Question about early pg- embryonic development
1 Replies
ICSI hopes - September 6

Dr. Smith, I posted earlier this year and you provided very helpful feedback prior to our ICSI cycle and afterwards as we planned for the FET. Thank you. Now, I hope you have some more great insight.

We had four three-day embryos frozen (all 8-cell low- or no- fragmentation when frozen). Thawed all four, two survived. Transferred both in a natural (unmediated) ovulatory cycle. Got positive beta hCG at 11dp3dt. Repeat at 13 and 15dp3dt were rising adequately, but not steller (above 66% increase, but not quite doubling in two days). Yesterday, ultrasound at 6w3d showed one gest sac measuring only 6mm. No fetal pole. RE sent me away 8w until to give embryo some time to grow before u/s again. RE told me he would like to see a larger gest sac at this stage, but he was not ruling us out yet. But 6mm seems awfully small for 6w3d to my (untrained) thinking. Do you think there is any chance for a healthy pregnancy to result from this slow-starting embryonic growth? Or is this certain to be chromosomal abnormality with arrested growth to occur soon? I am not looking for false hope here, just a reality check. I’ve had two 9-10 week miscarriages and one live birth (3yo daughter) before my husband’s testicular failure was diagnosed. This is our last shot as it took our surgical urologist 2 hours to find testicular sperm last time, found just barely enough to fertilize the 11 mature eggs we had retrieved and I agreed not to ask DH to go through this surgery again (and urologist gives us a low probability of finding sperm next time).

So- this is it. It was a long shot from the start. Just want to get your thoughts on whether a frozen (thawed) transferred embryo that gets this slow of a start has any chance of making it or is my RE just waiting because there is not harm to me, but no real chance of successful pg?

Thanks in advance.


Dr Smith - September 7

Well... Its hard to say. There is a higher incidence of first trimester losses when testicular sperm are used to achieve fertilization. Also, "suriving" the Day 3 thaw is usually defined as 50% or more of the cells surviving. If the embryos lost 3-4 cells in the thawing process, this too can cause problems during the first trimester. It can result in a blastocyst stage embryo that lacks sufficient stems cells for a term pregnancy. This type of embryo does implant and begin to grow. The hCG levels are good because it is the the non-stem cells of the embryo that produce hCG (trophectoderm). Before long, the hCG begins to drop off because there are no fetal tissues growing inside the "sac". Frankly, it doesn't look good. Hang in there and see what the next U/S shows.



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