sharedjourney home

I got pregnant with my own eggs (age 33, 37, & 38, 2 tubals, 1 ivf success(age 39), but lost the baby with a placenta problem @ 6 months(did CVS). I always had grade A eggs but my doctor did not freeze on day 3 so I lost 23(2 ivf cycles) grade A embroys on day 5(age 39). Now I am 41(just turned) and
the last IVF I did, my eggs did not divide too well so we moved to donar eggs. I went to Dr. Schoolcraft once and he said he bet it was the sperm even though it looked good because
I had been pregnant without tubals before too. Only with my husband did I start to
have problems. I have NO scaring in my tubes. When we have intercourse, it
feels like something is crawling in me. I can not stand it. It burns. Now IVF
has been unsuccessful--period.

We used donor eggs with a donor who had been used 8 months before on another
couple. They had success, got pregnant, plus had 5 blastocysts left to freeze.
Our embroys did not multipy well at all. 1 7 celled, 2 6 celled, rest 4 cells. It is hard for me to believe it is not the sperm. The donar has done it 3 times and
everyone has been successful with blastocysts to freeze.

You can not tell me a 23 year old just happened to produce bad eggs on our
IVF cycle? After the transfers, I always feel something weird happening about
day 3 after the transfer, almost like a rejection is going on. I feel that I am never going to get pregnant as long as my husbands sperm is involved and now
I am getting older--just turned 41.(Husband 47)

Does anyone have any knowledge in this area? I do not know what do do
from here. We have had 3 unsucessful IVFs now in a row and I am sooo
sick of it.

Any ideas--besides adoption? Please help. Did all the anti-sperm tests.

Please reply quicklly. Help.

Reply

It is possible that you husband's sperm DNA is highly fragmented and this is causing the embryos to arrest development prior to reaching the 8-cell stage. Although DNA fragmentation is correlated with abnormal sperm morphology, morphologically normal sperm can also have fragmented DNA. If you are going to attempt another cycle, I would recommend that you husband have the Sperm Chromatin Structure Assay. For more information on this test, see www.scsadiagnostics.com.

Reply

I"m sorry to swerve off subject a bit, but I have question about quality of embryos. Which is better, more cells or better quality? The data from my clinic indicates that better quality has better implantation rates, but I guess that's not the same as preg rates. In a grading scale of 5 (5 being the best), I had 3 grade 3 8- cell embryos at day 3 and 1 grade 2 7 cell. I'm 36. However, I also had a lot of embryos that arrested. Thank you.

Reply

Both the number of cells (cleavage rate) and the degree of fragmentation (grade) are important and are considered simultaneously when determining the developmental potential of the embryo.

Reply

This is a very interesting thread. I am not as sophisticated as the others who posted questions for me, but I will do my best!

I just completed my first IVF cycle and it was negative. I had 10 eggs retrieved, 5 fertilized successfully (the other 5 were fertilized with more than one sperm). My eggs divided, but they were slow. (On day three, I had one 5-cell, 2 4-cells and 2- 3cells). Nevertheless, two of my embies made it to blast and one to "almost" blast on day 6. All three were transferred but apparently none implanted because I did not achieve a positive beta. Based on what I read here, these three did not experience arrested development but were one day slow.

Do you think this means I also have an egg cytoplasm issue, even though some of my embryos made it to blast? I don't know about fragmentation since my clinic did not describe this to me. I do know at least one of my blasts was considered excellent quality.

Thank you.

Reply

A significant number of embryos that make it to the blastocyst stage do so on Day 6. Although these embryos are "slow" they retain good developmental potential. I don't think there were any cytoplasmic maturity problems with those eggs. However, a polyspermy (more than one sperm inside the egg) rate of 50% is unusual and suggests that the 5 eggs that were polyspermic may have been of borderline cytoplasmic maturity at the time of retrieval. The expected polyspermy rate is about 3-5%. I suggest you speak with your doctor about the high polyspermy rate.

Reply

I apologize for latching on to this thread, but our situation has some similarities.
We are baffled and our RE is as well, though he has not yet had time to review everything. I'm hoping you have some thoughts or ideas. Here is the summary:

First pregnancy: conceived first month of trying, healthy boy.
Second pregnancy: conceived second month of trying, 20 week ultrsound shows borderline thickened nuchal fold, amnio shows no genetic abnormalities, stillbirth at 32 weeks (unexplained cause)
Decide on IVF due to severe hyperemesis. Use egg donor due to wife's medical history.
First IVF: Proven egg donor, proven surrogate, eight embryos progress to blastocyst. Fresh transfer 2 (failed). Thaw remaining six (do not look good following thaw). Transfer all (failed)

Start new cycle with new egg donor and new proven surrogate. Eleven embryos retrieved, all fertilized. On day 5, no expanded blastocysts. Two early blasts plus one morula transferred (failed). Only two moderately expanded blasts were viable on day six for freezing.

In both cycles, the embryos developed slowly and we did not have any expanded blastocysts on day 5 to transfer. The same donor from the second cycle did another cycle with someone else shortly after and had numerous fully expanded blasts on day 5.

The common factor is my sperm, although I have had chromosome analysis including karyotyping and everything is normal. In addition, we have not had any trouble getting pregnant naturally.

Help!! We are baffled. Is there something else about my sperm that would cause embryos to develop slowly in culture, but would not show up in chromosomal testing?


Any thoughts or ideas at all??!!

We appreciate your help.

Reply

I need a bit more information. Could you please post the most recent semen analysis results (including morphology) and tell me whether or nor ICSI was performed in either or both IVF cycles.

DNA fragmentation in the sperm can cause fewer embryos to reach the blastocyst stage and also cause the embryos that do reach the blastocyst stage to be of poorer quality. Even though your karyotype was normal, there may be a sperm DNA fragmentation issue. There is a test for sperm DNA fragmentation. To read up on this, see www.scsadiagnostics.com.

Reply

First of all, a big thank you to all of you who took the time to post on this subject. I am encountering the same issue right now with mature eggs and slow growing embryos. I would like to hear if in my case it would be worthwhile to pursue genetic testing (karyotyping) on both my husband and myself or if we are possibly having a cytoplasm issue.

History: 34 years of age, one ectopic (age 21) and left tube removed, one miscarriage (age 30). We have been "trying" for approximately 4 years.

First IVF (August 2005), approximately 13 day stim cycle on Follistim, Menopur, Lupron and baby aspirin. Retrieved 21 eggs, 19 mature, 16 fertilized normally. By day 3, arrested development was seen. RE chose to do a day 6 transfer of 2 embryos, neither of which was yet at the blast stage. No embryos developed to the blast stage, none were frozen. Negative HCG.

Second IVF (October 2005), approximately 13 day stim cycle on Metformin, Follistim (lower dose), Menopur, Lupron, and baby aspirin. Retrieved 12 eggs, 9 mature and 9 fertilized. By day 2, embryos were around 4 cells, some were 2 cells. Day 3 (day of transfer), there was one 4 cell and two 5 cell embryos to transfer. After day 3, development arrested, no embryos made it to blast, no embryos to freeze.

Met with the RE yesterday for our follow-up appointment and he discussed a number of tests to do, but he thinks that overall the cycle was fine. He recommended switching the Lupron for Antagon and perhaps drawing blood work for karyotyping.

We are not sure as to how to proceed. The RE thought that the length of stims was fine and that ideally a patient should have a stim cycle of between 8 and 15 days. Are we having a cytoplasm issue or could genetics be playing a role?

Thank you in advance for your help.

Reply

I'd say the problem is genetic, but karyotyping may not reveal the source of the problem. Based on the information you provided, the problem appears to be with the genetics of the embryos, not necessarily the parents (i.e. you and your husband). Genetically abnormal embryos most often arrest on the 3rd day of development (just what you observed). If the karyotype of you and your husband is normal, another approach would be to perform pre-implantation genetic diagnosis (PGD) on the embryos of a subsequent IVF cycle. This will directly address the question. However, PGD may only serve to confirm what I already suspect - the embryos are abnormal. If that turns out to be the case, and the karyotypes of you and you husband are normal, it would leave you in a postion of using donor sperm and donor eggs as your most likely way to conceive.

Reply

Hi
Very interesting info! Thanks
My question is..we just did a day 4 transfer, because on day three, our one embryo was only at 4 cell..no fragmentation, but my doc likes to transfer 7-9 cells only..I insisted that my chances were zero, if we did nothing..so they transferred an embryo that looks like a morula today. It was still growing..had not arrested, but I was unclear as to whether I was seeing a morula, or a ton of frag. The shape was like the "rasberry" I have seen associated with day 4 embryo's, but there was some dark matter...If it was still growing at day four, is this a good sign?

Thanks
Sheree

Reply

hi, I am so confused about the cell division speed.

I have just had 1st attempt of IVf; 5 follicles, 4 eggs, 4 fertilised. Now day 2, 1 is not so good (6 celled with about 35% fragmentation), but 3 are grade A 1 or A 2 (ie very minor (about 5%) fragmentation).

My question is:- at 48 hours were still 2 cell. is this about average?

We have opted for a day 3 transfer, possibly with assisted hatching because of my age (41) rather than jepordise them by waiting until blastocyst stage.


I am hoping for a success (like everyone else), and have previous children. My endometrium was 14mm before retrieval, and E2 was 4530 p mol.
Is my embryo division too slow; the embryologist said it was right for day 2...



thanks

jacqueline

Reply

At 48 hours post insemination, the embryos should be between 2 and 4 cells. Your embryos are on schedule.

The IVF process is a series of hurdles. I think sometimes patients are in a big hurry to get over the "transfer" hurdle and perfer to have the transfer on Day 3, just to make sure they get a transfer. This doesn't make a lot of sense to me. Your age affects the chances of embryos making it to the blastocyst stage, but leaving them in the lab until Day 5 does not "jepardize" their growth. If they are developmentally competent, they will continue to develop whether they are in the uterus or the lab.

Reply

I did my first IVF this month and everything seemed great, 12/13 eggs fertilized and on day 2 I had 6 2-cell, 2 3-cell and 1 4-cell. Then on day 3, when I came in for the transfer I had only 1 6-cell, 3 5-cell and 1-4 cell with fragments and the others weren't developing or developing too slowly. My RE decided to transfer all 5. He said they were "good" quality, except for the fragmentmented one, but wanted to transfer all 5. Do you think I have a chance of pregnancy or am I another possible case of PGD. I have had one m/c at 9 weeks from IUI and I am 34 years old. Dh has above average sperm and is 33.

Reply

Whenever embryos are transferred there is a chance of pregnancy. However, as you are aware, the embryos were diving slowly and had not developed to the 8-cell stage that is appropriate for Day 3. The usual cause for this kind of slow or arrested development is aneuploidy (the embryo has an abnormal number of chomosomes).

Yes, in theory, you are a candidate for PGD. However, it is prefered to perform the PGD biopsy on 6-8 cell Day 3 embryos to avoid removing too much of the embryo's cellular volume. Although a 3- or 4-cell Day 3 embryo can be biopsied, it may compromise their later development. I would suggest an alternative. If the current cycle is unsuccessful, try culturing the embryos to the blastocyst stage. Although there is no guarantee that the embryos that reach the blastocyst stage are genetically normal, the vast majority of genetically abnormal embryos fail to reach the blastocyst stage. If no embryos reach the blastocyst stage, you have the same answer you would have got with PGD - all the embryos were abnormal. If, however, some of the embryos reach the blastocyst stage, you can be confident that at least they have the capability to attach and implant (which you don't know at this point about the embryos from your recent transfer).

Reply

Thank you so much for your informative reply, Dr. Smith. I guess only time will tell. I won't get my hopes up too much at this point. I'll let you know the outcome in a couple of weeks.

Reply