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Topic: good eggs but slow embryos? (Read 11248 times) |
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Dr Smith
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Re:good eggs but slow embryos?
« Reply #45 on: 03/13/06, 13:27 » |
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Yes, I think that's what happened. Ovarian stimulation is not an exact science and sometimes it requires some tweaking to get it right. Best of luck on your next try.
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Shari
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Re:good eggs but slow embryos?
« Reply #46 on: 03/28/06, 09:02 » |
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Hello Dr. Smith,
I just had my 2nd ivf cycle. In both cycles I had slow growing embryos. I was 39 at IVF #1 and 40 at ivf #2. I was diagnosed with Hypothryoidism (TSH 5.75) during infertility workup. Started on lowest dose of generic synthroid. TSH at 3.5 at start of IVF #1. IVF #1 had 9 eggs retrieved, 6 matured, 3 fertilized. Did a 3 day transfer of 3 4cell embryos. BFN. In between cycles, switched to name brand synthroid and doubled the dose. TSH dropped to 2.3. IVF #2, 9 eggs retrieved, 9 matured, 6 fertilized, 3 arrested by day 3 and 3 4cells were transferred on day 3. In both cycles I was on max stims (600 gonal-f on first cycle for 12 days and 450 follistim for 8 days on cycle 2). On cycle 2, my estrogen skyrocketed to 3000 by day 6 and coasted to day 8 ending at 4200. The two questions I have are: 1) could my hypothyroidism be causing the slow growing embryos. Note, double the fertilization rate with double the synthroid dosage. I wonder if I still need to fine tune meds. If get TSH to normal range for me (around 1-2) is it possible my embryos would grow normally? 2) Coud I be on too high of stimulation. I know they started me high because of my age, but I wonder if I need lower dose stims to start. I am very small, and have always been very sensitive to anything put in my body.
Thank you for your input.
Shari
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Dr Smith
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Re:good eggs but slow embryos?
« Reply #47 on: 03/28/06, 09:24 » |
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I am not aware of any link between hypothtroidism and embryonic growth (fast or slow). Your other question is for an RE. Please post on Dr Jacob's Infertility 101 Message Board.
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jeanice again
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Re:good eggs but slow embryos?
« Reply #48 on: 04/03/06, 22:37 » |
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I just noticed my email was still there. I used the frozen
donor eggs and it did not work. I am done. I feel since
my 2 tubals and placent problems and birth at 6 months,
my body has never been the same. I was a slam dunk
on getting pregnant since I had been pregnant (7)so many
times on my own, but now I am giving up. I feel that no one has given me anything that makes sense? Yes it is
probably the sperm, maybe but can all these eggs + a donors(age 23) be bad? All the sperm be bad? Not one good swimmer?I finally insisted on taking flagle(sp) and it helped with the irratation during intercourse, but not to the suggestion of my doctor, a girlfiend doing ivf with another doc in LA
suggested we try it and it worked. I have more frozen eggs from the donor left but I feel that since they were so slow to multiply4-6 cells, they are just not worth it.iNow,it could be partly my eggs because of age and 9-13 fsh levels(41 age)+ the sperm issue but ...I think there is more and no one has given me any other ideas or options? Sad to say I am giving up. I did not miscarry
all my pregnancies so God can not be punishing me for my bad luck(preg on pill 2x) etc. Any thoughts on what to do. I am adopting and thinking of just less invasive cycle and even sperm donor? Thoughts and advise anyone?
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Dr Smith
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Re:good eggs but slow embryos?
« Reply #49 on: 04/05/06, 08:07 » |
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Have you been tested for immunological problems (e.g. high levels of Natural Killer (NK) cells and/or abnormal activation of NK cells)? With your history of tubal pregnancies and premature labor, immunological problems may be present that inhibit or prevent implantation.
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Purpletangerine
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Re:good eggs but slow embryos?
« Reply #50 on: 04/05/06, 13:55 » |
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Dr Smith,
Is one protocol better than another to produce embryo's that are 7-8 cells? I am 39, with elevated antithyrod antibodies. I am currently starting a long lupron protocol.
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Dr Smith
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Re:good eggs but slow embryos?
« Reply #51 on: 04/05/06, 17:04 » |
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No one stimulation protocol is always better than another. Each patient is different. As long as the follicles are stimulated for an adequate length of time, most of the eggs within the follicles wil be mature. This is important because only mature eggs can fertilize.
If your doctor decided to stimulate your ovaries with the long Lupron protocol, he/she must have believed that it would deliver the best results. Wait and see what happens. If the cycle turns out to be suboptimal, then it can be canceled and another protcol can be used. Ovarian stimulation is not an exact science and there is considerable patient-to-patient and cycle-to-cycle variation.
The major determinant for embryo development is genetics of the embryo, not the stimulation protocol. At 39, roughly 70% of your embryos will be gentically abnormal and fail to develop beyond the 8-cell stage. Because of this, I'm afraid the harsh reality is that the chance of failure is considerably higher than the chance of success, regardless of which stimulation protocol is used.
Best of luck.
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anitasto
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Re:good eggs but slow embryos?
« Reply #52 on: 07/21/06, 01:50 » |
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I don't know how old your message is but if you're still trying I think you would very likely benefit from reading this site. Use of DHEA seems to IMPROVE egg quality. Information is new as of last year and I'm finding that many many endocrinologists are not aware of the case study. Here's the site:
http://www.centerforhumanreprod.com/premature_ovaries.html
Here's the case study:
http://www.centerforhumanreprod.com/pdf/dheafs.pdf
All the best!
Anita
Quote from: Fifka on 06/19/05, 12:22
Hi,
On my 3 IVFs, I generate plenty of mature healthy-looking eggs. My husband's sperm analysis is good. Most of eggs will fertilize, but most if not all resulting embryos are slow. Our 3rd IVF was the best - 2 out of 8 embryos were at 7 cells on day 3, the rest of embryos were 5 cells of less.
It's not lab's issue, as we tried it on 2 different clinics. It should not be age issue, as I am 32 and healthy. So what is it? Is it defect cytoplasm in my eggs? Do I have just very few of good eggs and the rest is bad? I had 2 early m/c's from IUIs. Should we test my husband's sperm DNA fragmentation?
Thank you very much for your opinion.
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Dr Smith
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Re:good eggs but slow embryos?
« Reply #53 on: 07/21/06, 08:07 » |
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The findings of this paper must be interpreted with extreme caution. It is based on a single individual (that's what a case study is). It was published in 2005 and, as far as I know, there has been no peer-reviewed, published follow up or confirmation by other investigators. I believe Dr. Gleicher is conducting a larger scale study based on his preliminary findings, but he has not yet published his findings in a reputable journal. Until his study is complete and published or his findings are confirmed by independent investigators, it should be interpreted for what it is. One woman had better eggs on a subsequent cycle. Happens all the time.
A cynical interpretation of linking this publication on CHR's promotional website is that it could be just a ploy to lure new patients. Every woman wants better quality eggs. What could be more enticing than that? It could be the ultimate sales pitch. Cave Canem - Buyer Beware
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teacher-ttc
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Re:good eggs but slow embryos?
« Reply #54 on: 07/23/06, 18:17 » |
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I appreciate all the information on this thread.
My husband and I are undergoing our first IVF cycle. We retreived 15 eggs, 13 fertilized, 9 developed. On day 4, they called to say six were still progressing and transfer would take place on day 5. On day five they clinic called because they wanted to take it out to day six to see which two would be best out of the four remaining. ANyway, later the RE called and said he DID want to do the day five transfer. Three of our embryos were at 12 cells, at least one was compacted. We decided to transfer all three. He said better in me than in the lab at that point. Any insight? Any hope?
We are both 30, no known sperm issues, and I have slight-pco-like tendencies.
Thank you.
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Dr Smith
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Re:good eggs but slow embryos?
« Reply #55 on: 07/24/06, 10:03 » |
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It is not unusual for embryos to take until Day 6 to reach the blastocyst stage. It is within the expected biological variation. After the embryos reach the compacting/compacted morular stage, they can be transferred into the uterine environment without any undue stress to the embryo.
I suspect that your RE was concerned that there may be no embryos for transfer on Day 6. You went from 9 to 6 to 4 to 3 and the RE was concenred that on Day 6, it might be zero. I don't think it would have been zero, the lab folks didn't think it would be zero, by RE's never, ever, want to have to tell the patient "there is nothing to transfer", especially in a 30 year old patient. So... to completely avoid that possibility, the embryos were transferred on Day 5. It won't harm the embryos to be transferred on Day 5, and the RE (and you) won't be anxious. The only down side is if it doesn't work. Then we will never know if the reason it failed was because of the embryos failing to reach the blastocyst stage or because of some uterine factor that prevented implantation.
Best of luck.
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teacher-ttc
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Re:good eggs but slow embryos?
« Reply #56 on: 07/24/06, 16:35 » |
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Thank you, Dr. Smith for your response!
I did receive more information about the embryos today from the lab (they called regarding the other embryos arresting...which was suspected). Anyway, we transferred two 12-cell rated two and one 12-cell rated three (1 being the best). One was definitely compacting and one appeared to be in the process. Do you think there is a possibility they have continued to grow and divde to the blastocyst stage within my body? If the lab was wanting to keep the embryos for one more day to find the two best, I would believe they saw hope in further development, do you agree? Finally, with cells that are a bit slower to divide, approximately how many days would it take to implantation (if it were to occur)?
Again, thank you very much for you time and insight!
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Dr Smith
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Re:good eggs but slow embryos?
« Reply #57 on: 07/24/06, 16:49 » |
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Yes, I think you still have a decent chance. The embryos were approximately 1 day behind at the time of transfer and, if they continue to develop, they would reach the blastocyst stage on Day 6, still in time for attachment and implantation. It ain't over yet. Keep us informed.
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teacher-ttc
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Re:good eggs but slow embryos?
« Reply #58 on: 08/01/06, 16:06 » |
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Dr. Smith,
Your messages really brought me hope when I thought there was none over the past week. We received word today that our beta was positive.....but low (HCG level 11). I am thrilled to know I actually achieved pregnancy, and now worried that it won't work. I will go back for a repeat beta on Thursday, but I know the numbers are low. Any thoughts? Questions I should be sure to ask my RE? Encouragement?
Thanks again,
Teacher-ttc
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Dr Smith
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Re:good eggs but slow embryos?
« Reply #59 on: 08/02/06, 09:16 » |
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If the embryos take until Day 6 to reach the blastocyst stage, then implantation is also delayed. The hCG level is relative to the timing of implantation. So, it is possible that the hCG will continue to rise. Hang in there.
Even if it turns out to be a "chemical" pregnancy, it is still encouraging as this means that implantation is possible for you (silver lining, as it were). For the most part, that rules out "uterine factors" that prevent implantation. However, elevated levels of Natural Killer (NK) cells or abnormally high activation of NK cells can also cause the embryo to be "rejected" at an early stage of implantation. If this turns out to be a chemical pregnancy, you may want to consider immune testing, just to rule this out as a cause or contributing factor. For more information, see http://www.millenova.com/tests/nkassay.asp
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