good eggs but slow embryos?
70 Replies
Dr Smith - April 5

Have you been tested for immunological problems (e.g. high levels of Natural Killer (NK) cells and/or abnormal activation of NK cells)? With your history of tubal pregnancies and premature labor, immunological problems may be present that inhibit or prevent implantation.

 

Purpletangerine - April 5

Dr Smith,

Is one protocol better than another to produce embryo's that are 7-8 cells? I am 39, with elevated antithyrod antibodies. I am currently starting a long lupron protocol.

 

Dr Smith - April 5

No one stimulation protocol is always better than another. Each patient is different. As long as the follicles are stimulated for an adequate length of time, most of the eggs within the follicles wil be mature. This is important because only mature eggs can fertilize.

If your doctor decided to stimulate your ovaries with the long Lupron protocol, he/she must have believed that it would deliver the best results. Wait and see what happens. If the cycle turns out to be suboptimal, then it can be canceled and another protcol can be used. Ovarian stimulation is not an exact science and there is considerable patient-to-patient and cycle-to-cycle variation.

The major determinant for embryo development is genetics of the embryo, not the stimulation protocol. At 39, roughly 70% of your embryos will be gentically abnormal and fail to develop beyond the 8-cell stage. Because of this, I'm afraid the harsh reality is that the chance of failure is considerably higher than the chance of success, regardless of which stimulation protocol is used.

Best of luck.

 

anitasto - July 21

I don't know how old your message is but if you're still trying I think you would very likely benefit from reading this site. Use of DHEA seems to IMPROVE egg quality. Information is new as of last year and I'm finding that many many endocrinologists are not aware of the case study. Here's the site:
http://www.centerforhumanrepr
od.com/premature_ovaries.html
Here'
s
the case study:
http://www.centerforhuman
reprod.com/pdf/dheafs.pdf

Al
l
the best!
Anita

[quote author=Fifka link=board=6;threadid=1142;start=0#7862 date=1119198133]
Hi,

On my 3 IVFs, I generate plenty of mature healthy-looking eggs. My husband's sperm analysis is good. Most of eggs will fertilize, but most if not all resulting embryos are slow. Our 3rd IVF was the best - 2 out of 8 embryos were at 7 cells on day 3, the rest of embryos were 5 cells of less.

It's not lab's issue, as we tried it on 2 different clinics. It should not be age issue, as I am 32 and healthy. So what is it? Is it defect cytoplasm in my eggs? Do I have just very few of good eggs and the rest is bad? I had 2 early m/c's from IUIs. Should we test my husband's sperm DNA fragmentation?

Thank you very much for your opinion.
[/quote]

 

Dr Smith - July 21

The findings of this paper must be interpreted with extreme caution. It is based on a single individual (that's what a case study is). It was published in 2005 and, as far as I know, there has been no peer-reviewed, published follow up or confirmation by other investigators. I believe Dr. Gleicher is conducting a larger scale study based on his preliminary findings, but he has not yet published his findings in a reputable journal. Until his study is complete and published or his findings are confirmed by independent investigators, it should be interpreted for what it is. One woman had better eggs on a subsequent cycle. Happens all the time.

A cynical interpretation of linking this publication on CHR's promotional website is that it could be just a ploy to lure new patients. Every woman wants better quality eggs. What could be more enticing than that? It could be the ultimate sales pitch. [i]Cave Canem[/i] - Buyer Beware

 

teacher-ttc - July 23

I appreciate all the information on this thread.

My husband and I are undergoing our first IVF cycle. We retreived 15 eggs, 13 fertilized, 9 developed. On day 4, they called to say six were still progressing and transfer would take place on day 5. On day five they clinic called because they wanted to take it out to day six to see which two would be best out of the four remaining. ANyway, later the RE called and said he DID want to do the day five transfer. Three of our embryos were at 12 cells, at least one was compacted. We decided to transfer all three. He said better in me than in the lab at that point. Any insight? Any hope?

We are both 30, no known sperm issues, and I have slight-pco-like tendencies.

Thank you.

 

Dr Smith - July 24

It is not unusual for embryos to take until Day 6 to reach the blastocyst stage. It is within the expected biological variation. After the embryos reach the compacting/compacted morular stage, they can be transferred into the uterine environment without any undue stress to the embryo.

I suspect that your RE was concerned that there may be no embryos for transfer on Day 6. You went from 9 to 6 to 4 to 3 and the RE was concenred that on Day 6, it might be zero. I don't think it would have been zero, the lab folks didn't think it would be zero, by RE's never, ever, want to have to tell the patient "there is nothing to transfer", especially in a 30 year old patient. So... to completely avoid that possibility, the embryos were transferred on Day 5. It won't harm the embryos to be transferred on Day 5, and the RE (and you) won't be anxious. The only down side is if it doesn't work. Then we will never know if the reason it failed was because of the embryos failing to reach the blastocyst stage or because of some uterine factor that prevented implantation.

Best of luck.

 

teacher-ttc - July 24

Thank you, Dr. Smith for your response!

I did receive more information about the embryos today from the lab (they called regarding the other embryos arresting...which was suspected). Anyway, we transferred two 12-cell rated two and one 12-cell rated three (1 being the best). One was definitely compacting and one appeared to be in the process. Do you think there is a possibility they have continued to grow and divde to the blastocyst stage within my body? If the lab was wanting to keep the embryos for one more day to find the two best, I would believe they saw hope in further development, do you agree? Finally, with cells that are a bit slower to divide, approximately how many days would it take to implantation (if it were to occur)?

Again, thank you very much for you time and insight!

 

Dr Smith - July 24

Yes, I think you still have a decent chance. The embryos were approximately 1 day behind at the time of transfer and, if they continue to develop, they would reach the blastocyst stage on Day 6, still in time for attachment and implantation. It ain't over yet. Keep us informed.

 

teacher-ttc - August 1

Dr. Smith,

Your messages really brought me hope when I thought there was none over the past week. We received word today that our beta was positive.....but low (HCG level 11). I am thrilled to know I actually achieved pregnancy, and now worried that it won't work. I will go back for a repeat beta on Thursday, but I know the numbers are low. Any thoughts? Questions I should be sure to ask my RE? Encouragement?
Thanks again,
Teacher-ttc

 

Dr Smith - August 2

If the embryos take until Day 6 to reach the blastocyst stage, then implantation is also delayed. The hCG level is relative to the timing of implantation. So, it is possible that the hCG will continue to rise. Hang in there.

Even if it turns out to be a "chemical" pregnancy, it is still encouraging as this means that implantation is possible for you (silver lining, as it were). For the most part, that rules out "uterine factors" that prevent implantation. However, elevated levels of Natural Killer (NK) cells or abnormally high activation of NK cells can also cause the embryo to be "rejected" at an early stage of implantation. If this turns out to be a chemical pregnancy, you may want to consider immune testing, just to rule this out as a cause or contributing factor. For more information, see http://www.millenova.com/tests/nkassay.asp

 

anitasto - August 16

Hi Dr. Smith,

I completely appreciate your caution on the dhea case study. I've been researching this stuff like a hound as I am 39 and heading towards a 4th IVF cycle with diminishing funds.
Dr. Gleicher has discussed the larger study clinical results on June 17 ESHRE in Prague (link: http://humrep.oxfordjournals.or
g/cgi/reprint/21/suppl_1/i68.pd
f
) and has 2 papers in press, one with FertSteril, the other with Human Reproduction. It seems like most docs aren't familiar with the updates Gleicher posts on his website or other related studies in addition to the 2000 IVF study and the 2005 case study publication (one Italian study that showed perimenopausal hormone levels returned to normal reproductive levels in all 30 subjects after 6 mos on dhea, plus another with 1400 women that directly related the 10% lowest DHEA levels to the same 10% lowest sexual function levels.)
Are you familiar with these studies and Dr. Gleichers latest?....are they relevant...
Do you think its reasonable that we poor responders move forward based on the info to date?

I had one consult where the doc said he wouldn't even offer a cycle with my own eggs and said he didn't think dhea would make any bit of difference. This was the #1 results guy in the US. So I faxed the most info I could find including the case study and, though it was new info to him, opinion unchanged.

Please help me understand the skepticism because I'm just a wanna be Mom.
Thanks so much for your time and input.
Anitasto

PS - And btw - I'm not an advertiser by any stretch.


[quote author=Dr Smith link=board=6;threadid=1142;start=45#22548 date=1153483663]
The findings of this paper must be interpreted with extreme caution. It is based on a single individual (that's what a case study is). It was published in 2005 and, as far as I know, there has been no peer-reviewed, published follow up or confirmation by other investigators. I believe Dr. Gleicher is conducting a larger scale study based on his preliminary findings, but he has not yet published his findings in a reputable journal. Until his study is complete and published or his findings are confirmed by independent investigators, it should be interpreted for what it is. One woman had better eggs on a subsequent cycle. Happens all the time.

A cynical interpretation of linking this publication on CHR's promotional website is that it could be just a ploy to lure new patients. Every woman wants better quality eggs. What could be more enticing than that? It could be the ultimate sales pitch. [i]Cave Canem[/i] - Buyer Beware

[/quote]

 

Dr Smith - August 16

Had to smile at your description of the morula. Yes, indeed, that's what it looks like. The cells get pretty small at the 12-16 cell stage (morula) and look about the same size as fragments in earlier stage embryos. Because it is contained within the zone pellucida, the embryo per se does not increase in size until it reaches the blastocyst stage. Prior to the blastocyst stage, every time the embryonic cells divide, the resulting cells are half the size of the original cell. So, they get pretty small at the morula stage and it looks like a "rasberry".

The "dark matter" could have been shading in the phograph or a few small fragments that have been pushed off to the side. Doesn't sound serious. It seems the embryo "caught up" and was at the appropriate stage for Day 4.

 

dees - February 27

Hi Doctor,

I am a huge fan of your honest responses, so I felt compelled to write to you.

A concise history of my case - 1 ivf attempt last september. 7 eggs retieved, none fertilised due to sperm not binding to egg. Just completed an ICSI cycle. Another 7 eggs retrieved, 5 fertilised. Day 2 - most at 3 cells, 2 are 2 cells,some with fragments. Day 3 - two are "A" grade at 6 cell and 7 cell. Three are "B" grade, one has 6 cells,and 2 have 4 cells. Day four - one is an early morula, and one is 8 cell. The rest are at day three stage. Day five (transfer day) - none have made it to blastocyst. They transfer one at 10 cell. The rest are too fragmented to use or freeze. (The plan was to transfer two blastocysts)

What do you make of my case ? Do you think the embryo quality is due to male factor ? Do you think that they did the transfer so they can say they did one ?
As I am not feeling confident about it, i wonder if you think it has any chance of success. Finally, any recommendations for future success ?




 

Inna - March 3

Dees,
Dr Smith is no longer available to answer.
Good luck to you!!!!

 

jzk1 - September 14

Well I'm turning 40 next week my husband is 36 we've been seeing RE in 4 different states at major university centers and just completed over the last 5 years 3 IUI's 1 GIFT and 6 IVF's I feel like I've been through a war. I'm covered in bruises my ovaries are aching and my heart is broken. Today I transferred back two 4 cell day 3 embryos and am certain of the outcome I have always had fragmented eggs up to 25% but this is the first time they are not dividing properly, there comes a time you have to throw in the towel. My work up was completely normal husband had varicocele repair 3 years ago with now normal seman studies except HOS we even tried the endometrial coculture today which clearly did not help we are both in healthcare and have utilized every medical contact we have. I guess I just need closure and am tired of venting and crying. Crying for all my little babies that are in heaven and hopefully for all you other prospective mommies.. Good luck to you all

 

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