estimation of odds?
9 Replies
teri-chan - November 6

Hi Dr. Smith,

I hope you're having some success taking care of all the things that must have piled up while you were on vacation.

I am in the middle of a donor cycle that did not go particularly well. Although 19 eggs were retrieved from the donor (who is 31), only 8 were mature, and only 4 fertilized. On Day 5, I had a "perfect" hatching blastocyst, one blastocyst with minor fragmentation (that showed up very early on and never got any worse as the days went by), and a morula with no fragmentation. The blastocysts were transferred. The morula did not make it to freeze.

I wonder whether you think that my chances with the two blastocysts are as good as normal (which for my clinic is about 58%), even though the cycle was so weird.



Dr Smith - November 7

I think your chances are good (i.e. you fall within the 58% average success rate for DE at your clinic). Even though there was a very high attrition, the resulting blastocysts appear to be of high quality and that's all that really counts. It would have been nice to freeze a few, but not essential for a pregnancy from the fresh transfer. We occasionally see this kind of high attrition at our program. The pregnancy rate is the same, but we don't ask the donor to come back. Sure, we squeaked by this time, but who's to say what would happen on a subsequent cycle....

Best of luck.


teri-chan - November 7

Thanks so much for your thoughts.

I wonder if you have thoughts about why a cycle would have high attrition like this. The donor was a second-time donor. And I know that my clinic was very pleased with her performance the first time, which was in summer of this year. I don't know the details, beyond knowing that the recipient is pregnant with twins, but I do know that my clinic wanted to give me a really good donor since I had been through one bad donor experience (14 eggs retrieved, only 3 mature, only 1 fertilized, and none to transfer), which they wanted to make up for (monetarily and by matching me with a proven donor).

I've been feeling vaguely suspicious about the fact that the "A team" was away at the ASRM meeting, when the donor came in for her last ultrasound before retrieval. Is there much of a chance that that made a difference? I guess I'm asking whether the "B team" might have been less good at measuring and counting follicles? (I feel pretty confident that the decision about when to trigger was made by phone by the "A team", but I wonder whether the data they were going on were good.)



Dr Smith - November 8

Its hard for me to say what happened without looking at the cycle sheet, but it would appear on this cycle there was significant dysynchrony in the growth of the follicles (i.e. some big, some small). That falls within the sh** happens category and there's not much anyone can do about it. SOP dictates that the decision to trigger is primarily made on the size of the lead follicles. There is cycle to cycle variation (donors and patients) and a good previous cycle is no guarantee of a good subsequent cycle. There are good crops of eggs and bad crops of eggs. Unfortunaely, it is somewhat random and unpredictable. I have seen this with our donors too. I don't think anybody did anything "wrong" here (A team or B team). Its just the way the donor stimulated on this particular cycle. I still think you have a decent chance. Hang in there.


teri-chan - November 8

Thanks so much for your answer. It's comforting to think that it's not likely that anything was mismanaged. It's even better--way better!!!!!--that my hCG 13 days past retrieval is 80! I'll keep my fingers crossed for the hCG measurement on Friday.


Dr Smith - November 9

Cool! Cautious optimism is in order. Hang in there.


teri-chan - November 9

At what point does "the pregnancy" begin making some progesterone? I know I'll be on shots for a while yet (if all goes well), but I'm just curious whether the shots are already being "supplemented" by "the pregnancy". (Since it's a donor cycle, the shots aren't being supplemented by the "yellow bodies" in my ovaries, since there aren't any.)



Dr Smith - November 9

There is an ovarian-placental shift in progesterone production that begins in the 8th week of pregnancy. In a "normal" cycle, the placenta begins to take over for the ovarian "yellow body" (coprus luteum) at 8 weeks. You are correct that, since you are a DE recipient cycle, there is no corpus luteum to produce progesterone. You will be on supplementation at least through the 8th week of pregnancy. However, you'll be relieved to know, you probably won't be on the shots the whole time (yes, I know, they are literally a pain in the *ss). In all likihood, you will shift to creams, suppostories, etc in the near future.


teri-chan - November 9

Thanks so much for your reply.

I just want to make sure that I understand the phrase "8th week of pregnancy". That means the 6th week after retrieval, right, since "weeks of pregnancy" are measured from the first day of the last menstrual period (in natural cycles)? In any case, I'm really happy to hear that the shots won't last that long anyway, even if all goes well with the next quantitative hCG test(s).

Thanks for the nice example of "literally" used correctly. It's a pet peeve of mine that people say things like, "It was literally raining cats and dogs." ;) I sure can't fault you for making that mistake, as my *ss will attest!


Dr Smith - November 16

A1. AH doesn't speed up the the attachment/implantation process that much. Maybe a few hours. So, in terms of detecting implantation earlier, probably not.

A2. Each "good" quality blastocyst stage embryo has about a 30% chance of attaching and implanting. Hence, the rationale for transferring two blastocyst stage embryos. Embryos that have reached the stage immediately preceeding the blastocyst stage (called the morula stage) have a somewhat dimished implantation potential. Dr S's crystal ball says about 25% 'cause they have to make it to the blastocyst stage before the end of Day 6 when the implantation window closes if they are going to have a chance of implanting.

A3. Yes it is very possible to test negative this early and still be pregnant. Day 8 is the ABSOLUTE earliest a urine kit would pick anything up and then, probably only with twins. If you think about, those are teeny tiny embryos and they have to produce enough hCG so that, when diluted by all the blood in your body, can be detect by a urine test (which is even more diluted than the blood). Day 8 is really pushing it. By Day 10-11 post blastocyst transfer you may pick up a postive on the urine kit. So you could test today (11/16) and pick something up.

Best of luck.



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