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IVF and embryo arrest

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. HI. I am a 29 yr old female and my husband is a 35 yr old male. My husband has a low sperm count and low motility and we recently just went through our first IVF cycle. I had 14 eggs that were retrieved and 11 of those fertilized normally.
On the day of the implantation we were told that all 11 looked great, and they implanted one blastocyst. However, just a couple of days later I was told that all of the remaining embryos arrested and only one that had just reached the blastocyst stage (had been a morulla - not sure of this exact name) had been frozen.
My husband and I are very let down. I am still in the 2 week wait period so I do not know if I am pregnant. The clinic said that this was just something that happened. However, I cannot get over the odds of the remaining 9 all arresting when everything was progressing nicely with them. They told me they were unable to determine why.
What you think is the likely reason this happened? And if it was just something that happened that are the odds that the embryo that they did implant would take this same path? I am a healthy female and was told I was a very good candidate for IVF. We never did any IUI cycles.

Thank you so much- hoping you can shed some light on this situation for me!



Category: Infertility Specialist

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Category: Infertility Specialist
Dr. Aarti Vazirani is online now

Expert:  Dr. Aarti Vazirani replied 4 Days.

Hello,

Thanks for writing to DoctorSpring.com with your health concern.

Sometimes what matters is not the number of eggs, but the quality.
Also, when a lot of eggs are retrieved, the quality exponentially declines.
Sometimes, when just 10 eggs are retrieved, they turn out to be overall better than 14 eggs, which are not of a very good quality.

Also, as you mentioned, there was a problem with your husband's semen count.
When the semen count and motility is low, then majority of sperms have poor chromosomal content.
These sperms might be able to fertilize the ovum, but then the development does not proceed as normally, hence the blastocyst arrest can be explained by that.

Another possibility is that the quality of preservation at the laboratory might not be up to the mark.
If the ambient temperature and other factors even deviate slightly, the embryos go into maturation arrest.

Yes, it is quite normal to worry over the one that is implanted.
However, factors inside the uterus are far more conducive to pregnancy development than in a laboratory.

There is no reason to assume that the implanted embryo would also be blighted.
However, in case this cycle fails, and you decide to go for a second cycle, make sure you go for PGD ( pre implantation genetic diagnosis ) and DNA fragmentation tests.
IT will tell you the reason for what happened, and possibly, an solution too.
Right now, just cross your fingers, and stay positive.

All the best. Would be glad to answer any follow-ups.
Take care.


Patient replied :

Hi Dr. Vazirani,
Thank you for your incredibly thorough and clear response!

I have one two other questions-
We went through ICSI. Would this be your recommendation or would you recommend regular IVF? During ICSI do they have the capability to select the best sperm?

Also, we did have genetic testing prior to IVF and it came back clear for both my husband and I. Is that what you mean by PGD or is this an actual test they can do on embryos already retrieved?

Again, you are very informative and thorough and I thank you for that!

Best Wishes.


Expert:  Dr. Aarti Vazirani replied 3 Days.

Hello
Thank you for the appreciation.

Firstly, for both ICSI and IVF the best sperms are processed and selected, as in the most motile ones. However, this encompasses only the motile looking sperm. Actual quality of the sperms can be assessed by the DNA fragmentation test which is specific for the quality of sperms, vs the quantity.

ICSI and IVF are both comparable, as the processing of the sperms is the same, but ICSI is preferable, because the sperm is directly introduced inside the egg, thereby increasing chances of fertilization, particularly in men with counts on the lower side.

Genetic testing is for both of you, PGD ( pre implantation genetic diagnosis ) as the term implies, is a genetic testing performed on the embryos that are harvested PRE implantation, or just before transfer, to select the genetically superior embryos to be transferred, thereby increasing chances of implantation, and decreasing chances of failure.

All the best.
Please feel free to contact me anytime.
Wish you luck!


Dr. Aarti Vazirani
Category: Infertility Specialist
Experience: 
Residency: Obstetrics & Gynecolog, BJMC,Civil hospital, Ahmedabad, 2008
Post Graduate: MS (Obstetrics & Gynecology), B.J. Medical College, Ahmedabad, 2008
Medical School: MBBS, B.J. Medical College, Ahmedabad, 2004
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