We recently treated a patient who presented an interesting dilemma. She'd done IVF at the age of 38 because she was worried about her poor ovarian reserve and hadn't got pregnant even after four years of trying.
We did an IVF cycle for her. We got three grade A blastocysts. We froze one, we transferred two. She got pregnant, and now she has a gorgeous one-year-old daughter.
She is now 40 and she's not sure what to do. She's wondering whether we should transfer the remaining one frozen blastocyst which we have, which is actually a great quality blastocyst, but she's not sure whether that will achieve a pregnancy or not.
Her other option is to keep this one in reserve and then do another fresh cycle, given the fact that it's only been a couple of years since she does her last cycle and hopefully ovarian reserve hasn't dropped too much and this way her hope is that she will get pregnant in the fresh cycle, and even if she doesn't she may be able to generate some more frozen blastocysts so that she'll be able to have a better chance of getting pregnant in case the fresh cycle fails.
Now this is an interesting dilemma. The frozen blastocyst which we created when she was younger obviously gives her a good chance of getting pregnant, and perhaps better than one with fresh blastocysts at the age of 40, but it's very hard to be able to make some of these decisions, both for the patient as well as for the doctor and I think sometimes it's better to be safe rather than to be sorry and I agreed with her that we should continue storing this blastocyst as a backup measure and we can always use it if required, and we should do another cycle for her rather than wait because if she does transfer the frozen blastocyst and she doesn't get pregnant, then she'll be that much older before she can do another fresh cycle.
This story exemplifies the fact that there are no straightforward black or white answers in IVF - patients need to decide for themselves , so they have peace of mind they did their best !