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Rebecca - October 19th, 2006 4:44 PM

Dr- I would like your opinion. I am 30 years old and have had 2 failed IVF cycles. A little history: Been TTC for 2 years with one early miscarriage and 1 "suspected" ectopic treated with MTX (both times conceived naturally). After my first IVF I was told I "may" have an egg quality issue but it was confirmed with my 2nd IVF. Basically I am a high responder with approx 22 eggs retrieved and a 90-95% fert rate. Problem is my embryos are fragmented and arrest leaving me with only 2 or 3. First time I had 2 8-cells and second time I had 1 7-cell, 1 6-cell and 1 4-cell. BFN both times.

Since my 2nd failed cycle, I went for a 2nd opinion at another top tier clinic and they diagnosed me as having atypical PCOS -- cysts in a pearl-like formation, I'm assuming some hormone issues but no out of control hair issues or overweight. I was told to do a low carb diet although I am not insulin resistant...they said it may help for next time.

My question is...Do you feel that I should be giving up at this point? Or could another lab make a difference. I'm not willing to accept donor or adoption at such a young age...I feel like I still need to try and push forward but don't know if it's worth it.


Dr Smith - November 7th, 2006 11:05 AM

Another doc may handle the simulation a little differently to allow more time for cytoplasmic maturation of the eggs prior to retrieval. This may reduce the amount of fragmentation in the resulting embryos. That being said, PCOS is one of the hardest problems to treat by IVF. Egg quality is always a problem due to the over-the-top stimulation and the unusually high number of eggs retieved. They simply do not mature properly during the stimulation. I don't think you should give up at this point and I think the new Doc will take a different approach as a result of the "atypical" PCOS diagnosis.

Good luck.

The lab is not the problem. Embryo fragmentation is very common in PCOS patients. It is not due to substandard lab conditions.


Rebecca - November 7th, 2006 11:38 AM

Thanks for your reply dr. One more question...is fragmentation always the result of cytoplasmic maturation or do I have "old" eggs? I'm trying to wrap my brain around this and I'm having trouble distinguishing between the 2 scenarios. I always thought poor egg quality meant you have "old" eggs and that you would have a higher incidence of aneuploidy, etc.

Also, do you feel that with time, it's possible to get pregnant naturally again? I'm on a few months rest from IVF so I'm trying to be hopeful :)

Dr Smith - November 7th, 2006 12:05 PM

Fragmentation can be caused by inadequate cytoplasmic maturation, old eggs and poor lab conditions. The latter is uncommon these days, the second cannot be controlled, but inadequate cytoplasmic maturation can be address by altering the stimulation protocol (i.e. slower and longer or by "coasting"). You may not have "bad eggs" per se. They may be "bad" during stimulated cycles, but that doesn't necessarily mean they are bad in unstimulated cycles.

If you are having regular cycles, it is always possible to get pregnant on your own. At 30, you have some time to try on your own. It is much less stressful and a lot more fun.


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