Age and ICSI
MaryIsobel - Aug 31st, 2006 2:27 PM
[ Original Post ]

Dear Dr Smith,
I would like advice on if it is worth further treatment.
So far....
1st go ICSI date: 06/2004 (age 41) 12 of 23 eggs fertilised. 2 transferred D3 BFN. 10 frozen
2nd go FET 1 x 6 cell, 1 x 5 cell, BFN
3rd go FET, 2 x 4 cell, BFN
4th go ICSI Date: 11/05 8 out of 14 fertilised. Explanation from the clinic was bad luck.
2 x 8 cell transferred Day 4. BFN
None survived as tried to go for blast.
5th Go date: 8 out of 13 fertilised. 3 transferred on Day 4. 2 x 6 cell, 2 x 5 cell BFN. Again, none made it to blastocyst. We were given no real explanation, apart from aneuploidy or perhaps the eggs were harvested too late.
After 3rd go, I had immunology tests and found have Factor V Leiden, so did next 2 cycles with Heparin.
Other factors; 1 blocked tube. DH has a low sperm count and high abnormal count although last ICSI was only 65% abnormal. LH & FSH normal. Menstrual cycle normal.

All of these attempts were with the same clinic, who said it was not an age problem throughout until the follow up appt after the last cycle. Their recommendation is to have PGS. We have decided to change clinics if we have another try. we have 6 frozen embryos remaining, but would be willing to do a complete cycle again.

Your thoughts would be greatly appreciated
Mary

Comment


 

Dr Smith - Sep 1st, 2006 10:30 AM

I think it was an age problem from the very first cycle. Although you are producing an reasonable number of eggs, the embryos were seriously behind schedule for Day 4. The embryos should have at least been 8-cell by Day 4 and embryos with good developmental potential would have been beyond the 8-cell stage and intiating compaction. Aneuploid embryos rarely make it past the 8-cell stage and most arrest between the 4 and 8-cell stage. Looks like the vast majority, if not all, of the embryos were aneuploid.

Poor fertilization rates following ICSI can also be a sign of aneuploid eggs. The low end sperm morphology was never an issue since the sperm genetic contribution does not manifest until after the 8-cell stage and none of the embryos made it past the 8-cell stage.

Although PGD would identify most aneuploid embryos in a subsequent cycle, it would not get you any farther ahead. I suspect PGD would only tells us what we already know. All it would do is save you the anxiety of the 2 week wait. PGD is expensive and I don't think there's any point.

I know this isn't what you want to hear, but, based on the history you provided, using donated eggs is your best option at this point.


MaryIsobel - Oct 8th, 2006 1:19 PM

Dr Smith, Thank you v. much for the response, however,
I may have put too much info and not been clear in my first message. The first cycle, 23 eggs collected, the fertilization rate was good with ICSI, 12 out of 13 fertilised, IVF was tried on only 7 of which none fertilised, I presume the remaining 3 were not suitable. For this cycle I had a 2 day transfer of 2 embryos. The following 2 FETS' were from the same batch of embryos. They were frozen on Day 2.
For the cycle I went through in Nov last year, an 8 cell and 10 cell were transferred on Day 4.

I accept that most of the eggs may be aneuploid, but we are going to try with the 6 remaining frozen embryos from the 1st cycle but with another clinic. I trust they were good enough to freeze and so we may have a chance if one of them makes it to blastocyst. If this fails, we may have one more fresh cycle using my eggs and have the embryos checked for aneuploidy. Am I wrong in believing that a fresh cycle could produce some eggs which are not aneuploid, or is it a question of after a certain age, all the eggs are aneuploid, no matter what drug regime one is on? I am not keen on Donor eggs as I believe there is no guarantee of a pregnancy although the success rates are much higher. At present if the next FET does not work or a further fresh cycl :)e we would consider the possiblity of adopting. The funds for ART have almost run out!
Best regards Mary


Dr Smith - Oct 10th, 2006 7:55 AM

About the frozen embryos... Although they probably looked "fine" when they were frozen on Day 2, there's no way of knowing their developmental potential from their appearance on Day 2. Hopefully, one will make it to the blastocyst stage. That does gaurantee genetic normalacy, but its a good sign.

At 41, there are still some genetically normal eggs remaining in your ovaries. The trick, of course, is getting them out. And that's a big trick! To be honest, if the FET doesn't work, I think you should move on to adoption. Here's hoping it wil work.

Best of luck.


MaryIsobel - Jan 20th, 2007 4:51 AM

Although PGD would identify most aneuploid embryos in a subsequent cycle, it would not get you any farther ahead. I suspect PGD would only tells us what we already know. All it would do is save you the anxiety of the 2 week wait. PGD is expensive and I don't think there's any point.

Dr Smith, I do not understand your reply above. Could you elaborate on PGD would tell us what we already know. The FET did not work, (Nov 06) We have just had a follow up consultation with the clinic in London which has told us our chances are 6% for my age with my eggs. If we have PGD/PGS it would rise to 27%. I would appreciate your comments on this. We have not decided yet. Is every batch of eggs the same once you get to a certain age ? Also, the embryo culture may be different at this new clinic where we have not undergone a full fresh cycle.

Many thanks