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Dear Dr Smith,
I posted a few mths ago under another ladys topic called fragmentation.
I have just turned 39 and have PCOS.I have been tring to concieve for 2 yrs and have had 1 anembryonic miscarriage.
I have subsequently had several cycles of IUI and 2 cycles of IVF.Both IVF cycles produced good numbers of eggs -15and 17, reasonably good fertization rates ,14 in cycle 1 and 7 in cycle 2 ( in cycle 2 we had to have icsi as my husband could not produce a sample on the day and had to have surgical sperm retrieval) .His sperm is normally good quality.
Both cycles resulted in fragmented embryos.
In cycle one I had 2 grade 2 four cells embryos replaced on day 2 and in my last cyle I had 2 grade 2 eight cell embryos replaced on day 3.On both occasions there was nothing to freeze.
Now I feel that time is not on my side as I am 39 and that my egg quality is probably poor.I raised this at my last review with my consultant and he didnt seem to share my view entirely and said try again ,same protocol
Apart from a reduction in my stim drugs dose in cycle 2 both cycles followed the same protocol.
I would like your opinion regarding my options from here
I am keen not to keep using my own eggs if they are pasted their sell by date.Similiarly I dont want to bail out in a panic.I cant get an appt to see my Consultant for 2 mths to discuss this second failed cycle ,so he has OKed a third cycle without a formal followup ,which I feel is a bit shoddy.
Anyway I have rambled on too long Apologies for the long post
Would greatly appreciate you advice
Eliza
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PCOS is a multifaceted syndrome. In fact, the definiftion of PCOS depends on your point of view. From an embryologist's prespective, a high number of eggs and highly fragmented embryos are the tell-tale signs of PCOS. Because there are so many factors involved, it is probably the most difficult type of infertility to treat (I'm sure you didn't want to hear that!). Of course, it worth doing a couple of IUI's and a couple of IVF's, but there comes a point when you have to evaluate what you're up against.
As you pointed out, at 39, you have two major issues. On average, about 70% of your eggs/embryos will be genetically abnormal and fail to develop. On top of that, the high fragmentation of the embryos would compromise even the genetically normal ones.
My opinion: Call it quits. I don't know if using donated eggs is an option where you live, but, if available, I think its you best bet at this point.
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