Hi I'm 39, well really 40 next month. I tried to get pregnant for 6 months no success. I had one miscarriage at age 37, getting pregnant on the pill but was told was unlikely to be the pill.  I definitely do not want twins and would never do a reduction so I asked to implant only one embryo. I actually would love two kids if possible but I don't want to carry two or have two young infants at the same time.  I was on 225 gonal f and one dose menopure then ganirelix as well.  I had 15 eggs, 9 were mature. They told me 7 fertilised and its a great number.  How many typically fertilize. Was told you cannot fertilize immature egg I did Icsi because we were told if we wanted to do pgd need Icsi. Is that true? I am going to try to see if I get pregnant now without pgd.  Pgd is costly and is scary to me. Do you think pgd is safe? Also was told pgd doesn't catch many genetic anomalies.  We are waiting to see if embryos are good quality. Is 7 a high enough number.  Was told at my age that 80% of my eggs likely to be bad. Is it possible for an older woman to have more good ones than that? I don't believe women get pregnant naturally like at 46 but I'm one of 3 and my mother was shocked when she got pregnant at 42, gave Birth to healthy baby at 43. My brother was huge even though 6 weeks premature so he was able to go home.  I or my spouse have no known fertility issues. There may be something there but we didn't find anything after many tests.  I think wanting this so badly and having such high stress didn't help us.  Anyway I hope I will get good news on embryo quality.  I was told I could do pgd later if there are any embryos frozen. Do you think pgd will get better? How many embryos survive freezing? I was going to freeze eggs for moral considerations but was told that egg freezing is not that great and at my age would likely be a total waste. I feel a little selfish so I didn't go that route.  Do embryos deteriorate the longer they're frozen? Just trying to understand my timetable if I have embryos to freeze.  Also I had a bad reaction to the stims. Not ohss but very bloated w cramps. And I HATE needles. How come they don't just implant embryos if everything seems normal with hormones and endometrium? Why more shots?  Thanks so much

Hello Delilah from the U.S.(New York),

You certainly have a lot of questions that should have been answered by your IVF clinic.  They're not doing a good job leaving you with all these questions.

Some of the information they are giving is not correct, or maybe it's just that this clinic hasn't had good success with PGD and embryo freezing.  If done well, PGD should not harm the embryo (if done at the blastocyst stage and not the Day#3 stage) and the same goes with freezing and thawing.  Despite the age of your embryos these two procedures should be safe and reliable in a quality clinic/center.  So let me see if I can dissect your questions and answer each of them.

1.  My threshold for fertilization is 60%, so your number is good (7 of 9)
2.  You are correct that you cannot fertilize immature eggs, mainly because they will not fertilize and not because of some technical issue.  Maturity occurs as the last stage of embryo development before retrieval.  It is NOT true that you need to do ICSI in order to do PGD.
3.  PGD is safe as mentioned above.  The advantage it gives is the ability to discern the chromosomally normal embryos from the abnormal ones so that you only choose the normal ones.  This is especially important if you are only going to choose to transfer one.  PGD only evaluates chromosomes, and some genetic abnormalities such as Tay sachs disease, Sickle cell, Muscular dystrophy, etc. are within the chromosome but the chromosomal complement is normal.  So PGD will be able to detect Down's syndrome or Turner's syndrome, which are abnormalities of chromosome number.
4.  The statistic is based on all the eggs you have and NOT based on the number retrieved in this cycle.  There is no way to know how many of the current numbers are good or bad.  They could all be good or all be bad or some combination.
5.  In a good clinic/center, 90+% of embryos survive freezing and thawing. PGD is perfectly safe in the hands of a good and experienced embryologist.
6.  If the embryos reach blastocyst stage, they are certainly worth freezing!
7.  Frozen embryos should remain for many many years if done properly and maintained properly (tank not allowed to get low).  There has been a pregnancy from embryos that had been frozen 20 years prior.
8.  The continued hormones are required to help with implantation and maintenance of the pregnancy.  Keep in mind that IVF is an artificial cycle and so every aspect of the reproductive process has to be reproduced and maintained.  Otherwise, it may not work.  Certainly if you did a "natural cycle" IVF, in which case no stimulation or minimal stimulation is used and the natural cycle followed, these supplements may not be required, but would you be willing to not get pregnant because there was an inadequate amount of some hormone such as progesterone?

Good Luck,

Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program

Monterey, California, U.S.A.

for additional information check out my blog at check me out on twitter with me at @montereybayivf and facebook @montereybayivf.  Skype and internet comprehensive consultations now available via my website for those who want a more extensive evaluation that this site can accommodate.  I also now provide an Email Concierge Advisory Service with a 1 year subscription for patients that want easy access to me to answer questions along their journey (women's health, infertility, pregnancy).  Contact me at if you are interested in continuous access to me.  


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Edward Joseph Ramirez, MD, FACOG


I am a specialist in infertility and advanced gynecological care. I can answer questions about infertility, gynecology related ills, menopause...virtually anything that affects women's health. PLEASE tell me where you are writing from as I am always interested.


I have been practicing as an Ob/Gyn and Infertility Specialist for over 23 years. Gynecology, advanced laparoscopic surgery, basic infertility, IUI's, IVF, reproductive surgery, and ovulation induction are all areas of my expertise. I am Board Certified. I have been doing In Vitro Fertilization in my clinic for 19 years.

American College of OB/GYN, American Board of Obstetrics and Gynecology, American Society of Reproductive Medicine, California Medical Association, American Association of Gynecologic Laparoscopists, Fellow of The American College of Obstetricians & Gynecologists

American Journal of Obstetrics and Gynecology, Wall Street Journal, Monterey Herald, SERMO, Women's Health and Fertility Blog

Medical Degree from Stanford University, Residency at Tripler Army Medical Center, Reproductive Training at Pacific Fertility Center, San Francisco

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