" We are making babies, not cookies"

An honest interview with Dr Rahi Victory from Victory Reproductive Care, about the importance of a personalised approach in Assisted Reproduction.

Should anyone be given a chance to Assisted reproduction regardless of their circumstances? Are supplements and diet any good? How often should we change protocols? Is a personalized approach better? What to look for, when we are looking for an RE?

Q: Trying to conceive. For how long should we try on our own, before seeking help?

Dr Victory: This is dependent on age and menstrual regularity. If your periods are irregular you should seek assistance immediately. This is typically because of PCOS. Patients with PCOS have substantially higher risks of uterine cancer due to irregularity and chances of conception are extremely low. These patients need help immediately.

For patients with regular cycles, they should follow the following guidelines:

< 35 years of age – try for one year then seek help

35– 40 years of age. – try for six months then seek help

>40 – try for three months then seek help

Q: How old is realistically too old, with own eggs, in Assisted Reproduction? At which point does it become a waste of time and money?

Dr Victory: This is a great question but difficult to answer because it really depends on a number of factors, including age, BMI, social habits, AFC, AMH. So for example, if the patient is 43 but has an AFC of 20, and an AMH of 20 pmol/l (2.5 ng/ml) then she still has a decent chance. But on average after the age of 40 chances of success are less than 25% in most centers and continue to decline rapidly to the point where they are negligible after 43.

There is some complicated chronologically backwards math, but it essentially goes like this:

A) 60% of euploid blastocysts will adhere and survive in utero

B) 60% of mature fertilized oocytes will reach blastocyst stage

C) 90% of oocytes can be fertilized with advanced ICSI

D) At age 43, 90% of oocytes are genetically abnormal (probably 75%- 80% at age 40)

E) So if you do the math you need close to 40 eggs to get one pregnancy on average.

Most patients can’t make 40 eggs at the age of 40.

Obviously the math is just math and you could make a normal embryo on first try, but based on averages it would be very difficult…

Q: Do you have cut-offs for AMH, AFC or FSH? Or do you believe everyone should be given a chance, regardless of their ovarian reserve, yet up to a certain age?

Dr Victory: I believe that everyone should be given a choice regardless of their circumstances. However, I think they need to be told honestly what those chances actually are in clear terms so they’re not just paying for something without knowing what they’re actually getting out of it.

So if you know your chances are 5% and you still want to go ahead, that’s fine. But if you think that your chance is 30% and it’s actually 5% that is dishonest on the part of the physician.

Q: Do you believe the term “geriatric” should apply to a woman over 40 trying to conceive? Many clinics employ this term.

Dr Victory: Lol. I have a post on this! I hate the term geriatric pregnancy. Risks for pregnancy don’t increase till after the age of 40. The term geriatric specifically applies to women over the age of 65. The only risks of pregnancy for older women include hypertension and diabetes, and we can minimize these with careful diet and use of aspirin. There are fetal risks of autism, cerebral palsy and these are real and unavoidable. And of course there are genetic risks for the fetus starti