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Dr. Jacobs,
We are doing IVF/ICSI due to male factor. My husband and I are 29 years old, and we did our first cycle back in April. I was on long protocol with BCP, lupron and was stimulated for 9 days with 300 IU of Follistim. I ended up having 18 eggs of which 8 were immature. Out of 10 mature eggs 4 fertilized normally, and two more immature eggs were ICSI-ed on the following day and fertilized. So we ended with only 6 embryos, 5 at 4 cells and 1 at 5 cells (this one from immature egg that got mature and was ICSI-ed on day 2) with no fragmentation.
3 embryos, 2 4-cell and 1 5-cell (graded 1.5, on a scale of 1 to 4, 1 being the best) were put back on day 3 and I did not get pregnant. Doctor suggested that we freeze the remaining 3 4-cell embryos, and we followed his advice.
I am concerned with a couple of factors: (i) the quantity of immature eggs, although the hormone levels were adequate; (ii) low number of embryos fertilized with ICSI; (iii) the fact that embryos were only at 4 cells, and apparently they were at 4-cells already on day 2, which I believe indicate an embryo arrest. We did karyotype tests after the negative result, and they came in normal.
My doctor is now starting me on a second fresh cycle (since chances with frozen embryos are low; only 3 frozen embryos at 4 cell). What can we do differently to increase our chances of having better quality embryos this time around? I am afraid our embryos arrested on day 2. Do you thinks that's the case? Could this be due to male factor or could I have poor egg quality? Is there any way to find out?
I appreicate a lot your advice.
Becca
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It is difficult for me to tell you how to change the protocol, since I do not know all the details, or the details of your response. Hind sight is easy, but I think you may have faired better if you had stimulated for another day. I do not know what criteria your RE used to determine when to give you your hCG. Also, we grow embryos for 5 days. Since genes from the sperm do not play a role in embryo growth and developement until day 3, we can find out on day 5 which of the day 3 embryos are still growing.
Good luck.
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