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KellyAD - March 10th, 2006 6:40 AM

History includes 6 day iui stim on 75 fsh, 2 non-ART children, 34 yo, normal to slightly low sperm count/morph, normal day 3 tests/hsg.

IVF#1, Long Lupron protocol, 3 weeks on lupron before stims as I ovulated on BCP at the lupron flare. 225FSH, 150 menopur, trigger day 10 at 3100 E2, 12 eggs retrieved. 4 fertilized normally, 1 poly, 5 with only 1PN, 2 no fert. All four remaining were 2 cell on day two and 4 cell on day three. Transferred three 4-cells on day 3 with assisted hatching.

Any thoughts on what might be the problem? Will ICSI help next time? Anything that sticks out about the protocol/results that would help decide where to go from here?

Dr Smith - March 10th, 2006 1:00 PM

Yes, I'd suggest ICSI next time. The stimulation looks O.K., but there certainly were some problems with the eggs on that cycle. In addition to ensuring that a sperm gets into each mature egg, ICSI may assist in egg "activation" which normally occurs when the sperm penetrates the eggs. Sometimes this "activation" process fails and the result is 1PN embryos. There may also have been dissynchony in the follicluar growth during the stimulation (a few big follicles and the rest were intermediate or small). This translates to variation in the degree a cytoplasmic maturity of the eggs. Those from the large follicles are fine, but eggs retrieved from the smaller follicles had not had an adequate amount time to complete cytoplasmic maturation. Eggs with immature cytoplasm fail to undergo the "activation" process when the sperm penetrates. It wouldn't hurt to get a second opinion about how the ovarian stimulation went. I would encourage you to try again. Best of luck.

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