1st IVF produced all embryos with chomosomal abnormalities

[Shera276]

Hi Doc - I'm 39 yrs old and my hubby is 49. I've undergone 2 Ivfs in the past 4 months. We had to go the Ivf route bc my hubby had a failed vasectomy reversal. My Amh was 5.5 and fsh in the 6.4. We do Comprehensive Chomosomal Screening using PCR (polymerase chain reaction) where my embryos have been biopsied on day 6. We are banking at this point. Ivf stats below

- ivf 1: bcp + antagonist protocol (300 gonalf, 1.5-3 menopur, ganirelix starting day 6 or 7, hcg trigger) - 16 eggs retrieved, 12 icsi (using hubby's frozen sperm), 7 fertilized, day 3 - all ( I'm pretty sure some showed signs of fragmentation) 7 ongoing, day 5 - 6 ongoing, day 6 - 1 survived for biopsy (the rest arrested or just stopped developing). Chromosomal testing game back good and the 6ab embryo has been frozen.
- ivf 2 (for this ivf I had been on supplements listed below for 2 months prior): no bcp, antagonist protocol (same except 3 menopur and I triggered with both a lupron and hcg shots) - 19 eggs retrieved, 14 icsi (using hubby's FRESH sperm thru tese), 9 fertilized, day 3 - all 9 ongoing (4 looked good, 3 ok, 2 poor), day 5 - 4 ongoing, day 6 - 1 survived for biopsy (the rest arrested or just stopped developing ) with 5ab grade. Chromosomal testing game back abnormal (44, xx, -16). Dr said the embryo was missing 16th chromo and usually leads to miscarriage around week 10.

My dr wanted to see if fresh sperm made the difference but it didn't. He said that I respond well to stimulation. I'm going to see him next week on next steps but he did say he might want to do a letrozol protocol so it's more gentle on my eggs (bc we wants to work on egg quality/development). He needs to meet with the embryologist to before making final plan. I think he's going to ask us to get karyotype testing to make sure there isn't anything they missed. Also blood sugar and vit d (last physical in October said I was a little high in blood sugar and low in vit d).

He said I'm doing everything I can. He okayed the supplements below 3 months ago, although his tone made it sound like he didn't think it would do much. I few days ago I brought up dhea and he said the evidence is far from conclusive and doesn't think I need to take it.
DHEA – 25mg x 2/day
Myo Inositol 2gm (twice a day)
Melatonin 3mg (at bedtime)
Co Enzyme Q10 - 200 mg x 2/day
Omega-3 fatty acid 1000mg (once daily)
Vitamin C 500mg (once daily in the AM)
Vitamin E 200IU (once daily)
L-arginine 1000mg (twice a day)
Pycnogenol 100mg (once daily)
Multivitamin
Vit d3 (1000 iu)
Understanding you don't have enough detail about my records, I just wanted to get your thoughts on how I can get more embryos to survive to day 5/6 and obviously chromosomally normal. Perhaps ivf 2 was just a fluke since first one had 1 good embryo. Also what are your thoughts about the supplements I'm on. Is there a chance any of them caused the bad quality eggs/embryos and the abnormal one in ivf 2? Perhaps I should stop some.

I am getting a second opinion in June though. I'm in nyc otherwise I would have come to u

Oh I should also mention that my cat was sick for the last 6 months. She died a month before ivf 2. In fact I was supposed to start the 2 the day she passed away (which was unexpected) but dr decided to postpone it bc of stress. So my stress has been pretty high.

Thanks!

Sheila

[Dr. Wisot]

This situation really requires a consultation.

But a few observations. I generally agree with your doctor. It's a tough situation. Anything they can do to improve embryos reaching the blastocyst stage will interfere with the PGS, like co-culture. The only exception is to use growth hormone during the stimulation.

Perhaps a minimal stimulation approach might be a good one for you.

Let us know what the consultation reveals.

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

[Shera276]

Thank you for your reply. Some follow up qs to your comments if that' ok:
- To clarify are you saying that pumping me with the regular stims from cycle 1/2 could have just hit my eggs so hard and that's why we had minimal embryos reach blast phase?
- And same thing could affect chromosomes as well? - -Letrozol or a lighter stims might help both # embryos reaching blast and chromosomes issues as well?
- how would anything they do (like coculture) interfere with genetic screening? I guess that's what I'm unclear on really.
- last q: any objection to supplements I take?

I'll def let you know how follow up appt (next week) with dr goes (as of Monday he wasn't 100% sure he'd do letro protocol until he discussed with embryologist). I'll also let you know what 2nd opinon dr says in June.

[Dr. Wisot]

- To clarify are you saying that pumping me with the regular stims from cycle 1/2 could have just hit my eggs so hard and that's why we had minimal embryos reach blast phase?

That's possible. We do a lot of minimal stimulation, mostly on older women who cannot make a good number of embryos and have been impressed the that embryos they create from the lower stimulation do surprisingly well.

- And same thing could affect chromosomes as well? - -Letrozol or a lighter stims might help both # embryos reaching blast and chromosomes issues as well?

No. Nothing will change the chromosomes.

- how would anything they do (like coculture) interfere with genetic screening? I guess that's what I'm unclear on really.

The extra cells in the culture confuses the PGS results.

- last q: any objection to supplements I take?

No. In fact it looks like our recommendations. See our Lifestyle & Fertility pages and links.

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

[Shera276]

Thx will def read. If I understand you correctly you're saying that coculture (which I think is where they take some endometrium or uterine lining and place it with then embryo while it develops) might give the embryo a false abnormal bc of the extra cells. That is abnormal chromo result when it wasnt? I'll confirm but I don't think they did coculture on me. Or are you saying pumping me with stims could have given me a false abnormal.

Thank you for answering my questions as this helps on what to question my dr with.

[Dr. Wisot]

Contamination from whatever cells are used in co-culture (we used granulosa cells) can give incorrect results from PGS.

The stimulation would have no effect on the chromosomes. But less stimulation may produce eggs more capable of creating embryos more likely to reach the blastocyst stage.

Arthur L. Wisot, M. D.

[Shera276]

Thank you again for you time! I'll keep you posted!

[Shera276]

Hello! Just wanted to give u an update: my dr started me on glucophage and said he wants to do the long lupron protocol (I think it's down regulation) so he doesn't hit my eggs too hard. No menopur this time. He also said for me to stop dhea. He retested my blood sugar and vit d (7 months ago it was 5.7 and 23). Now they are 5.6 and 29. He also did karyotype testing on me and my hubby. Haven't received the results of that yet though.

He said glucophage helps reduce androgens in follicles hopefully improving egg/embryo quality

Sheila

[Shera276]

Sorry it's called the ocp/lupron protocol (down reg with bcp)

[mary_ir]

hello doctor,

I'm 31 years old and have had 2 IVF cycles so far.
first cycle: 14 eggs retrieved,12 mature, 10 fertilized through ICSI. 7 survived till day 3 but all poor quality, and 5 developed slowly till day 5 and still poor, on day 6 one survived but it didnt get to blastocyst stage.

i went through second IVF cycle a month ago(4 months after first one) in another clinic and transferred all the medical records and froze sperms to their lab this time my dr put me on higher doses and mentioned he wanted to retrieve more eggs, he added lupron for three days before stimulation begins. this time 23 eggs were retrieved 21 mature, 19 fertilized through icsi(both times we used my husband's frozen sperm).
on day 3 per my doctor recommendation they did assisted hatching on all embryos since we wanted to do PGS testing.(wasn't sure if it cause any damage to them my doctor assured me it does not cause any problem or damage) we had 14 embryos (8 better quality)
on day 5: 8 of them stopped growing and one of them (6BB quality)was biopsied and frozen.
on day 6: 1 out of 5 was still growing but in very poor condition (5CD quality) they biopsied that and froze it. sent two samples for PGS testing.
few days ago got the PGS testing result which was the worst day of my life.both two embryos came back abnormal. one with 6BB quality had turner syndrome(45X) and the other with poor quality 5CD had multiple aneuploidy chromosomes.

they retrieved my husbands sperm through testicles before cycle one and froze them bc he has an obstruction and sperm does not come out in a normal ejaculation also low quantity of the sperm was the reason we chose to go through IVF.

at this point we are heartbroken and feeling so devastated. I am not sure if we go to third cycle that would help or not. i am not sure why the pgs result came back abnormal cause my doctor mentioned woman age is the main factor and you are young there should be no problem. what is your opinion? they mentioned before they were able to use very poor quality sperm to get patients pregnant and after this failure they said your husband sperm quality was so poor. is abnormal chromosome related to poor quality sperms? what are my options now? please help