My IVF Cycle Failed – What Went Wrong? Question #17: Why Didn’t I Get Pregnant When I Used a Young Egg Donor and Had Good Quality Embryos?

30 Aug
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This is #17 in a series of answers to common questions about failed IVF.

For women whose advancing age and/or ovarian resistance make having a baby with their own eggs unfeasible or unlikely, IVF using donated eggs from a young donor (under 35 years) is an excellent option and is statistically highly successful – with approximately 60% conceiving following embryo transfer. The main reason why IVF with egg donation is so highly successful resides in the improved number and quality of a younger woman’s eggs:

  1. Younger women usually have a healthy ovarian reserve and are thus capable of yielding numerous eggs at the time of egg retrieval (ER).
  2. Since age is the major determinant of egg chromosomal integrity (the rate limiting factor in human reproduction), the eggs of younger women are far more likely to be “competent,” meaning that upon fertilization, they are capable of propagating chromosomally normal (“competent”) embryos. Such embryos are the ones that are most likely to develop into normal, healthy babies.

Women choosing to undergo egg donation understandably have high expectations of a successful outcome, and when they fail to conceive, they are often bewildered, angry and feel betrayed. But there are explanations as to why IVF with egg donation can and does fail.

  1. Even younger women can have diminished ovarian reserve that goes undetected. In other cases, in spite of best effort on the part of the treating medical team, an egg donor will have a low yield of eggs.
  2. Less than half the eggs of younger women are euploid (have a normal number of chromosomes) and abnormal (“aneuploid”) eggs cannot develop into competent embryos.
  3. The eggs derived from very young donors (in their late teens or early 20’s) are often of poorer quality and may produce more “incompetent” embryos. That is why, in my opinion, the ideal age of an egg donor is between 26 and 35 years.
  4. In addition, very young donors are much more prone to ovarian hyperstimulation on fertility drugs. In such cases, egg quality can also be compromised.
  5. On the other side of the equation, there is the reality that some embryo recipients may have embryo implantation dysfunction(usually undiagnosed). This can be due to:o Inadequate endometrial (uterine lining) thickness(more common in post menopausal women who have had prolonged estrogen deprivation).o Previously undetected/unaddressed uterine surface lesions that interfere with implantation (submucous fibroids, scar tissue or polyps)o Immunologic implantation dysfunction which often goes unsuspected, undetected, undiagnosed and untreated.
  6. Hitherto unrecognized male factor infertility.

Unless such issues are addressed, even the transfer of the very best quality donor embryos will often not propagate viable pregnancies.

The answer (as always) lies in the fact that each egg donation candidate and her partner must be thoroughly evaluated before embarking on a cycle of IVF with donated eggs, and each egg donor must be carefully selected and evaluated for ovarian reserve.

In my opinion, the ideal egg donor is 26-34 years of age, has regular ovulatory cycles, has had no prior difficulty in achieving pregnancy and (ideally) will in the past have successfully donated eggs which propagated one or more viable pregnancies. True, it is rare to find all these attributes in most egg donors, but knowing the “best case” criteria can help a couple more effectively evaluate their donor choices and optimize their chances of IVF success.

45 Comments

  • Alana says:

    Hi Dr Sher,

    I’m 39 with a 6 year son conceived easily and I’ve just completed my 4th IVF cycle in Australia where we ended up with 6 blastocysts, 2 transferred and 4 frozen. No pregnancy again. This time after LIT treatment and all the immune meds included (prednisolone, doxycycline etc) yet still no attempt at implantation.

    We are now at a loss what to do? All 7 blastocysts that we have transferred over the past two years have been considered top quality, and one had been tested normal through day 3 CGH. Yet none implanted. My AMH is low at 4, but I always yield many eggs. Husbands sperm isn’t great in motility or morphology but has normal DNA fragmentation. We feel we’ve addressed the immune issues, and my lining is at 8mm each time, so we are so confused and disheartened now we don’t even want to transfer the last four blastocysts for fear of wasting more time and money.

    Is there something we might be missing? Could these strong blastocysts be aneuploid, even after the CGH testing? I’m so scared to move to donor egg and have that fail, but surrogacy seems ridiculous given I’ve carried a baby to term though we wonder now if it’s my uterus. Deciding what to do next is feeling impossible.

    Any suggestions are greatly appreciated.

    • Geoffrey Sher says:

      You could have an alloimmune implantation dysfunction (DQ alpha/HLA matching)which requires a different approach to treatment. Please go to the home page of this blog, http://www.IVFauthority.com . When you get t there, find the search bar and type in “Immunologic Implantation Dysfunction” (2 articles posted on May, 10th and on May 16th respectively)into the bar, click and this will take you to all the relevant articles I posted there. Consider calling 702-699-7437 to arrange a Skype with me so we can discuss your case in detail.

      Finally, perhaps you would be interested in accessing my new book (recently released). It is the 4th edition (and a re-write) of “In Vitro Fertilization: The ART of Making Babies”. The book is available through “Amazon.com” as a down-load or in book form. It can also be obtained from most bookstores.

      Geoff Sher

      P.S: Please go to http://www.youtube.com/watch?v=Vp3GYuqn2eM&feature=youtu.be
      To view a video-tutorial by Linda Vignapiano RN, Clinical Manager at SIRM-Las Vegas.

  • chantal says:

    Hello Dr.Sher,
    I am 43 yrs old and I have had 5 missed miscarriages in the last 4 years. I had 2 ivf cycles and fresh embryo transfers in 2011-2012 which did not result in pregnancy. My husband and I had our karyotypes tested; both normal. Two of my miscarriages were due to tetraploidy and trisomy 16. The Reproductive endocrinologist recommended donor egg. We chose a 25 year old donor and had 100% fertilization. We got 1/3 of the 21 eggs retrieved. 5 grade 5AA 5-blastocysts were cryopreserved on day 5 and and the 6th on day 6. Fresh embryo transfer resulted in a chemical pregnancy. Sadly, last month, FET ended in a missed miscarriage. We heard the heartbeat at 6 and 7 1/2 weeks. However it was only 109 bpm and at 8 1/2 weeks it had stopped :( The POC testing unfortunately had maternal cell contamination so we did not find out if baby was normal or not. I was on prednisolone for positive ANA. I have pain in my hands and fibromyalgia but have tested negative for autoimmune panel. RPL panel only showed positive ANA.

    It seems that I have really bad luck with aneuploid embryos even with an young egg donor. Do you think we should have CGH on the remaining 4 Frozen embryos? My husband is worried that maybe his sperm has been causing the miscarriages all along. I would greatly appreciate your opinion on this please.

    • Geoffrey Sher says:

      No! I do not recommend CGH because it would require thawing the embryos for biopsy and then refreezing while you await the result…only to r-thaw for transfer. This might work but in my opinion is very traumatic for the embryos. I suggest you get tested for an immunologic implantation dysfunction. Then if it turns out you have an autoimmune of alloimmune-related activation of uterine NK cells that this 1st be addressed. I do suggest that if you do fresh IVF again with donor eggs that CGH be done then.

      Please go to the home page of this blog, http://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 for IVF: The most important determinant of IVF Outcome” (Nov. 2103)

      3. “Agonist/Antagonist Conversion Protocol”

      4. “Embryo Implantation………” (Part-1 and Part- 2—-Posted August 2012)

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

      6. “Unexplained IVF failure”

      7. “IVF success: Factors that influence outcome”

      8 “Use of the Birth Control Pill in IVF”

      9.”Staggered IVF”

      10.“Array CGH versus metaphase CGH in IVF patients….’

      11.“Egg Donation”

      Consider calling 800-780-7437 or 702-699-7437 to arrange a Skype with me so we can discuss your case in detail.

      Finally, perhaps you would be interested in accessing my new book (recently released). It is the 4th edition (and a re-write) of “In Vitro Fertilization: The ART of Making Babies”. The book is available through “Amazon.com” as a down-load or in book form. It can also be obtained from most bookstores.

      Geoff Sher

      P.S: Please go to http://www.youtube.com/watch?v=Vp3GYuqn2eM&feature=youtu.be
      To view a video-tutorial by Linda Vignapiano RN, Clinical Manager at SIRM-Las Vegas.

      • chantal says:

        Thank-you Dr Sher for your response. I will have implantation dysfunction tests done. Sorry, I used the wrong word. Vitrification is the process they used on the embryos, not freezing. If I test negative for implantation dysfunction then should I assume the embryos had chromosome abnormalites?

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