IVF Failure
1 Replies
LucyLu - December 7

I was wondering if you could help me. I have recently had two IVF failures (in August and November) and am trying to decide what to do next. Some background. I am 38 (almost 39) years old, my FSH is good (below 5 on CCCT and several subseqent tests) and all my other tests were normal. My husband is also normal with a very high sperm count. I have no health problems.
Did 2 IUIs with clomid (no success) and 4 IUIs with Repronex (one chemical pregnancy, one with only one follicle due to dominant follicle). First IVF attempt - 11 follicles with 9 mature eggs retrieved, 8 fertilized (half ICSI, both groups same fertilization rate), transferred 3 good embryos on day 3 (1-10 cell and 2-8 cells) with one having a little (10%) fragmentation. None of the remaining embryos survived to the blast stage. Second IVF attempt - 10 follicles with 9 mature eggs, 8 fertilized, transferred 4 embryos (1-9 cell, 2-8 cells and 1-7 cell). While this time the embryos divided normally, there was more fragmentation this time - 2 under 20%, 1 at 20% and 1 at 25%. None of the remaining embryos made it to blast. My seven day progesterone was always good, although lower than it had been for my IUIs.
My RE believes that there may be an egg quality issue despite the fact that my FSH is good and the eggs fertilize and divide normally - he believes that my reproductive process is inefficient due to high numbers of chromosomally abnormal embryos, although he admitted there would be no way to test this short of doing PGD (which he feels would be risky to my embryos considering how many I've had and that fact that none have made it past day 3). What do you think? What could cause the increased fragmentation? Is this an indicator of poor egg quality? I don't believe that any of the remaining embryos were above 6 cell.

I am trying to decide whether to try once more with my own eggs. I am in a relatively small city, but my RE seems good and has relatively good overall live birth rates (greater than 40%). What can a larger, more renowned clinic do differently? Would you have tried to take the embryos to blast, and would that have possibly made a difference considering none of the non-transferred embryos had made it to 8-cell on day 3?
If I do decide to go the donor egg route, would you recommend any further testing to determine (i) uterine problems, such as a test for the integrin adhesion molecule or (ii) immunological problems (we did test for antiphospholipids which were normal, but my RE does not really buy into the whole concept).

Thank you so much - I really need some objective advice right now.

 

Barry Jacobs, M. D. - December 7

For a description of the evaluation I do for my paatients, I refer you to our web page, <www.texasfertility.com>. I do not know anything about your community, the IVF lab, or your RE. Just because the program is small, does not mean it is not good. You do have a major issue in that you are 38, not 28. You have at least 3 optioins. You can try again, before moving on to other treatments. You can have biopsies done of embryo to check the number of chromosomes. That may leave you with nothing to transfer, if there is not a normal embryo in the batch. You ca use an egg donor. The last provides the best odds, if you plan to continue treatment.
Good luck

 

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