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Please tell me your opinion from the lab point of view.
I'm 36 with no tubes due to scarring from prev. ectopic and surgeries. Two prev. children - both teenagers. All pregnancies from same marriage. Last ectopic & surgery was August.
Just completed IVF#1 which ended in a chemical pregnancy. Beta 42 then 25.
Antral follicle count on day 2 check after ectopic was 4 (fsh was down to 1.3) but increased to 12 on next day 2 so we went forward with IVF but did a MD Lupron flare protocol so that I could cycle right away. Stim meds were 225 Follistim and 150 Menopur.
11 eggs retrieved. 7 fertilized . No ICSI. On day 2, I had 4 top graded 4-cells and 3 top graded 2-cells. Not enough embryos at 4 cell stage to go to day 5 per my clinics criteria. Two grade 1 8-cell embryos were transferred on day 3 one of which was compacting. 5 remaihig embryos were placed in extended culture and d/n make it to freezing (which I think is done on day 6). When I go in for my next consult I will insist they tell me when exactly they arrested as I think that info. is diagnostically important.
I've read that a chemical preg, indicates that the implanted embryo had to have made it to blast stage. Do you agree with this? What are the chances that my eggs are still good and that a day 5 transfer could have made a difference? I guess I just want to know that IVF#2 isn't destined for failure also. I think I will opt to go with a standard long protocol this time. I wonder if that will help also.
Thanks for your time.
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At 36, approximately 60-70% of your eggs are anueploid (abnormal number of chromosomes). Anueploid embryos rarely make it past Day 3 and usually arrest between 4 and 8 cells, sometimes up to 10-12 cells. Based on the available genetic information, I would expect 1 or 2 of your 7 embryos to make it to the blastocyst stage. So, the most likely reason the remaining embryos arrested development prior to the blastocyst stage was because they were genetically abnormal. This is a good thing. It nature's way of preventing abnormal pregnancies.
In your case, any embryo reaching the blastocyst stage could have been evaluated to determine the number stem cells present in the blastocyst. Embryos with an inadequate number of stems cells can and do result in "chemical" pregnancies and early miscarriages. Thus your "chemical" pregnancy may have been avoided by culturing the embryos to the blastocyst stage. However, it is also possible that you would have been left with no develomentally competent embryos for transfer. You would have to be willing to accept that possibility from the beginning of the cycle. The question is, would you rather get the news on the day of transfer or two weeks later with a chemical pregnancy?
It is true that the embryo had to reach the blastocyst stage, attach to the endometrium, initiate the implantation process and secrete enough hCG to be detectable in you blood. However, just reaching the blastocyst stage may not be enough to be developmentaly competent.
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Dr. Smith,
Thanks for your response. I have a quick f/u.
I spoke to the lab and they said that on day 3 all 7 of my embryos were grade 1 8-celled, which they said was unusual but excellent results for that stage. They kept them until day 6 at which time they were deemed unfreezable.
I have a f/u appt. in 2 weeks and I'm wondering if I should be thinking about donor eggs, even if my clinic d/n bring it up, or if it is just a matter of continuing to try until we get lucky and tranfer a good one. Maybe I should insist that 4 embryos be transferred instead of 2 next time to increase the odds. What would be your opinion?
Thank you.
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It was unusual to see 7/7 at the 8-cell stage and of top grade and then to have 5/7 crash and burn on the way to blastocyst and a chemical pregnancy from the 2 that were transferred. Hmm... How much experience does the lab have in blastocyst culture? From seven 8-cell, grade 1 embryos, I would expect at least 1-2 to make it to the blastocst stage. It seems a little bit wierd and I'm sure the lab was surprised as well. Once embryos make it to the 8-cell stage, they have a pretty good chance of making it on to the blastocyst stage.
This was your first IVF cycle. We learn from each cycle and try to improve by tweaking this and tweaking that. I wouldn't give up and go to donor egg just yet. Go to the f/u appointment and see what they have to say. They may want to change the stimulation in some way or culture all the embryos to the blastocyst stage. It is not unusual to have to try a couple of times.
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