My 2 failed cycles

[CrystalTipps]

Hi Carole, I have undergone 2 unsuccessful Donor Egg IVF/PGD cycles, details as follows:

Cycle No. 1
Donor - 28 years old, 2 children of her own, good pretesting
AFC 16
12 eggs retrieved
8 fertilised & sent for 5-probe PGD
7 abnormal
1 normal, albeit v. poor quality. Did not implant.

Cycle No. 2
Donor - 20 years old, 1 child of her own, good pretesting
AFC 18
11 eggs retrieved
7 fertilised & sent for 5-probe PGD
7 abnormal, no transfer.

Most of the embryos had multiple problems and 2 in the second cycle were 'XQ' which I have never heard of before. I wonder if you have ever seen anything like this? I am not sure where to go from here and wonder if you are able to offer any insight from a technical point of view. In particular, I am wondering if it is a sperm issue. My RE didn't seem to think so, although I don't know how we would know that.

Many thanks,

Crystal

[Carole]

Hi CrystalTipps,
First, I am so sorry that you are going through this now. I can only imagine how frustrated you feel. Second, having two young proven donors with these results is NOT common. I don't think I have ever seen this but then my experience has been with smaller volume centers (under 400 cycles per year). In any case, this is an uncommon result. Third, I agree with your assessment. Based on the data you have shared, nothing rules out male factor. The other possibility is that the PGD testing lab ran the tests wrong- twice. Also less likely, IMO, than looking at male factor. Before you do another IVF cycle, you might consider getting a second opinion from another RE or from a male fertility specialist (urology doc specializing in male infertility). Ask another physician whether some sperm (sperm DNA integrity testing) or blood/cheek cell testing (looking for chromosomal abnormalities/translocations) might be useful diagnostic testing for your husband. A urologist specializing in male infertility may have some better suggestions for additional testing. Although running all the available tests may still not provide an obvious explanation, it is hard to rule out male factor based on the results you describe. In any case, you might benefit from asking another physician to review these results. I wrote a post recently on some male testing which discusses the uses and limitations of some of the diagnostic tests out there. http://fertilitylabinsider.com/2011/06/wishing-for-a-happy-fathers-day/ Best Wishes, Carole

[CrystalTipps]

Thanks Carole. I shall read your article and look into sperm DNA integrity testing and cell testing for my husband, if only to rule it out.

After posting, I remembered something that our RE said. He said that the eggs had looked "dark". Do you know what this means and how it could have affected the outcome?

Thanks again.

[Carole]

Hi CrystalTipps,
Dark eggs is not a good thing; it is generally a sign of cell deterioration or death. Healthy eggs look bright, shiny and you can see internal structures. This opens up questions about donor egg quality, which can be due to genetic issues with the donor or old age or due to a poor stimulation. With proven young donors, egg issues are less likely and lab or stim issues are probably more likely-but there's no way to tell at this point. In any case, for this reason as well as the concerns about sperm quality you have, you might consider getting a second physician opinion. Good Luck!! Carole

[CrystalTipps]

Dark eggs is not a good thing; it is generally a sign of cell deterioration or death.

Oh dear! I wonder why our RE failed to mention this until after the cycle. What kinds of "lab or stim issues" could cause the dark eggs? I appreciate one can only guess at this point, but it gives me some interesting avenues to explore before we do in for Round 3.

I have also asked Dr Potter's opinion, hopefully he will respond.

Thanks again for all your help, it's great having you on here :-)

[Carole]

Postmature eggs can sometimes look dark. Re: lab issues: there are just too many ways to kill an egg or embryo in the lab to try to go into all these things here. Normal quality control procedures to ensure that culture media is at the right temp, right pH, that the incubator is providing the correct atmosphere and that techs are trained to handle cells gently and that all items that come in contact with the gametes and embryos have been embryo tested go a long way to keeping cells safe. I think we are coming to a point of diminishing returns here with "email diagnosis". IMHO, i think you need to ask your current doctor to explain his meaning behind descriptions like "dark eggs" and comments that imply he doesn't think sperm is an issue and see what he has to say. if his answers are unsatisfactory or unclear, you might want to get a second opinion. Have a good holiday weekend! Carole

[CrystalTipps]

Thanks Carole, this has all been very, very helpful. I shall await Dr Potter's advice and then make some decisions about where we go from here.

It's business as usual for us out here in the middle east, but wishing you a good holiday weekend and thank you again for all your help.

Crystal x

[Carole]

You are very welcome! Good Luck! Carole

[lana2020]

If you don't mind where you cycle? if it is in Middle east which clinic?