12 frozen donor egg embryos
brenda - Aug 20th, 2005 8:24 PM
[ Original Post ]

Hi
I have had a second consult with another clinic regarding our frozen donor egg embryos. We have 4 frozen at day 1 2 PN, and 8 frozen on day 3. The grade of the day 3 embryos is very poor, and graded b-.

I spoke with the Lab director at the new facility and the RE and I am not liking their recommendation. I read a prior post and appreciate if a clinic says they do not have good experience taking embryos to blastocysts then the lab is updated. Both of the clinics we have visited are saying that same thing that they do not have good success either freezing the blastocysts or taking embryos to blastocysts.

The recommendation for us, is to unthaw all 12 embryos, and then do pgd on the embryos on day 3, and transfer the normal ones from the pgd on day 4.

The lab director said the 4 embryos at 2pn, have a 75% unthaw rate and they will be the more viable embryos.

The issue is whether the other 8 embryos that are 8 cell and b- grade quality is our concern. This clinic says that they do not know if it is an egg or a sperm issue. I stated our donor hyperstimulated and that we were told by the embryologist we had an egg issue, however the RE pretends she knows nothing about it.

When does the sperm add it cellular energy to the embryo? Meaning the ability to divide or have the energy to continue to day 5?

We are afraid if we unthaw all 12 of them, and given the stats on what will make, we could have 4 embryos at the day of the transfer and have to refreeze a couple of the embryos and then we could potentially lose those embryos, and then have to start again.
we are already 76,000 into this process and at the end of our financial resources.
what would you recommend,
1.) when does the sperm add its material to the cellular energy of the embryo
2.) unthaw all 12?
3.) continue to look for a lab that is more updated and current.

Also would pgd prove anything to us, especially since this is a donor egg and also my husband sperm factors we think are ok.

Comment


 

Dr Smith - Aug 22nd, 2005 10:44 AM

I think they're just trying to take more of your money through PGD. Of the eight B- grade embryos frozen on Day 3, it is unlikely that the embryos will survive with all the cells intact. It is more likely that one or more of the cells of each embryo will die during the thawing process. For example, when an embryo frozen at the 8-cell stage is thawed, 4 cells die, thus leaving only 4 viable cells from which the embryo must grow. Your situation appears even worse, since many of your Day 3 embryos probably contain fewer than 8 cells and have significant fragmentation (B- grade). For these embryos, you will be lucky if any cells survive. if, on top of this, the embryologist removes 1-2 [i]more[/i] cells from the embryo for PGD, there will be no cells left in the embryo.

Of the four embryos frozen at the 2PN stage (Day 1), of which 3 are likely to survive, what is the point of performing PGD if there is no suspected sperm problem. The sperm DNA begins to affect embryo development after the 8-cell stage (i.e. Day 3-5). Since many of the problems with your embryo development were apparent prior to the 8-cell stage, egg quality was the most likely source of the problem.

It appears to me that the donr's stimulation was not managed well, she hyperstimulated, the egg quality was compromized and resulting embryo development reflects this. I think they are trying to cover this up.

They are playing with you. Any lab capable of performing PGD and culturing the embryos to Day 4 is capable of culturing embryos to the blastocyst stage (Day 5).

I suggest you keep on looking for a program that would consider thawing the four 2PNs and any additional Day 3 embryos, as needed, to have 2-3 blastocyst stage embryos for transfer. It is very unlikely that you will have more than two blastocyst stage embryos from the entire group of frozen embryos.


Brenda - Aug 22nd, 2005 3:16 PM

thank you Dr. Smith for your reply bc it seems the more we try to decide what is the best option for us, the more it seems we get no where.

I have called another clinic to see if that Dr. will give us more of a call on what he thinks to do with these embryos. The second opinion all they would say is they do not know if it is an egg or a sperm issue.

Q1--When does the genetic material of the sperm come into play in the embryo? Is it correct the sperm adds its genetic material on the day of implantation or around day 10? for a day 3 embryo?

Q2--Are you saying bc of the fragmentation or increased fragmentation that less and less of the cells will make in the unthaw process for the day 3, 8 cell embryo?


Q3--We are trying to determine on the 2 PN embryos if there was a sperm chromatin issue, unfortunately that is the unknown, I did miscarry and the sperm chromatin does cause miscarriages? Before that sample for the 2 PN was given, there was a sperm chromatin issue. The sperm chromatin issue was discovered in July and the sample used to make the 2PN was given in the last part of september. Our thinking is bc the morphology is ok, for that sample there is a good chance there was no sperm chromatin.
Is there a correlation between morphology and sperm chromatin?

Q4-What is a sperm genome that adds to the embryo on day 3?

thanks Dr. Smith.
Believe me if I could I would transfer all these embryos to your facility.


patricia Wright - Aug 22nd, 2005 5:36 PM

referring to your first post, can you really re-freeze embryos? i didn't think that was possible.
my husband and i are planning to have a frozen/thawed blostocyst transfer next month and we only wanted to transfer two at a time. unfortunately our lab froze all four of our blasts together without asking us. it would be great if we didn't have to use them all at once.


Dr Smith - Aug 23rd, 2005 10:30 AM

A1. The genetic material (DNA) of the sperm becomes active on the third day, between the 4 and 8-cell stage of development. Pror to the 8-cell stage, the developmental capacity of the embryo is derived from the inherent quality of the egg. After the 8-cell stage, the development of the embryo is governed by a combination of genetic instructions from both the sperm (paternal) and egg (maternal) DNA. Problems with embryo/fetal development that occur after the 8-cell stage of development can be attributed to either the sperm DNA, the egg DNA or both. However, problems in embryo development that arise prior to the 8-cell stage of development are a direct result of egg quality (the sperm DNA has not yet become active).

A2. Yes, the more fragmentation that is present, the less likely the embryo is to survive the thawing process.

A3. Yes, problems with the sperm DNA can cause miscarriage, but it is usually attributed to problems with the egg DNA. Aside from genetic problems, there are other causes of miscarriage. (e.g. immunological and thrombophilias). Yes, there is a correlation between poor sperm morphology and high DNA fragmentation indices. However, men with normal sperm morphology values can still have high DNA fragmentation indices, so just because the sperm morphology for the IVF cycle was better, it doesn't mean that the "chomatin problem" was gone.

Q4. The specific genes from the sperm DNA that are activated on Day 3 onward are not well understood at this point. This question will have to wait another 10-20 years for an answer.

Patricia,

Although it is technically possible to re-freeze embryos, it is not recommended. The reason your four remaining embryos were frozen together in one straw is because, relaistically, these embryos represent a single (reasonable) attempt at a successful pregnancy. It would be unlikely that the transfer of four frozen-thawed blastocysts would result in a multiple gestation (twins+).



Brenda - Aug 23rd, 2005 7:37 PM

thank you Dr. Smith, I appreciate your very informative answers and this gives us more lead way on how to approach these embryos.
I do have immunological issues and I am going to meet with or do a telephone Consult with an REI, and discuss.
I have printed literature here regarding this immunological issue that said the embryo toxicity is the issue or my aulloimmune issues, and it is not the embryo. this will be our last attempt and I want to make sure all the issues are ruled out or that would optimize my chances.

thanks, is not expression enough for my grattitude. You are wonderful what you do to help us ladies go through sometimes a very tough journey. You are the best. with warmest regards

Brenda