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Topic: good eggs but slow embryos? (Read 11249 times) |
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JACQUELINE
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Re:good eggs but slow division?
« Reply #15 on: 01/22/06, 14:38 » |
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hi, I am so confused about the cell division speed.
I have just had 1st attempt of IVf; 5 follicles, 4 eggs, 4 fertilised. Now day 2, 1 is not so good (6 celled with about 35% fragmentation), but 3 are grade A 1 or A 2 (ie very minor (about 5%) fragmentation).
My question is:- at 48 hours were still 2 cell. is this about average?
We have opted for a day 3 transfer, possibly with assisted hatching because of my age (41) rather than jepordise them by waiting until blastocyst stage.
I am hoping for a success (like everyone else), and have previous children. My endometrium was 14mm before retrieval, and E2 was 4530 p mol.
Is my embryo division too slow; the embryologist said it was right for day 2...
thanks
jacqueline
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Dr Smith
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Re:good eggs but slow embryos?
« Reply #16 on: 01/23/06, 10:03 » |
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At 48 hours post insemination, the embryos should be between 2 and 4 cells. Your embryos are on schedule.
The IVF process is a series of hurdles. I think sometimes patients are in a big hurry to get over the "transfer" hurdle and perfer to have the transfer on Day 3, just to make sure they get a transfer. This doesn't make a lot of sense to me. Your age affects the chances of embryos making it to the blastocyst stage, but leaving them in the lab until Day 5 does not "jepardize" their growth. If they are developmentally competent, they will continue to develop whether they are in the uterus or the lab.
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Sam
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Re:good eggs but slow embryos?
« Reply #17 on: 02/07/06, 12:12 » |
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I did my first IVF this month and everything seemed great, 12/13 eggs fertilized and on day 2 I had 6 2-cell, 2 3-cell and 1 4-cell. Then on day 3, when I came in for the transfer I had only 1 6-cell, 3 5-cell and 1-4 cell with fragments and the others weren't developing or developing too slowly. My RE decided to transfer all 5. He said they were "good" quality, except for the fragmentmented one, but wanted to transfer all 5. Do you think I have a chance of pregnancy or am I another possible case of PGD. I have had one m/c at 9 weeks from IUI and I am 34 years old. Dh has above average sperm and is 33.
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Dr Smith
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Re:good eggs but slow embryos?
« Reply #18 on: 02/07/06, 12:40 » |
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Whenever embryos are transferred there is a chance of pregnancy. However, as you are aware, the embryos were diving slowly and had not developed to the 8-cell stage that is appropriate for Day 3. The usual cause for this kind of slow or arrested development is aneuploidy (the embryo has an abnormal number of chomosomes).
Yes, in theory, you are a candidate for PGD. However, it is prefered to perform the PGD biopsy on 6-8 cell Day 3 embryos to avoid removing too much of the embryo's cellular volume. Although a 3- or 4-cell Day 3 embryo can be biopsied, it may compromise their later development. I would suggest an alternative. If the current cycle is unsuccessful, try culturing the embryos to the blastocyst stage. Although there is no guarantee that the embryos that reach the blastocyst stage are genetically normal, the vast majority of genetically abnormal embryos fail to reach the blastocyst stage. If no embryos reach the blastocyst stage, you have the same answer you would have got with PGD - all the embryos were abnormal. If, however, some of the embryos reach the blastocyst stage, you can be confident that at least they have the capability to attach and implant (which you don't know at this point about the embryos from your recent transfer).
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Sam
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Re:good eggs but slow embryos?
« Reply #19 on: 02/07/06, 13:47 » |
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Thank you so much for your informative reply, Dr. Smith. I guess only time will tell. I won't get my hopes up too much at this point. I'll let you know the outcome in a couple of weeks.
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allison
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Re:good eggs but slow embryos?
« Reply #20 on: 02/07/06, 13:51 » |
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Dr. Smith,
You replied to a question I posted earlier, and I really appreciated your response.
Yesterday I had the retrieval of my 4th IVF. My RE, it seems, finally found the right protocol for me, and I stimmed very well on Menopure and Cetrotide. From our experience, my eggs need time to mature and are found to be best in the larger follicles. So I stimmed for 14 days with the largest follicles reaching 28-30mm. Of a total of 24 follicles, 14 eggs were retrieved - my best yield yet. 7 were mature and looked very good. They were all ICSId (there's no sperm problem, but after 3 previous failed attempts our RE decided to take all measures).
Today (day 1) our RE called and said none of the eggs fertilized. He was in shock. They're still following them to see if maybe there was late fertilization, but I know the chances for that are close to zero. Our clinic and RE are very reputable. It seems like everything went so well this cycle. Do you have any thoughts on what could be the problem and whether it can be dealt with?
(I'm 34, day 3 FSH 4.7, LH 2.2, E2<30)
thanks, allison
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Dr Smith
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Re:good eggs but slow embryos?
« Reply #21 on: 02/08/06, 08:57 » |
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Fragmentation usually shows up early, in the first couple of days. The fact that the embryo reached the 4-cell stage without exhibiting framentation indicates that what you saw on Day 4 were true cells, not fragments. The cells get pretty smal by the time the embryo reaches the morula stage and can be confused with fragments if you don't know how much fragmentation was present at the earlier developmental stages (confusing even for embryologists). I would be more confident if the embryo had initiated the compaction process prior to transfer, but as such, a morula on Day 4 is considered developmentally "on time".
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Dr Smith
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Re:good eggs but slow embryos?
« Reply #22 on: 02/08/06, 09:16 » |
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Allison:
Every once in a while we get thrown a curve ball. I do not have a good explanation for what specifically went wrong. When ICSI fails to activate the eggs (assuming the ICSI was performed properly by an experienced embryologist), the problem lies with the cytoplasm of the eggs. This can usually be explained by inadequate cytoplasmic maturation caused by not waiting until the follicles are large enough or cutting the stimulation too short. Neither of these conditions apply to your cycle. So, I'm sorry to say, I'm left scratching my head too. Curve ball.
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allison
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Re:good eggs but slow embryos?
« Reply #23 on: 02/09/06, 19:52 » |
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Thanks for the answer. We consulted another RE who seems confidant that the stimulation was way too long and that the eggs must have been post-mature. He doesn't think that it is right that my follicles need to be so big for the eggs to maure. Do you think this could be the case? Would this type of result -- no fertilization at all (7 eggs) with ICSI be consistent with eggs that are post-mature?
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Dr Smith
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Re:good eggs but slow embryos?
« Reply #24 on: 02/10/06, 07:51 » |
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Yes to both questions, but hindsight is 20/20. Failed fertilization due to post-maturity usually occurs with conventional IVF insemination, not with ICSI. That's why I didn't menion it in my previous post, but it is possible.
Also, be aware that whenever you go for a second opinion, the new doc will find fault with the old doc. These guys are highly competitive amongst themselves and sometimes patients get caught in the crossfire. You mentioned that you did better on previous cycles when the follicles were left to grow a little bigger. O.K., so maybe this time the doc went a little too far to try to maximize the number of good, mature eggs, but a shorter stimulation is worse than a longer one. Beware of docs that promote themselves by criticizing others. There's no absolute right or absolute wrong way to do this. Ovarian stimulation is not an exact sceince.
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racheal
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Re:good eggs but slow embryos?
« Reply #25 on: 02/14/06, 10:08 » |
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I have just finished my 5th round of IVF however this time they also included PGS (Pre Genetic Screening). I am 34 years of age however due to operations have blocked tubes. My issue has always been the growth rate of the embryos they only ever seem to become 4 cell on day 3. This time round they carried out a biopsy on 4 embryos on day 3 however they were only 4 cells. So by removing one cell from each embryo they could check the chromosomes (genetic make up). On day 4 they result came back as normal however they had only gone on to the 6 cell stage 2 have been put back & I now have the dreaded 2 week wait....Can anybody offer any advice or even maybe some encouragement I don't know If i can go through it again.
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Dr Smith
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Re:good eggs but slow embryos?
« Reply #26 on: 02/14/06, 10:41 » |
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Dr. Doom-n-Gloom here. I know you are looking for encouragement, but I play the part of a realist on this board. If you're emotionally up to it, let me know. I'll give you the objective, scientific point of view. If you're not emotionally up to it, that's O.K. too. Waiting for the pregnancy test can be the worst part of the whole process. I understand. I don't want to contribute to your woes by giving you cold facts when you need warm feelings. Best of luck.
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Sam
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Re:good eggs but slow embryos?
« Reply #27 on: 02/28/06, 13:51 » |
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Dr. Smith,
I posted previously and wanted to let you know that as expected my first IVF was unsuccessful (I had plently of fertilized eggs, but none that made it to 8 cells by day 3). I met with my RE and he wants my husband to do a thorough sperm analysis (FISH) w/genetic testing (personally I think it's a waste) and for me to try another IVF with PCG and a 3dt. I suggested your recommendation to do a 5dt and he thought since I've had a previous miscarriage, a PGD with a 3dt (if applicable) would be a better route to take. I've heard PGD can be expensive and am wondering if I should strongly request a 5dt and take my chances that they will make it to 5 days. What do you think? Do you have any idea as to why my eggs would stop developing after everything else went so well? I know they were genetically abnormal, but do you think another IVF with my own eggs is a waste of time and $? Or is there a chance that I just had a bad batch and next time the result could be better?
I am just at a loss here and would greatly appreciate your honest opinion. Thanks, Sam
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Dr Smith
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Re:good eggs but slow embryos?
« Reply #28 on: 02/28/06, 14:25 » |
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A paternal DNA problem doesn't really explain what you observed, since abnormal paternal DNA usually causes arrested embryo development later on (i.e. Day 4-5, or later during the first trimester of pregnancy). So I agree with you that a comprehensive genetic analysis of the sperm may not be worthwhile. Of course, it can't hurt either (except your wallet).
If PGD is performed on Day 3 (as it usually is), then the embryos would not be transferred until Day 4 at the earliest because it takes 24 hours to get the PGD results back from the genetics lab. What would be the harm in waiting one more day to be sure they reach the blastocyst stage? Hmmm, your doctor's recommendation doesn't quite make sense. The miscarriage has nothing to do with the choice to go to Day 5 or not. Obviously the embryo that resulted in the miscarriage made it past Day 5. And a single miscarriage is not a justification for PGD. Recurrent miscarriage is a justification, but that means 3 or more successive miscarriages. That's not your situation. PGD is expensive and will add approximately $3K to the final price. I think your doc is grasping at straws trying to explain the failure (which may very well fall within the "sh** happens" category) and trying to give you something different to look forward to on the next cycle. Personally, I'm not so gung-ho about the PGD at this point.
I think you should try again. Every batch of eggs is genetically different and there may be a good one in the next batch. Did your doc suggest a change in your stimulation protocol? That could have been a problem too and could explain (to some degree) the high embryonic arrest you observed. If the cytoplasm of the eggs had not had an adequate amount of time to mature (short stimulation, small follicles), it can cause arrested development (although your situation is a bit extreme for that explanation).
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Sam
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Re:good eggs but slow embryos?
« Reply #29 on: 02/28/06, 18:34 » |
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Dr. Smith, thank you so much for your thorough reply. I honestly don’t think there is a problem with the sperm, but his reasoning was that since they can’t genetically test the eggs (other than from the PGD), it would show where the genetic abnormality came from by ommission or confirmation and it’s a pretty easy test to do, so why not, but my feeling is why if it’s not necessary.
I don’t know what the harm in waiting one more day for the 5 day transfer would be either, but he seemed to think if we waited until day 5, we wouldn’t have anything to transfer (not very encouraging). I think he mentioned the miscarriage because he was proving his point that although the embryo made it past the blastcyst stage, obviously there was something genetically wrong with it and if he did the PGD he’d know what was worth and not worth transfering. I guess.
My RE doesn’t want to change the protocol because he said he was pleased by how I responded to the meds, but obviously it didn’t work, so I was hoping to try something different. I had my retrieval on CD14, which seemed a little early. I really like your recommendations and am now wondering if I should see someone else or at least see if he’s open to longer stimulation and 5 day transfer. Is my situation common, where you get a lot of fertilized eggs that don’t make it to 8 cells on day 3? Do you think it would be a good idea to meet with another RE? I am Newport Beach, CA so I am lucky to have a lot to choose from nearby. I apologize for so many questions, but greatly appreciate your feedback.
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