donor cycle, refreezing sperm
6 Replies
teri-chan - July 5

Dr. Smith,

I posted a longer message earlier, but you haven't responded, so I thought I'd try a shorter message.

I have just completed a donor cycle with the following results. 14 eggs retrieved, 3 mature (but at least one more must have matured in the lab), 4 injected, 1 fertilized, arrested on Day 4, so nothing to transfer. The donor is 26 years old, and was on stimulating medications for 11 days.

Can you give me some idea of what might have happened? (Is the donor someone who probably has a very, very serious infertility problems?) I think my clinic is reputable. Their stats overall are better than the national averages (according to the CDC reports for 2002 and 2003). The managed a cycle for me when I was 41.5 in which I produced 12 eggs, 9 mature (with one abnormal), 8 injected, 4 fertilized, 2 for Day 5 transfer, 1 chemical pregnancy. I felt that my cycle was managed intelligently and that the results were well within the range of normal, given my age.

I can't find any information on the CDC ART report about how rare this type of cycle is with a donor, since the stats for donor cycles are given only in terms of number of live births per TRANSFER instead of per CYCLE and PER RETRIEVAL and PER TRANSFER. I have no way to figure out how rare it is for a donor cycle not even to go to transfer.

I would also like to know about the chances of successfully refreezing donor sperm from a vial containing about 5 million sperm to use for multiple ICSIs.

Thank you.

 

Dr Smith - July 6

Sorry, I must had missed your previous post.

It is likely that the donor did not take the hCG shot on time and/or properly. hCG induces the final maturation of the eggs rendering them mature and therefore "fertilizable". The retrieval is purposefully timed at 35-36 hours after the hCG shot to allow sufficient time for the eggs to undergo this final maturation process. If the donor took the shot later than instructed, or did not administer the hCG injection properly, then the eggs did not have enough time to respond to the hCG. In our program, we measure the hCG level the day following the injection to make sure the level is appropriate. On occasion, we have seen unexpectedly low hCG levels in donors and, when questioned extensively, they admitted to having taken the shot at the wrong time. The retrieval is then delayed until the appropriate 36 hour interval has elapsed. The cycles were saved and the results were fine.

It is very rare for a donor not to make it to transfer. Accordingly, the CDC reports live birth per tansfer which is virtually equivalent to cycle start or retrieval.

I would not recommend trying to re-freeze previously frozen-thawed sperm. The survival will be very, very low. If this sperm donor is no longer available, and this is the last vial, you could try it. If you are going to attempt another cycle, I would have another vial of sperm (from a different donor?) waiting in the wings - just in case.

 

teri-chan - July 6

Dr. Smith,

Thanks SO VERY MUCH for your reply.

Here's the issue with the donor sperm. Because my ethnicity and other characteristics are very hard to match whereas my husband's are relatively easy to match, we decided to try to find a sperm donor whose characteristics are like mine and an egg donor whose characteristics are like his. And even though it's so much easier to find sperm donors than egg donors, it was still a struggle to find a sperm donor. (When I went shopping for donors, Fairfax Cryobank had none that matched my ethnicity. California Cryobank had about half a dozen, but since I'm IgG and IgM negative, my options were more limited. The trait I am most concerned, after ethnicity, to have a donor match is my intelligence and curiosity. But this makes things difficult since I test in the 99th percentile for quantitative and analytical abilities. I'm saying this only to give you a sense of the odds of my finding an appropriate donor.) Anyway, nearly miraculously I did find an appropriate sperm donor. Unfortunately there were only three vials of semen left. I bought them all, but now one of them has been wasted on this past cycle.

I continue to look for appropriate sperm donors, but so far, no luck. So it makes me very, very nervous to be down to only two vials. I thought about refreezing because it seems to me that since ICSI requires only one sperm per egg, even if very few sperm made it, there would still be enough. (Out of 5 million, we'd need only 0.0003 PERCENT to survive!) Is there something wrong with my thought here? Is it likely that a sperm that survived two freezes and two thaws would be less able to produce a pregnancy than a sperm that survived just one freeze and thaw?

Thanks so much for the possible explanation for the terrible results of this cycle. I will ask my clinic about the possibility of testing the donor's HCG level the day after the shot. It sounds like an utterly reasonable thing to do.

I guess you didn't read my earlier post, but one of my questions had to do with what it is reasonable for me to expect my clinic to do financially in a case like this. (Do you work in the embryology lab or in accounts payable?! I know the answer, but I didn't know anyone else who'd be more apt to know the answer than you.) The cycle started out as a shared recipient cycle at $12K each, then since the donor did not produce 10 mature eggs, it went to a single recipient cycle for which I would be charged another $7K. I'm happy to report that my clinic is not charging me the additional $7K; MOREOVER they are in essence refunding my $12K (they'll actually hold that money, but then not charge me for the next cycle). This brings me though to a question. Most of the donor cycles at my clinic are done as shared cycles. And my clinic has, for donor cycles, a liveborn rate of 53%-64% per transfer, according to the recent CDC reports. Would one expect single-recipient cycles to do much better? My clinic says that they don't see a difference, but I think they don't do enough single recipient cycles for that to be meaningful. Can you give me information that might help me calculate the odds myself? I ask because I feel that I have only two more chances, given that the supply of sperm is just two vials.

Thanks again. Your generosity with your time and knowledge are truly remarkable and very much appreciated.

 

Dr Smith - July 7

As long as you have the other two vials as back up, you could re-freeze the frozen-thawed sperm. You're right that when ICSi is performed, only a few sperm are needed. However, there have been a few publications from independent labs demonstrating that cryopreservation induces DNA damage in the sperm. In addition to ending up with a very few viable sperm, they may contain damaged DNA. They will look normal on the outside, but if used for fertilization, can cause embryonic arrest - usually before the blastocyst stage. I would consider this risk seriously.

As long as enough eggs are retrieved from the donor (i.e. >10), they can be split between two recipients and still maintain a high term delivery rate. Each recipient only needs 2-3 good embryo to achieve a pregnancy. HOWEVER, in split cycles, it is rare to have any extra embryos to freeze, especially if the embryos are cultured to the blastocyst stage prior to transfer. That means that a subsequent pregnancy attempt would likely be from another donor egg source instead of sibling embryos that were cryopreserved at the time of the IVF. That would be important if a second child is desired. Because additional embryos can (and usually are) cryopreserved in a single recipeint case, the cummulative pregnancy rate (not surprisingly) from a single DIVF case is higher in single recipient cases compared to slip cases. We do not split donors at our program for these reasons.

 

teri-chan - July 7

Thank you for the information.

Do you know the averages for the following for a donor cycle: # of eggs retrieved, # of mature eggs retrieved, # of mature eggs that fertilize, # of embryos that make it to blastocyst stage, # of blastocysts transferred, # of embryos frozen?

I'm under the impression that embryos are frozen on Day 3, then when thawed are cultured to blastocyst stage. If that's right, how does a lab determine which of the growing embryos to freeze and which to allow a chance to develop to blastocyst stage in the fresh round? I take it that if a large number (3 or 4 or more) of embryos make it to blastocyst stage, the "extras" would also be frozen. Is that right? Do embryos that are frozen on Day 3, then cultured to blastocyst stage tend to do better than those that are frozen as blastocysts?

As always, thank you.

 

Dr Smith - July 10

Can't speak for other programs, but in our program the following is an average breakdown (individual cycles will vary):

# eggs: ~18-25
# mature eggs: ~80% of eggs retrieved
# mature aggs fertilized: ~80% of mature eggs
~60% of embryos make it to blastocyst stage
2-3 blastocyst stage embryos transferred
3-5 blastocyst stage embryos frozen
(Note: only very good quality blastocysts are transferred or frozen)

At our program, we culture all embryos to the blastocyst stage for both patients and donors. The following is based on what I hear is going on in other programs:

It is rare for programs to freeze on Day 3 and then culture to the blastocyst stage post-thaw. The vast majority of programs that freeze on Day 3, transfer the embryos immediately post-thaw. That is because embryos frozen on Day 3 have a lower chance of making it to the blastocyst stage post-thaw. They are transferred immediately with the "out-of-sight, out-of-mind" approach. This is reflected in the relatively lower pregnancy rates for embryos frozen on Day 3 (on a per embryo basis).

If the embryos have made it 8-cell stage with minimal fragmentation by Day 3, they are cadidates for extended culture to the blastocyst stage. How many are actually cultured is program-specific.

Embryos can be successfully frozen at the blastocyst stage. At our program, we expect about 85% of the blastocyst stage embryos to survive the thaw. Other programs have had similar results, but many programs were unable to perfect blastocyst freezing and have returned to freezing on Day 3. Accordingly, they only culture 2-3 embryos to the blastocyst stage. "Extra" embryos are frozen on Day 3.


 

teri-chan - July 10

Thank you so much for your answers.

 

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