Dr. Smith: I've had 2 failed IVF's, both with normal fertilization rates, but each time numerous of the eggs retreived were described as dark and granular. I've read that decreasing some of the stimulation drugs may help egg quality--can you tell me anything about that for my case?? I'm 39 and a "good responder" to the flare protocal. Thanks
This is more of a question for Dr Jacobs. Please also post on his Infertility 101 Message Board.
From the embryology perspective, as long as an adequate amount of stimulating medications are used and the stimulation takes the appropriate amount of time (i.e. 9-11 days), the eggs are fine. Managing the stimulation properly (i.e. rate of follicular growth) is more important than the actual dose of medications. I am not aware of any scientific study that concluded that a lower dose of medication per se improved egg quality.
Thanks Dr. Smith! So, with regard to managing follicular growth, would you say the flare protocal affects this or not? Also, if you saw a lab report saying the eggs were dark and granular, would you interpret that as being definetly of poor quality and possibly unviable? thanks again, floss
A flare protocol is employed when the patient's ovaries do not respond to the usual down-regulation protocol. As long as the stimulation is managed well (regardless of protocol), the eggs will be O.K.
A dark and granular appearance is not necessarily conclusive of an "egg problem". Mismanagement of the stimulation can result in eggs with a dark and granular appearance (indicative of inadequate cytoplasmic maturation). Also, dark and granular cytoplasm can be observed at the pronuclear stage and be completely absent by the 2-cell stage. In spite of their appearance at the pronuclear stage, these embros can go on to develop normally.
Thanks again Dr. Smith! That's very interesting, because the clinic staff I'm dealing with say the darkness is a sign the eggs are unviable and I should move on to donor eggs... hmmm... Thanks, Floss
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