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pingc383 i agree with @Maxwellsmum about poor egg quality/poor responder.
Just because you get good "grades" it doesnt mean the embryos actually are any good. The grades measure how well the embryos progress, i.e. have they divided during the timeframe normally - right number of cells for each day, are the cells similar sizes and % of fragmentation. But these 3 things are the only things they can "see" with a microscope and unfortunately these 3 measures cant tell you whether the embryos are chromosomally normal. So really, they can look great and be graded AA but still not be any good.
So the way they tell you have poor egg quality is even if you have transferred lots of "good looking-good graded" embryos or "poor graded" embryos but whatever they looked like under the microscope, they didn't result in pregnancy. HOWEVER they never really know, its not like they can test for it without doing pgd, in any definate way. They just conclude, if youve transfered lots of embryos but they never work, then your eggs overall arent likely to be good or get better. Yes, there may be a good few eggs in there somewhere but the drs are basically saying it could take a long time, many cycles and lots of money if you want to keep trying to find a good one. I transfered 6 embies from 4 full cycles, 2 were average graded and 4 were graded good/very good. But none took and if they were chromosomally normal, youd think after 6 tries that at least one of them would have made a baby.
Being a poor responder means no matter what doses of stim or type of stims you take, you dont get many eggs. 'Normal' responders should produce 10-12 eggs. Poor responders consistently get less. In my last 3 stim cycles i only got 4 eggs each cycle, so 12 eggs in 3 full stim cycles. A normal responder could get 12 eggs just by doing 1 cycle. So they problem with being a poor responder is that your not getting good chances each time you do a cycle. If you have 12 eggs the odds of getting a good 1 are much higher.
There seems to be a correlation between poor egg quality and a poor response. Many ladies have both. So, it makes it even harder to succeed. 1) you have less good eggs overall and 2) its harder to find them because your only pulling out 4 eggs at a time.
Someone explained it like this once and it helped me understand:
Looking for the golden egg is like if you have 100 fish in a barrel. The fish are your eggs. If you have good quality eggs there would be 20 golden fish in there. The other 80 are no good. This is same as normal fertility. I.e. 20% chance.
If you have poor egg quality, there might be say only 1 - 5 golden fish in there. I.e. 1-5% chance.
So you will have less chance of having a golden egg overall.
A round of ivf is like scooping a net into the barrel and collecting a batch of the fish. Normal responders can scoop out 10 fish at a time. So they can find the golden egg faster (less ivf cycles) because after 10 scoops, getting 10 fish each time, thats the whole 100 fish- you would have found the golden egg for sure. Poor responders, only scooping out 5 fish at a time would have to put the net into the barrel 20 times, with 5 eggs each time to scoop out the 100 eggs.
If that makes sense? The more % of good eggs and the more you can scoop out, the more likely you are to find the golden egg.
I think of myself as having a small percentage of good eggs in the first place because i have tried naturally for 20 cycles and they got 20 eggs in ivf. So out of 40 eggs, they didnt fertilise or died off in days 1-5 and the 6 embryos i transferred didnt take. So im like none from 40. 40 eggs and not one of them resulted in pregnancy. I dont have blocked tubes so all my natural cycles had no reason not to work. So when i think, in a barrel of 40 fish, ive scooped them all out and not one of them was golden. My other problem with ivf is being a poor responder getting 4 eggs each ivf (which is $$$ and mentally and physically awful) its going to take so much money and pain to keep trying.
I have endometriosis and the drs say often ladies with endo tend to have poor egg quality. Unfortunately im a poor responder too.
There is a correlation in that its not usual for a woman to have great quality eggs and be a poor responder. If you are a poor responder, your more likely to have poor egg quality too.
Wow, what a long posts. I just wanted to try and explain about how the grading system doesnt really tell you much in terms of your egg quality. Only doing lots of transfers and failing will indicate poor egg quality. And only doing lots of cycles and not getting many eggs will indicate poor response. xox
Last edited by gorgeousgeorge; 30-07-2016 at 09:36.
LillyM - this is correct. Day 5 biopsy has become the preferred process for PGD rather than day 3 as at day 3 there are much less cells and therefore potentially a higher risk of damage. There is a small risk of damage with the PGD biopsy process however it is just that - small - and if a reputable clinic and scientist is doing the biopsy the risk should be minimal. There are risks with many parts of IVF -fertilisation with ICSI also has theoretical risks however most times the potential benefits outweigh the small risks.
@pingc383 my above post, upon reading back sounds a bit morbid. Most specialist will diagnose you as poor quality poor responder after about 4 full stim cycles with low egg numbers and no pregnancy from any embryos transferred. I think thats when they feel they have enough evidence to, rightfully imo, explain to you that ivf is not likely to be a quick and easy solution for you. They WILL let you keep trying though, for as long as you want and many ladies just keep going and they do find that 1 golden egg.
Like most of the ladies here whove moved on to donor eggs, we just decided that we didnt have the time, money and or mental/ physical strength to keep searching for our own golden eggs. Lots of ladies do persevere and are successful eventually. No one but you will know when its the right time to 'give up' on your eggs.
And, lovely, if you are only up to your second cycle, you dont have to worry about any of this stuff yet :-) But its good to know anyway, i think. You might find after 4 stim cycles your specialist will start to mention this stuff.
I hope you get preggers asap and you wont need to worry about any of this xox
@pingc383 hi lovely, pkease dont let me worry you needlessly- im not qualified to give medical diagnoses- if youve 'only' done 2 cycles, no one can tell if you are a poor responder yet. 10 eggs from a cycle would be considered good / normal response, so i guess at this stage, 1 good cycle /egg numbers and 1 not so good cycle/less eggs, who know? Sonetimes they say you can just have an "off" cycle. So in 2 cycles, they cant really tell if you are consistently getting a poor response. I guess you are at 1 out of 2 cycles. Whereas i was 3/4 poor cycles. My first cycle i got 8 eggs, 7 fertilised, and had 3 blasties on day 5, so i thought everything was ok. Then on my second cycle i only got 4 eggs, 3 fertilised and 1 blastie on day 5. So then i thought, oh, maybe this was just a one off bad cycle. My 3rd cycle was like the second one, and i started getting worried. My 4th cycle was a bad as cycles 2 and 3, so i realised things were not good at all and that my first good cycle was actually the 'abnormal' one in that it was the odd one out, from the 4 cycles i did.
Who knows, my 5th cycle might have been great and gotten a bfp or my 6th or 7th... but i figured i couldnt bear what i would have to go through for an indefinate amount of time with no good prospects of a positive outcome.
Basically, you and your FS have to do about 4 full cycles to start to see a pattern. I dont think any FS would recommend changing to donor ivf until after 4 full cycles using the results of the 4 cycles as evidence for suggesting poor egg quality. I think they feel that they are obliged to inform you that, now they have evidence from 4 cycles, they think things will be difficult.
I havent done the protocol you mention. I just did what my specialist recommended, increasing doses of gonal f until my last cycle i was taking the max. dose i think. I like my FS , trust him and think he is one of the good ones. He also specialises in endometriosis, as well as ivf so that my particular problem so i feel lucky he's the one closest to me. Its helpful for me that because i have nothing else wrong with me besides endo, that i count in my natural cycles as evidence that my eggs are poor quality. I tried for 16 cycles from ages 30-31 and thats young imo. So for me, it seems that even at the age of 30 it seems that my eggs were no good.
To be honest its that first cycle i did with 8 eggs that made it the hardest. I almost wish all my 4 cycles were crap because i kept clinging to that first cycle as good and hoping the next 3 were anomolies. @Maxwellsmum so lovely when someone says, "thats like me!" Iykwim. And, lol, if drinking too much and eating junk foid and having left over unshiftable prednisolone weight is an issue, then ive definately got issues mate!
Yeah, that fish in a barrel thing was said by someone else on bubhub and it helped me understand. I frucking hate fishing, literally and metaphorically!!!
Last edited by gorgeousgeorge; 30-07-2016 at 10:13.
pingc383 i dont know much about the dh's sperm results stuff. Other ladies im sure will know or be able to point you towards more info.
I think, that the sperms dna does affect the embryo quality too though. I think, but not sure, that if the sperms dna isnt great but you have a good egg, the egg can compensate for the sperm for a few days, i.e. the emby will "look good" under the microscope on day 5, but a few days after that the poor sperm quality will affect the embryo overall and it wont be 'golden'. I am not sure about this though. Other ladies will chime in eventually and give better information, i guarantee. @BlondeinBrisvegas knows everything about eveything!
Im almost certain that the only thing that can be done, to check your embryo is euploid (chromosomally normal ) is to do pgd testing. They literally count that the emby has 26 chromosomes, 13 from egg dna and 13 from sperm dna. Embys with 26 chromosomes, i.e. a pair (1 from mumma and 1 from dad) of chromosome 1, a pair of chromosome 2, a pair of chromosome 3, and so on, up to chromosome 26, is highly likely to result in pregnancy because it will make a viable human being. Im interested to hear what other ladiessay about the sperms dna effect on an embryo :-)
@pingc383 yeah i thought law was no more than 2, only after age 35, and after 2 failed transfers but each clinic or state laws might be different. If its your 2 cycle only and if you got 4 frosties that could be a positive thing. If the embys are poor quality and you only get a 2- 3 eggs n day 5, like some of us do, then its rare to get any frosties at all. I only ever got 2 frozen from my first cycle. 1 didnt work and 1 didnt thaw. So again, there's no way to know if your 4 frosties are golden but the fact that you had 4 embys at all is a good thing (in terms of response) and the fact that the 4 of them were good enough to freeze is also a good thing but again, thats no guarantee they are euploid/normal. It also coukd be seen as a positive thing to be able to transfer 4 embys without having to do and pay for, 4 full stim cycles. This sounds harsh, but that way, even if they dont work (which will be davastating each time that happens) at least its a cheaper way to gather evidence of suggested poor embryo quality. Some (lots of?) us end up with only 1 or 2 embies to transfer and nothing to freeze. So then you have to take all the drugs, have the full epu operation and pay full cycle costs 4 times and it takes 4 times longer to "try out" 4 embryos. So im trying to think of some things for you, in a positive way. Unfortunately with ivf despite everything they can do, there are still no definate guarantees of anything really. Its such a hard kesson to accept!!! Thats what makes ivf so hard and why it sends us all crazy! ;-)
Last edited by gorgeousgeorge; 30-07-2016 at 12:16.
Oh and i only have bubhub on my phone so i cant see what fertility issues you have and yeah, im just a lady on bubhub not a doctor so the stuff ive said is either repeating things ive heard/read other people say or my way of thinking about my specific fertility issues and my ivf journey's results. Always happy to help, respond and share :-) but im not the bible of fertility, ive just read and experienced a bit more stuff than the 'normal' ivf-er, if there is such a thing as 'normal' ivf. I wonder sometimes???
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