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Topic: good eggs but slow embryos? (Read 11246 times) |
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Dr Smith
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Re:good eggs but slow embryos?
« Reply #30 on: 03/01/06, 08:55 » |
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PGD is a very superficial genetic analysis. Of the 23 pairs of chromosomes, PGD can evalauate a maximum of 9 to determine if there's one extra or one short. That leaves 14 other chromosome pairs that could make trouble. In addition, the number of chromosomes in a embryo is only the tip of the iceberg from a genetic point of view. Subtle genetic defects (like single gene mutations) can lead to miscarriage and these cannot be identified with PGD at present. I think that PGD is being over-pitched by the ART community. It has become the "next big thing" in assisted reproductive technology, but in actuality, it is a very crude tool to determine the genetic normalicy of an embryo. Although PGD can reduce the chance of miscarriage in women with recurrent miscarriage, PGD does not prevent miscarriages altogether (not by a long shot). Beware the PGD sales pitch.
I think a second opinion is a good idea. Have another RE review your records and see what they have to say about the stimulation protocol, the necessity of the sperm testing, the PGD option, Day 5 transfer, etc.
Lucky you in Newport Beach. We're getting 6-8 inches of snow in NYC tomorrow. Catch some rays for me California Girl.
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Sam
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Re:good eggs but slow embryos?
« Reply #31 on: 03/01/06, 20:24 » |
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Thanks again Dr. Smith, I think I will get a second opinion. It definitely can't hurt. WOW -- 6-8 inches of snow! I won't even say what the weather is like here, but I'd actually rather be in NYC, I love it there! Take care.
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Roberta
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Re:good eggs but slow embryos?
« Reply #32 on: 03/04/06, 00:23 » |
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Perhaps you could evaluate this situation for me...
I had a 5 day transfer of one blastocyst the other day. On day 3 it was a perfect 16 cell morula that my RE classified as "best quality", which I assume means, even cell division. and little fragmentation. By day 5 the blastocyst was only 40 cells... Is the fact that the growth slowed down a bad sign?
Thanks for any comments...
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Pst23
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Re:good eggs but slow embryos?
« Reply #33 on: 03/04/06, 13:41 » |
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Dr Smith,
I had 3 failed IVF cycles. Unexplained Infertility. Never had a BFP. Husband's sperm is ok. Both DH and I had genetic testing.
1st Cycle @ reputable University - Gonal-F, Lupron, 17 retreived but the ones that fertilised stopped dividing at 2-4 cells, poor quality. They transfer 4 anyway on day 3. After I got the bad news, I made some lifestyle changes in terms of diet, exercies, herbs, and reducnig stress.
2nd Cycle - Gonal-F, Lupron, 21 retreived, ICSI 10 and Inseminated 10. Only 2 fertised with ICSI and 8 fertilised naturally. They said they picked the best eggs for ICSI. Embryo quality was more than 5 times better than the 1st, 6-8 cells. The embryologist was afraid to transfer more than 3 in case of multiple pregnancy. None good enough to freeze. Day 3 transfer. After negative result, I made real strict lifestyle changes. Also my hormal levels mimmicked that of a PCOS patient ONCE. So they wanted me to take Metformin. I decided to try it (one month) and when I went to a new clinic, the dr. told me to stop. I have no evidence of PCOS, just once my levels looked off.
3rd Cycle @ a new clinic - Follistim, Antagon, 24 retreived, 18 mature, 14 fertilised. By day 3, 9 fertilised correctly and were doing well, grades 1 and 2. Day 5 transfer they starting slowing down, none were blastocysts. 4 were compacted moruelas and one 8 cells by day 5. No pregnancy. February 06. .
I paid for 4 cycles up front and will get my money back if I dont acheive pregnancy/delivery. This was my first cycle at this clinic. He's one of the top doctors in the city. He doesnt thinlk I have a genetic issue. I dont know if he did Assisted Hatching. My question is, what do you make of my situation? Do you think AH would be beneficial for a day 5 transfer? Do you think diet, exercise, herbs, stress can have help make this kind of improvement? Is it weird that less eggs fertised with ICSI than without, especially since they picked the best quality eggs for ICSI?
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Dr Smith
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Re:good eggs but slow embryos?
« Reply #34 on: 03/04/06, 15:32 » |
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The major difference between cycles 1-2 and the third one is the absence of Lupron. Apparently, you respond better without Lupron. Some folks do and it looks like you're one of them. You new doctor gavit a try without Lupron and you had a better (more physiological) stimulation that resulted in better embryo development. Embryos at the compacted morula stage on Day 5 are within the expected range. When we observe this in our program, we wait until the morning of Day 6 to be sure they have reached the blastocyst stage before transferring them. They usually do, so no harm was done by transferring them on Day 5 at the compacted morula stage. However, the 8-cell had arrested, so there was no point to transferring that embryo.
It has been my experience (and that of others) that assisted hatching of blastocyst stage embryos immediately prior to transfer improves implantation rate.
The developmental potential of eggs cannot be assessed by just looking at the them. Hence, chosing the "best" eggs by their appearance is misleading. Your ICSI results make my point. The developmental potential of eggs lies in their genetic normalicy which cannot be determine by looking at them at the time of ICSI or insemination.
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Pst23
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Re:good eggs but slow embryos?
« Reply #35 on: 03/04/06, 16:39 » |
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Dr. Smith,
Thank you for your response. I will discuss this with my doctor. I have a few more questions - Can you do AH with a day 5 compacted morula? Can AH damage the embyros? Is it typical for a clinic to wait for a day 6 transfer if the embryos havent reach the blastocyst stage? If the embryos are at the morula stage on day 5, what is the likelihood they will make it to the blastocyst stage? And if they dont make it to the blast stage is there a typical reason why? Also, if you dont mind me asking, what clinic are you with? I am also in NYC. I appreciate your response. Thanks again.
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Asunflower
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Re:good eggs but slow embryos?
« Reply #36 on: 03/05/06, 08:05 » |
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We tried our first IVF in Jan. BFN. I am 31, DH is 36 with low sperm count. We had 19 eggs retrieved. Used Follistem. 6 eggs were mature day 1 and were ICSI. 5 more matured on day 2 and were ICSI. Total of 11 were fertilized. We did day 3 transfer of 3 emryos. 2 were only 4 cell division 1 was a 5 cell. The day 1 maturation eggs gave us our 3 embryos for transfer. The other 3 embryos were only a 2 cell division day3. The 2nd day mature eggs were also at around 3 and 4 cell divisions on day 3, 2 had some fragmentation. We ended up with 2 perfect blastocysts to freeze though out of these 11. RE was a little surprised with our outcome. This next cycle he is trying Lupron and we are waiting for blastocyst. From reading your other responses, it sounds like we stimulated too quickly and the eggs did not have time to go through all their phases of development. Do you aree?
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ttc for over 2 1/2 yrs.
1st failed IVF in Jan. 06
2nd failed IVF April 06-chemical pregnancy
3rd failed IVF Aug. 06
FET Oct 06 chemical pregnancy
Miracle pregnancy on our own! Jan 07
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Carole
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Re:good eggs but slow embryos?
« Reply #37 on: 03/05/06, 09:52 » |
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Dr. Smith ~ I am 38 with history of endo/ovarian chocolate cysts/lap, dh is 41 (always has normal SA). We started ivf since I was 34 (we had 4 ivfs in total). We had first 2 ivfs in China since dh were on a 3 year business assigment there. We had 29-30 eggs retrived. 12-15 fertilized without icsi and we had 1-4 8-celled top grade embryos (no fragments) to transfer on day 3. Rests were slow growing ranging from 6-celled to 4-celled embryos (majority were in 6-celled stage on day 3). We got bfn on both attempts.
Last year, dh comes back and we tried 2 ivfs in a "top" clinic in the U.S. RE recommended icsi. So we went for it. 1st ivf there (3rd in total) we had 20 eggs retrived, 10 matured, 3 (two 8-celled, one 6-celled top grade) embryos transfered on day 3. bfn.
2nd ivf (4th in total） I was hyperstimulated (day 5 e2=2400). 14 eggs retrived, 6 mature, 3 made to day 3 transfer (one 7-celled with 40% fragmentation graded 3+, one 6-celled grade 4-, one 4-celled graded 4) (on 1-4 scale, 1 being worst, 4 being best).
My questions are,
1) By looking at my 4 ivfs history, is it normal for a person to have about 50% fertilization rate and besides of having 1-4 8-celled embryo, the rests are in 6-celled stage on day 3? Does it indicate egg quality problem?
2) As for my last (4th) ivf, do you think poor embryo development was due to hyperstimulation? This cycle RE increased LH to 150iu/day. I had this dose from beginning till end of stims. Previous cycles, RE only added LH to help my follicles to grew faster while I was on gonal f. Thanks.
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Asunflower
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Re:good eggs but slow embryos?
« Reply #38 on: 03/05/06, 11:20 » |
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Dr. Smith-We tried our first IVF in Jan. BFN. I am 31, DH is 36 with low sperm count. We had 19 eggs retrieved. Used Follistem. 6 eggs were mature day 1 and were ICSI. 5 more matured on day 2 and were ICSI. Total of 11 were fertilized. We did day 3 transfer of 3 emryos. 2 were only 4 cell division 1 was a 5 cell. The day 1 maturation eggs gave us our 3 embryos for transfer. The other 3 embryos were only a 2 cell division day3. The 2nd day mature eggs were also at around 3 and 4 cell divisions on day 3, 2 had some fragmentation. We ended up with 2 perfect blastocysts to freeze though out of these 11. RE was a little surprised with our outcome. This next cycle he is trying Lupron and we are waiting for blastocyst. From reading your other responses, it sounds like we stimulated too quickly and the eggs did not have time to go through all their phases of development. Do you aree?
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ttc for over 2 1/2 yrs.
1st failed IVF in Jan. 06
2nd failed IVF April 06-chemical pregnancy
3rd failed IVF Aug. 06
FET Oct 06 chemical pregnancy
Miracle pregnancy on our own! Jan 07
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caroledm
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Re:good eggs but slow embryos?
« Reply #39 on: 03/05/06, 14:33 » |
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Dr. Smith~I had done 4 ivfs. All were bfn. Me 38 and has history of endo/chocolate cysts/lap, dh 41 (alwyas has normal SA). Otherwise we are normal on all IF tests (FSH, LH, E2, PRL, TSH, TH, HSG, saline ultrasound, hystoscopy, APA, anti-sperm antibody, SA, chromosomal analysis/karyotyping etc.)
My questions are:
1) Previous 2 ivfs in China (dh had work assigment there for 3 years), I had 29/26 eggs retrieved, 15/12 eggs fertilized naturally and had 1/4 8-celled top grade embryos on day 3 transfer. Besides 8celled embryos, majority of my embryos are in 6celled stage on day 3. Do you think my embryos are slow growing?
2) My 3rd/4th ivfs were done in a "top" clinic in the U.S. last year. We did icsi due to previous 50% natural fertilization rate. We had 20/14 eggs retrived, 10/6 mature, and only 6/4 fertilized. 3rd ivf, on day 3 we had two 8celled top grade embryos, one 6celled top grade embryos to transfer. bfn. 4th ivf, I was hyperstimulated (e2=2400 on day 5) and on day 3 only had one 7celled (40% fragmentation) grade 3+ embryo, one 6celled grade 4- embryo, and one 4celled grade 4 embryo (1-4 scale, 1 being worst, 4 being best). bfn. Why I have worse fertilization rate with icsi? I know 4th cycle was not a bust. What impression do you have after reviewing all my ivfs. Do you think I have an egg issue? The "top" clinic in U.S. I went to, RE there gave me 65% succsee rate. Every RE I saw gave me very high chance of success, but how come ivf never worked, not even a chemical?
Thanks.
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Asunflower
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Re:good eggs but slow embryos?
« Reply #41 on: 03/05/06, 17:40 » |
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Dr. Smith-We tried our first IVF in Jan. BFN. I am 31, DH is 36 with low sperm count. We had 19 eggs retrieved. Used Follistem. 6 eggs were mature day 1 and were ICSI. 5 more matured on day 2 and were ICSI. Total of 11 were fertilized. We did day 3 transfer of 3 emryos. 2 were only 4 cell division 1 was a 5 cell. The day 1 maturation eggs gave us our 3 embryos for transfer. The other 3 embryos were only a 2 cell division day3. The 2nd day mature eggs were also at around 3 and 4 cell divisions on day 3, 2 had some fragmentation. We ended up with 2 perfect blastocysts to freeze though out of these 11. RE was a little surprised with our outcome. This next cycle he is trying Lupron and we are waiting for blastocyst. From reading your other responses, it sounds like we stimulated too quickly and the eggs did not have time to go through all their phases of development. Do you agree?
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ttc for over 2 1/2 yrs.
1st failed IVF in Jan. 06
2nd failed IVF April 06-chemical pregnancy
3rd failed IVF Aug. 06
FET Oct 06 chemical pregnancy
Miracle pregnancy on our own! Jan 07
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maguire
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Re:good eggs but slow embryos?
« Reply #42 on: 03/08/06, 16:26 » |
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Hi Dr. Smith,
I just completed my IVF cycle # 2. In IVF#1 I used the lupron protocol. 11eggs were retrieved 6 were mature and 5 fertilized using ICSI. My RE decided a day 5 transfer was best because all 5 embryos were 8 celled on day 3. We ended up putting back two embryos (one a late morula and the other an early blast). That cycle ended in a negative.
Cycle #2 my protocol was adjusted to antagonist. 21 eggs were retrieved 18 mature and 16 fertilized using ICSI. I was advised again on day 3 that I would have transfer on day 5. All embryos were 8 celled on day 3. On day of transfer my doctor called to advise that all 16 of my embryos had arrested. At my consult we were advised that based on husband's poor sperm morphology that we may have paternal DNA issues. This would justify why our embryos arrested. I am 30 yrs old so doctor did not think that we had an egg issue. My husband took the SCSA test and his results were excellent sperm. My doctor called with the results and stated that based on husband's results that they think we now have egg issues.
Please let me know what you think based on my two cycles. Could it be possible that there was a lab error or that my embryos are better off in me on day 3 than stressed to grow to day 5 in dish? What would you recommend for cycle # 3?
Your opinion is much appreciated. Please be honest.
Thanks,
L
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Dr Smith
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Re:good eggs but slow embryos?
« Reply #43 on: 03/10/06, 11:18 » |
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Embryonic arrest between Day 4 and Day 6 (as in your case) is usually associated with paternal DNA problems. The SCSA test examines DNA fragmentation, but does not test the actual genetic make-up of the sperm. There could still be problems with the sperm DNA that are not addressed by the SCSA test results.
Problems with the genetics of the egg can also cause this kind of embryonic arrest. Genetic problems with the eggs are associated with aging. You didn't post your age, so I'm not sure this is a factor.
From what you've said, your doctor seems very knowlegable. I think you should trust his opinion.
I don't suspect a lab "error". Problems in the lab don't cause embryos to arrest between Day 4 and Day 5. It looks like the problem is genetic (coming from either sperm or egg) and transferring the embryos to your uterus on Day 3 would not have changed the genetic make up of the embryos. If the embryos had been transferred on Day 3, you would know even less about your situation than you do now.
It is possible to test the "genetic problem" hypothesis through pre-implantation genetic diagnosis, but even PGD is not all together conclusive.
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Asunflower
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Re:good eggs but slow embryos?
« Reply #44 on: 03/10/06, 18:23 » |
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Dr. Smith-We tried our first IVF in Jan. BFN. I am 31, DH is 36 with low sperm count. We had 19 eggs retrieved. Used Follistem. 6 eggs were mature day 1 and were ICSI. 5 more matured on day 2 and were ICSI. Total of 11 were fertilized. We did day 3 transfer of 3 emryos. 2 were only 4 cell division 1 was a 5 cell. The day 1 maturation eggs gave us our 3 embryos for transfer. The other 3 embryos were only a 2 cell division day3. The 2nd day mature eggs were also at around 3 and 4 cell divisions on day 3, 2 had some fragmentation. We ended up with 2 perfect blastocysts to freeze though out of these 11. RE was a little surprised with our outcome. This next cycle he is trying Lupron and we are waiting for blastocyst. From reading your other responses, it sounds like we stimulated too quickly and the eggs did not have time to go through all their phases of development. Do you agree?
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ttc for over 2 1/2 yrs.
1st failed IVF in Jan. 06
2nd failed IVF April 06-chemical pregnancy
3rd failed IVF Aug. 06
FET Oct 06 chemical pregnancy
Miracle pregnancy on our own! Jan 07
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