4 Responses to “Case Study Poor Quality Eggs/Embryos: in Young Women With Good Ovarian Reserve: Case #7 – Poor Embryo Quality Due to Sperm Dysfunction”

1. london lady says:

   November 17, 2012 at 4:43 pm

   hi. i found this article fascinating. i have 4 biological children with my husband. i have twin daughters by ED (23) with my husband. i have just gone through an ED with an older donor(34) which i am unhappy about as the clinic (world leader) promised me a young donor, with proven fertility. When I finally got the report and the images, it showed 2 morulas (one poor) and a early blastocyst, all from day 5. the clinic said they tx 3 blasts, which is worrying, and never divulged the age of donor until my pregnancy had failed[ horrific betas, finally culminating in a doubling time of 580 hours, by 6 weeks, and a 2mm embryo at 8 weeks]. i wonder if my husband now 54 might have male factor issues, or if might have been the donor. either way, it was a disaster, i have 6 children at home, and my uterus etc work fine. Wondering in the light of this article whether i should opt for spilt – transfer with donor sperm. but husband is nervous that if the clinic lied to us, all the way along, won’t they do the same again, even on a repeat cycle. just wish i could afford a payment plan and come to you, as i can see you are a world leader, and represent an institution of integrity. any advice?? regards london lady

   Reply
   • Geoffrey Sher says:

     November 17, 2012 at 10:20 pm

     I am sorry that your last ED cycle never worked out, but quite honestly 34 years of age is not too old for an egg donor. Also, it is not likely that your husband has suddenly developed poor sperm parameters.It is far more likely that the stimulation of the donor, for whatever reason never went as well as hoped. To get a better idea of how important it is to select an individualized protocol of ovarian stimulation, please go to http://www.IVFauthority.com and when you get to the home page find the “search bar” in the right hand column. Type in the following subjects into the bar and it will take you to all the relevant articles I posted there.

      “An Individualized Approach to Ovarian stimulation” (posted on November 22nd, 2010)
      “Ovarian Stimulation in IVF: Why is it important to down-regulate LH?”
      “Agonist/Antagonist Conversion Protocol”
      “Traveling for IVF from Out of State/Country– The Process at SIRM-Las Vegas” (posted on March, 21st 2012)
      “A personalized, stepwise approach to IVF at SIRM”; Parts 1 & 2 (posted March, 2012)
      “IVF success: Factors that influence outcome”
      “Egg Donation”

     We do see many patients from the U.K and would be delighted to host you here, but frankly, you do not sound like a very complicated case to me and I really do not see why coming here would necessarily be of benefit. However, if you wish to have my input, call 702-699-7437 and arrange a telephone or Skype consultation While an audiovisual (Skype) interaction is much more personable and preferable than a discussion by telephone, either will suffice.

     Good luck!

     Geoff Sher

     Reply
2. Maame says:

   March 3, 2013 at 5:04 pm

   Hi Dr. Sher,

   I have had about 10 fresh IVF cycles. I have severe PCOS and have been overstimulated several times on even very low dose short protocols. Partner has severe low sperm count and so all IVF treatments have been with ICSI. When we have used long protocol and Menupur we get more embryos but never gotten pregnant. With Puregon we get for example only 2 very good quality eggs out of 20 collected and get pregnant but have miscarried in 6weeks, 6weeks, 12weeks.
   We decided to then do Immune testing as getting pregnant 3times out of 10 fresh and 4frozen cycles is very low. We found out I have some gene mutation, high NK cells activity, blood clotting disorder, and I used to have thyroid issues but that seems to be under control now.

   Therefore, I started a treatment which is the first ever with Intralipid, prednisolone, clexane, aspirin. This had to be cancelled as a fresh cycle as on day 7 of stimulation I had produced around 35eggs on a dose of 125 of Gonal F which is quite high for me anyway so wasn’t very smart. It was reduced and out of 40 some eggs seen, most were over matured. Only 12 made it and only 4 were fertilised with icsi which were frozen on day 1. I got overstimulated and hospitalised so no transfer, to reduce risk.

   Now, I am starting a frozen cycle, with IVIG on day 11 of Østradiol and then transfer will be around day 17 or 18 after exposure to progesterone and a day 3 transfer is being targeted.

   My questions:
   1. Are the medicines being used enough or should I ask for anything else. Is the timing good from your point of view? The doctors are pretty open to ideas as the immune treatments are in their early stages here.

   2. Is the timing of the IVIG ok?

   3. Those embryos produced are there any chances that they are even good?

   4. They have said my egg quality used to be very good but this time they were not so great but they can’t see enough about it to judge. Could severe PCOS and all these treatments and overstimulations be causing a lower and lower quality of eggs and is it possible my eggs are no good? I am 30years, started this journey at 26. Have a ridiculously high AMH I think 17.2 or so.

   5. Will we benefit from donor sperms? The last sperm count they got from my husband after washing was 1million with 50% mortality. When we started it was around 6million but now it is getting worse and worse. He had undescended testes as a kid and had surgery at age 10 so that is where the problem is from.

   The doctors keep saying they do believe we can get kids eventually because every single time they have managed to get some good embryos who have always made it to day 3, we never tried blastocyst because since we decided to try it we have never gotten enough embryos to justify it. This time was supposed to be blastocyst but well, 4eggs are too risky to try they claim.

   Any advise or things we should look into will be helpful. They have tried to do a water scan and found my fallopian tubes open and my womb to be free of any foreign stuff. My ovaries are of course very polycysic. My period has gotten worse and worse as in very painful, huge clots, heavier as time goes on, and my PCOS has only gotten worse as in lesser periods, huge hormonal imbalances, etc, well I improved this drastically last year by doing a lot of exercise, losing 7kgs and eating an almost zero sugar, zero carb diet for 6months. I am of black origin and have been asking for them to check fibroids, but each time I am told i don’t have them. What else could be done for us? Any advise will help as this is becoming a puzzle for the doctors here. Thanks.

   Reply
   • Geoffrey Sher says:

     March 4, 2013 at 12:08 am

     1. Are the medicines being used enough or should I ask for anything else. Is the timing good from your point of view? The doctors are pretty open to ideas as the immune treatments are in their early stages here.

     A: You need a low dosage long down-regulation protocol in readiness for “prolonged Coasting” (see below”)

     2. Is the timing of the IVIG ok?

     A: In my opinion, Intralipid and steroids are preferable. However, regardless of whether IL or IVIG is used, the 1st infusion should be given 7-14 days prior to ET and the second with the +ve beta hCG test.

     3. Those embryos produced are there any chances that they are even good?

     A: At a young age and with a good protocol, you should be able to produce enough “competent” eggs/embryos.

     4. They have said my egg quality used to be very good but this time they were not so great but they can’t see enough about it to judge. Could severe PCOS and all these treatments and overstimulation be causing a lower and lower quality of eggs and is it possible my eggs are no good? I am 30years, started this journey at 26. Have a ridiculously high AMH I think 17.2 or so.

     A: No! And as for the rest, it is all about the right protocol being used, judicious use of “coasting” (as needed) and the proper timing and dosage of the hCG trigger (10,000 U of hCG or 500mcg of Ovidrel).

     5. Will we benefit from donor sperms? The last sperm count they got from my husband after washing was 1million with 50% mortality. When we started it was around 6million but now it is getting worse and worse. He had undescended testes as a kid and had surgery at age 10 so that is where the problem is from.

     A: Not sure. I would recommend your husband have his FSH, LH and Testosterone tested to ascertain if there is a chance that he in fact could be treated with clomiphene (I doubt this though, given his history of undescended testes…but it is worth a shot). Aslo, an SCSA is worth doing. Either way, since he has 50%^ sperm being motile, I would hold off on Donor Sperm. CGH to evaluate embryo “competency” is worth considering.

     Please go to the home page of this blog, (www.IVFauthority.com). When you get there look for a “search bar” in the upper right hand column. Then type in the following subjects into the bar, click and this will take you to all the relevant articles I posted there.

     1. “An Individualized Approach to Ovarian stimulation” (posted on November 22nd, 2010)

     2. “Ovarian Stimulation in IVF: Why is it important to down-regulate LH?”

     3. “Severe ovarian hyperstimulation syndrome (OHSS)”

     4. “Immunologic Implantation Dysfunction” (posted on May, 10th and on May 16th respectively.

     5. “Prolonged Coasting”

     6. “Traveling for IVF from Out of State/Country– The Process at SIRM-Las Vegas” (posted on March, 21st 2012)

     7.“A personalized, stepwise approach to IVF at SIRM”; Parts 1 & 2 (posted March, 2012)

     8. “Hormonal treatment of male infertility”

     9. “Staggered IVF”

     10.“Embryo Selection: A Critical factor in IVF Outcome”

     11. “PCOS”

     12. “FET”

     13. “Embryo Vitrification”

     Consider calling 702-699-7437 to arrange a Skype consultation with me so we can discuss your case in detail.

     Geoff Sher

     Reply