All abnormal PGS

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Rooish

All abnormal PGS

Post by Rooish » Thu Aug 27, 2015 6:32 pm

Hello- me and my hubby are both 32. I have PCOS, I was quite overweight through most of my 20s but lost 80lbs through weight loss surgery and am now a normal weight. My AMH is 3.6 (I think). I don't know my fsh, but I was told all was normal. We've been told we needed ivf because of my husband's sperm count. It was between 13 mil to 17 mil with low motility and morphology of 0-1%. We had an re recommend clomid for him. After 9 months of unmonitored use, his sperm count went to essentially 0. New RE recommended Varicocele repair. One year laterHis sperm count has never fully recovered, but we've gotten it up to 6 mil with decent 12ish % motility. His DFI was also tested and came back at 7%.

Ivf#1 was bcp, follistim, menopure, ganirelix and hcg trigger. We had 24 eggs, 18 mature and 16 fertilized. We ended up with 7 embryos but they were highly fragmented. 2 were "beautiful" quality and we did an eSet. It ended in a CP. Ivf#2 was a long lupron protocol with 1/2 dose menopure. We had 25 eggs, 21 mature and they all fertilized. Day 5 had 7 beautiful blasts with 4 even hatching this time. PGS results came back all abnormal. I don't know the specifics of the abnormalities except that they were all over the place. No pattern to them that would lead them to know if it was egg or sperm. The clinic graciously offered to test our remaining embryo from the first cycle, but we don't have the results yet. One quirk with this cycle was that Hubby's fresh sample was really low, so they used a back up sample. Unbeknowst to me at the time, they used a sample from before his varicocele surgery.

So, to my question. They're now telling us it has to be an egg issue and are recommending egg donor. I'm a bit baffled because of my age, although I know the pcos is a factor. I'm also a bit confused because they told us it had to his sperm after the first try. I'm wondering if you have an opinion regarding their recommendation? I'm actually OK with the idea of egg donor due to some family health issues, but I'm just scared that the eggs aren't the problem. However my RE feels strongly that because of the high quality of the embryos that it is much more likely to indicate an egg problem.

Thank you in advance for your time!

Dr. Wisot
Site Admin
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Re: All abnormal PGS

Post by Dr. Wisot » Fri Aug 28, 2015 10:54 am

None of the factors regarding you or your husband should have anything to do with the chromosome abnormalities.

I don't know how they could identify the eggs as the problem.

I don't have all your information, but I would suggest you take all your records to another RE for a second opinion.

I would probably look at another IVF/PGS cycle and sometimes the results are radically different. This is a common question on this board and I cite a patient of mine, 36, who's first PGS yielded one normal of four tested. Before the transfer she hoped to bank another normal embryo. In that cycle she had 3 of 4 normal and is now pregnant.

Arthur L. Wisot, M. D.
Reproductive Partners Medical Group
Redondo Beach, California

AT

Re: All abnormal PGS

Post by AT » Mon Aug 31, 2015 9:41 pm

Hi Dr. Wisot,

I have a similar question so would like to ask for clarification. I am 36 years old (almost 37). All of my bloodwork FSH/AMH/Estradiol has been deemed normal and average for my age. Tubes are clear. Might have PCOS based on how my follicles look, but I do not experience the regular symptoms of PCOS. Due to my good response to stimulation, my doctor has been careful not to overstimulate due to potential for OHSS.

Results:
2 rounds Clomid+IUI - Negative pregnancy test

1st Egg Retrieval. 150 Follistim, 75 Menopur, Ganirilex, and Lupron trigger. ICSI due to below avg sperm morphology. 14 retrieved, 11 fertilized, 7 Day 5 blasts, 2 normal post PGD

2nd Egg Retrieval (I wanted to bank a couple extras to have the option for a 2nd or 3rd child). Same protocol though at lower levels 125 Follistim, 75 Menopur, Genirilex, and Lupron trigger. ICSI. 11 retrieved, 9 fertilized, 7 Day 5 blasts, 0 normal embryos / all abnormal embryos

The question I want to clarify - can I expect different results if I see another RE? My current RE has said that she wouldn't change the protocol and that all she can offer me at this point is to take 2 months off, that I should take supplements (Royal Jelly, CoQ10, Myo-Inositol, Arginine, Omega 3, Pycnognol, Vit C & E) and try again in 2-3 months.

At my age 36 (almost 37) and the number of eggs that I have on my ultrasounds (10-15 per ovary during in-cycle ultrasounds), I find it hard to believe I had no normal embryos.

Can I expect a different result from seeing another RE? Are the protocols that different? Or can the results per cycle be that different? Is it worth taking 2-3 months off? Will a break also produce better results? We are paying 100% out of pocket so it is not only a stressful, but also costly process, only to not produce any results.

I would appreciate any advice. Thank you!

Dr. Wisot
Site Admin
Posts: 1208
Joined: Fri Oct 14, 2005 11:16 am

Re: All abnormal PGS

Post by Dr. Wisot » Tue Sep 01, 2015 7:51 am

Hi:

This is a very common scenario and just points out the inefficiency of the reproductive system. Even in someone like you with normal FSH and a good response has an enormous amount of abnormal embryos.

That's one reason why it may take a fertile 20-something a year to get pregnant with a successful pregnancy.

Your protocol and results with so many blasts seems very prudent. Changing RE's, waiting or taking supplements won't help. Just make sure your RE is using a quality lab for the PGS.

Arthur L. Wisot, M. D.
Reproductive Partners Medical Group
Redondo Beach, California

AT

Re: All abnormal PGS

Post by AT » Wed Sep 02, 2015 9:39 pm

Dr. Wisot,
Thanks for your response and candid advice.

If I may ask 3 follow up questions:
1) My doctor used Reprogenetics for the PDG testing. Does that lab have a good reputation with PGD testing? When you say quality lab - does this mean there variability in terms of how a lab deems an embryo 'abnormal'?

2) I was also told that the embryologist can make a difference in terms of how he/she grows the embryos in the lab. Is the embryologist a factor that would be make it worth changing REs?

3) Can there be a wide variance in results in egg retrievals cycle over cycle? My worst fear is paying for another cycle and getting no abnormal embryos again. I am weighing whether I have a good chance of having normal embryos if I do a 3rd egg retrieval.

Thanks again - I appreciate your professional opinion and feedback.

Dr. Wisot
Site Admin
Posts: 1208
Joined: Fri Oct 14, 2005 11:16 am

Re: All abnormal PGS

Post by Dr. Wisot » Thu Sep 03, 2015 8:00 am

1. Reprogenetics has an excellent reputation. We use them.

2. The embryologist can have a effect on the development of the embryos but not the chromosomes. The development of yours does not seem to be a problem.

3. For most patients there is significant variability in the percentage of normal embryos in different cycles. The exception is the woman who has significant ovarian reserve issues, i.e. age, high FSH. But sometimes that provides an answer; it's time to consider egg donation. :cry:

Arthur L. Wisot, M. D.
Reproductive Partners Medical Group
Redondo Beach, California

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