Overstimulation affect embryo quality?
1 Replies
jennt - November 30

Hello, I am 33 years old. I recently did IVF and was overstimmulated (48 eggs retrieved). 31 of the 48 fertilized w/ ICSI. On day 3, 3- level 2, 8 celled embryos were transfered and 16 were placed in cryo. Beta was negative. FET cycle was scheduled yesterday and out of the 5, 3 day embryos thawed, only one made it to blast on day 6. The others arrested in development on day 5 without reaching to blast stage.

My questions are...Do you think that the overstimmulation had an affect on embryo quality? Could this be a fluke of some sort? What else can you think of that may cause this 1 out of 5 ratio? Should I try again with a different protocol once the 10 embryos that are frozen are utilized or move on to donor eggs?

Thanks- jennt


Dr Smith - December 5

Egg/embryo quality problems are common when a very high number of eggs are retrieved. This is particularly true for patients with polycystic ovaries (PCOS). The stimulation medication does not cause a high number of eggs to be retrieved [i]per se[/i]. The stimulation medications act to sustain the growth of however many follicles were available at the beginning of the cycle. The medications do not cause you to have more more follicles, but the dosage of medication does affect the number of follicles that reach maturity at the end of the cycle and the length of the stimulation phase.

During their time in the follicles, the eggs undergo a final maturation process that renders them capable of developing through the first two days (to the 4-cell stage). When many, many follicles develop, the eggs inside the follicels do not complete the maturation process. The reason for this is poorly understood. The result of incomplete maturation is that a disporportionately high number of embryos arrest prior to reaching the blastocyst stage. This explains the high post-thaw attrition. However, I have to complement the lab for culturing the frozen-thawed embryos to the blastocyst stage prior to transfer. This demonstrates that they were aware of the high level of post-thaw attrition and wanted to make sure that the embryos transferred were capable of implantation.

If you do not conceive after any subsequent FETs, I would recommend trying again with a lower dose of medication. This will result in a slower stimulation that may allow the eggs to mature properly before retrieval. If that cycle fails, you may want to consider DE.



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