Degenerate Eggs
2 Replies
michou - July 25

I just had my first failed IVF attempt. I am 32 years old and have a 2 1/2 year old conceived naturally (although we ttc for 11 months). All tests normal (did 3 rounds Clomid which ended in 1 ectopic pregnancy and moved straigit to IVF). I did the long lupron with gonal-f and menopur, stimmed for 12 days, retrieved 16 eggs, 14 mature. The lab did ICSI on all my eggs (agreed to ICSI half of th eggs due to unexplained infertility but the lab ended up doing ICSI on all eggs without my consent because they said they had "tough oolemus."). 6 eggs degenerated after ICSI, 1 did not fertilize, we had four 4 celled embryos grade A and three 2 celled grade A embryos on day 2. On day four we had:

3 - 7cell grade A embryos (symmetrical with no fragmentation)
2 - 6 cell grade A embryos (symmetrical with no fragmentation)
2 - 4 cell grade A embryos

Transferred two 7 cell on day 3 and let the rest go to blast to freeze. Two made it to Morula (sp) and did not progress further so we didn't have any eggs to freeze.

My RE told me that I have intrinsic bad egg quality and have a poor prognosis for success. Told me to move forward with microdose flare with max dose of stims to get as many eggs as we can to get "one good one." I've asked him many times if there is anything else that can cause poor quality eggs and what causes eggs to degenerate and he has not given me any answers so far. I am concerned about the lack of information I am getting in addition to the extreme steps he wants to take for my next cycle. Couldn't I do a second round with completely different results or is this unlikely. I am looking to go get a second opinion. Can you please help me get some answers:
1 - what causes eggs to degenerate after ICSI
2 - do i really have "bad eggs" and is there nothing I can do to make things better
3 - do you think the next protocol would be good for me... don't I want qaulity over qauntitiy. I did get 16 eggs out of last cycle. I thought that was ok. But doctor said he liked to see me get around 30...


michou - July 25

Oh yea... I forgot to mention. My E2 levels were on the low side during stims... Although they did double every 48 hours and were 1800 at trigger. My RE said he wuold have liked a higher E2 level so I guess that was the only thing that was slight off during stimming.


Dr Smith - July 28

I know it is hard to fathom, but it looks like your RE may be right. The "tough oolema" means that the egg's plasma membrane (the membrane that separates the inside of a cell from the outside) was abnormal and probably nonfunctional. When ICSI is performed, the plasma membrane must "heal" around the sperm injection site. If the plasma membrane is too rigid (or "tough"), it will not heal properly and the cytoplasm leaks out, and the egg degnerates. The unusally high rigidity observed may have been caused by a imbalance in the chemicals that make up the plasma membrane (too much cholesterol in the membrane). When left to their own devices, eggs with rigid or "tough" membranes usually do not fertilize "naturally" as they are defective to begin with. Having almost half your eggs degenerating after ICSI is unsual and supports the conclusion that there may be an inherent "egg problem".

It is not clear at this point whether this just a "bad" crop of eggs or not. It is impossible to draw conclusions from a single failed cycle. The type of stimulation and management of the stimulation can make a difference in egg quality. I think you should give it another chance. If, however, similar results are obtained, I think you will have your answer.

It is imposible to increase the absolute number of follicles/egg with medication (gonadotropins), so going from 16 to around 30 is simply impossible. What the medication can do is to modulate the growth of the follicles that began to grow on that particular cycle. The speed of follicular growth can be optimized into the 9-11 day window to maximize egg "quality". That's all the medication can do. The medication has no effect on how many follicles start to grow at the beginning of a cycle. The number of follicles that begin to grow on any given cycle is dependent on your age and your ovarian reserve. If it was a simple as just taking more medication, then everyone (even 45 year olds would have tons of eggs).

I recognize that you are disappointed, but the reason that it didn't work doesn't necessarily have to be anyone's "fault". I see your expections were very high because you were taking the big jump to IVF. Keep in mind that IVF, in addition to its therapeutic value, provides invaluable diagnostic information about why you weren't getting pregnant in the first place. You may very well have an inherent "egg problem". And, if that's true, there's not much that can be done about it except what your RE has suggested - change the stimulation to obtain as many mature eggs as possible and hope for a "good" one.

Second opinions are useful. However, it is easy for a doctor to criticize what has already been done (after all, it didn't work, right?). Hindsight is 20/20. The real question to ask in second opinion consult is "What would you do differently?" and "Would it make a real difference?", or are they suggesting something different just for the sake of doing something different. After the consult, take the information from the second doctor back to your original doctor and see what they have to say about it. Then decide the pros and cons of each approach.

Best of luck.



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