Question:
A bit of history...2 miscarriages in the last 2 years. We were referred to an RE who did testing and found that my husband has a balanced translocation. We were advised to do IVF with PGD - I had no apparent problems. Our IVF cycle resulted in 10 eggs, 7 fertilized, 3 made it to day 3 for pgd and stopped dividing later that day. The PGD revealed very abnormal embryos with multiple trisomies and some chromosomes with only 1 copy.
The dr said I must have bad eggs - he indicated he was very surprised because all my levels were normal and I'm only 29. he has suggested donor eggs. I'm wondering if I should try another protocol or just go along with the donor eggs. I feel like I'm too young to have bad eggs but since no embryos lived there must be something wrong right?
Any advice would be greatly appreciated!
Answer:
Your history is a little odd, because for someone your age, I would have expected a better outcome in terms of the number of embryos to test. It is most likely that the abnormal embryos are coming from your husband. Not you. I think, unless finances is a problem, I would continue trying. You will eventually have a good embryo, and hopefully, a subsequent cycle will give you more embryos to test. You were not stimulated very strongly and could be. Because of the poor embryo development, I would try to get you to produce 15-20 eggs. That will probably require more medications. PGD can be done to check the embryos with subsequent cycles to see if they are chromosomally normal or not. Keep in mind though, that recent studies have shown decreased pregnancy rates with PGD, probably due to embryo injury or affects from removing one of the blastomeres. In other words, you may harm a potentially "good egg".
If you go another 2-3 tries and still no normal embryos, then I would suggest you consider donor sperm with IUI. You could do IVF but that would be much more expensive. I would think that if you persist in having abnormal embryos it is because of the abnormal sperm. That is why I suggest donor sperm. If you are dead set on having a genetic child from your husband, then you will just have to keep trying using IVF.
I don't agree that your outcome in the first cycle is a sign of bad "eggs", especially at your age.
Good luck and try to keep in mind that you do have options.
Sincerely,
Edward J. Ramirez, M.D.
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
Monterey, California, U.S.A.
Hello Dr. Ramirez and Happy New Year.
ReplyDeleteI continue to follow your blog and am always fascinated by the topics you cover even if they don't always pertain to my particular situation.
As the wife of a husband diagnosed with male-factor infertility, I would say I agree with your assessment of the 29-year old with "bad eggs". Poor sperm quality seems to have definitely been the culprit in my particular situation...7 pregnancies, 2 live-born children. All 5 pregnancies that ended, terminated between 5-8 weeks, usually around the 6-week window, which I've been told is fairly typical with male-factor infertility.
I think I commented previously that our first born (age 5) is an in vitro baby and our youngest (age 3) is a "bonus" baby!
In November of 2003, I followed a traditional IVF protocol with ICSI and we transferred 2 5-day embryos. One took...Mary Catherine! It was our first attempt at IVF.
Eighteen months later I discovered that I was pregnant with Benjamin...a total shock! We thought we were finished with one child since we had nothing left to freeze. (Most of our embryos began defragmenting on Day 4.)
Well, I am excited to report that we are expecting #3 due in early August (08/06). Ultrasound at 6w1d confirmed intrauterine pregnancy with heartbeat and follow-up ultrasound yesterday showed a beautiful 9w4d fetus with strong heart beat, squirming and moving those arm and leg buds like crazy! While I don't feel completely out of the woods, my high-risk OB says that all signs are pointing in the right direction!!!
Here's the kicker...I turned 40 in August and agreed with my husband that it was time to throw in the towel, so to speak. We have 2 beautiful children and that was enough. We have been on an 11-year roller coaster struggle with infertility and it was time to close this chapter of my life. Even contacted a charity about donating my maternity and baby clothes...never heard back from them! Ha!
Will be having an NT ultrasound on Jan. 25th, but other than that, I think we're good to go!
Sorry so long-winded, but just thought that I would share with your readers one woman's story of both loss and success.
Wishing all of your patients and blog readers baby success this New Year.
Valerie
Dear Valerie,
ReplyDeleteExcellent news!!! Congratulations to you both. I think your third "bonus" baby will be a wonderful addition to your family. As you say, infertility can be like a roller coaster, but if you hang on, I feel at least, there can be success. In your case, it is very heartening to others to see that success can result over time and when you least expect it. Thank you for the kind words and I hope that others that read this blog will benefit not only from my advice but from your experience!
Good luck and take care,
Edward Ramirez, MD
Hello Dr. Ramirez, I wanted to know if the quality of an egg can determine whether or not the gestational sac will be empty? If I had a 5day frozen embryo with 2 4AA embryos are my chances of a viable pregnancy greater due to the grade of the embryo.
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