Question regarding Egg Quality after IVF

Music123 · 11-09-2009, 03:20 PM

This is my second IVF. I just had my ER on 11/04/09 and today my RE transferred 2 blasts. One of my lower grade embryo had assisted hatching done. Well, my egg quality isn't so great and for some reason I'm starting to not believe that age plays a factor because apparently it's not. Today the embryologist gave me a picture of my 5 day embryo report, gave me a brief overview about the report, and the 2 that is going to be transferred. The majority of my eggs are vaculated and fragmented (This seems to apply for both of my 1st and 2nd IVF).

* I'm 27
* I don't have any known issues, just a narrow cervix (which IUI and IVF can bypass)
* DH has no problems, he's healthy as can be
* My FSH level for my 2nd IVF is 7.44 (1st IVF was even lower)
* I respond very well to meds (always trigger earlier than speculated)

My RE informed me that it's probably the protocol that they had me on. For my 1st IVF, I was only on Follistim, which ended in bad egg qualities. 2nd IVF, I was on Lupron, Follistem, and Menopur, which still resulted in low egg grading.

For this IVF, I've been taking Prenatal vitamins, BA, DHA, Folic Acid. I've been consuming fruits and vegetables, no or little sugar, hardly any dairy, just pretty much trying to maintain a healthy diet for at least 2-3 months and I'm not seeing any improvement.

I was wondering if anyone has ever had vaculated or fragmented eggs or just poor egg quality, and is there anything out there that can help improve the outcome? Any insight or thoughts are welcomed!

mangopuppy · 11-09-2009, 05:14 PM

It CAN be related to the stim protocol. Stimming too fast / too slow can easily compromise the quality. It's not your own doing. That's why there's such a trial / error factor in each protocol.

kiellara · 11-09-2009, 07:16 PM

The Wiki article on folliculogenesis is really good
Folliculogenesis - Wikipedia, the free encyclopedia
what it shows you is that eggs actually start getting ready something like a year before they end up in an active cycle. So my RE told me that lifestyle changes can often take months to have an impact in the woman, whereas a few days is usually sufficient for the guy! (Don't we always get the rough end of the deal?)

K

Music123 · 11-09-2009, 09:12 PM

MangoPuppy - It took me 7 days to stimm for my first, and 10 days to stimm for my 2nd with 2 different protocols. You would think there would be some variances? Is there anything that could help prevent this?

Kiellera - I've been exercising and nourishing my body with proper nutrients. Do you think whatever DH consumes also affects embryo quality. For my 1st IVF all 15 eggs that were retrieved, all fertilized. And this one, only 12 out of 18. Oh dear, months vs days is so unfair! We always get the hard bargain of the deal!

There are others that is doing the same protocol as me and yet their egg quality is grade A? I just don't understand that correlation. Thanks ladies for your input.

kiellara · 11-09-2009, 09:48 PM

Hi Music
Yes, its all frustrating because unfortunately this is a very inexact science, more like alchemy than chemistry.. And most of the time, your RE doesn't actually know, because it would appear that every human responds and functions slightly differently to things. I didn't know until recently that certain genotypes respond better or worse to drugs like plavix or warfarin or asprin or even cancer treatments. So the reason that person A is ok on one protocol may simply be because their genes are ok with those drugs whereas yours don't like it.

But they haven't yet done genetic testing on what works best with what genotype, although I think there are some plans to start doing that. At the moment probably the most useful thing for them to do would be to start genotyping all the folks doing IVF and tracking responses and then see if there seems to be any correlation.

I have no idea why I responded badly to my first protocol. My RE 'has some ideas' which we'll discuss in the consult but she'll simply be narrowing the field based on past experience and making some recommendations on what to do next based on whether she's seen anything like what happened with me happen to someone else.

Here's what my wonderful RE nurse who manages the cycles explained early on to us. I'd forgotten her analogy until this evening. I don't mean it to be condescending by the way.

She said IVF right now is like cooking a well known dish - lets say sweet potato casserole since its near THanksgiving. There are many ways to end up with a sweet potato casserole although all have the same basic ingredients of sweet potato, butter, sugar etc.

Each RE is like a cook. They have developed ways in which they get the best sweet potato casserole as much of the time as possible, but they have extra variables to deal with which is why it isn't consistent.

For a start, every time they make one, the kitchen is different!! (ever try to cook with someone elses oven/stove?....) And then, they don't have any control over what's happened to the ingredients before they get them, all they can do is make suggestions (hey, go to this store vs that store as it tends to work out better this way, or don't refrigerate the sweet potatoes before using).

And it may take them a few tries to figure out what they need to suggest in regards to the ingredients to make it work best in your kitchen, although if they've used a kitchen like yours before, or seen similar characteristics in the ingredients, they may be able to shortcut the process.

And even then, the doorbell will go and something unexpected can happen.

I guess what the nurse was trying to say is "don't let all the medical jargon fool you, we're merely scratching the surface trying to understand what these drugs are doing and how that correlates to the various hormones we can measure and track"

And while its terribly frustrating, its just the way it is until medical technology improves.

Sorry for the length!

K

oli · 11-09-2009, 11:21 PM

Hello,

During our second IVF in August, our doc said that our embryos did not look good. We had 8-all fertilized. Five were fragmented on the 3rd day and 3 looked OK, I guess. We put all three at that time resulting in one baby. Everything is fine with the baby.

During our first IVF in 2005, we had 6 eggs fertilized. They looked GREAT. The doc pushed to wait till they became blasts. I was nervous as I read that many good ones d not make it because of the environment. I shared this info with my doc. He said that all of our 6 looked fantastic, so he did not worry. Sure enough, 4 arrested on day 4. we transferred 2 blasts resulting in our daughter. The doc apologized telling me I was right. I often wondered if we were to transfer some on day 3 and freeze the ones that made it to day 5, we could have just done an FET rather than another fresh cycle.

I am now a strong believer in putting the embryos back earlier rather than waiting for 5 days.

When you say EGGS, do you mean after they were fertilized? Were they fragmented at all stages? My doc said that they can be fragmented on one day and catch up on the next day?

lw962 · 11-10-2009, 05:16 AM

To improve egg quality, my Re has me on DHEA 25mg, 3 daily. Also, L-arginine 500mg daily during stims.

babywarrior · 11-10-2009, 10:01 AM

Kiellara:
I LOVED your cooking analogy. It is great! The only thing that confuses me is that my RE isn't making any changes. My ETs have failed twice, yet I am still on the same protocol. What gives for that? I don't understand why they aren't tweaking each one.

mangopuppy · 11-10-2009, 01:57 PM

Quote:

Originally Posted by kiellara

The Wiki article on folliculogenesis is really good
Folliculogenesis - Wikipedia, the free encyclopedia
what it shows you is that eggs actually start getting ready something like a year before they end up in an active cycle. So my RE told me that lifestyle changes can often take months to have an impact in the woman, whereas a few days is usually sufficient for the guy! (Don't we always get the rough end of the deal?)

K

NO FAIR!!!! So the weed I smoked a year ago and puking my brains out after getting piss drunk on T-day last year screwed me over? Greeeeat, this is the stuff no one ever tells you!

mangopuppy · 11-10-2009, 02:09 PM

Kiellara -- your cooking analogy is dead-on.

Warrior -- you mean they did not tweak your protocols during your fresh cycles, or during your FET? Your fresh cycle protocols should def. be tweaked if they failed.

Music -- I think you mean embryo quality? I guess I'm a bit confused b/c it sounds like you are getting the majority to all of the eggs fertilized (no small feat -- the average is about half!), so it sounds to me like your eggs themselves are ok but the embryo quality isn't that great? But Kiellara and Oli gave really good responses. What I told you about stimming is exactly what my RE told me during our last consult after our last failed IVF. Basically they want slow but steady maturing of the eggs. Don't want some growing faster than others, don't want estrogen level peaking. It's a juggling act and really is a lot of art in addition to the science.

11-09-2009, 03:20 PM	#1 (permalink)
Music123 100-199 post 3 of hearts Join Date: Jul 2009 Location: TX Posts: 144	Question regarding Egg Quality after IVF This is my second IVF. I just had my ER on 11/04/09 and today my RE transferred 2 blasts. One of my lower grade embryo had assisted hatching done. Well, my egg quality isn't so great and for some reason I'm starting to not believe that age plays a factor because apparently it's not. Today the embryologist gave me a picture of my 5 day embryo report, gave me a brief overview about the report, and the 2 that is going to be transferred. The majority of my eggs are vaculated and fragmented (This seems to apply for both of my 1st and 2nd IVF). * I'm 27 * I don't have any known issues, just a narrow cervix (which IUI and IVF can bypass) * DH has no problems, he's healthy as can be * My FSH level for my 2nd IVF is 7.44 (1st IVF was even lower) * I respond very well to meds (always trigger earlier than speculated) My RE informed me that it's probably the protocol that they had me on. For my 1st IVF, I was only on Follistim, which ended in bad egg qualities. 2nd IVF, I was on Lupron, Follistem, and Menopur, which still resulted in low egg grading. For this IVF, I've been taking Prenatal vitamins, BA, DHA, Folic Acid. I've been consuming fruits and vegetables, no or little sugar, hardly any dairy, just pretty much trying to maintain a healthy diet for at least 2-3 months and I'm not seeing any improvement. I was wondering if anyone has ever had vaculated or fragmented eggs or just poor egg quality, and is there anything out there that can help improve the outcome? Any insight or thoughts are welcomed! __________________ IUI #1 & #2 (Feb/Mar 09) - BFN IVF #1 & #2 (May/Oct 09) - BFN FET #1 (Aug 09) - Chemical Dec 09 - Natural Miracle For I know the plans I have for you," declares the LORD, "plans to prosper you and not to harm you, plans to give you hope and a future". Jeremiah 29:11

11-10-2009, 05:16 AM	#7 (permalink)
lw962 1000-4999 post queen of hearts Join Date: Oct 2007 Location: Miami, FL Posts: 4,328	To improve egg quality, my Re has me on DHEA 25mg, 3 daily. Also, L-arginine 500mg daily during stims. __________________ Me

11-10-2009, 10:01 AM	#8 (permalink)
babywarrior 200-299 post 4 of hearts Join Date: Jan 2009 Location: Pennsylvania Posts: 201	Kiellara: I LOVED your cooking analogy. It is great! The only thing that confuses me is that my RE isn't making any changes. My ETs have failed twice, yet I am still on the same protocol. What gives for that? I don't understand why they aren't tweaking each one. __________________ Me (32) & DH (38) TTC #1 for 4 1/2 years DX: PCOS & MTHFR; DH: low count (double whammy!) IVF#1: 18 eggs retrieved, 15 fertilized, 11 good quality, 2 transferred 8/23/09 - BFN FET#1: 3 thawed, 3 transferred 9/29 - BFN FET #2: 6 thawed, 3 transferred. 11/3 - BFN 2ww of IVF/ET #4... This time 20 eggs retrieved, 10 fertilized, 8 good quality, 2 transferred 3/12/10

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11-09-2009, 05:14 PM	#2 (permalink)
mangopuppy 300-399 post 5 of hearts Join Date: Jul 2009 Location: San Jose Posts: 352	It CAN be related to the stim protocol. Stimming too fast / too slow can easily compromise the quality. It's not your own doing. That's why there's such a trial / error factor in each protocol.

11-09-2009, 07:16 PM	#3 (permalink)
kiellara 100-199 post 3 of hearts Join Date: Oct 2009 Location: California Posts: 154	The Wiki article on folliculogenesis is really good Folliculogenesis - Wikipedia, the free encyclopedia what it shows you is that eggs actually start getting ready something like a year before they end up in an active cycle. So my RE told me that lifestyle changes can often take months to have an impact in the woman, whereas a few days is usually sufficient for the guy! (Don't we always get the rough end of the deal?) K

11-09-2009, 09:12 PM	#4 (permalink)
Music123 100-199 post 3 of hearts Join Date: Jul 2009 Location: TX Posts: 144	MangoPuppy - It took me 7 days to stimm for my first, and 10 days to stimm for my 2nd with 2 different protocols. You would think there would be some variances? Is there anything that could help prevent this? Kiellera - I've been exercising and nourishing my body with proper nutrients. Do you think whatever DH consumes also affects embryo quality. For my 1st IVF all 15 eggs that were retrieved, all fertilized. And this one, only 12 out of 18. Oh dear, months vs days is so unfair! We always get the hard bargain of the deal! There are others that is doing the same protocol as me and yet their egg quality is grade A? I just don't understand that correlation. Thanks ladies for your input.

11-09-2009, 09:48 PM	#5 (permalink)
kiellara 100-199 post 3 of hearts Join Date: Oct 2009 Location: California Posts: 154	Hi Music Yes, its all frustrating because unfortunately this is a very inexact science, more like alchemy than chemistry.. And most of the time, your RE doesn't actually know, because it would appear that every human responds and functions slightly differently to things. I didn't know until recently that certain genotypes respond better or worse to drugs like plavix or warfarin or asprin or even cancer treatments. So the reason that person A is ok on one protocol may simply be because their genes are ok with those drugs whereas yours don't like it. But they haven't yet done genetic testing on what works best with what genotype, although I think there are some plans to start doing that. At the moment probably the most useful thing for them to do would be to start genotyping all the folks doing IVF and tracking responses and then see if there seems to be any correlation. I have no idea why I responded badly to my first protocol. My RE 'has some ideas' which we'll discuss in the consult but she'll simply be narrowing the field based on past experience and making some recommendations on what to do next based on whether she's seen anything like what happened with me happen to someone else. Here's what my wonderful RE nurse who manages the cycles explained early on to us. I'd forgotten her analogy until this evening. I don't mean it to be condescending by the way. She said IVF right now is like cooking a well known dish - lets say sweet potato casserole since its near THanksgiving. There are many ways to end up with a sweet potato casserole although all have the same basic ingredients of sweet potato, butter, sugar etc. Each RE is like a cook. They have developed ways in which they get the best sweet potato casserole as much of the time as possible, but they have extra variables to deal with which is why it isn't consistent. For a start, every time they make one, the kitchen is different!! (ever try to cook with someone elses oven/stove?....) And then, they don't have any control over what's happened to the ingredients before they get them, all they can do is make suggestions (hey, go to this store vs that store as it tends to work out better this way, or don't refrigerate the sweet potatoes before using). And it may take them a few tries to figure out what they need to suggest in regards to the ingredients to make it work best in your kitchen, although if they've used a kitchen like yours before, or seen similar characteristics in the ingredients, they may be able to shortcut the process. And even then, the doorbell will go and something unexpected can happen. I guess what the nurse was trying to say is "don't let all the medical jargon fool you, we're merely scratching the surface trying to understand what these drugs are doing and how that correlates to the various hormones we can measure and track" And while its terribly frustrating, its just the way it is until medical technology improves. Sorry for the length! K

11-09-2009, 11:21 PM	#6 (permalink)
oli 1000-4999 post queen of hearts Join Date: Nov 2004 Location: AK Posts: 3,055 Blog Entries: 2	Hello, During our second IVF in August, our doc said that our embryos did not look good. We had 8-all fertilized. Five were fragmented on the 3rd day and 3 looked OK, I guess. We put all three at that time resulting in one baby. Everything is fine with the baby. During our first IVF in 2005, we had 6 eggs fertilized. They looked GREAT. The doc pushed to wait till they became blasts. I was nervous as I read that many good ones d not make it because of the environment. I shared this info with my doc. He said that all of our 6 looked fantastic, so he did not worry. Sure enough, 4 arrested on day 4. we transferred 2 blasts resulting in our daughter. The doc apologized telling me I was right. I often wondered if we were to transfer some on day 3 and freeze the ones that made it to day 5, we could have just done an FET rather than another fresh cycle. I am now a strong believer in putting the embryos back earlier rather than waiting for 5 days. When you say EGGS, do you mean after they were fertilized? Were they fragmented at all stages? My doc said that they can be fragmented on one day and catch up on the next day?

11-10-2009, 02:09 PM	#10 (permalink)
mangopuppy 300-399 post 5 of hearts Join Date: Jul 2009 Location: San Jose Posts: 352	Kiellara -- your cooking analogy is dead-on. Warrior -- you mean they did not tweak your protocols during your fresh cycles, or during your FET? Your fresh cycle protocols should def. be tweaked if they failed. Music -- I think you mean embryo quality? I guess I'm a bit confused b/c it sounds like you are getting the majority to all of the eggs fertilized (no small feat -- the average is about half!), so it sounds to me like your eggs themselves are ok but the embryo quality isn't that great? But Kiellara and Oli gave really good responses. What I told you about stimming is exactly what my RE told me during our last consult after our last failed IVF. Basically they want slow but steady maturing of the eggs. Don't want some growing faster than others, don't want estrogen level peaking. It's a juggling act and really is a lot of art in addition to the science.