Reduced embryo quality
1 Replies
jeanne - November 8

Dr. Smith,
A am 36. I recently had an IVF cycle where on trigger day I had about 20 follicles that were of good size (15-21mm) and an estradiol of >3500. 11 eggs were retrieved but only 6 were mature. Of those, only 3 fertilized. The next day apparently some of the immature eggs matured and one fertilized (resulting in a 4 cell embryo on day 3). The other 3 embryo's were 1-4 cell (grade C) and 2-6 cells (grade B to B/C). We had a similar cycle 2 years ago with one 6-cell, one 5-cell and two 4-cells, which was successful. My question is...do you think we still have decent odds since we conceived previously with similar embryo quality? Also...any thoughts from the lab point of view as to why so many eggs were not retrieved and half of the ones that were retrieved were not mature? Do you see pregnancies from eggs that mature in the lab for a day and then are fertilized??
Thanks so much for your input.

 

Dr Smith - November 9

It is hard to retrieve eggs from immature follicles (<16mm). Also, it is not unusual to have a significant porportion of immature eggs, when the number of follicles gets high (i.e. >15). No one knows why. I think it may have something to do with overcrowding within the ovary and this results in a significant number of the follicles/eggs not maturing properly. I see this in my lab too. Another explanation is discordance in follicluar growth. Half the follicles are mature (>16mm) while half are considered immature (<16mm) or borderline. Although you had a normal range of follicular size, there may have been many borderline matures (around 16mm).

"Rescue ICSI" is the term used when eggs mature in the lab and are then ICSI'd on the next day. These embryos rarely develop beyond the 8 cell stage and Rescue ICSI is more of "feel good" procedure. It goes along the lines that everything that could done, was done.

 

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