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atl7 - May 16th, 2006 3:59 PM

Dear Dr.,

I am a bit disappointed and, frankly, confused after an IVF.

At retrieval (hCG shot on Day 9 of stim), we had 17 mature eggs out of 31 total. As my husband's sperm is bad in terms of morphology (1% Kruger), all 17 were ICSI'ed and 14 fertilized. As a result, at least 5 were Grade 1 on Day 1.

However, on Day 3 only 1 was Grade 1- (7-cell, otherwise it looked good), and 7 were Grade 2 (6-cell, with some fragmentation). The remaining 6 "arrested" in their development on Day 2.

What can account for the drop in the number and quality of the embryos?

Please shed some light or at least speculate...

Thanks so much!

Dr Smith - May 17th, 2006 9:11 AM

I need more information:

How old are you? Do you have PCOS? Have you ever been prenant and carried to term? If so, how long ago?

atl7 - May 17th, 2006 10:54 AM

Dr. Smith,

I am 34 y.o. and my husband is 38. I have never had (never been diagnosed with) PCOS and have never been pregnant. TTC 3.2 years.

Just to add, I had over 20 antral follicles in each ovary before the stimulation.

Thanks again!

Dr Smith - May 17th, 2006 1:27 PM

If you have not been diagnosed with PCOS, then you are considered a "hyper-responder". When so many follicles develop in each ovary, the quality (i.e. developmental capacity) of the eggs is diminished (overcrowding?). The early arrest (prior to Day 3) of your embryos is indicative of this kind of diminished quality. More is not necessarily better in ovarian stimulation. It has the added sting of generating high hopes because you here things like "Your response is "great!" before the retrival. Then the crash when it turns out the quality is bad. You may benefit from a milder and extended stimulation to allow the eggs to undergo additional maturation in the follicles prior to retrieval. That's what we do here and it seems to work better.

The other explanation is that your eggs are of poor quality to begin with and this explains why someone as young as you has not become pregnant with 3+ years TTC. However, I wouldn't draw too many conclusions from your IVF cycle until you tried another stimulation protocol.

Best of luck.

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