egg and sperm issues
3 Replies
Cooper02 - November 19

Hi Dr. Smith -

First, thank you for the time you give in answering questions here - so appreciated!

I am 34 and have egg quality issues (although FSH is below 4) - we have undergone 2 IVF in which one resulted in a chemical pregnancy. RE diagnosed us with egg quality issues based on the high fragmentation of our embryos and some eggs that were missing zonas.
After a second opinion, we found my husband has morphology issues also - only 3% normal on Kruger test.

We are thinking of trying another cycle - RE recommends ICSI and possibly PGD. Do you think the ICSI will help?

We have the opportunity to try donor embryo and think that this may be a more successful route for us.

Any advice is appreciated.

Liz

 

Dr Smith - November 20

Yes, I would reccommend ICSI. With 3% normal forms, he fits the criteria for ICSI. I think it will help.

The missing zonas may have been an artefact of the retrieval process. The zonas can rupture when the eggs pass through the retrieval needle. It happens somtimes. But you may have particularly fragile zonas.

I don't believe that PGD will be partcularly helpful in your case. It will not identify that cause of the fragmentation and PGD will not make the fragmentation go away. PGD is a very crude tool to evaluate the genetic "normalacy" of the embryos. At 34, I think we can safely assume that abnormal embryo genetics are not playing a huge roll in the egg problem. Don't waste your money on PGD.

I would also suggest culturing the embryos to the blastocyst stage prior to transfer. Chemical pregnancies are often caused by embryos that reach the blastocyst stage, but have an inadequate number of stems to continue development. These embryos implant, begin to secrete hCG, but fail to grow. By elauating/grading the blastocyst stage embryos prior to transfer, blastocysts with an inadequate number of stems can be identified and determined to be unsuitable for transfer. In this way, another chemical pregnancy may be avoided. Yes, you do run the risk of having no suitable blastocyst stage embryos for transfer. When would you rather get the bad news? At the time of the scheduled transfer, after the two week wait, or worse, after another chemical pregnancy? Your call.

My advice would be to try one more cycle with ICSI and blastocyst culture. If that fails, move on to embryo donation. Best of luck,

 

Cooper02 - November 20

Thanks Dr. Smith -

I was also wondering if I should pursue some immune testing before starting another cycle. I have a +ANA, but have not been symptomatic for any immune related disorder. RE does not really believe in testing for immune problems unless I am symptomatic for something - he says many healthy people do have +ANA's. Rheumotologist I saw after I received the results of the ANA wanted to immediately put me on a steroid even though I had no health complaints.

So, as you can see I've got 2 doc on opposite sides of the spectrum here. Any advice?

Thanks.
Liz

 

Dr Smith - November 21

Sorry, I can't help you here. I'm afraid you need yet another doc's opinion. I'm not qualified (not an MD) to answer your question.

 

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