Bulls-eye defect embryos ?
3 Replies
Sri - April 12

I am 29 years old. Due to male factor infertility we opted IVF with ICSI. I had 11 eggs retrieved on April 6th. My doctor called on April 7th and informed that out of 11 eggs, 7 were mature and 5 fertilized. They wanted to do a day 2 transfer as all the embryos showed abnormal growth (my doctor used the term bulls eye defect- a black hole in the center of the embryo). On the day of transfer(April 8th), I only had 3 left , 1 4cell and 2 2cell, but they all had bulls-eye defect). We decided to go ahead with all the 3 emb. What are my chances of success with this defect ?
I did not find any information about it on the net. Anyone heard about this defect? I appreciate any information you can provide.


Dr Smith - April 12

This "defect" goes by different names. Some embryologists describe it as a "bull's eye"; others describe it as a dark and grainy cytoplasm. I put the word "defect" is quotation marks because its not necessarily a bad sign. Sometimes the fertilized egg can have this appearance, but after dividing into two cells, the cytoplasm looks normal. Accordingly, its difficult to say how the embryos might develop after the transfer. Your doctor panicked and transferred the embryos prematurely. It would appear that your doctor was afraid that the embryos might stop growing in the laboratory and wanted to make sure that, if they did stopped growing, they stop growing in your uterus, not the laboratory. That way, it would be your fault that the embryos stopped growing, not the doctor's. The truth is ITS NOBODY'S FAULT when embryos stop growing. Had your doctor waited to see which embryos developed to the blastocyst stage in the laboratory before transferring them, we wouldn't be wondering now.

The high degree of attrition from 11 eggs retieved to one 4-cell embryo on Day 2 is unusual for someone your age. You have a high FSH value for your age suggesting that you have a diminshed ovarian reserve. However, at 29, the assumption is that your egg quality should be good. That's what make the high level of attrition so unsual. It sounds like something was not quite right with the stimulation. Was the stimulation (the time you were taking stimulation medications) too short (<9 days) or too long (>12 days)? What was your highest estadiol level? What were the diameters of the largest follicles just before taking the hCG shot?

Alternatively, there are 29 year old women with poor quality eggs, but this is rare.


Sri - April 12

We were shocked as we had thought our only problem was mf and that my egg quality was one of the last things we would have to worry about (due to my age and fsh). Our doc was very hopeful for our cycle quoting us a success rate upwards of 60-70% through out my cycle. My endometrium tests, ultrasounds and bloodworks seemed normal too. I had 20 follicles before my retrieval day. Here is the additional info you requested.

1. I am not sure how the stimulation time is calcuated, but here is all the information.

2/28 to 3/19 - I was on birth control pills (my period was on 2/25) for 20 days (last pill on 3/19).

3/17 to 3/24 - I took LUPRON -10units. I had my period on 3/21.

3/25 to 3/29 - I took LUPRON-5units, Gonal F - 225 units for first 3 days then150 units daily.

3/30 to 4/3 - I took LUPRON-5units, Gonal F - 150units and REPRONEX 2 vials.

4/4 - Stopped all medicines and took HCG shot

4/5 - no meds.

4/6 - egg retrieval.

2. My highest estadiol level was 3637
3. The diameter of the largest follicle was 23.
4. FSH level before stimulation 4.2

You have mentioned that I have high FSH value fo my age. Whay do you think so?
I am not sure if this going to work again. This is my first ivf cycle. I appreciate any suggestions you may have. I am totally lost.


Dr Smith - April 13

I'm sorry. I was confusing you with a different person. You FSH is in the normal range for someone your age.

It looks like your stimulation went very well, so we can rule out that the quality of the eggs was a result of a mishandled stimulation. It looks like your have an "egg problem". That does NOT mean there are no "good" eggs, but it does appear that you have fewer "good" eggs than the usual number for someone your age. If this cycle is a bust (and thats still a big if at this point) and you decide to try IVF again, I would suggest that you request that the embryos be cultured to the blastocyst stage [i]no matter what![/i]. That way, at least you will be sure that the embryos transferred at the blastocyst stage have the capability to generate a pregnancy. If none of the embryos reach the blastocyst stage on a second cycle, I would recommend using donated eggs to achieve your first pregnancy.



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