Sunday, March 7, 2010

Poor Embryo Quality: Donor Eggs Vs. Change Protocol Vs. Change Centers


Question:

I have undergone 3 IVF cycles without success in Canada. First IVF using long protocol, failed to stim and the cycle was cancelled. Subsequent 2 IVF cycles were done in flare protocol.

Of the flare cycles, first one was using Gonal F (450IU) and Luveris, we got 18 eggs, 13 mature, all 13 fertilized, but on day 3 only 2 had divided to 6-8 cells. All others arrested at 2-4 cells. Transferred 2 back with assisted hatching, but failed.

Second flare cycle was using Menopur (375IU), 13 eggs retreived, 8 mature, all 8 fertilized, but on day 3 only 2 were good enough to transfer, one that had started compacting, another at 8 cell, both were transferred back with assisted hatching, but failed again. All others divided will odd cells (3-5) and arrested on day 3. After the 3rd cycle, doctors suspect the egg quality to be very poor and advice us to use donor eggs. All blood/hormone tests are normal, left fallopian tube is blocked at fimbral end. I'm now 33, never been pregnant. My husband's results are normal.

Is this indeed due to poor egg quality? Is there any treatment available to improve egg quality? Is there any other IVF protocol that we can try that might give better results?Any advice based on your extensive experience is greatly appreciated.

Answer:

Dear S. from Canada,

Based on the information you gave me, you certainly did stimulate well in your second and third cycles. One option is to use a combination protocol with Gonal-f and menopur, and the antogonist (ganerelix or cetrotide), instead of lupron flare protocol. That may help with egg development and quality. There have been several studies showing the benefit of the combination protocol. The antagonist allows the ovary to stimulate and develop the eggs without being suppressed, as occurs with lupron. You'll have to ask your docs if they feel comfortable using an antagonist protocol.

There is no direct way to improve egg quality after fertilization. However, eggs/embryos are very sensitive to their environment i.e. laboratory quality. Any airborne gas or contaminant can effect them.

For example, in 2007 I had terrible pregnancy rates. In review, we found that in this year, the building where I had previously had my offices & center had gotten several new tenants and was doing a lot of remodeling. The air flow system in that building was not isolated and the air shared throughout all the offices. We had a very good Hepa filter in the lab but it could not isolate the air effectively with the huge change in parameters. Luckily, in early 2008 we moved our center to a new building where we are the only tenants. I was able to build my lab using the latest technology and air flow recommendations. My under 35 pregnancy rate went from 27% in 2007 immediately to 74%. The only difference was the air quality and control. Our lab is now in an isolated part of the building and does not share airflow with any other part of the office. Environmental controls and air flow have been studied and written about extensively in the IVF literature.

Certainly, if you are consistently having poor embryos, then the only alternative would be donor eggs. But before I would draw that conclusion, you might want to try a different center. Another experience I had was a patient who moved from Washington D.C. to California. She had gone through two IVF cycles there and, like you, had poor embryo quality and also was recommended to undergo donor IVF. But because her husband's job location changed, they moved here and she presented to me. Like you, she was young and I counseled that she should continue trying with her own eggs, at least two more times. Well, in her first cycle with me, she had three excellent quality embryos and became pregnant with twins (all three were transferred). It just goes to show not only that a different center could have a different outcome, but because we know that each cycle is unique, the outcome could be different from just having a different set of eggs and embryos.

I hope this helps,

Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
Monterey, California, U.S.A.

3 comments:

  1. Hi I have been trying for a baby for 8 year I have been pregnant twice two years ago but both ended in miscarriage one at 5 weeks then the second one at 13 weeks, just don't know what to do now because I want a baby so bad. Plus the doctor won't do nothing when he knows that I have had pcos in the past. Also since I was 13 I have been having heavy periods which could last for 21 days some 7 days some 10 days and some 15 days there was one time I was on a period for a year when I was 14 it was that heavy I had to change about 12 times a day and the pain was unbearable I could even walk property I have been like this until about 3 months ago my periods have just slowed down I only on my period for 1 to 3 days with no pain just totally weird for me now as been having bad periods for 13 years I'm 26 now and want a baby I'm not getting any younger. Also they said the reason for my miscarriage at 13 weeks was something to with antibodies and the babies blood really not understand what they was saying.

    ReplyDelete
  2. i am 34 years old and i used o
    have my period for 3-5 days. scanty on the first day,heavy flow on the 2nd day and the 3rd day is moderate,and scanty until it stops.i use pada and i used to consume 3-4 pada a day for the heavy flow. Few months ago i noticed that my period had changed, 1st day being heavy while 2nd day is moderAte and the 3rd and 4th scanty or just spotting. im worried i mightbe going thru peromenopause and i am not married yet. should i see a doctor? or get my fsh tested for early menopaus?

    ReplyDelete
    Replies
    1. Hi,

      Changes in women's flow or quality of menses can change over time and with life changes. That does not necessarily mean than anything is happening. You would be quite young to be going through menopause. I certainly would not do anything in this situation.

      Delete

LinkWithin

Related Posts with Thumbnails