Fragmentation & other questions
2 Replies
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Dear Dr Smith,
I wonder if you could give me some of your valuable advice?
A brief outline of previous treatment during past 3 years. I'm now 39. Clinic grades embryos 1 to 3 (1 being best). All day 2 transfers.
1st IVF: 9 eggs, 6 fert, 2 x 5 cell embies, grade 2.5 transferred: + result, missed miscarriage at 7.5 wks
2nd IVF: 8 eggs, 1 fert, 1 x 2 cell embie, grade 1.5 transferred: + result, ruptured ectopic.
3rd ICSI: 4 eggs, 3 fert, 2 x 3 cell embie, grade 2 transferred, negative.
Just moved onto donor eggs abroad:
4th DE ICSI: 6 eggs, 4 fert, 2 x 4 cell, grade A embies transferred. 10% fragmentation. Awaiting outcome.
We also have male factor, although SA does not warrant ICSI. ICSI used on last 2 attempts because of poor fertilisation on No. 2. Reason unknown but been told probably an egg quality problem.
I'm wondering if our current DE ICSI is unsuccessful whether you would consider hubby having SCSA test? Best quality embies we've had is current donor egg cycle although we still have 10% fragmentation. Don't have details on fragmentation with my own eggs.
What causes fragmentation, ICSI or sperm problem?
Is 10% anything to be worried about?
Another question always at the back of my mind is that I never had blood tests during stimulating injections to determine egg maturity. I was also a poor responder. Surely this was not good?
As I achieved pregnancy 2 out of 3 times, I have been told this is good news.
Many thanks for any advice or hope that you can give me.
Holly
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There was some embryo fragmentation during the cycles with your own eggs. That's what the grading system (1-3) refers to. Looks like between 10 and 25% on those cycles. The grading system works as follows: Grade 1 = <10% fragmentation, Grade 1.5 = about 15%, Grade 2 = about 20% and Grade 2.5 = about 25%. Embryo fragmentation is strictly an egg quality issue. The miscarriage was probably a result of a genetic abnormality in the egg. The cause of the ectopic is anyone's guess.
Sperm DNA fragmentation (which is very different from embryo fragmentation) does not impact embryo development until after the 3rd day and since in two cases the embryos implanted and continued to grow, I do not think the problem lies with the sperm.
Embryo fragmentation of 10% or less is of no consequence, so I wouldn't worry about the fragmentation that was observed on the donor egg cycle. However, I should point out that 6 eggs from a donor is on the low end and does not really give you the maximum chance of success.
In most centers it is routine to monitor the rise in estradiol during the ovarian stimulation. Monitoring by ultrasound alone may be adequate, but I think most Reproductive Endocrinologists believe that monitoring the estradiol also helps in evaluating the response to the stimulation medications. You had a reasonable response to the medications on 2 of the 3 cycles (9 and 8 eggs respectively), however, the poor fertilization on cycle #2 may have been a result of a high number of immature eggs (that could have been predicted by monitoring the estradiol level).
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Thank you so much, your reply has been very helpful.
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