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.

51 Comments

  • Linda Applebaum says:

    Hi Dr. Sher:

    I went to you back in 2012′ in Vegas and did two cycles in a last attempt to find normal embryos. Although I was always a high responder, we gave up after developing no blasts.

    I had a natural pregnancy at 40 (blighted ovum), fresh cycle pregnancy (early m/c 6 weeks) and FET (early m/c 7 weeks) (age 41)

    We just just got a negative pregnancy result from a donor embryo cycle –2 blasts made the thaw (from 2004 amazingly). We have one frozen left. Our friends gave these to us, and they had twins in 2004.

    I not super excited about doing the last donor embryo, but we’ll give it the college try in two months.

    If this doesn’t work, we’re thinking donor egg, maybe with you guys. Questions:

    1. Husband’s sperm. DFI was 16% and then tested again (year later) and shot up to 29%. (Morphology 2%) Sperm expert says my husband must be taking something to have this happen. He’s just taking a lot of antioxidants. Back in 2012, you though 29% was okay. What techniques, if any, do you use in this situation. Or do you feel under 30% makes no difference. We would test this again, of course.

    2. Are you doing a lot of frozen CGH donor eggs? Would you recommend those in my situation?
    Are you having better stats with those verses fresh cycle donor. What are your stats? I’m in excellent health, great lining every time, 47 years old. You also told me back in 2012 that I don’t have autoimmune problems –did NK test to be sure. Only test we did not do was for allimmune issues between my husband and I.

    Thanks,
    Linda

    • Geoffrey Sher says:

      Hi Linda,

      Nice to here from you again but sorry about all the problems that persist.

      So many advances have taken place in the IVF setting since I last interacted with you that I think there would be merit in reconnecting to discuss your case. Why don’t you call 800-780-7437 and have Tina set up a Skype consultation so we can talk.

      Now to your questions:
      1. Husband’s sperm. DFI was 16% and then tested again (year later) and shot up to 29%. (Morphology 2%) Sperm expert says my husband must be taking something to have this happen. He’s just taking a lot of antioxidants. Back in 2012, you though 29% was okay. What techniques, if any, do you use in this situation. Or do you feel under 30% makes no difference. We would test this again, of course.

      A: I am still not overly concerned with a DFI of <30%.

      2. Are you doing a lot of frozen CGH donor eggs? Would you recommend those in my situation?
      Are you having better stats with those verses fresh cycle donor. What are your stats? I’m in excellent health, great lining every time, 47 years old. You also told me back in 2012 that I don’t have autoimmune problems –did NK test to be sure. Only test we did not do was for allimmune issues between my husband and I.

      A: This is precisely the arena where so much has changed. Please call so we can discuss this. There is too much to allow for this forum of interaction.

      Thanks,

      Geoff Sher

  • Hi i want to Ask some questions about ivf. I had failed my first treatment n that is my second ivf i got 5 egg but 4 egg are fresh. On 26 sep i got egg. But it ws faild treatment. I was polyp befor so doctor removed. So this time i had No any problem but i don’t understand why Should i got failed? Can u give me answer what’s wrong with me.

    • Geoffrey Sher says:

      Clearly it is an egg quality issue. Also it sounds as if you have diminished ovarian reserve and time might be critical. In my opinion, you need a very individualized strategic protocol for ovarian stimulation, followed by embryo banking, staggered IVF and CGH embryo selection before it becomes too late.

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

      7. “IVF success: Factors that influence outcome”

      8 “Use of the Birth Control Pill in IVF”

      9.”Staggered IVF”

      10.“Embryo Banking”

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

      12.“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.

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