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Dr. Smith,
We are doing IVF/ICSI due to male factor. My husband and I are 29 years old, and we did our first cycle back in April. I was on long protocol with BCP, lupron and was stimulated for 9 days with 300 IU of Follistim. I ended up having 18 eggs of which 8 were immature. Out of 10 mature eggs 4 fertilized normally, and two more immature eggs were ICSI-ed on the following day and fertilized. So we ended with only 6 embryos, 5 at 4 cells and 1 at 5 cells (from immature egg ICSI-ed on day 2) with no fragmentation. 3 embryos, 2 4-cell and 1 5-cell (graded 1.2, on a scale of 1 to 4, 1 being the best) were put back on day 3 and I did not get pregnant. Doctor suggested that we freeze the remaining 3 4-cells embryos, and we followed his advice.
I am concerned with a couple of factors: (i) the quantity of immature eggs, although the hormone levels were adequate; (ii) low number of embryos fertilized with ICSI; (iii) the fact that embryos were only at 4 cells, and apparently they were at 4-cells already on day 2, which might indicate that embryo arrest. We did karyotype tests after the negative result, and they came in normal.
My doctor is now starting me on a second fresh cycle, since we have only 3 frozen embryos at 4 cells. What can we do differently to increase our chances of having better quality embryos? I am afraid our embryos arrested on day 2. Do you thinks that's the case? Could this be due to male factor or could I have poor egg quality? Is there any way to find out?
I appreicate a lot your advice.
Becca
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The problem here appears to be that the stimulation did not go long enough for the eggs to complete cytoplasm maturation. Inadequate cytoplasmic maturation results in a high number of immature eggs, poor fertilization in the ones that are mature, and poor development of the ones that do fertilize. Sound familiar?
So, for this cycle it is important to slow down the stimulation to give your eggs adequate time for cytoplasmic maturation before the hCG trigger shot. Talk with your docotor about trying to slow things down a bit. Hormone levels and follicular size are only a CRUDE measure of the of the maturation state of the egg in side. However, its the only measurement we have, so we do the best we can.
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