egg quality question
2 Replies
vsflowrgrl - November 19

I am a 37 y/o scheduled for another IVF/ICSI round Jan 2006. I have a 21 mo dd on third IVF attemp. 1st IVF M/C. 2nd try nothing. 3rd attempt successful.

IVF/ICSI done for male factor- husband has antisperm antibodies from vasec. reversal. No medical factors for me.

Each cycle approximately 20 eggs were retrieved but every time vacuoles appeared. Transferred embryos were 7-8 cells with very little or no fragmentation, but with vacuoles.

Obviously each time I was devastated when they appeared since I thought there would be no problems on my end, and PCOS was definitely ruled out as well. Protocol was changed slightly and I was even put on Metformin thinking this would help- but to no avail. I have found little or no information on this phenomenon except to say that success is minimal with this abnormality. Obviously I have a perfect dd, so I don't know what to think.

I am scheduled for IVF Jan 06 and worried about this happening again. Have you had many patients with this same problem? Could these have been caused by my last protocol since I have read this could have a big effect on quality? Any information or opinions you could share would be helpful.

Thank you!

 

Dr Smith - November 21

True vacuoles do not cause problems, but rather are an sign of problems in water regulation for the embryonic cells. The plasmam membrane that separates the inside from the outside of the cell is "leaky" and water is seeping into the cell. The compensate for this, the cell packages the excess water in vacuoles and exports the excess water through exocytosis. Vacuoles can be a transient observation, that is, they can be observed on Day 2 and be gone on Day 3 or they may be persistant. Since the embryonic cells are showing signs of dealing with the water problem, it is NOT a definitive sign of an egg "problem". As the embryo develops, the properties of the plasma membrane change and their "leakiness" repaired in time.

Patients with vacuoles usually are consistent and have vacuoles present in some eggs on every ivf cycle regardless of the stimulation protocol used. However, usually, not all the eggs in a particular batch are affected. Some may be fine, while others are affected and the affected eggs may repair in time. So, I don't think you should put too much weight on the appearance of vacuoles. Slow cell division and excessive fragmentation are far greater predictors of poor egg quality than vacuoles. Hang in there.

 

vsflowrgrl - November 21

Thank you very much for your time and response. I can't tell you how much better this makes me feel!

 

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