QuestionHello Dr. Ramirez,
i am 37 next month, DH is 41
we were ttc naturally for ~1 year, nothing
did tests, DH has severe MF, got four different opinions, IVF ICSI was suggested option, not enough swimmers to do IUI
i have three sisters, and including my mother, there is a long history of m/c in my family, but my mother did have four healthy daughters and my younger sister, 34, had a baby two years ago and is pg again
i did intralipids and took dexa to help with ET, sadly didnt need it..
cycle 1
15 eggs/7 mature/4 fertilize/zero make it to day 5
protocol was lupron, gonal f & menopur
i was way over stimulated with e2 peaking over 4k and then crashing as stims were reduced
RE was incompetent but mentioned it might be egg quality as eggs didn't look great. figured this was due to poor care and moved on
cycle 2
excellent care, estrogen patch, lupron, gonalf, luveris
very carefully managed, e2 rose steadily
23 eggs/21 mature/14 fert/only one 8 cell on day 3
RE said that 16 of the eggs were 'strikingly' abnormal - with multiple polar bodies.
RE suggested it's premature aging or genetic
do you have any experience of eggs with multiple polar bodies or other abnormalities? could i be more successful with a different protocol? anything i should be doing/not doing to improve quality? i understand that there are only a few good eggs in each cycle, what % are normally good?
thanks so much
AnswerHello,
What you are seeing is the "age factor". As a woman increases in age, the quality of her eggs deteriorate. Previous studies using PGD have shown that at age 37, only 20% of formed embryos are genetically normal. This would correlate with a high multinucleation rate. However, despite this, we saw a 67% pregnancy rate and 56% delivery rate in our 35-37 year olds in 2008.
What that means is that it may not work the first or second time (the first time should probably not be counted). The majority of patients get pregnant within 2-3 attempts. Studies have also shown that despite poor outcomes in preceding cycles, each cycle is unique and different and the outcomes vary and can lead to successful pregnancy.
I use a different protocol in my patients than your last doctor did. Each clinic is unique in their approach. It is good that you realized that the first clinic was not a good one, although he/she was probably surprised by your high responder status. Because of this, I can't recommend any specific protocols, because I am biased to my own. Things certainly did look good in the second cycle with a good retrieval number, good maturity rate (HCG was timed perfectly) and good fertilization rate (should be at least 60%). Development quality is totally inherent in the embryo. With such good stim and fert rates, I think it is just a matter of time before you are successful. Hang in there. Remember, because of your age, it will be harder to become pregnant, but not impossible.
Sincerely,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
