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    • 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?

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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.

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      9 Responses to “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?”

      1. Kitty says:

        I am 28 and have a low ovarian reserve. We turned to using a donor to achieve pregnancy. In our fresh cycle our donor (23 with a successful pregnancy and healthy cycles – approved by my clinic) produced 27 eggs of which produced 24 embryos. On day of transfer we had 11 embryos of which 2 were transferred and 9 were successfully frozen. Our fresh cycle failed and a subsequent FET also failed. In 4 years I've never managed to achieve a pregnancy. My lining is always perfect 12.2mm on day 11 and my RE is sure that when I get the 'right embryo' I will concieve.
        I am on immunological IVIG treatment, asprin etc
        I have 5 frozen embryos left and my RE feels that out of the 9 I should get a pregnancy. I'm feeling very disheartened as I thought we would definitely fall pregnant and now I feel as though it might never happen. I'm worried that we're missing something out. do you think my donor is a classic case referred to in your posting? As she was 23 and produced alot of eggs. But they managed to freeze 9 does that not count for something. Should I accept that her eggs were of poor quality due to age and hyperstimulation? Or do I need to look more into immunological issues? REgards Cathy

      2. HB says:

        I am one of your international readers from Hungary. I am 43 old and had several IVF in the past years with 2 missed abortions as a result. (So I could manage pregnancy) Considering my age, we have decided to use an egg donor. Our healthy donor (34) produced 11 eggs of which produced 11 embryos. We had 10 blastocyst embryos on day 5. In the fresh cycle 2 blastocyst were transferred but failed. I had two FETs and both failed. I am on immunological treatment, IVIG, steroid, heparin etc. We have 4 embryos left which was advised to transferred at once. My doctors say that the donor was too old (34) and the fact we had high number of blastocyst doesnt automatically mean that they are euploid embryos. They suggested to try a younger donor next time.
        May I ask your advise on my case.
        Kind regards,
        Helen

        • Geoffrey Sher says:

          Something is wrong here…It does not add up. There remains an implantation issue likely at the root. Either the immunotherapy was not optimally devised and implemented or you have an alloimmune issue that has been overlooked (DQa/HLA matching with husband). The age of the donor was optimal..that does not explain this at all (in my opinion)

          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 corner. Type the following subjects into the bar, click on it and it will take you to all the relevant articles posted there.

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

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

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

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

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

          6. “IVF success: Factors that influence outcome”

          7. ” Unexplained IVF Failure”

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

          Geoff Sher

      3. Anuksha says:

        i am 34 from Inda. Got pregnency in 2008 but could not carry beyong 4 weeks. post which had 4 cycles of IUI followed by laproscopy where in i was detected with endometriosis which was treated through 3 injections. I also have polysistic ovary. this was again followed by 4 iui’s followed by 2 IVF’s. I had 20 eggs in the pick up with 13 embriyo’s formed out of which 10 was AA category. I got pregnency in first IVF with 3 embriyo’s transfered buy could not carry beyond 6 weeks, andno luck in the 2nd IVF even with blastocyte transfer of 3 embriyo’s at 5 days.grateful if you could suggest if we are going wrong somewhere ?

        • Geoffrey Sher says:

          Please read the articles below with special emphasis on PCOS and on Endometriosis and I believe you will gain the insight you seek. Go to the home page on http://www.IVFauthority.com and look for the “search bar” in the upper right hand corner. Type the following subjects into the bar, click on it and it will take you to all the relevant articles posted there.

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

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

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

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

          5. “IVF success: Factors that influence outcome”

          6. “Endometriosis”

          7. ” PCOS”

          Consider calling 800-780-7437 or 702-699-7437 to arrange a Skype consultation (free of charge to those who reside in the United States or Canada) with me so we can discuss your case in detail

          Geoff Sher

      4. EO'Connor says:

        Dear Dr Sher,

        I have ovarian failure and my first egg donor cycle was successful and I have a 2 year old girl.
        I since have had 6 failed transfers with 3 different donors.
        My cytokines are high at 47 but normal NK cells.
        ANA and DS DNA are also positive. TSH was normal/ high and I am now on thyroxine.
        All other tests are normal.
        My husband has a DNA frag of 32%.
        We are doing another egg donor cycle.
        What drugs and doses would you recommend for me?

        • Geoffrey Sher says:

          Something is wrong here. I am concerned that the right NK test might not have been done. Hopefully they did a K-562 Target cell test and did not simply base the report on NK cell concentration.

          Geoff Sher

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