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You are correct in you interpretation that PGD will not lead to definitive answer as to whether the problem lies with the sperm, eggs or both. Therefore, I can't see any indication for PGD. Everyone seems to be in a big hurry to perform PGD (the latest, greatest thing in ART treatment), even when it doesn't make clinical sense. I think its tied into the notion that "We've gotta do something different next time 'cause last time didn't work". At your age, its a 50/50 chance anyway. O.K., so you were in the 50% that is unsuccessful. That doesn't mean its mandatory to kick up the technology a notch, particularly when it not justified by either improving the chances of pregnancy or providing definitive diagnostic information. In my opinion, PGD is not necessary in your case.

There is no clinical test availalbe to determine the genetic normalcy of sperm (in terms of chormosome numbers). However, there is a test (Sperm Chromatin Structure Assay) that evaluates the degree of DNA fragmentation in the sperm. Excessive DNA fragmentation in the sperm has been linked to both higher embryonic arrest prior to reaching the blastocyst stage and a higher 1st trimester miscarriage rate. I think its worth a shot. More information about the test can be obtained from www.scsadiagnostics.com. If it turns out that the DNA Fragmentation Index (DFI) is high, then you may consider using donated sperm to improve your chances. If the DFI is normal, then the problem was probably with the eggs. However, every cycle is different (a different crop of eggs and sperm) and therefore resulting embryos are different every time. One bad batch is not absolutely predictive that the next batch will be bad as well - particularly in some your age.

I would also recommend culturing the embryos to the blastocyst stage pior to transfer next time. That way you can be sure that the embryos that are transferred are at least capable of attachment and implantation (only blastocyst stage embryos can attach and implant). For more information on the virutues of Day 5 transfer, see http://www.sharedjourney.com/
articles/3vs5.html

Bes
t
of luck.

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Dr. Smith,

Thank you very much for your reply. It was very helpful to hear another professional's opinion. A couple of more questions, if you don't mind:

One thing I forgot to add about our previous treatments was that my husband's sperm count was not only borderline, but motility was also quite low (definitly low post-wash, we're assuming it was also low pre-wash). Would this be a further indication of sperm issues (as it relates to using sperm for IVF)? I guess we were assuming the motility issue would not be an issue, because it was being placed in the egg. But could low motility be a symptom of a bigger issue (i.e., genetic issue, chromosome issue, etc.?)

We also checked the website for the SCSA. It said that for males with low sperm count, the test results are usually inconclusive. They list a low count at "500,000/ml". I don't understand the numbers too well, but when we see our doctor, he tells us my husband's count is at 5,000,000. I believe that is post-wash. Would you assume he's saying it's 5,000,000/ml?

Lastly...is it unusual for a number of embryo's to not make it to blastocyst stage (in the lab)? It seems that our friends who have had IVF have always had all their remaining embryos make it to be frozen. But someone else said that they heard that 40% of embryos do not make it to blastocyst stage? I have to admit, we're feeling a little discouraged to know that none of our embryos were able to be frozen...we feel like we're losing hope, because we don't know what would be different the next time. (But I know you've also said that one batch of eggs/sperm might be different than the next...it's just been such a long time going through this!). I know it's only been 1 IVF, and we're ready for the next, but we're just trying to make sure we're doing what we can to be informed.

Thanks so much for your help.

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As far as I'm aware, there is no direct link between between sperm motility and the genetics of the sperm. However, sperm morphology is realted to genetic problems. ICSI over comes the motility probelm, but the sperm also have poor morphology, then there still may be a genetics issue.

I think your doctor is referring the the concentration of sperm in the semen, not post wash. 5 million/ml is a low concentration (> 20 being normal). The SCSA test requires a concentration of more than 500,000/ml. At 5 million/ml, your husband's sperm can be analyzed by SCSA with a reasonable degree of accuracy.

Unless the lab is really crappy (and that is highly unlikely these days), the percentage of embryos that reach the blastocyst stage is NOT related to whether or not they are in the lab. It is primarily a function of genetics. Genetically abnormal embryos arrest development. It is a natural process to "weed out" embryos that will result in abnomal pregnancies. The percentage of embryos that reach the blastocyst stage is a function of maternal age. The older you are, the lower the precentage of embryos that make it to the blastocyst stage (the flip side of the higher the percentage of genetically abnormal embryos). All things being equal, at 31, you can expect about 40-50% of the embryos to make it to the blastocyst stage. The reason you did not achieve this percentage could have been due to the stimulation (poor egg quality) or genetics (due to sperm, egg or both) or the luck of the draw, or a combination of all three. I'd say give it another try with a new stimulation and see what the results are.

FYI: Since you're taking progesterone supplementation following IVF, serum progesterone levels during the two week wait are not predictive of success. If your progesterone levels are high, it just means you have enough progesterone in your system to support a pregnancy, if one occurs.

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Good afternoon,

My wife (40) and I (35) went through 3 failed IUI before deciding on IVF. The entire IVF experience was very painful for my wife. We just recently (last Friday) had two (2) A1 quality embryos implanted, and were also told that the remaining two (2) did not make it past the blast... stage (or whatever you call it). We wanted to freeze the remaining two (2), but were told by the Doctore that all is to late for us. We both cannot aford another round of IVF.

Any thoughts?


Ricardo M.

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Can embryps that do not survive blast... stage be frozen?

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