New to the forum? Sign Up Here! Already a member? Please login below.

Forgot your password? Need Help?  
mykonos - October 5th, 2006 5:39 PM

Hello,

I just received news that I tested negative. We underwent a donor cycle. The donor is 22 years of age, 15 eggs were retrieved, 13 were mature and 12 fertlized. On day 3 we had five at 9 cell and up, 3 at 8 cells, one at 7 cells and the balance under 6 cells. We asked for a day 5 transfer. On day 5 we had two grade 1 quality blastocysts, which we transferred and on day 6 we froze another two grade 1 blastocysts. The two couples that underwent a shared cycle prior to us both were successful with this donor. What went wrong? Is it the sperm? In addition, while preparing for the transfer we found out that I have a polyp (the doctor says its one and small, however, this was concluded using a 3D ultrasound). We are devastated. After nine years of this we are reaching the end of our rope. What do you suggest we should check? I did have all the symptoms, cramping, my breasts increased by almost one cup size, constantly thirsty, irritable etc.

Best Regards,

Tina


Dr Smith - October 6th, 2006 3:01 PM

Even in the best cases, the chance of pregnancy through the use of donated eggs is about 60%. The flip side is that 40% of the time it doesn't work. You may just be in the 40% and there may be no other reason than the luck of the draw. Although a 30% blastocyst rate is a little low, the donor "performed" appropriately. Yes, there could be a contributing male factor that decreased the blastocyst rate by 10-20%, but its hard to say from a single cycle.

The polyp should be removed before any other ART treatment is attempted.

I realize that you are completely frustrated by the recent cycle, but hang in there. Your best chance is through the use of donated eggs and you do have 2 more embryos in the freezer. Let things settle down emotionally and then give the FET a try. However, before you go on to the the FET, you may want to consider immunological testing to evalaute you NK cell level and activity. If you have never been pregnant throughout the 9 years of fertility treaments, this is a rather large red flag that something else is going on (i.e. NK cells). Immunological problems can be treated prior to the FET.


mykonos - October 6th, 2006 3:53 PM

Dear Dr. Smith,

Thank you kindly for your response. Just to clarify, although the donor produced 13 eggs, 12 fertlized, 3 out of the twelve failed to reach 6 cells on day 3, is this an embryo problem? If we analze the data, on day 3 there were 9 embroyos over seven cells, 50% of 9 is 4.5. I am correct in my figures. We had 4 grade 1 blastocysts. Is this low based on my clarification? I read that 50% of good quality embroyos (I assume 8 cell and up) on day 3 make it to blastocyst. My husband underwent the dna fragmentation test and was told it is A- (15% fragmentation). However, since his testing he has been taking ativan. Also, my lining on the day of the transfer was 9 and three striped. The reason why we chose the donor route is because I was diagnosed with permature ovarian failure. The reason why we asked if it is a sperm problem, because we read that 54% of blasts fail to hatch (assisted hatching was not performed although we did request it) and this is largely attributable to sperm problems.

Once again, thank you. Your site is such of great value to many of us.

Best Regards,

Tina


Dr Smith - October 10th, 2006 7:19 AM

There are two ways to calculate blastocyst formation: using fertilized eggs (zygotes) as the denominator or the number of 8-cell embryos as the denominator. I use the former. In a donor egg case, I expect about 50% of the zygotes to reach the blastocyst stage by Day 5 or 6. I would also expect the vast majority of these blastocysts to be of good quality. According to the way I calculate blastocyst rate, 4 out of 12 reach the blastocyst stage - roughly 30%. This is within the normal expected variation one would expect in a biological system.

Sperm does not contribute to the hatching process (no worries there). As the blastocyst stage embryo expands to approxomately 3x its original size, it stretchs the protein coat (zona pellucida) that surounds the embryo. This internal pressure may be insufficient to break the protein coat (hatching). In the Fallopian tubes and uterine cavity, there are digestive enzymes that help to thin the zona from the outside. In the laboratory, these enzymes are absent, so embryos grown in vitro may not have the ability to hatch in vitro (that's where you read that 54% of blastocysts failed to hatch IN VITRO). However, when replaced in the uterine cavity, these same embryos may hatch without a problem because, albeit a little late, they are now exposed the the digestive enzymes.

That being said, just to be on the safe side, I hatch all blastocyst stage embryos immediately prior to transfer. Call me paranoid.


mykonos - October 10th, 2006 4:57 PM

Dear Dr. Smith,

Once again, thank you for your response. The following represents my last set of questions.

We explained that a polyp was discovered. What kind of adverse affect may a polyp have (I was told it was small?). Could this be the reason that this donor cycle did not result in a pregnancy? The sad part was we found out about the polyp by accident, our doctor had no intention of informing us about the polyp. We were very concerned and recommended freezing all the embroys and transferring them after removing the polyp. He said that we are being silly and that small ployps do not interfer with getting pregnant. What do you think about his opinion?

In addition, you speak of digestive enzymes in the uterus, could such enzymes be absent in some women. I was tested for the NK cells in the past (2000), and there was no problem there. Should I repeat this test?

Thanking for all your assistance and cooperation.

Best Regards,

Tina


Dr Smith - October 11th, 2006 9:50 AM

The polyp question is more of a medical issue. I don't think I'm qualified to answer the relative impact of a small, medium or large polyp on IVF success. Best to ask an RE like Dr Jacob. Polyps may be located in the area where implantation occurs thus preventing implantation. In addition, polyps can interfere with the implantation process by expanding the uterine cavity and allowing the embryos to float around more than they should.

Nature, by design, is redundant. There are several proteolytic (protein digesting) enzymes present in tubal and utereine fluid. If one was missing, say due to genetic mutation, the remaining enzymes would pick up the slack. I don't think that they would all be absent at the say time in the same individual.

The NK cell problem (number and abnormal activation) is aquired. I think it would be prudent to undergo testing again - it has been 6 years.


Message:


Please login or register to post on this thread.
Ask a Question