? about egg quality
10 Replies
holly-co - January 19

I have talked to you in the past about my diagnosis but not sure if you will remember. I am currently 32 yo (but 29 when we started IVF), have nl fsh, good response to stims (anywhere from 16-22 eggs retrieved), healthy, non-smoker etc. but my eggs when visualized doing ICSI (for mf too) have dark and grainy cytoplasm. This has been present at 2 separate clinics/labs and with different protocols (except all have been with long lupron). Some eggs also have thicker than normal zona pellucida and they have also noted at times that I have areas of the cytoplasm that has smooth endoplasmic reticulum. Our embryos usually are slow to grow cell wise (we have had 2 8 cells out of about a total of 50 mature eggs retrieved, rest are 6 cells or less and nothing ever frozen but are usually considered good quality with even cell sizes and very minimal fragmentation). Often, the darkness and granularity improves significantly after the 2pn stage but we still have slow embies. Fortunately despite these findings, I have had success once and have a 23mo daughter. The success came at age 29 on our 2nd overall attempt (but 1st at a new "top" clinic) however we have had 2 failures since then. It does seem like we can say this is truly an intrinsic egg problem and not due to protocol or lab even though I know that is not very common.

A couple ?'s for you. Is there any new research about this phenomena esp. in younger pts with apparently nl ovarian function (cause, ways to improve etc.)? And also, I have read alot about dark, grainy cytoplasm but what is the significance of the areas of smooth endoplasmic reticulum? Is that the same as a vacuole? What causes this, if known?

I know my best odds at this point is with donor eggs but I feel like I need to give it a few more tries since I am still on the youngish side and have had success once before despite this issue showing that I do have some (maybe just one?) normal eggs.

Thank you for your time.

 

JENW77 - January 19

Holly-

I hate to intrude on your question but..... I am 29 and just had first failed IVF. I like you respond well to medication and was very suprised to hear after the retrieval that my eggs were dark. 13 eggs were taken only 2 fertilized. We had a 3 day transfer with only a 5 and 6 cell embryo. We are trying to decide if we should do another IVF or move on to donor eggs.

My question is with your first IVF success were your eggs considered dark and granular?

Thank you for any input!!!
Jen

 

Dr Smith - January 19

Holly-co

When the smooth endoplasmic reticulum (SER) of an egg aggregates into a disk-like shape, it is a sign of cellular degreneration. The SER aggregate appears as a transparent circular-shaped disk in the cytoplasm and may be confused with a vacuole by an inexperienced embryologist. Vacuoles are related to water management inside the cell and they come and go. SER aggregates do not come and go. Eggs with SER aggregates rarely fertilize, even with ICSI. If they do fertilize, the rarely procede beyond the 4-cell stage. We haven't got the faintest clue about what causes the SER problem, but it has been suggested that it may be an artifact of ovarian hyperstimulation since SER aggregates have never been observed in "naturally" ovulated eggs. In other words, these eggs degenerate during the stimulation and when they are retrieved, they are already lost.

Although SER aggregates are somewhat rare, I've never observed SER aggregates in all the eggs retrieved from a patient (some, yes; all, no). So, even if this is a reoccuring problem with your eggs, there's probably some "normal" eggs in there. A modest approach to the stimulation may help.

 

Dr Smith - January 19

JENW77

You should try another cycle and employ ICSI next time. A single bad cycle is not conclusive of an "egg problem". I don't think you have to consider donor egg just yet.

 

holly-co - January 20

Jen-
I am sorry about your failed cycle. I know how bad it hurts and then to compound it with the "egg quality" thing at a young age is even more frustrating. However, like Dr. Smith said, I would definately give it another shot. Sometimes these egg things can be related to protocol or lab and it takes at least 2 cycles with the same findings to know for sure. Even if there is a problem, I would think that you would have some good eggs in there too at your age.

Yes, with my successful cycle they also noted the eggs to be dark and granular. That cycle we did transfer 1 8 cell and 2 6 cells and ended up with a healthy singleton.

Dr. Smith-Thanks for your reply. I think you are right in that not all my eggs had this appearance. I think most are usually dark and grainy though. Maybe my eggs that don't fertilize with ICSI are the ones w/ SER. We did have a lower fertilization rate than we normally do this past cycle (about 50% vs. 75%).

 

Bronte - January 23

I am 42 in six weeks time. Trying to decide whether to go for second attempt at IVF. 25 eggs were collected on first attempt but none were good enough for implantation, mostly chromosomal problems. Do you think it is possible that there may be some decent eggs on another attempt or is it likely that they are just too old to be viable?

Many thanks for your help.

 

Dr Smith - January 23

At your age, its simply a numbers game trying to beat the odds. The more eggs that are retrieved, the better your chances. Having 25 eggs retrieved is very good for your age. So I wouldn't suggest giving up yet. If you have another good cycle, you might get a "good" egg. At 42, there are still a few "good" eggs left in there.

Alternatively, if you have discussed using donated eggs with your husband and you both find that option acceptable, and your are running out of time and financial resources, your best chances (>50% take-home-baby) are with donated eggs.

Best of luck with whatever you decide.

 

Rio - January 27

I am almost 37, TTC almost 4 years. FSH in the 7-9 range. Normal ovulation, hx of endo but no evidence of recurrence since lap in 1/04. I tried my first IVF in November. I had only 5 follicles, and only one egg at retrieval (at 5 amps of Menopur x 7 days). There was no explanation for why there was only one egg (the only thing I found later on the internet suggested it was drug related, not physiological). Because there was only one egg, RE recommended ICSI (there is no male factor problem at all). The egg did not fertilize.

Do you have any idea whether another protocol would produce more follicles and/or more eggs? Would you do ICSI with no male factor but a low egg count? Is it worth it to try again, or am I looking at donor eggs?

Thanks for your time.

 

Dr Smith - January 27

It is unlikely that it was the medication per se although Menopur alone does not seem to achieve the same quality of stimulation as a mixed protocol (i.e. a pure FSH product and Menopur). I think a couple of things went wrong. There was probably significant dissynchrony in follicular development - one big follicle and the rest too small to contain a mature egg for retrieval (hence only one egg retrieved). The second problem is that the stimulation was too short. It should be a minimum of 9 days. Seven days is too short to allow adequate maturation of the cytoplasm of the egg. When an egg has immature cytoplasm, even ICSI can't activate the egg to initiate embryo development. Your cycle was seriously mismanaged. I'd look for another RE.

 

rio - January 28

Thank you for the information. Unfortunately, I was working from memory when I did the last post (without the benefit of a calendar). I actually did menopur for 12 days - 5 amps for the first 10, then 4 x1 and 3 x 1, plus antagon on days 10-12 (easy to try to block unpleasantries from the memory!). So it wasn't the time to mature, but may still have been the menopur without a pure FSH? Do you have an opinion on the menopur vs repronex debate?

Do you tend to see dissynchrony in follicular development recur, or is it possible that would not happen in a second attempt?

Thanks for your time, and sorry for the earlier error.


 

Dr Smith - January 29

We didn't have much luck with Menopur alone. The stimulations dragged out (around 12 days like yours) and, in spite of the extended stimulation, the egg maturation was so-so. Menopur seemed to work alot better in combination with a purified FSH product. They're all about the same, so it doesn't matter which FSH product is used. I think what happened was cycle-specific. Better management of the stimulation in combination with a purified FSH product should improve things (i.e. less disynchrony and fewer "empty" follicles). Repronex seems to have a lower bioactivity than Menopur (compared dose to dose), but Repronex has been used successfully in mixed protocols as well.

 

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