What should our next steps be?
1 Replies
Brenda - July 28

Hi Dr. Smith
Was this board down for a while, I had trouble accessing it.

My husband and I face a dire sitution and I do not know what to do at this point, and we have no peace on how to proceed.
We want to maximize everything at this point, bc we feel this will be our only chance for success and pregnancy.

My history is did own ivf at age 41 and got a grade A embryo, and miscarried, due to submucosal fibroid. No other tests were run at that cycle.
Moved onto donor egg bc fsh was 14.00 at age 44.

We have 2 separate batches of frozen donor egg embryos from two different donors from 2 different clinics & RE's
Clinic #1/Batch 1 frozen donor egg embryos-we have 4 frozen 2PN embryos. Donor was 22 years old, prior pregnancy, shared cycle and other recipient couple did get pregnant.

Undetermined sperm chromatin for husband sperm with sperm that was utilized on embryos. ICSI was utilized as standard protocol and we are not aware of any problems.

the first transfer from this cycle, was we unthawed 3, and 2 made. The grades were 6 cell b+, and a 4 cell B. We did get pregnant, however the pregnancy ended in a blighted ovum. DX for miscarriage was unknown sperm chromatin, chromosonal, submucosal fibroids, and immunological issues. Elevated anticardiolipins. I tested postive for immunological issues after the miscarriage.
Unfortunately the embryos from this cycle, we have very little information, on other participants from this program. We left the care of the RE as a bogus recommendation was made for a surrogate. There is no need for a surrogate.

we flew my husband's sperm to Romania and the embryos were made in Romania. It was also a shared cycle with another recipient couple and that couple did achieve pregnancy with the eggs from this 22 year old donor. Not sure of how pregnancy rates were determined if by beta, ultrasound, or live birth rates.

We do not have any relationship with the RE who was in charge of this program.

we would like to proceed with these embryos, however the current clinic they are residing at, does only 3 day transfers, and has no experience with 1 day 2 PN. In the first unthaw of the 3 frozen embryos, techinically 48 hours were not given to the embryos and at the time of the transfer we actually walked away from the transfer bc the embryos at 43 hours after the unthaw were only 2&3 cells. We did not realize that less than 48 hours was given.

We were told to go to lunch and we gave it 5 more hours and then when we came back the embryos developed out to 4 & 6 cells.

Our dilemma is this, the current RE, says there are not other tests to run for embryo implanation issues or miscarriages other than what she has run which is immunological issues. No endrometrial biopsy, nor other tests.

Current RE wants to proceed with the frozen and transfer on day 3. There are only 4 embryos left and a second opinion clinic says to do pgd on these embryos. however their embryologist has never completed pgd .

on frozen donor egg embryos.

Q1-Would taking these embryos to blastocysts, do the same as pgd testing?

Q2-Should I move these 2 PN embryos to a clinic that has experience with 2 pn embryos development. The unthawing procedure and protocol is one of the easiest or least complicated there is in the industry.


Q3-What other questions should I ask the RE to perform on me the recipient to optimize my conditions. The 2nd opinion doctor wants to perform an endrometrial biopsy to rule out endrometrosis.

Q4-What day of development does the sperm genetic material contribute to an embryo. Our Current RE says that the genetic material by the sperm is not added until 2-4 weeks later. And if there is a sperm genetic problem that is the reason for increased blighted ovums or miscarriages?

Q5-What does an blighted ovum tell an RE, if anything?

When I am looking for a new clinic to take these embryos and the 2nd opinion clinic is willing to take these embryos from Romania, no problem per this 2nd opinion RE. However their frozen success rates are 30%.

Q6-Should I ask the new clinic their success rates for frozen and particularly their experience with 2 PN?

What if any other questions should we pose to any new clinic regarding our chances to maximize our chances with these embryos.

Currently with this Romanian donor egg embryos the frozen success rates here in the USa are 70%. That is 10 out of 14 couples have achieved success, and not sure how success is measured.

thanks for your insights.

 

Dr Smith - August 8

Egg-related problems (slow or arrested division, excessive fragmentation, nultinucleation) show up prior to the 8-cell stage of development. Sperm-related problem can manafest at any time after the 8-cell stage of development.

 

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