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If you need to contact me , please write to me to this email ID : manjupadmasekar@yahoo.com. I will be happy to help.

Monday, April 29, 2013

Why do some embryos stop growing in the IVF lab ? Growth arrest of embryos !



Stages of human pre-implantation embryo development. Phase-contrast images of human embryo development from day (d) 0 to day 7. Following fertilization, embryos undergo a series of mitotic cell divisions. Arrowheads in d0 and d1 indicate pronuclei. On or around day 4, the embryo compacts, resulting in the formation of a morula that consists of cells (or blastomeres) in a compact cluster contained within the zona pellucida (the glycoprotein layer that surrounds the embryo). The blastocyst, which forms on day 5, is a fluid-filled structure composed of an inner cell mass (white arrowhead) and trophectoderm (gray arrowhead). On day 6, the blastocyst ‘hatches’ from the zona pellucida and it is ready to implant into the uterine wall on day 7.Courtesy : dev.biologists.org

If you have gone through IVF, you may have heard your IVF doctor or embryologist say - “Some of your embryos stopped developing (got arrested), and we had to discard them .” There are some unlucky women who end up with no embryos to transfer,  because all their embryos stopped developing at some time point during their preimplantation growth ! Why does this “developmental arrest “of embryos happen ? Are there any ways to prevent it ?

It is a well-known fact that 10-15% of IVF embryos permanently arrest during mitosis (during cell division) at the 2-4 cell cleavage stage. Some arrest immediately following fertilization and will not divide past the one-celled stage. Over half of all arrested human embryos display chromosomal abnormalities (genetic defect). Hence it is assumed that developmental arrest happens in order to prevent the growth of abnormal or poor quality embryos.

. An embryo might undergo developmental arrest because of :


1)      Sub-optimal culture conditions

2)      Chromosomal abnormalities

3)      Failure to activate its embryonic genome

4)      Mitochondrial defects

When embryos are exposed to sub-optimal culture conditions in the IVF lab ( for example, when the lab incubators malfunction; or if there is an infection in the culture medium) . they might stop dividing further. If you learn that the greater proportion of your embryos have stopped growing, please ask the embryologist about the possibility of lab error, and ask them to show you how embryos from other patients are faring under the same culture conditions. This will help you to understand whether lab conditions have played a role in the growth arrest of your embryos . Some labs maybe understandably reluctant to share this information with you, and this should serve as a red flag.

Oocytes from women of advanced maternal age have a higher chance of carrying genetic defects such as aneuploidy (wrong number of chromosomes). Such oocytes, when fertilized , can give rise to embryos; but depending on the chromosomal abnormality they are carrying, they stop growing at different time period. Some do not get past the single-celled stage (zygote stage); some stop developing before they are transferred to the uterus (in the IVF lab petri dish); some after being transferred to the uterus; and some even after implantation (remember that 60% of miscarriages happen because of a genetic abnormality in the embryo !). Genetic lesions in embryos are one of the commonest factors for developmental arrest, which is why embryos from older women are more prone to growth arrest when compared to embryos of younger women !

When the egg and the sperm fuse together , fertilization happens and an embryo is formed. The embryo thus formed carries the genetic material from both the mother and the father. On the first day of its formation , an embryo is just a single-celled entity. This single-celled embryo develops into a full-fledged baby provided it carries all the necessary genetic information .  The initial few cell divisions of a single celled embryo are carried out by the information provided by the oocyte (egg) and not by the sperm . The cytoplasm of the egg contains key information which will help the embryo to divide upto the 4-8 cell stage. It is only after the the 4-8 cell stage that the embryos’ own genome gets activated , and it produces the information necessary for further development. In some embryos this genomic activation fail to happen and they stop developing past the 4-8 cell stage, causing developmental arrest.

An embryo needs energy for its development.  The energy requirement of the dividing embryo is met by specialized organelles called mitochondria, which are also called as “cellular power plants”. They carry their own genetic material. They synthesize energy molecules called ATP (Adenosine triphosphate). ATP is the “energy currency” of a cell and the cells utilize ATP to carry out several functions, including cell division. Because the mitochondria are found in the cytoplasm, the embryo gets all its mitochondria from the mother - from the oocyte cytoplasm. The mitochondria from the sperm are immediately degraded after fertilization. When eggs from a woman of advanced maternal age are used to form embryos, there is a higher possibility that these mitochondria are genetically or functionally defective (as a result of aging !) Such defects compromise their function, including ATP production, as a result of which the embryo might not get enough energy to carry out its cell division , and will eventually stop dividing. This kind of mitochondrial dysfunction of oocyte has been proposed as one of the causes of developmental arrest. It has been shown that when the cytoplasm ( which contains the mitochondria ) from the oocyte of young women is transferred to the oocyte of older women (cytoplasmic transfer) , the developmental capability of the embryos was restored. Such kind of cytoplasmic transfer is being used to treat certain forms of infertility, leading to live births; but their efficacy and safety is yet to be appropriately investigated !

Once you find out your embryos have arrested in vitro, can anything be done to revive them  ? Sadly, the answer is no.  The arrest is irreversible and these embryos cannot be rescued. The important thing is to document this; and learn from it, so you can improve your chances of success in your next cycle.

If you are an older woman who has experienced developmental arrest of your embryos, donor oocytes can be a very good alternate option to have a baby. If you are young, and if you were informed that all your embryos have arrested, you should consider changing the IVF clinic. If this situation repeats itself, cytoplasmic transfer is one treatment option which you could explore; but this treatment is still in its infancy, and is not practised widely. If you are undergoing IVF, you should be aware that a very small percentage of your embryos can arrest during their development in IVF lab, and this is quite normal. 

You should always ask your IVF clinic to provide you with photos of your embryos ! You can see what embryos should look like at www.drmalpani.com/embryos.htm

The bitter truth is that during IVF, not all the eggs can be fertilized; not all the embryos which are formed will be good enough to be transferred to the uterus; and not all the embryos which are transferred to the uterus will develop into a baby. Which embryo will become a healthy baby is a million dollar question, and hopefully in the near future, with the help of scientific advances, we will be able to pin point that single “good embryo” which will grow into the much desired baby. Until then it is wise to remember this – “all babies come from embryos but not all embryos can become babies” !

95 comments:

  1. Thanks for taking thd time to write such a clear and sensitive post. I've just had 2 5d embryos implanted and was curious about the early cell development. We also have 4 fozen and 3 that didn't make it to day 6 so I was curious why they can't keep growing them until day 7...your piece has helped me understand. I look forward to reading more of your posts. By the way your profile made me tearful with hope.

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    1. Thank you so much for the kind words ! This is what helps to keep writing. Lots of good luck for your endeavor !

      I think once the blastocyst hatches out of its shell, it will attach to the substratum of the culture plate. That is why it is not possible to grow a blastocyst past day 6. I hope you understand what I have said. Until the embryo is within the shell it floats in the culture medium but once it comes out it just attaches to the bottom of the plate, just like it attaches to the endometrium. Does this explanation help ?

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    2. You could see in the above picture how a d7 embryo has already attached to its substratum and it is not possible to transfer the embryo to the uterus once it grows so. That is the reason why embryos are not grown more than 6 days old in an IVF lab.

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  2. Dear Manju, thank you. I did understand your explanation. Your English is very impressive. I was reading your post about adoption as that has crossed my mind a lot. I think unlike your story, I have not responded to IVF due to an almost non-existent ovarian reserve and this latest partial success was from donor eggs, so adoption is the only next alternative. It sounds like you lived in Germany and they have high expectations of competency in German...maybe your should move to the UK if you ever decide to pursue the adoption route, which is a whole other ball game and like you elude to in your piece not a cure to inferility.
    The serenity prayer also came in handy last night when I was trying to stay in the here and now. Judy

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    1. Dear Judy,

      I hope you end up successful this time. Lots of good luck ! I am happy that serenity prayer helps you - I learned it from my Dr. I would like to have an adopted kid too and perhaps we will move to India in a couple of years time and that makes adoption easier. Are you in UK ? My mail ID is manjupadmasekar@yahoo.com. Please do write to me when you find time :)
      Manju

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  3. I do have a question. I had two embryo transferred I was pregnant with one. Everything was going well was growing at 6 weeks and half we could see a small fetus but after one week nothing. The doctor told me there was nothing to do. They couldn't even frozen any embrio. Is this related? Why happen? I am 38 and I have never be pregnant before. Thanks for your answer.

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    1. Dear Sarah,
      When the embryo stops growing it gets reabsorbed in the uterus. At 6 weeks the embryo is just the size of lentil, about 8mm. So it doesn't take longer to get rebbsorbed after it's demise.

      I am sorry Sarah, lots of hugs. I know it pains, hope you feel better soon.

      Most embryos stop growing in the uterus because of some genetic defect. This is nature's way of removing defective embryos. Nothing could be done and it is not your fault. Many generically abnormal embryos do not implant and even if it does so, it stops growing.

      The problem is your age. You are of advanced maternal age as far as reproduction is concerned. Women of your age produce more genetically abnormal eggs - nothing we can do about it. Lack of frozen embryos also indicates that the eggs are of not genetically good quality.

      What is your AMH value ? How many eggs you produced ?

      This doesn't mean you can't get pregnant with a genetically normal embryo next time. The challenge is to find that genetically normal egg which will become your baby and I wish you find success soon.

      Lots of good luck !

      Love,
      Manju

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  4. hi, i am 29, and i have gone through the IVF_ICSI recently, 3 eggs are retrieved and only 2 are good. problem is both of them are stop dividing at 2 cell stage, so practically i had no eggs to transfer. so why they stop dividing at that stage? my doctor said, my DH sperm is not mature enough, is that correct?

    your blog is so helpful, it reduced my pain and i almost feel like the same of your first experience.

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    1. Can you please tell me the reason for IVF and how long were you trying to conceive ? Did they check your AMH ? Is your husband's spermiogram normal ? How did they retrieve sperm from your husband ?

      Please give me these details, then I can answer your question in a better way !

      I am happy that my blog reduced your pain a bit, that is what this blog is for : ) - to reduce my pain as well as those of people who read it. Thank you !

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  5. I am married 7 years back, and there is a problem with my husbands sperm count, so he has taken homeotherapy, recently his count reached 0.5 million, so they suggested us to try IVF procedures (because homeo is a long process). The sperm retrieved by testicular aspiration at the same day of my egg retrieval. After the first ultrasound they said i am developing the fibroids now (more recent), and i had some tests before IVF, and the doc said i was ok from my side (i am sorry that i do not remember the test names). after my third day of egg retrieval, they said there is no progress, i saw my embryos (2) and they stop divided at 2 cell stage, they suggested that my DHs sperms are not pushing the cells from thet stage.

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    1. Please do not waste time with homeotherapy anymore !

      You have to now do two things :

      I am bit surprised by such a low egg yield. I do not know how much gonal f they used to stimulate your ovaries. If they have used high dose and if only 3 eggs a're retrieved then you must have an idea about your ovarian reserve. ASK YOUR DOCTOR TO CHECK YOUR AMH LEVEL. Please look in your reports if they have already done it.

      They say it is because of immature sperm the embryos got arrested. Do you have photos of the embryos and the sperms retrieved from your husband. Up to 8 cell stage, cell division depends on the egg and it's mitochondria. After that sperm's DNA plays a role too. Since they say your eggs got fertilized and the embryo got arrested at 2 cell stage, it is very hard to say whether it is sperm or egg issue.

      There is a kind of sperm problem called globozoospermia. The sperms whigh are globozoospermic lacks an essential structure called acrosome necessary to fertilize the egg. Ask your doctor whether the sperms had such a problem and in which aspect they are immature.

      If you have the photos of egg and sperm, please send it to me. My m aol id is manjupadmasekar@yahoo. com

      Hope this helps !

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    2. Sorry, I meant photos of embryo and sperm, not egg.

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    3. Hi manju,
      I was reading all ur blogs. I am married for 11 years, had icsi thrice. This time I had 2 emryos transferred and result came positive but I had uncomfortable feeling in legs which I normally have b4 periods ...brown discjarge started an then aftet 3_4 days light bleeding started n tests wre still positive . Now I have heavy bleeding. Do u think it happened bcoz of stress or low quality mitichondria...n the dtls u gave above. I am 41

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    4. Please double the dose of estrogen and progesterone you are taking ! Try to drink lots of water and relax. Is your pregnancy test still positive ? Did you do a blood test ? How many times blood test was done ?

      This might be a chemical pregnancy unfortunately. I hope it isn't ! The reason for chemical pregnancy is, chromosomally abnormal embryo implanting but fails to proceed further. The reason for such an happening is your advanced maternal age. I am really sorry !

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  6. I have gone through 3 IVF cycles and all the times have had around 20 eggs retrieved, most have fertilized but have had all eggs stooped developing Between 2- 4 cell stage. I have been to two different Labs and both had same results. I am also in my mid 20's. No RE had an explication of why this is happening. Husband sperm is normal and all my infertility testing cake back normal with only one MTHFR gene mutation detected. What could be the issue?

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    1. Denise, it is impossible to guess whether the problem is with egg or the sperm. The only way out is to use a donor sperm for fertilizing your egg and also donor egg to see how your husband's sperm fares with donor egg. This will pinpoint where the problem lies. But because of ethical issue many clinic will refuse to do so.

      Is anyone of your close relative ( both from your and your husband's side ) having infertility problem ? Are you both of normal weight ? Anyone in your family or his family had any kind of cancer ? Please let me know !

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    2. Since the embryos stop developing at an early stage and the early development of the embryos are mostly driven by egg's mitochondria, it might be possible that the eggs have some defect in the mitochondria they are carrying. Perhaps cytoplasmic transfer can provide some answers too !

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    3. We have no one in our family with infertility issues. In fact both sides have the opposite issue. On our 3rd ivf we used a donor sperm eith 75% and husband 25%. My husband actually produced better quality egg though still arrested at 6 cell day 4. We are both normal weight and have no cancer or any other health concerns in the family. We want to try ivf one more time but I wanted to get advise on what I should try different next. We tried changing stim drugs already, added HGH one time. Nothing really changed the outcomes. Although I have been pregnant naturally 5 times and do have 2 healthy children ages 9 and 11 months. (Ivf happened between the births.)

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    4. This comment has been removed by the author.

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  7. My husband and I having been trying to get pregnant for 4 years. We went through our first IVF in March, and they retrieved 9 eggs. All fertilized with conventional fertilization; 8 did so normally. Six of them arrested at 2 cells, the other two where 4 cells and fragmented on day 3. We transferred them anyways, but the cycle failed. My RE has no explanation for why this happened. I am 30 years old. My AMH is 3.1, FSH 9-10. My husband's SA is on the low end of normal for everything accept morphology, which is between 1-4% (based on his samples). His acrosome test was normal. Our RE does not think his sperm were the cause because the eggs fertilized without ICSI. We are getting ready for a second IVF cycle in July. I'm trying to be optimistic, but I'm afraid it will happen again. We have discussed the possibility of asking my 23 yr old sister to donate her eggs if our next cycle fails.

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    1. Is the reason for infertility unexplained ?

      I would suspect two things : First, competence of your IVF lab in creating good embryos. Do you know how were the embryos of other women who underwent egg retrieval as the same time as you ? You must have asked them to show you other embryos too, this might have helped!

      The other problem might be some unknown defect in the egg since your embryo arrest development at an earlier stage. Is any of your sibling or close relative suffer from infertility. When did your mom reach menopause ? Do you have PCOD, are you overweight ? Please answer these questions so that I can help you better.

      Hope your 2 nd cycle goes well. Please keep us informed. Good luck !

      Manju

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  8. The RE told us the lab had no other problems with the embryo cultures of other women cycling that month, but I did not see any of their embryos. I will definately ask to see them if this happens again. I have two sisters, both younger, with no known fertility issues. My mother went through menopause in her mid 40's, but it was related to chemotherapy.
    I am normal weight and BMI, and have not been diagnosed with PCOD. The RE has classified us as unexplained.

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    1. If the same scenario repeats again, it is not unexplained anymore. May I know what cancer your mom had ? Is there anyone else in your family who had cancer too.

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  9. hi
    i am 38 years old read you blog and it makes me feel better and live with HOPE.
    i went under ICSI last month and retrieved 13 eggs , but the doctor said that only 7 were mature enough to be fertilized. after the fertilization they said than only two were developing, on the first day. on the second they said that only one . on the third day the doctor said that only one was very good and could be transferred on the 5th day due to my husbands sperm problem, and he asked me if can consider the possibility of transferring one embryo of mine, very good and another one of 5th day froma young donor. we accepted and tomorrow is my first pregnancy test. i was worried wondered if ill be pregnant of twins, or nothing, but after reading you blog i felt happy and understood that everything can happen and sometimes you have to let nature and God do their job.
    by the way i did not have idea that i could have ask for photos of my embryos, sperm, etc. the doctor said that anyway if this cycle falls we can not use my husbands sperm.
    allt the best to you
    maria

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    1. Maria, I wish you lots of good luck ! May you get a positive tomorrow, please do let me know.

      May I know what is the nature of the problem in your husband's sperm ?

      Manju

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  10. Dear Manju
    today before i went to the clinic suddenly my period started,but believing that probably could be a mistake i went to the lab and in my country they dont have enough material to have the results on the same day and they have to send to Lisbon and only after one week or 5 days will have the results, but as we know it will be negative. i went to the lab because same people said that sometimes its not a period, but embryos implantation signals.
    about my husbands sperm i did not ask the doctor ,but i will send an email telling him that my period started and asking about what is the real problem of my husbands sperm.i am sad and i did not tell him about my period yet. i will tell him at the end of the day. he is 43 years old and have 2 children of his earlier relationship.
    now i m thinking about what to do and definitely i need some more information. reading you blog i realized that i did not ask for my records.
    many thanks for you blog and God bless you
    maria

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    1. Dear Maria,

      I am really sorry. Didn't you do a home pregnancy test ?

      Ask the doctor hereafter that you must see your embryos and get a picture of it. Ask for all your medical records.

      How old are you Maria ?

      Manju

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    2. Dear Manju
      i did not do a home pregnancy test, i was too anxious .
      i am 38 years old and have bilateral hydrossalpinx. i did 2 laroscopies and one histeroscopy before my ICSI.
      many thanks, with Love
      Maria

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  11. I am 38 and my husband and I Have tried for 2 years to have another child. I did 4 cycles of IUI this year and then this past Monday, 8/11/14, I had egg retrieval. the next day 3 of the 4 eggs fertilized. Today was day 5 and the doctor called me before going to my appointment for transfer and said that none made it. they stopped dividing. After reading previous posts and comments, I am wondering if there is anything that can be done to help another cycle not arrest? I am obese but underwent gastric bypass 5 years ago to lose excess weight. I have 1 ovary due to endometriosis and chronic pelvic pain. My sister has infertility issues too. my mom went through menopause in early 40s I believe. I am seeing the doctor again next week to discuss everything and to see if anything else can be done? I am worried that I caused this to not work? My husband's sperm count is great! forget the numbers but we were told there's no issues with sperm. can you offer some insight? thank you in advance.

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    1. May I know your AMH or day 3 FSH or e2 value ?

      Not all the embryos from a woman grow to blastocyst stage. Only 40% of the embryos grow to blastocyst normally. Since you had only 3 embryos, I would expect atleast one to reach the blastocyst stage. For a women of 38 years with poor ovarian reserve or with poor egg quality ( I need your AMH value for this ) the blastocyst forming rate is even less, perhaps 25% or so.

      The reason why your embryos didn't develop into blastocyst might be due to :

      Poor egg quality ( more genetically abnormal eggs ) because of poor ovarian reserve ( your age, your mom's menopausal age, endometriosis all points to this ).

      Since you had only few embryos, it is hard to get blastocyst out of those few.

      Is your IVF lab good in blastocyst culture ?

      I would say poor egg quality is to blame.

      It is not your fault, please do not blame yourself. Unfortunately poor egg quality due to age is irreversible. Nothing you can do to improve it.

      For the next cycle you can try the following :

      Try to transfer the embryos on day 2 or day 3 to your uterus. As there are only few embryos, growing them to blastocyst doesn't make much sense. If I am given an option to select between growing the few embryos I get in an artificial environment or natural environment ( in the uterus ), I would select natural environment. Who knows this helps the embryos !

      Ask your doctor if he could tweak your ovarian stimulation protocol so that egg quality improves. What was your e2 before hcg trigger ? Sometimes, not for sure, tweaking the protocol could help.

      Don't beat upon yourself. Nothing you did or you didn't do have prevented your embryos from growing. Lots of good luck !

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  12. Thank you. I am new to all of this IVF stuff but I believe my e2 was 1080. I am not sure what AMH is though. it is heart breaking because I did not even think this would happen. I thought once they were fertilized, we were ok! Thank you again!

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    1. I understand your pain. If such things happen, we feel very cheated and heart broken. I wish your clinic talked to you about this possibility before trying to grow your embryos to blatocysts. Your e2 sounds fine, a mature follicle produces anywhere between 200-400 pg of e2. But, still with this it is hard to comment on the egg quality ! I hope all goes well when you try again and you get a sibling for your LO.

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  13. Hi Manju
    i m thinking about my next IVF and still waiting for the Doctors response about the problem of my husbands sperm, i also asked him if my eggs were good enough in order to continue using them, reading you blog , apart from asking the clinic for all my reports and photos of my embryo, iam considering the possibility of moving to another clinic and doing a research of clinics i send an email to one of them and they said that :
    "We recommend that you take the birth control pill starting one to two months prior to your IVF
    cycle. This is to simplify the planning of your cycle. You should take active pills only (no placebo pills)
    and stop the active pills 3 days prior to your planned period date. With this approach we will know
    exactly when you will start your period. Three days after the last active tablet you will start your
    bleeding. That is day one of the cycle."
    are they correct on that approach? because on my first IVF the Doctor did not tell me to take that birth control pill.
    cheers and all the best for you and you husband on this IVF cycle
    Maria

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    1. It is perfectly OK to take birth control pills. Some clinics put their patients on BCP and some not ( just to schedule them according to their convenience). Taking BCP will not harm your cycle.

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  14. thank you very much. tomorrow i ll have a tele-consultation with my doctor to clarify my concerns of what went wrong on my last IVF, what is the real problem with my husbands sperm, the quality of my eggs, etc.
    all the best and God Bless you
    Maria

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  15. Dear Manju,

    Today is a day I felt like suddenly dropping from a sky height, when my doctor told us our embryos all stopped growing after day 3.. I am 38 years old, have a healthy 7 years old boy and have been trying to get a second baby all these years. Did an IUI cycle failed, and continued on for this 1st IVF. Retrieved 7 eggs 5 days ago, and 2 were graded embryo grade 1 and grade 2 at day 3. The other 5 doesn't survive. Today we were at the clinic to do the transfer but he doctor told us the 2 embryos all died.. It was devastating and I really don't know what to do.. And don't know what is wrong with me..

    When I found your blog I salute you for that many cycles and still standing strong, and even started this blog to help all!! I gotta be strong and learn some optimism from you! And I wish you all the best and hopefully you would have a healthy baby soon!

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    1. Thank you so much for all the kind words!

      I am sorry about what happened to your embies! I think you didn't even expect that growth arrest and it must have come as a shock (((Hugs))). I know it will be painful and unbelievable.

      Can you let me know how many of your 7 eggs fertilized? Is it only 2? Is it an IVF cycle or ICSI? Do you know your day 3 FSH and e2 levels? What is your AMH level?

      If you could answer the above questions, I would be able to help you better.

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    2. Dear Manju,

      Can't sleep whole night and good to see you replied! It's really warm to see your response ...

      I had 3 out of the eggs usable according to the doctor.. And only 2 fertilized. I only know on day 3 the 2 embryos were grade 1 and grade 2. When I was told the news yesterday I was devastated and didn't ask much. I will email the doctor and ask him for all the readings..

      I can't sleep whole night thinking if it would be a facility/incubator problem. My husband keep calming me down and asking me to let go and move on. I really salute you and your writings help a lot Manju! Hugs..

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    3. Sorry Manju I forgot to mention in my earlier reply, it was an ICSI as doctor mentioned they took one sperm to inject into the 3 chosen good eggs.

      This was our first time going through all these and we don't even know what was some of the right question to ask the doctor and are so ignorant about it.. (Crying..)

      You are a great role model for me and I need that kind of courage you have Manju!

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    4. I am happy that I could be of some help to you. Please relax! Eventhough it might be painful for you, dwelling on it is not going to help.

      I think your age might be the reason for the outcome. As women age, their egg quantity and quality decreases. For some women this can happen much quicker. Your AMH and FSH value will give much insight into what happened really!

      There are the following possibilities:

      Your ovarian reserve is declining and egg quality is not good.

      Your doctor did a poor job of stimulating your ovaries hence only 2 fertilized.

      The IVF lab is not good enough.

      Your AMH value will shed light on what might have happened.

      Please look at the brighter side, you are not a failure. This didn't happen by anyone's mistake. The science of IVF is not perfect. I wish you read a lot about the procedure and become well-informed, that will give you courage and peace of mind. You did your best and please leave the rest to the power above us. Write to me when you get the results in hand.

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    5. These are the questions you must ask your doctor:

      What is my AMH and FSH value?

      What is my antral follicle count?

      Why only 3 eggs were used for ICSI? If other 4 eggs are immature, is it possible to change the protocol and get more mature eggs?

      Did my eggs look good under the microscope?

      Can I see the photos of the embryo and have them?

      Do you think my age is the reason for the poor outcome?

      What can we do to rectify the problem? Is it possible?

      Everyone becomes courageous when they face hardships, you will become strong too. Please do not get disheartened, just enjoy the ride.

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    6. Dear Manju,

      Thanks for your replies and help me along the way to understanding the process better.

      So I talked to the nurse today over the phone, she dig my file and talked to the doctor and called me back. She said they never did a blood test for AMH and FSH as they don think that was needed when they scan and saw some 10 follicles prior to the egg collection. They do have e2 and they sent the report in PDF to me.. Anyway I can email a copy to you? I don't understand it and asking them to write a detail report to me about my whole embryo situation and progression which they promised will send it to me tomorrow.

      I am feeling much better now! Thanks Manju! I am learning a lot from you, not just the process but living the live!

      2014-11-18 patient :)

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  16. Dear Manju,first I want to say thanks to your helpful answers to my hopless situation.Me and my wife are now in 36.we have known that my wife has HIV infection before our marriage.She has been under treatment since 2003.we married in 2007 i am still clean from infection.after 7 years we decided to have children.In april 2014,we check up and found that I am having mild oligospermiaand she has complex hyperplasia without atypia.After treatment of complex hyperplasia the ICSI treatment start in this november.After 10 days of injections ,can retrive 24 eggs,GV-4,M1-3,MII-17,after ICSI 13 feterlized ,I attached the page of our result.We did grade B of 5 embryos to biospy and only one is normal.The left 8 embryos are watched and on day 6 ,they said they discard this cycle.we are so crushed,we can't even stand on our legs.Our Dr suggested to test the chromosomes of mine and said for next cycle will do half of eggs with mine and half with donar sperms,and also give some vitamins for me and DHEA 25mg tabs for my wife and said can start next cycle after 2 month.I am feeling something is missing for us.We are hoping much more suggestions.Is there any way to improve for next cycle,we are afraid of the result like this cycle discard.We don't want to spend our age and our money by discarding the cycle

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    Replies
    1. I am sorry you have to go through this, I understand your pain.

      Your wife had good number of eggs. How good is the IVF clinic that you are going? I do not agree with your doctor's suggestion of using donor sperms. Most of the time genetic defect in the embryo stems from the egg and not the sperm. Why were you advised to do genetic testing? How good is your clinic in the technology? Can you send me the pictures of the embryos to my mail id? manjupadmasekar@yahoo. com.

      Can you please send me the details so that I could guide you better!

      Delete
  17. Dear Manju,

    I am so glad to accidentally find your blog when I was searching for possible explanation why my embryo stop growing. I read this informative article and your reply to each question. Really appreciate your insight and genuine care. A brief background of me: I am 34, went on IVF because I can't ovulate properly (having symptoms of PCOS). Had two cycles with pretty similar problems - got 20+ eggs retrieved each time, but only 4 and 7 eggs were useful respectively, got 3 Day 3 embryos (1 10 cells, 2 8 cells, all class B) and 4 embryos (1 10 cells, 1 9 cells, 2 8 cells) each time . because of the OHSS, the clinic had to freeze my Day 3 embroys. But for both of the times, the embryos couldn't thaw properly: grows slowly on day 4 and stop growing at day 5. I am very frustrated:

    1) Is this my problem or the clinic problem? They claim to have a thaw rate of 90%
    2) What are the possible reasons?
    2) How can I do differently next time?

    Thanks so much!
    Lynn

    ReplyDelete
    Replies
    1. Dear Lynn,

      I think your problem is PCOD? What is your AMH level and BMI? Are you overweight or too thin? Is your androgen levels normal?

      The problem is your doctor is not experienced enough to do a proper ovarian stimulation on a woman who is having PCOD. I think most of your eggs are immature, and the ones suitable for fertilization are of poor quality because of this. Can you please write down your ovarian stimulation protocol and how many days they stimulated you? What is the dosage of meds used? Do you have photos of your embies?

      I believe if your ovarian stimulation is done in experienced hands, you have a very good chance of getting good embryos and good chance of success. Good luck!

      Delete
  18. Dear Manju,

    Thanks for your useful blog :)

    I'm 32 years old, and we have to do ICSI because of my husband's congenital absence of deferens.

    My side: AMH is 39, used gonal f of 150 units for 10 days, got 15 follicles but only collected 6 eggs and only 5 mature. Why so few mature eggs compared to the follicles since my AMH level is quite good. Luckily we got 5 fertilised (100%), and all grew to 3 day embryo with 2 10-cell, 2 6-cell and 1 7-cell. And I did the embryo transfer on day 3. Seemed everything went smoothly by this phase. However, after that I ve got the negative result which showed no implantation occured. Before this, I already did 1 fresh cycle and 2 frozen cycles with good-looking day 2 embryos but also no implantation. There must be a reason why no implementation at all.every time before embryo transfer, everything went well.

    My husband's side: 33 years old, tested CFTR gene with no mutations, also tested Y deletion and normal chromosome with everything OK. He did TESE on the same day as my egg retrieval and used the fresh motile sperm to do ICSI.

    We are so desperate and want to find out the reason why no implementation. We are not sure whether it's embryo's, or eggs or sperms, or even the lining's problems. Any suggestion or opinions? Thanks for your reading such a long comment.

    ReplyDelete
    Replies
    1. Dear Sophie,

      I understand your frustration. First, you must understand that on an average it takes atleast 3 IVFs to attain success. 60% women conceive within 3 IVF cycles, others might need more attempts.

      In your case I suspect that you are not with a competent clinic. The high amount of immature eggs might indicate that your ovarian stimulation is not optimal. Do you have photos of your embryos? Can you send it to me?

      A good IVF clinic plays a very important role in achieving success. Because, creating good quality embryos and good embryo transfer practice is in their hands, which plays a major role in IVF success. Whether the clinic you go is in the field of IVF for a long time? Is the doctor well-experienced?

      Since your ovarian reserve is good, I would expect good quality embryos. Haven't you tried blastocyst transfer?Perhaps next time you must tell them to retrieve more eggs and aim to get more embryos so that you can grow them to blastocyst. I don't think there is any other major problem. Hope this helps!

      Delete
  19. Thanks for your prompt reply :) I have sent the embryo pictures to your email: manjupadmasekar@yahoo.com. I searched your previous comments and found this address, hope you can receive it :)

    ReplyDelete
  20. Ok I need to ask because I am kinda confused on feb 19th they removed 11 eggs and were only able to create 2 embryos, I wanted to cry when the told me only 2 were able to be created, the nurse tried to re assure me that they are "good" embryos, she said one embryo has a 3bb and the other has a 4 bb., question is that honestly good? 2nd question what does BB stand for? ( or is it db or bd

    ReplyDelete
    Replies
    1. Please see these links :http://www.advancedfertility.com/blastocystimages.htm

      http://www.drmalpani.com/articles/embryologist_faqs

      They have explained clearly about the grading of blastocyst. I wish you lots of good luck !

      Delete
  21. This comment has been removed by the author.

    ReplyDelete
  22. Dear Manju
    English is not my first language so I will try my best to explain our IFV failure.
    My husband is 55 he had 3 kids in his first marriage. He has the vasectomy now. I just turned 37 this year and kinds no pregnancies before.
    We want a baby together so we tried our first IVF last February. At the egg retrieval they collected 11 eggs, only 6 were fertilized. None of the 6 survived. The only 2 they kept until day 6 were graded 1-BB and 2-CC. None reach the blastocyst stage.
    My E2 were 5,000 when I did the lupron trigger so we couldn't do a fresh transfer. At the end with no embryos no frozen transfer either.
    Do you think our embryos were poor quality because our age?
    Doctor suggested to do a second cycle but half of the eggs fertilize them with a donor sperm and the other half with my husband's.
    We are afraid to do a second cycle because maybe is not the sperm issue, like you said maybe is my eggs quality.
    Thanks in advance.

    ReplyDelete
    Replies
    1. First, very sorry for such a delayed response. Your English is pretty good :)

      Lack of blastocyst formation can mean two things :

      The embryo quality is poor
      Or
      Your clinic is incompetent

      Changing the sperm is very unlikely to help as 90% of the reason for poor embryo quality is the egg.

      If I were you, I would change clinic and do a second IVF cycle. If the result is the same, using donor eggs is the better thing to do rather than changing sperms. Hope this helps and my sincere apologies once again for not answering quickly.

      Delete
    2. Thank you so much for your advice. We are looking for another clinic and hear a second opinion.
      I really appreciated your answer. :)

      Delete
  23. Aged 43, AMH 22. FSH 7.5. Uterus lining excellent.

    I've never had children or been pregnant. I've just had my first IVF. 13 eggs retrieved. Two died immediately. 3 made it to 8 cell stage and the two very best ones transferred. The remaining good one didn't make it to blastocyst stage in the lab so couldn't be frozen. Should I be optimistic? Trying to be positive. I eat organic food, don't smoke or drink. It's hard not to get anxious. I'm currently on my two week wait!!

    ReplyDelete
  24. Aged 43, AMH 22. FSH 7.5. Uterus lining excellent. Husbands sperm count: excellent.

    I've never had children or been pregnant. I've just had my first IVF. 13 eggs retrieved. Two died immediately. 3 made it to 8 cell stage and the two very best ones transferred. The remaining good one didn't make it to blastocyst stage in the lab so couldn't be frozen. Should I be optimistic? Trying to be positive. I eat organic food, don't smoke or drink. It's hard not to get anxious. I'm currently on my two week wait!!

    ReplyDelete
  25. It is good to be optimistic, cautiously optimistic !

    If you want me to talk scientifically, age is the most important criteria which says about your egg quality (than your FSH, AMH , appearance, food habits etc ). With IVF a 43 year woman's chance of taking home a healthy baby is 3 percent or less. But, statistics doesn't apply to individuals. And, miracles happen too. So, just pray, have faith in the power of your thoughts, your body and God. Be well prepared too to accept the verdict whatever it might be. Lots of good luck !

    ReplyDelete
  26. Okay thank you. I'm trying to be optimistic and have hope. My grandma gave birth at 43. My Aunty had twins naturally at aged 42. I'm only having IVF because my fallopian tubes are blocked. At least I know I have plenty of eggs. My husband does not believe in statistics. I have never felt so 43 as I do right now!! Either way....What will be will be! X

    ReplyDelete
    Replies
    1. Your family history shows that you have very bright chance of success ! I didn't mean to break your hope. I just do not want to give you too much hope because it hurts too badly when hope fails. Please do update us the outcome ! I wish yours is a success and many more advanced maternal age women feel inspired by your success.

      Delete
  27. Hi Manju,

    I'm 25 & my husband is 26. I have PCOS and mild endometriosis. Im 5'7" and 150 lbs. so not really that overweight. My husband has normal sperm.

    We just went through our first round of IVF. They retrieved only 8 eggs. A lot of my follicles were empty. Out of 8 eggs, only 3 were mature & only 2 fertilized.

    We were set for a day 5 retrieval. They called & said both embryos had degenerated around day 3. He said next time, if we choose to try again, he would up my meds a lot, but I'm still wondering....did we just get unlucky or is there something else wrong or something with my clinic?

    ReplyDelete
    Replies
    1. Dear Jessica ,

      I think it is the problem with your clinic's competency. They might have used a very less dose of FSH to stimulate your ovaries because of your PCOD status and age. They might have been afraid of ovarian hyperstimulation syndrome. Is your hcg injection timed correctly ? Might be they gave the trigger shot too early. You can give them one more chance because they must have learned how your ovaries react from your first cycle. Hope the next cycle goes well. Some PCOD patients need a higher dose of FSH to start with to get the best response.

      Delete
  28. Hi Manju,

    I'm the 43 year old who emailed recently, who's never been pregnant who's just had my first IVF due to two blocked Fallopian tubes. I don't smoke, I don't drink, I meditate every day, I'm very spiritual, I believe in positive affirmations... I trust the universe!!

    I'm pregnant!!

    I hope I give faith and inspiration to other women who are constantly made to feel 'too old' once over 40 and who are tied in with scientists depressing statistics! Trust your body and your heart. Have faith. Every person is an individual. Everyone has there own journey in this life so please don't compare your experiences to others experiences. You are you. Love & hope sent to those 40 plus women who've suffered the negativity I have from the medical profession. Believe and you may receive! Xxxxxx

    ReplyDelete
  29. Hi Manju,

    You are doing great job with this blog! It's so informative.

    I'm 26 and my husband is 44. I'm very healthy and my weight is always under control. Doctor has told me I have PCOS but I don't think so I have it anymore. My menses have been regular for past one year. The problem is with my husband. He is suffering from azoospermia and we have 3 failed ivf . The first ivf, they found nothing in muhusband's testicles during the TESA and the second one they found the germ cells , spermatids and 2 abnormal sperms that are not moving and with large head. During this 2 nd ivf, the doctor actually planned to do a fresh transfer so I was also stimulated with Gonaf F . I produced 20 matured eggs and soon they found my husband have nothing they immediately froze all my eggs. After that we took a break as it was going through a emotional roller coaster with all these failures . Last year , we did another ivf but at a new fertility clinic. Their more professional and quite aggressive in finding something out of his tissues. During this ivf, his tissues were taken as a large chunk and they managed to get 14 spermatids and 2 sperms. They injected one of the spermatid and it went till day 3 and degenerated so later the doctor said he is going to inject all the eggs with the spermatids and sperms left. 4 didn't fertilise and the rest were slow dividers and degenerating after 2nd day. So the doctor took a 2 cell embryo which was a late divider on day 3 with another day 3 embryo also with a 2 cell and quite fragmented embryo and transfered into my uterous. While I was praying hard and day dreaming one side, it just end up in chemical pregnancy. We was so devastated though the doctor was convincing that adleast we found something from my husband and not like before. We been doing ivf yearly once since 2012 and now I'm getting a bit fed up because it looks like all this vitamins and herb I give my husband is just a waste of money. I google so much everyday to find a solution but I just go to bed with nothing everyday. By the way, my husband is taking Solaray Zinc plus , Vit. E 400, CoQ10 150, GNC Multivitamin , Vit. C 1000 , and speman and clomid (both which was told to take by the doctor lasts time before coming for another cycle) and today I bought grape seed extract and pomegranate 500 for him because I read DNA fragmentation can make embryos arrested after the fertilization and antioxidants can help reduce em. I am on my prenatal and we both exercise everyday. He have never fathered a baby before , only 2 hernia operation during his 20s which what the doctor thinks created Azoospermia. What do you think I can do to help him produce better sperms that will go till blastocyst. One more thing, his semen is just a watery liquid, nothing there.

    ReplyDelete
    Replies
    1. I need some time to reply. I will get back to you.

      Delete
  30. Hi Manju,

    I'm the lady of 43 who wrote recently re: my first IVF. I'm now nearly eight weeks pregnant with identical twins! My husband and I are over the moon. We'd never had children... I'd never been pregnant.... Only starting trying 8 months ago to find my tubes were blocked... Hence no pregnancy! We can't believe we hit jackpot first time with IVF! I had two embryos transferred... One obviously didn't make it... The other split into two! So that now six sets of identical twins in my family lol!!! So excited!! Hope I give hope to those who have felt labelled by their age. 'Hope' & 'faith' kept me going... I never stopped... And indeed it's payed off! Over the moon!

    ReplyDelete
    Replies
    1. Hi, I am 44 and all levels perfect like in early 30s woman. Husband has no issues. No problems with tubes, uterus, or immune. Had two natural pregnancies in the last two years ending in miscarriage. Just waiting for that one good egg. Going through second IVF now and in 2ww. First didn't result in pregnancy- one 2d transfer. Full of positive ness though like you. Wanted to see how your pregnancy is coming along and wishing you all the best and praying for you.

      Delete
    2. Hi, I am 44 with all levels good like a 30 year old, no immune, tube, uterus issues. Husband has none. Two natural pregnancies resulted in the last two years resulted in miscarriages. First IVF with one 2d transfer didn't succeed. Now in second IVF with three 2d transfer and in 2ww period with full of positive ness like you. Wanted to see how you are doing in your pregnancy With twins and wishing you all the best and praying for you.

      Delete
    3. Good luck ! Hope for the best and prepare for the worst. Please visit my blog's home page !

      Delete
  31. Hi Manju,

    Your comments are very useful. Thanks so much for your brilliant blog. I have just had my embryo transfer. I had 20 eggs (from around 30 follicles), which were described as good quality at the time, by day one 12 had fertilised and the hospital were hopeful. I was told to come in on day 5 for blastocyst transfer. I turned up to be told only one had made it. This blastocyst was implanted. The others had arrested at day 3. I am 29, my husband is 35. I have PCOS, but all other tests are normal and I am not overweight. I have a very high ovarian reserve. My husband has no known sperm problems. It seems so strange that so many would arrest after the hospital was so positive about how things were going. Do you have any thoughts on what might have been the problem? And do you think the one that was implanted has a reasonable chance of survival?

    Thanks

    ReplyDelete
    Replies
    1. A few things to add. The hospital say that they had several successful blastocyst transfers this week and many were frozen. Also, just two of the embryos were slowing after three days. The other 9 we lost were find on day 3 but were only checked on day five (not 4) when they confirmed degeneration. Seems a very late fail for the vast majority of what had looked like good eggs. The single one that made it was 4AA.

      Delete
    2. I think, PCOD is your problem. PCOD women have very high insulin and male hormones in their body. This was supposed to play havoc with egg quality. What you can do is, try using some insulin sensitizers like metformin or myoinositol if in case you cycle again, arrest 3 for months. This will bring down male hormones too. Doing so will definitely help in retrieving better quality eggs. A good exercise regimen and a diabetic diet is a must too, even when you take metformin or myoinositol. Taking Vitamin D, B12 and fish oil helps too.

      Another problem is, many doctors fail to stimulate the ovaries of PCOD women appropriately because of the fear of OHSS. Make sure your clinic is experienced in handling PCOD patients.

      Of course every embryo has a chance of becoming a baby. I hope this cycle is for you. Good luck !

      Delete
    3. 4AA was a great blasto, hope all goes well !

      Delete
  32. Hi Manju - I love your blog! I am 37 almost 38 in a few months. Just had a first IVF/ICSI cycle fail. My husband is 41, the only reason we are doing ICSI is for male factor infertility. We got 18 eggs, 15 mature. Of those 15, only 7 fertilized normally - by day 3 we had only 4 as 3 arrested by day 3. Of those 4, we got a morula, one of 8 cells and 2 of 7 cells. Cycle got cancelled as I got OHSS (sharp pain attack in the ovaries right before a day 3 transfer). So we ended up doing a FET 2 months later...on the day of FET 3 of our 4 embryos did not survive the de-vitrification!! We were shocked...so we at least implanted one...negative. I saw the pictures and only 1 embryo looked like it had less than 10% fragmentation. The others had under 30%. We have gone to a different clinic to start the 2nd cycle in a couple of months. They have said they only do blastocyst transfer and will change my stimulation protocol (my AMH is 6.6, day 3 FSH: 5.3, estradiol was 38 and LH was 6.5 - all perfect results). Obviously the issue was egg quality plus the new clinic has asked my husband to do a sperm DNA fragmentation test. I do not have PCOS or PCO...am on supplements to improve egg quality & lower my homocysteine. My grandma has my mother at 40 & my mother had me aged 34. I dont have ovarian reserve issues but have you ever seen a woman my age with similar results needing donor eggs? I was so confident it would all work the first time...

    ReplyDelete
  33. Hello Manju =)

    Wife and I just did our first IVF cycle. We are both 37.
    My sperm is very good, with very high numbers (always 350million+) with good morph, etc.

    She has endometriosis (which was removed via cauterization via surgery) and PCOS.

    They had her on 2 menopur and 2 bravelle for 8 days, on 9th day her E2 lvls spiked, they were concerned with OHSS, so reduced meds by half, she started to plateau, and her egg follicles weren't quite 17 1/2 mm so they dropped dose completely and let her coast for 2 days (while giving her...gamo something? to help prevent ohss).

    She had 30+ egg follicles, they retrieved 23 eggs, 18 of which were mature.
    10 had fertilized the next day using ICSI (our clinic prefers using it regardless).

    Day 3 showed:
    1 @ 10 cells, grade 18
    2 @ 8 cells, grade 18
    2 between 6-8, grade 17
    1 between 6-8, grade 16
    2 @ 6 cells, grade 17
    1 @ 5 cells, grade 15
    1 @ 3 cells, grade 15

    according to them.

    Today, Day 4....she called and said.
    2 had gone to morula
    4 added a few more cells, but had become very fragmented
    4 hadn't changed from yesterday.

    I've read that after day 3, its kind of the sperm that determines if they go forward in growth. But from what i read from you, you almost say that its more the egg.

    A bit of background on me, the wife and i separated and i was with a woman, whom our first time sleeping together got pregnant. She miscarried due to her having Incompetent Cervix at like 20 weeks. 3 months later she was pregnant again and had a healthy baby.

    But wife and I, have had issues.
    I'm hoping the two good ones survive into tomorrow and form early blasts.

    I guess what i'm asking here is, and not to point fingers. But do you think it could be a sperm issue? DNA fragmentation in the sperm perhaps? as i heard younger women's eggs, may have a chance to repair sperm with DNA fragmentation.

    I'm wondering what we have 4 embies that were good with only slightly fragmentation, suddenly showing severe fragmentation and not going forward. Since i thought after day 3 it was sperm related.

    ReplyDelete
  34. Hi MAnju,

    I am 29 years old with pcos no problem with weight. Been taking glucophage for around 3 months;my husband is azoospermic. We did our first cycle after a testicular biopsy we got one grade B embryo but negative result.
    Now we are undergoing our second ivf cycle with a sperm donor. They have transfered 4 embryos grade A on day 3. The 3 other embryos couldnt make it to day 5 unless 1.

    I still have 10 days to know the result.
    What do you think about the success rate?

    ReplyDelete
    Replies
    1. Hope for the best and have faith. Good luck ! I need more information. How many eggs were retrieved from you ? How many fertilized ? How many embryos were formed ?

      Delete
  35. This comment has been removed by the author.

    ReplyDelete
    Replies
    1. I am really sorry that you have to go through this. I feel your pain. Hope yohur baby wish gets fulfilled soon.

      What is the reason for IVF ? Is it unexplained infertility ?

      Are all your hormone profiles normal - thyroid etc ? Does diabetes run in your family ? What's your BMI ?

      Any other health problems ? Is your menstrual cycle regular, how far apart they are ?

      Did embryologist comment about egg quality ? Did give a reason for poor embryo development ?

      Did you do all three IVF cycles in the same clinic ? How good is your clinic ?

      Please answer my questions so that I could help you better.

      Good luck !

      Manju

      Delete
    2. Iam desperately looking forward to it reply. I have written a short summary of my Ivf cycles. Need an honest opinion from u

      Delete
    3. I am really sorry ! I will definitely reply soon. Give me an hour. Sorry !

      Delete
  36. This comment has been removed by the author.

    ReplyDelete
    Replies
    1. It's hard if we do not know what's wrong.

      Perhaps, now you have an explanation for the unexplained !

      What can be done ?

      You must check your fasting insulin and fasting glucose. If the fasting insulin is high, you can try taking metformin and try IVF again after few months, hoping the egg quality improves.

      Is your thyroid normal ?

      Was genetic testing ( karyotyping) done on both of you ? Mostly this will not reveal any problems. But just for your peace of mind. Very seldom this can point out where the problem is !

      If there are some genetic problem, unfortunately there is no other way rather than using donor eggs or sperms.

      Perhaps, you must meet Dr. Malpani. You can do a cycle with them and see how it goes. If the results are the same, he might show you the embryos and explain you everything, including other options.

      I understand it is painful. Stay strong. Have an open mind to different treatment options.

      If possible, share with me the results of fasting insulin and fasting glucose.

      Try taking DHEA 75mg thrice and see whether it helps . But remember, it is not a cure or panacea.

      Hope this helps ! I couldn't help much.

      Are you underweight ?

      I do not think protocol is a problem. My guess is, you have a kind of PCOD and insulin resistance. If that is the case egg quality can be improved. Why can't you email me ? manjupadmasekar@yahoo.com.

      Manju

      Delete
  37. Hi Manju,

    I am so happy to come across your blog, you light up my hope to find the answers!

    I am 34 years old, tried one IVF cycle earlier this year, failed. Then I tried 3 IUI using donor sperm, all failed. My husband had vasectomy 20 years ago, he had two healthy children before. I was pregnant once 10 years ago but did abortion.

    For the IVF cycle, I had 16 eggs simulated, 11 of them were matured, and 7 of them were fertilized. Day 3 they transferred two 8 cells embryos to me, day 5 they called and told me the rest 5 all died, so they have nothing to freeze. And the 2 8 cells transferred test negative 2 weeks later. I was very angry and frustrated. I am a healthy women, still fairly young age for IVF, every single test during the process was excellent, how come all the embryos died?!

    We questioned the clinic:
    My first doubt is the sperm quality. Are the sperm quality are good enough to process? Because when they tried to get my husband’s sperm, they can’t get it directly with needle, they have to open one area and take them out. Also there is a note said the sperm quality is poor that they have to use simulation to make them active before they fertilized with my eggs.
    Our second doubt is why they did day 3 transfer instead of Day 5. Why they didn’t wait longer to see if the 2 8 cells will grow? Because the rest of the 5 all died in Day 5.
    Third, we doubt the capability of the lab also the doctor. They didn’t give us any clear answers for our questions above. They said they don’t know what is wrong because there is not enough data, and if they will do it again, they will increase medication so they can get more eggs and hopefully get more fertilized, also do Day 5 transfer (base on our request).

    With all the doubts, we went to the other clinic for consulting recently, they have high success rate of IVF in the country. There are mix feeling and very confused after the visit.

    First Doctor said if all the embryos died, it is 80% chance that are caused with poor egg quality (I was shocked to hear this, I always think it is the sperm quality, and the clinic before never mentioned about the possibility of poor egg quality). But doctor also said maybe it is just one cycle of poor egg. And we only need to do one cycle to find out if it is egg quality or not. Also we can do genetic screening to find out the embryo quality.
    Second the Doctor kind of implying us not to go to their place, he said we travel so far and spend a lot of money to do IVF over there, the outcome might be the same, it might be waste of time and money, they don’t guarantee the success.
    Third, the nurse said they have higher successful rate is because of the way they culture the embryo, they must do something right to get higher successful rate than other clinic. And they only do Day 5 transfer.

    After reading your blog, I find out that I might have PCOS or PCOD too, although my OB never said so, but my period mostly not on time and cycle time is usually around 35 days. And I highly doubt that my IUI timing were right which lead to fail.

    My question to you is, what do you think about the two fertility center? Should we try the second one? Do i really have poor eggs? should we do genetic screening? Why the doctor sounds like refusing us to do IVF there?

    ReplyDelete

  38. My husband and I are both 34. I have stage 2-3 endo and he has low motility and morphology. I have had two laparoscopies, the last one being a little over a year ago.
    We skipped IUIs and went right into IVF with ICSI after about 6 months of TTC with no luck. Our first IVF cycle was in September. My AMH is 2.83 and FSH is 6.2.
    My Dr (Dr. Robins at the Center for Reproductive Health in Spokane WA) had me on the pill for about 13 days. Then about 5 days later I started 225 gonal f and 20 units lo dose HCG at 7 pm. My husband also started doxy at this time. 6 days into that, we added ganirelix at 10:20 that morning. I also started levothyroxine. Apparently I’d surged early… We did retrieval still and got 10 eggs/7 mature/5 ICSId/3 fertilized. Our 3 day report was semi bleak and on day 6 they’d all arrested. No transfer. Also, My Dr flat out refused to do day 3 transfers.
    We waited for a couple months and did this current cycle at end of November-present. In the meantime, I started weekly acupuncture, coq10, fish oil, Cordyceps, NAC, and folate along with my prenatal. I was told no baby aspirin. I’d also given up gluten, soy, caffeine, and alcohol more or less completely.
    This time he suppressed me much longer with 7-8 weeks of bcp. I then started a very small dose of 37.5 gonal f in the evenings. My labs and ultrasounds continued to look great. I have stayed on the thyroid meds the whole time as well. After a week on that dose, we upped it to 300 gonal f and 20 HCG for one night and then the next day I had to also do 7 am injections of 150 gonal f and 7 pm 150 gf and 20 lo dose. 3-4 days later we added ganirelix in the evening. My follicle count went from 12-16-15-11. So 11 on retrieval day. Only 5 mature and only 3 fertilized. On day 3 and 5 they looked pretty good. A 6 cell and an 8 cell and only 10 percent fragmentation on only one. On day 6, they arrested. Two cycles with nothing to transfer. So devastating. What do you think??
    Help!!
    Gianna
    Reply

    ReplyDelete
  39. For all the ladies, families that are still struggle to get success using IVF process. I have an excited news to share. With all the doubts with both fertility center, we still decided to change to the second one. I did the egg retrieval on Feb 4th at the second fertility, they got 13 eggs, and 11 of them fertilized, and we get the news on Feb 10th that we have 7 embryos get to the blast stage! We are so happy and excited! It solved all our questions we had with the first fertility, it is not my husband's sperm quality, it is the capability of the lab! whatever technology/knowledge/the way they culture the embryos doesn't work! It also solve our doubts for the second fertility center, it is not my egg quality! My eggs are totally fine! These two mystery was with us for the whole 2015, it is not easy but we made it! Now we are waiting for the result of genetic screening, if they are all healthy embryos, we are going to do transfer sometime in March. I can't wait for my baby in 2016!
    One very important advise: go to the fertility has highest or high successful rate, do not go to the ones only has 40% or lower successful rate, it means 6 out of 10 times they will fail. Go to a fertility at least have 50% successful rate, there are reasons why they can get higher success rate. They might be much more expensive, but it is totally worth it!

    ReplyDelete
  40. Hello. I had a blighted ovum and now I am trying to conceive again. I wonder what was the cause of the blighted ovum? Was it the sperm or my egg? I was 34, normal weight, my mother had breast cancer when she was 60 years old. She reached menopause late, maybe at 56. My partner was also 34, using weed and an ex heavy drug user. His father had intestinal cancer when he was 30 years old. Me and my partner broke up and I will try with someone new. My question is if you think in the case of blighted ovum, was it my egg or his sperm the faulty one. Thank you very much.

    ReplyDelete
  41. is an amh of 1.9 bad? Also my question is what are the chances of a 4 cell embryo chances on a day 3 transfer being successful? Can the fact that it was frozen make it grow slower? or is this a lost cause?

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  42. Hi there i am 28 and had my first IVF. i over stimulated so they froze 32 embryos. I was supposed to have my transfer today but they called and said all 32 embryos did not divide at all. The embryologist said she has never seen this before in her 20 some years of working there and they would investigate this. All my eggs were good quality and my husbands sperm is fine as well. I have not been able to find any similar situation have you heard about this before. Would it be smart to try again and switch clinics? Im worried they messed up and may not own it or is it possible my eggs are just no good?

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  43. Did they freeze the eggs or embryos ? If it is embryos on what day did they freeze it ? How long were you trying to conceive ? Is PCOD the reason for IVF ?

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  44. They called them Zygotes and froze them the day after fertilization. I have endometriosis. I had my left tube removed back in 2010 due to a rupture from a ectopic preg. In 2011 i had another ectopic in my right tube. My clinic told me I should have my right tube clipped to prevent further ectopics and better my shot at IVF so i did that. I dont have PCOD. Was told my ovaries were great and no issues. They said all 32 Zygots looked really good. Then they called me on Friday and said not one started to divide and i couldn't use any of them.

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    Replies
    1. That's unfortunate.

      The possible reasons are :

      Lab error - they did mistake in thawing them , or the vial is not frozen properly. How good is their embryo storage system ? Ask them for the pictures of embryo that didn't divide , if possible , demand that you see the embryos of other patients which were thawed on the same day as yours - at least ask them whether they are dividing well. Ask what can be the possible reasons , please talk calmly , if you get emotional and nervous , they might tend to hide their mistake.

      Some genetic defect ! - This is very , very rare.

      If I were you , I wouldn't change clinic immediately. I will do another cycle with them on a condition - If the embryos you get the second time around divide without any problem , then it's clear that the mistake is theirs and they must make your IVF cycle a free one. Any good IVF clinic will agree to this.

      If the second cycle ends the same , you need to do the third with a different clinic.

      I personally don't believe that your clinic will wantonly do something to prevent your embryos from dividing second time.

      It's up-to you to decide now.



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  45. Hi Manju -

    My name is Gwen. My husband and I just completed our 2nd IVF cycle. We are doing PGD due to a genetic defect I have that we don't want to pass onto to our children. During the 1st cycle, we had a total of 4 embryos that made it to the blastycyst state. However, the PGD testing fee is a flat $6000 fee for up to 8 embryos to be tested. As a result we did we a 2nd cycle in hopes of obtaining at least 4 more blastocysts.

    We just received a call from the clinic and out of the 11 eggs that were fertilized in our 2nd cycle, 9 of them have 3 pronuclei!! And 2 are normal with 2 pronuclei. We didn't have any embryos with 3 pronuclei in our first cycle (which was completed about 1 month ago).

    Do you have any ideas as to what could have happened? Could there have been lab error? The clinic seems to be confused as well and said they are researching to see what happened. Please let me know what your thoughts are and how we should proceed with this situation.

    Thanks,
    Gwen

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    Replies
    1. Dear Gwen ,

      How old are you ?
      Was the fertilization done using IVF or ICSI ?

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