 | rba - August 27 |
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Dr. Smith,
I had my retrieval yesterday. This is my 2nd IVF (last time they were able to get 3 eggs and none fertilized).
My stimulation protocol was changed this time - increased gonal-F. I had about 21 follicles in the last ultrasound before retrival. About 10 follicles were >16.
The RE was able to retrieve 7 eggs. Today, I was told that of the 7, one was fragmented, 4 died, 1 became a 1pn and the last one is a 2pn and that's the only viable one that they are following.
I should add that I am 34, no known infertility problem from me or husband. FSH, E2, LH all normal.
I'd really appreicate it if you can give me answers for the following questions:
1) What could be the reason for getting only 7 eggs when there are about 21 follicles?
2) What could be the reason for 4 of the egss "dying"? is it normal? does it mean the timing of the retrieval was not good? Is it normal to get only one embryo from 7 retrieved eggs?
3) Do you think I may have an egg quality problem? If so, do you have any suggestions of what to do next?
4) Can you please explain what a 2pn means, and, if it continues to develop, what questions I should be asking, and what are the parameters that could indicate high/low chances of success with it? (My clinic usually does a day 3 transfer -- and that's what I've been tentaively scheduled for).
Thanks for your help!
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A1. Overall, we expect to get eggs from about 80% of the follicles that are aspirated. However, that is not always the case. Some patients develop cycsts (empty follicles) which look the same on ultrasound as follicles containing eggs. However, at the time of the egg retrieval, the fluid aspirated from the cyst is clear and does not contain any cells (eggs or otherwise). You can ask your doctor if the other follicles were cycsts.
A2. If ICSI was performed, the eggs did not survive the sperm injection process. In the hands of an experienced embryologist, this is usually due to an inherent problem with the egg, specifically, the surface membrane of the egg does not "heal" up after the injection. If ICSI was not performed, the eggs were dead or dying at the time of the retrieval. Follicles develop with or without viable eggs inside and it is impossible to tell if the eggs inside the follicles are viable from the ultrasound pictures during the stimulation. It is not unsual to retrieve some dead or dying eggs from older patients. Although you are 34, your eggs appear to have aged more rapidly than would be expected from your age alone.
A3. Yes, from what you have said, I think there appears to be an egg problem. Unfortunately, there is no "cure" for the kind of egg problems you describe. The only alternative is to use donated eggs.
A4. "2PN" is embryologist shorthand for "two pronuclei". Normal fertilization is defined as the presence of two pronuclei. One pronucleus from the sperm, one from the egg. These pronuclei (each containing half the genetic material it takes to make a human being) will migrate towards each other, fuse and the true embryo's nucleus will form. The one-celled embryo will then begin dividing. The pronuclear stage is considered Day 1 of development. The embryo should be at the 2-4 cell stage on Day 2 and the 4-8 cell stage on Day 3. If the embryo is at the 8-cell stage and exhibits minimal fragmentation, you chances of success are moderate. If the embryo is less than 8 cells and/or exhibits excess fragmentation, your chances of a term pregnancy are poor.
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