QuestionQUESTION: A bit of history...2 miscarriages in the last 2 years. We were referred to an RE who did testing and found that my husband has a balanced translocation. We were advised to do ivf with pgd - I had no apparent problems. Our ivf cycle resulted in 10 eggs, 7 fertilized, 3 made it to day 3 for pgd and stopped dividing later that day. The pgd revealed very abnormal embryos with multiple trisomies and some chromosomes with only 1 copy. The dr said I must have bad eggs - he indicated he was very surprised because all my levels were normal and I'm only 29. he has suggested donor eggs. I'm wondering if I should try another protocol or just go along with the donor eggs. I feel like I'm too young to have bad eggs but since no embryos lived there must be something wrong right? Any advice would be greatly appreciated! Mandy
ANSWER: Dear Mandy,
Your history is a little odd, because for someone your age, I would have expected a better outcome in terms of the number of embryos to test. It is most likely that the abnormal embryos are coming from your husband. Not you. I think, unless finances is a problem, I would continue trying. You will eventually have a good embryo, and hopefully, a subsequent cycle will give you more embryos to test. You were not stimulated very strongly and could be. Because of the poor embryo development, I would try to get you to produce 15-20 eggs. That will probably require more medications.
If you go another 2-3 tries and still no normal embryos, then I would suggest you consider donor sperm with IUI. You could do IVF but that would be much more expensive. I would think that if you persist in having abnormal embryos it is because of the abnormal sperm. That is why I suggest donor sperm. If you are dead set on having a genetic child from your husband, then you will just have to keep trying using IVF.
I don't agree that your outcome in the first cycle is a sign of bad "eggs", especially at your age.
Sincerely,
Edward J. Ramirez, M.D.
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
---------- FOLLOW-UP ----------
QUESTION: We are going back to the dr for another consult next week. What should I ask him? Should I ask for a different med protocol if we do another cycle? I did bc pills, 300 gonal-f, ganirelix and ovadril trigger. Is there a better protocol? Also, I did not mention that my husband had testicular cancer 9 yrs ago and had chemo. Could the chemo have affected the sperm DNA? Should we have his sperm checked for DNA fragentation? We certainly do not have an endless back account so money is an issue with doing multiple ivfs. We can afford one more but I don't know about any more than that. If we can only do one more cycle would you advise donor egg and donor sperm to give us the best chance of having good embryos? Or something else? Thank you for taking the time to answer these questions!
AnswerHello Again,
Based on the information that you gave me, there is a high likelihood that the sperm is the problem. The sperm fragmentation test does not help to evaluate for chromosomal defects in the sperm. My recommendations would be as follows:
1. I would increase your medication dose. I would use s IU step down protocol(300IU Gonal + 150IU Menopur for two days then decrease to 225 IU Gonal + 75 Menopur). That adds more hormone to stimulate you harder, and I believe that the mixed protocol Gonal + Menopur will have a better yield.
2. I would substitute donor sperm, if that is okay with your husband. Otherwise, you have no other option but to continue trying with his sperm.
3. I do not recommend donor eggs for you.
4. If your doctor will not do this for you, then I would recommend that you find a doctor that will be more aggressive. Your doctor is too timid/conservative.
Sincerely,
Edward J. Ramirez, M.D.
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
