration for anyone undergoing IVF.
Featured Speaker:
Dr. Weckstein has served on the board of directors of the Pacific Coast Reproductive Society and was a past California representative to the National Advisory Council of the American Society of Reproductive Medicine. Dr. Weckstein has authored more than 50 publications and abstracts with a focus on IVF and Egg Donation. He serves as a special reviewer for the infertility journal “Fertility and Sterility.” He is medical and IVF director at RSC. Dr. Weckstein also serves on Progyny’s Medical Advisory Board.
•Reproductive Science Center of the San Francisco Bay Area
•Undergraduate degree: University of Michigan
•Medical training: University of Michigan
•OB/GYN residency: University of California, Irvine
•Postgraduate training in IVF and infertility: University of California, Irvine
•Joined RSC Bay Area: 1990
•RSC location: San Ramon facility
Louis Weckstein, MD, RE
Dr. Louis Weckstein received his training in infertility at University of California-Irvine in 1988 with one of the most successful IVF teams in the country at that time. After establishing a successful OB/GYN private practice in Southern California, he returned to training that included special emphasis on assisted reproductive technologies. He is certified by the American Board of Obstetrics and Gynecology and is a member of the Society for Assisted Reproductive Technology and the Society for Reproductive Surgeons.Dr. Weckstein has served on the board of directors of the Pacific Coast Reproductive Society and was a past California representative to the National Advisory Council of the American Society of Reproductive Medicine. Dr. Weckstein has authored more than 50 publications and abstracts with a focus on IVF and Egg Donation. He serves as a special reviewer for the infertility journal “Fertility and Sterility.” He is medical and IVF director at RSC. Dr. Weckstein also serves on Progyny’s Medical Advisory Board.
•Reproductive Science Center of the San Francisco Bay Area
•Undergraduate degree: University of Michigan
•Medical training: University of Michigan
•OB/GYN residency: University of California, Irvine
•Postgraduate training in IVF and infertility: University of California, Irvine
•Joined RSC Bay Area: 1990
•RSC location: San Ramon facility
Transcription:
How to Choose Which Type of IVF is Right for You: Fresh, Frozen, PGT or Not
Bill Klaproth (Host): So, how do you choose which type of IVF is right for you, fresh, frozen, PGT or not PGT, that is the question. So, let’s get some answers with Dr. Louis Weckstein, IVF and Medical Director at Reproductive Science Center of San Francisco Bay. This is Fertile Edge, podcast by Reproductive Science Center of San Francisco Bay. I’m Bill Klaproth. Dr. Weckstein, so are frozen embryo transfers replacing fresh IVF transfers in fertility centers?
Louis Weckstein, MD, RE (Guest): I remember when embryo freezing was just beginning in IVF centers throughout the world. The technology has come a long way in many centers including our own. Frozen embryo transfers are more common than fresh IVF transfers. In fact, in our center, in 2018, only about 10% of our IVF cycles had a fresh embryo transfer.
Host: So, why do you think this is happening?
Dr. Weckstein: Well for a fresh IVF transfer to be successful, you need a good embryo, a good uterine lining and good hormone levels. In a frozen embryo transfer cycle, also called a FET cycle, you can more optimally prepare the uterine lining and control the hormone levels and in many situations, this can increase the chance for pregnancy. In addition, for IVF cycles that are planned to have preimplantation genetic testing; which we will talk a little bit about later; you need to freeze embryos in order to have time to get the results back from that genetic testing in order to make a decision which embryo is normal to transfer.
Host: Okay so since frozen embryo transfers are more common, is it still reasonable then to do fresh IVF transfers?
Dr. Weckstein: Yeah, that’s a great question. And I think our thinking about this has gradually shifted over the years. And I think it varies from center to center and their own individual experience. In our center, we see that if a woman is under the age of 35, does not have two excessive a response to IVF medication, her uterine lining is good, and her progesterone hormone level is in the ideal range; then we find that live birth rates with fresh embryo transfers are still slightly higher than live birth rates with frozen embryo transfers. Live birth rates are approximately equal to frozen embryo transfer live birth rates if the embryo for the frozen embryo transfer in this young age group was genetically tested.
In a slightly older age group, and age is really a dominant factor here, in women 35 to 37 years of age, live birth rates with fresh embryo transfers are slightly higher than live birth rates with frozen embryo transfers if the embryos are not genetically tested but lower than the success with frozen embryo transfers when the embryos are genetically tested.
And most importantly, in women 38 years of age and older, fresh embryo transfers had a lower live birth rate than frozen embryo transfers with and without genetic testing of embryos with the highest success rates in this older age group in women who did frozen embryo transfers when preimplantation genetic testing of embryos were done.
Host: So, for certain candidates, it’s good that we have the data to help guide us, fresh IVF transfers still may be a better option.
Dr. Weckstein: Agreed. Definitely in that younger age group when everything is perfect, fresh embryo transfers are slightly better success.
Host: Okay so you just mentioned preimplantation genetic testing or PGT. So, what benefits are there to adding PGT to an IVF cycle?
Dr. Weckstein: We found over the years that PGT technology has improved more and more and so success rates have gotten better and better. It’s most important that a woman who is getting older does PGT since a higher percentage of eggs left in an older woman’s ovaries are genetically abnormal as she ages. Older studies have suggested that PGT may be indicated in women 38 and older who do IVF but as this technology and IVF laboratories have gotten better; we are seeing that even younger women may benefit from genetic testing of embryos in an IVF cycle.
And once again, you mentioned looking at data. When we look at data in our center pooled from 2012 to 2018, comparing live birth rate by age in frozen embryo transfer cycles with and without genetic testing; we see a nine percent higher live birth rate in women under 35 when PGT is done. That increases to 20% increase in live birth rate in women 35 to 37 and 38 to 41 and an even greater 23% increase in live birth rates in women over 41.
Another advantage of PGT testing is that it reduces miscarriage rates and reduces the risk of delivering a child with a chromosome genetic abnormality like Down’s Syndrome and it also reduces the number of embryo transfer cycles it takes to have a baby because we are able to know that we are putting in an embryo that has the highest chance of sticking because it is a genetically normal embryo.
Host: So, there’s a lot of benefits then to PGT testing and even though you were talking about data again and data helps guide the decision; I’m still thinking there’s still is a lot of worry involved. So, do patients need to worry that if they freeze their embryos that they may not survive when they are thawed?
Dr. Weckstein: One of the biggest reasons that frozen embryo transfers have gotten more successful is the addition of improved technology for embryo freezing that’s called vitrification or flash freezing. And this has now been done for quite a few years in most IVF centers. In our center, we see that greater than 97% of embryos that are frozen and thawed survive the thaw and are available for embryo transfer. It really is a very small percentage of embryos that don’t make it through the thaw.
Host: All right, so, then let me ask you this. Does doing a frozen embryo transfer cycle cost more than a fresh IVF transfer?
Dr. Weckstein: Unless a patient only has one embryo that develops from her IVF stimulation; if she is doing a fresh embryo transfer cycle, she is going to incur the cost of freezing extra embryos more than that one embryo for future use anyway. If you add that cost of embryo freezing to the cost of a fresh embryo transfer cycle; a frozen embryo transfer cycle is almost the same cost as a fresh embryo transfer cycle. So, which treatment will give you the best success really depends on your age, your clinical situation and we’d be really happy to sit down and talk with you about our individual recommendations for you based on your fertility history at any time.
Host: And getting individual recommendations can really help bring clarity. Dr. Weckstein, thank you so much as always. And to get connected with Dr. Weckstein or another physician please visit www.rscbayarea.com and if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. This is Fertile Edge, by Reproductive Science Center of San Francisco Bay. I’m Bill Klaproth. Thanks for listening.
How to Choose Which Type of IVF is Right for You: Fresh, Frozen, PGT or Not
Bill Klaproth (Host): So, how do you choose which type of IVF is right for you, fresh, frozen, PGT or not PGT, that is the question. So, let’s get some answers with Dr. Louis Weckstein, IVF and Medical Director at Reproductive Science Center of San Francisco Bay. This is Fertile Edge, podcast by Reproductive Science Center of San Francisco Bay. I’m Bill Klaproth. Dr. Weckstein, so are frozen embryo transfers replacing fresh IVF transfers in fertility centers?
Louis Weckstein, MD, RE (Guest): I remember when embryo freezing was just beginning in IVF centers throughout the world. The technology has come a long way in many centers including our own. Frozen embryo transfers are more common than fresh IVF transfers. In fact, in our center, in 2018, only about 10% of our IVF cycles had a fresh embryo transfer.
Host: So, why do you think this is happening?
Dr. Weckstein: Well for a fresh IVF transfer to be successful, you need a good embryo, a good uterine lining and good hormone levels. In a frozen embryo transfer cycle, also called a FET cycle, you can more optimally prepare the uterine lining and control the hormone levels and in many situations, this can increase the chance for pregnancy. In addition, for IVF cycles that are planned to have preimplantation genetic testing; which we will talk a little bit about later; you need to freeze embryos in order to have time to get the results back from that genetic testing in order to make a decision which embryo is normal to transfer.
Host: Okay so since frozen embryo transfers are more common, is it still reasonable then to do fresh IVF transfers?
Dr. Weckstein: Yeah, that’s a great question. And I think our thinking about this has gradually shifted over the years. And I think it varies from center to center and their own individual experience. In our center, we see that if a woman is under the age of 35, does not have two excessive a response to IVF medication, her uterine lining is good, and her progesterone hormone level is in the ideal range; then we find that live birth rates with fresh embryo transfers are still slightly higher than live birth rates with frozen embryo transfers. Live birth rates are approximately equal to frozen embryo transfer live birth rates if the embryo for the frozen embryo transfer in this young age group was genetically tested.
In a slightly older age group, and age is really a dominant factor here, in women 35 to 37 years of age, live birth rates with fresh embryo transfers are slightly higher than live birth rates with frozen embryo transfers if the embryos are not genetically tested but lower than the success with frozen embryo transfers when the embryos are genetically tested.
And most importantly, in women 38 years of age and older, fresh embryo transfers had a lower live birth rate than frozen embryo transfers with and without genetic testing of embryos with the highest success rates in this older age group in women who did frozen embryo transfers when preimplantation genetic testing of embryos were done.
Host: So, for certain candidates, it’s good that we have the data to help guide us, fresh IVF transfers still may be a better option.
Dr. Weckstein: Agreed. Definitely in that younger age group when everything is perfect, fresh embryo transfers are slightly better success.
Host: Okay so you just mentioned preimplantation genetic testing or PGT. So, what benefits are there to adding PGT to an IVF cycle?
Dr. Weckstein: We found over the years that PGT technology has improved more and more and so success rates have gotten better and better. It’s most important that a woman who is getting older does PGT since a higher percentage of eggs left in an older woman’s ovaries are genetically abnormal as she ages. Older studies have suggested that PGT may be indicated in women 38 and older who do IVF but as this technology and IVF laboratories have gotten better; we are seeing that even younger women may benefit from genetic testing of embryos in an IVF cycle.
And once again, you mentioned looking at data. When we look at data in our center pooled from 2012 to 2018, comparing live birth rate by age in frozen embryo transfer cycles with and without genetic testing; we see a nine percent higher live birth rate in women under 35 when PGT is done. That increases to 20% increase in live birth rate in women 35 to 37 and 38 to 41 and an even greater 23% increase in live birth rates in women over 41.
Another advantage of PGT testing is that it reduces miscarriage rates and reduces the risk of delivering a child with a chromosome genetic abnormality like Down’s Syndrome and it also reduces the number of embryo transfer cycles it takes to have a baby because we are able to know that we are putting in an embryo that has the highest chance of sticking because it is a genetically normal embryo.
Host: So, there’s a lot of benefits then to PGT testing and even though you were talking about data again and data helps guide the decision; I’m still thinking there’s still is a lot of worry involved. So, do patients need to worry that if they freeze their embryos that they may not survive when they are thawed?
Dr. Weckstein: One of the biggest reasons that frozen embryo transfers have gotten more successful is the addition of improved technology for embryo freezing that’s called vitrification or flash freezing. And this has now been done for quite a few years in most IVF centers. In our center, we see that greater than 97% of embryos that are frozen and thawed survive the thaw and are available for embryo transfer. It really is a very small percentage of embryos that don’t make it through the thaw.
Host: All right, so, then let me ask you this. Does doing a frozen embryo transfer cycle cost more than a fresh IVF transfer?
Dr. Weckstein: Unless a patient only has one embryo that develops from her IVF stimulation; if she is doing a fresh embryo transfer cycle, she is going to incur the cost of freezing extra embryos more than that one embryo for future use anyway. If you add that cost of embryo freezing to the cost of a fresh embryo transfer cycle; a frozen embryo transfer cycle is almost the same cost as a fresh embryo transfer cycle. So, which treatment will give you the best success really depends on your age, your clinical situation and we’d be really happy to sit down and talk with you about our individual recommendations for you based on your fertility history at any time.
Host: And getting individual recommendations can really help bring clarity. Dr. Weckstein, thank you so much as always. And to get connected with Dr. Weckstein or another physician please visit www.rscbayarea.com and if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. This is Fertile Edge, by Reproductive Science Center of San Francisco Bay. I’m Bill Klaproth. Thanks for listening.