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lilla - December 4th, 2006 2:31 PM

My husband and I recently completed our first IVF due to his balanced translocation. I am 32 with an FSH of 9.5 and responded well to stims - almost too well - they started me on 300 iu of follistim + 75 iu menopur and had to drop me to 50 iu of follistim after 2 days, then down to 25 iu. I triggered on day 8.

We retrieved 16, ICSI'd 15 and 14 fertilized. All 14 were biopsied and 12 of the cells had no nuclei. We were told this was b/c of poor embryo quality. Of the remaining 2, 1 was normal / balanced and 1 was unbalanced. We transferred a compacting morula and did not achieve a pregnancy (this had been one of the grade 4 embies, with 4 the lowest rating).

I now have the embryo report and on the day of biopsy (day 3), we had 3 grade 2, 7 grade 3 and 4 grade 4 embryos (1 being the highest quality). Most of the embryos were 6 or 8 cell. There was one 3 cell grade 4 and one 4 cell grade 2.

All three grade 2 embryos went on to be early blasts by day 5. One of them (not the one that was only 4 cell on day 3) was degen by day 5. We did nothing with the other 2 EB b/c we had no genetic information on them.

Does this sound like an egg quality issue?

I am convinced the lab made errors during the PGD process and that is why 12/14 had no nuclei. I have not read anything that refers to more than a 10 - 15% chance of cells without a nuclei. If we go with IVF / PGD again, with another clinic obviously, how can we confirm that they know what they are doing?

Dr Smith - December 5th, 2006 1:28 PM

It may not have been a lab screw up. When embryos are highly fragmented, its really, really difficult to determine what's a large fragment a what's a cell. It is not always possible to see a nucleus in every cell that is to be biopsied. Fragments do not contain nuclei, thus, if they biopsied what they thought was cell and it was really a large fragment, the results would come back "no nucleus". This is not a screw up, just the limitations of the technology. I've been in the same position myself and there's nothing you can do about it. I have to agree with the embryologist. It was a poor embryo quality issue.

Yes, this sounds very much like an egg quality problem. However, it may have been caused by the stimulation which was atypical. Decreasing the dose of FSH after two days of stimulation is a bit unusual and may have resulted in abnormal maturation of the follicles/eggs. In addition, it has been our experience, that an 8 day stimulation is not enough to allow adequate cytoplasmic maturation. The result: highly fragmented embryos. A subsequent stimulation with more controlled follicular development may result in less fragmentation and embryos with better developmental potential. Ovarian stimulation is tricky and sometimes takes a second time to get it right.

lilla - December 5th, 2006 2:15 PM

Dr. Smith,

Thank you very much for the input and information. I am still a little leary of our lab b/c of the fact that we had no info on the three grade 2 embryos also...

At any rate, your advice is encouraging to me, since we are considering another IVF / PGD cycle with a different clinic. I agree that there is probably much to be learned from this past cycle re: my response to stimulation. That was actually the first time I'd ever taken any fertility drugs at all, and my FSH was 9.5, so I know the doctors were not sure how I was going to respond.

We'll probably give it another shot...if that doesn't work. I'll just have to suck it up and accept that multiple miscarriages are probably part of my future....but that there's bound to be a healthy one at some point!

Thanks again.

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