Saturday, April 27, 2013

Why do some embryos stop growing in the IVF lab ?


If you have gone through IVF, you may have heard your IVF doctor or embryologist say - “Some of your embryos stopped developing (got arrested), and we had to discard them .” There are some unlucky women who end up with no embryos to transfer,  because all their embryos stopped developing at some time point during their preimplantation growth ! Why does this “developmental arrest “of embryos happen ? Are there any ways to prevent it ?

About 15% of IVF embryos arrest during mitosis (during cell division) at the 2-4 cell cleavage stage. Some arrest immediately following fertilization and will not divide past the one-celled stage. Over half of all arrested human embryos display chromosomal abnormalities (genetic defect). This means the commonest reason of in vitro developmental arrest is a genetic problem, which prevents the growth of abnormal embryos. However, this is not the only reason for the arrest.

. An embryo might undergo developmental arrest because of :

1)    Sub-optimal culture conditions
2)    Chromosomal abnormalities
3)    Failure to activate its embryonic genome
4)    Mitochondrial defects

When embryos are exposed to sub-optimal culture conditions in the IVF lab ( for example, when the lab incubators malfunction; or if there is an infection in the culture medium) , they might stop dividing further because of the insult they have suffered. If you learn that the greater proportion of your embryos have stopped growing, please ask the the embryologist about the possibility of lab error, and ask them to show you how embryos from other patients are faring under the same culture conditions. This will help you to understand whether lab conditions have played a role in the growth arrest of your embryos . Some labs maybe understandably reluctant to share this information with you, and this should serve as a red flag.

Oocytes from women of advanced maternal age have a higher chance of carrying genetic defects such as aneuploidy (wrong number of chromosomes). Such oocytes , when fertilized , can give rise to embryos; but depending on the chromosomal abnormality they are carrying, they stop growing at different time period. Some do not get past the single-celled stage (zygote stage); some stop developing before they are transferred to the uterus (in the IVF lab petri dish); some after being transferred to the uterus; and some even after implantation (remember that 60% of miscarriages happen because of a genetic abnormality in the embryo !). Genetic lesions in embryos are one of the commonest factors for developmental arrest, which is why embryos from older women are more prone to growth arrest when compared to embryos of younger women !

When the egg and the sperm fuse together , fertilization happens and an embryo is formed. The embryo thus formed carries the genetic material from both the mother and the father. On the first day of its formation , an embryo is just a single-celled entity. This single-celled embryo develops into a full-fledged baby provided it carries all the necessary genetic information .  The initial few cell divisions of a single celled embryo are carried out by the information provided by the oocyte (egg) and not by the sperm . The cytoplasm of the egg contains key information which will help the embryo to divide upto the 4-8 cell stage. It is only after the the 4-8 cell stage that the embryos’ own genome gets activated , and it produces the information necessary for further development. In some embryos this genomic activation fail to happen and they stop developing past the 4-8 cell stage, causing developmental arrest.


An embryo needs energy for its development.  The energy requirement of the dividing embryo is met by specialized organelles called mitochondria, which are called “cellular power plants”. They carry their own genetic material. They synthesize energy molecules called ATP (Adenosine triphosphate). ATP is the “energy currency” of a cell and the cells utilize ATP to carry out several functions, including cell division. Because the mitochondria are found in the cytoplasm, the embryo gets all its mitochondria from the mother - from the oocyte cytoplasm The mitochondria from the sperm are immediately degraded after fertilization. When eggs from a woman of advanced maternal age are used to form embryos, there is a higher possibility that these mitochondria are genetically or functionally defective (as a result of aging !) Such defects compromise their function, including ATP production, as a result of which the embryo might not get enough energy to carry out its cell division , and will eventually stop dividing. This kind of mitochondrial dysfunction of oocyte has been proposed as one of the causes of developmental arrest. It has been shown that when the cytoplasm ( which contains the mitochondria ) from the oocyte of young women is transferred to the oocyte of older women (cytoplasmic transfer) , the developmental capability of the embryos was restored. Such kind of cytoplasmic transfer is being used to treat certain forms of infertility, leading to live births; but their efficacy and safety is yet to be appropriately investigated !

Once you find out your embryos have arrested in vitro, can anything be done to revive them  ? Sadly, the answer is no.  The arrest is irreversible and these embryos cannot be rescued. The important thing is to document this; and learn from it, so you can improve your chances of success in your next cycle.

If you are an older woman who has experienced developmental arrest of your embryos, donor oocytes can be a very good alternate option to have a baby. If you are young, and if you were informed that all your embryos have arrested, you should consider changing the IVF clinic. If this situation repeats itself, cytoplasmic transfer is one treatment option which you could explore; but this treatment is still in its infancy, and is not practised widely. If you are undergoing IVF, you should be aware that a very small percentage of your embryos can arrest during their development in IVF lab, and this is quite normal.

You should always ask your IVF clinic to provide you with photos of your embryos ! You can see what embryos should look like at www.drmalpani.com/embryos.htm

The bitter truth is that during IVF, not all the eggs can be fertilized; not all the embryos which are formed will be good enough to be transferred to the uterus; and not all the embryos which are transferred to the uterus will develop into a baby. Which embryo will become a healthy baby is a million dollar question, and hopefully in the near future, with the help of scientific advances, we will be able to pin point that single “good embryo” which will grow into the much desired baby. Until then it is wise to remember this – “all babies come from embryos but not all embryos can become babies” !


This is an excerpt from our forthcoming, book, The Expert Patient's Guide to IVF. This being authored by our expert patient, Manju and me.


You can email Manju at manjupadmasekar@yahoo.com


Her blog is at www.myselfishgenes.blogspot.com

98 comments:

  1. Andrea2:37 AM

    What are causes of failed embryonic genome activation in a young woman? I just recently underwent my second IVF w/ ICSI cycle where all 16 of my "excellent looking" embryos arrested at the 8-12 cell range. My RE is convinced it is my eggs, although all of my testing has been normal. Can there ever be issues with the sperm that can cause this to happen?

    ReplyDelete
  2. This is very unusual and maybe because of a lab problem ( infection or incubator malfunction).

    What happened in your first cycle ? Does your clinic routinely do blastocyst transfers ?

    Do you have photos of your
    embryos ?

    Dr Aniruddha Malpani, MD
    Malpani Infertility Clinic, Jamuna Sagar, SBS Road, Colaba
    Bombay 400 005. India
    Tel: 91-22-22151065, 22151066, 2218 3270, 65527073

    Helping you to build your family !

    My Facebook page is at www.facebook.com/Dr.Malpani

    You can follow me on twitter at https://twitter.com/drmalpani

    Watch our infertility cartoon film at http://www.ivfindia.com

    Read our book, How to Have a Baby - A Guide for the Infertile Couple,
    online at www.DrMalpani.com !

    Read my blog about improving the doctor-patient
    relationship at http://blog.drmalpani.com


    ReplyDelete
  3. Andrea10:52 PM

    In my first cycle, I had 10 mature oocytes, 5 fertilized, and all arrested at the 8-12 cell range as well. I switched clinics, and my new RE felt confident that my meds were dosed inappropriately and there was a lab issue. For this second cycle, I once again did the antagonist protocol, but was on higher doses. I had 29 mature eggs, 23 fertilized and had 16 "excellent" embryos on day 3 that all arrested. I do not have pictures, but they told me they looked very good. They were completely shocked. I am 23 years old. We are using my husbands frozen sperm that he banked in 2007 when he was diagnosed with leukemia. He had not had any chemo at that point. My RE says that he would bet this is due to my eggs. We are now about to start our 3rd IVF with donor sperm to r/o if I am the issue. Could sperm cause this problem?

    ReplyDelete
  4. No, this is very unlikely to be because of a sperm problem.

    You should always insist on embryos photos - every good IVF clinic provides these routinely !

    ReplyDelete
  5. Andrea12:12 AM

    The lab I am currently using routinely does blastocyst culture. They also use an embryoscope. Do you think this problem is due to my eggs?

    ReplyDelete
  6. If embryos arrest, the problem is far more likely to be because of an egg cytoplasm ( mitochondrial) problem, rather than a sperm problem. It's the mitochondria in the egg cytoplasm which power ( provide the energy) for cell division/ cleavage.

    ReplyDelete
  7. Dear Andrea,

    Is your husband's genome tested for translocations ? Is the reason behind his leukemia deciphered - is it due to genetical reasons ? Sometimes leukemia can be the result of translocations which affect the genome (a genetic defect which occurs during conception). For example, a translocation called phladelphia translocation can cause chronic myeloid leukemia. These kind of translocations are known to cause embryo growth arrest. (PMID: 14680550) Type in this number in pubmed.com, you will find the reference !

    Your age and healthy development of your embryos upto 8-12 cell stage rules out the possibility of oocyte defect (atleast to a great extent !) After the 8 cell stage activation of embryonic genome (which includes the paternal genome) happens. Since the embryos arrest around this time period, I do think translocation in your husband's genome is preventing embryos further development.

    You can ask for testing your husband's chromosomes for detecting translocation. If my guess is right, your will not have any problem reaching blastocyst stage with donor sperm. Good Luck !

    ReplyDelete
  8. I will be very grateful too if you could give a feedback after your IVF cycle with donor sperm !

    ReplyDelete
  9. Dear Andrea,

    You must be completely confused by now - you are getting such diametrically opposite opinions !

    In a mouse lab, we could do cross testing ( donor egg plus husband sperm ; and donor sperm plus egg) to see where the problem lies – but this is not possible in a human IVF setting !

    ReplyDelete
  10. Andrea4:20 AM

    Manju, by genome testing do you mean karyotyping? We were told two different stories: first we heard that he had not had it done prior to treatment, then we were told that he did and it was normal. However, we were unable to get a copy of the results of this? I had kayotyping done that was normal. His oncologists are unsure what caused his cancer (genetics, environmental factors, etc.) but we have been told by several oncologists that with leukemia and other types of hematological cancers, that infertility can be caused by the cancer itself, not just the treatment.

    I start my meds next week for our donor sperm cycle, so I will keep you posted. I am starting to believe that the problem is with my eggs, but it is just shocking to me with all normal testing (FSH, AMH, AFC, etc.) that I am the issue. I am only 23 years old. I guess we shall see.

    ReplyDelete
  11. I am happy that you replied. Sorry I haven't checked this post for a long time.Yes, I meant karyotyping. But not all karyotype can pick up all the translocations. I am eagerly awaiting to hear your donor sperm cycle outcome. Lots of good luck !

    ReplyDelete
  12. Andrea8:51 AM

    Sorry I didn't post sooner! The cycle with donor sperm was a success, at least partially anyway. I opted to do a day 3 transfer since we never had a transfer before, but I did not get pregnant. However, we had several blasts, 3 good enough quality to freeze. My RE still thinks I may have an issue with my eggs since he felt I should have had more high quality blasts, but we are just thankful to have made it to this point. I'll be doing a frozen embryo transfer next month, hopefully we will finally have success after trying for 3 years. Thank you very much for your support and information, it truly gave me hope during such a stressful time.

    ReplyDelete
  13. Dear Andrea,

    This is good news - best of luck !

    Do you have photos of your embryos ?

    ReplyDelete
  14. Anonymous10:42 AM

    I was going through ivf-pgd few weeks ago and yesterday was supposed to be my day of embryo transfer. I'm 31. My husband 32. All healthy and fit. We had 2 healthy daughters earlier on. And I had no problem conceiving naturally, just that we wanted a baby boy this time. The clinic called us yesterday morning and told us no need to go for embryos transfer anymore because the leftover 6 embryos . 2 were bad and 4 were all females and abnormal. Before egg extraction I had 16 eggs. Extract only 15 eggs. 5 disposed due to unripe, leaving only 10. Only 6 were fertilised. Now all 6 were abnormal and bad. We never expect such results. What could the reason be?

    ReplyDelete
  15. Hi Doctor,

    Thank you in advance for sharing your knowledge.

    I am 30 years old, with PCOS. My husband (32) has an above-average sperm count (measured between 85 million and 135 million at different times, with above average morph and motility). We conceived in 2009 naturally (without treatment) following Ovarian Diathermy and gave birth to a healthy girl who is now 3. In 2012, we started treatment again to try for #2. We started with FSH injections, as I didn't conceive on clomid (despite ovulating 3 times). After 5 injectables cycles (timed intercouse) with beautiful ovulations and BFNs, we decided to move on to IVF recently. I am a super-responder to the FSH, so I was put on 92 units, and the antagonist protocol. I overstimmed (and had to keep lowering the FSH -getting down to 66 units) - I managed to get 30+ follicles, and an estrogen level of 22000 (Australian measurements) 2 days before the Egg Retrieval. I was given a Lupron trigger to avoid OHSS and they retrieved 21 eggs. We chose to attempt fertilisation on 10 of them (without ICSI). 9 of them fertilised but *none* made it passed one-cell division.

    I have an appointment with my specialist shortly to discuss, but it sounds like they don't know what's going on? Do you think it's likely my eggs, or could it be sperm fragmentation? Is it possible for my eggs to have become so bad since my daughter was conceived 4 years ago? Would Ovarian Diathermy have a "good" effect on my eggs - helping me to have conceived? It doesn't *seem* to be a lab error (although it's always possible) because it's the first time our lab has seen anything like this. We don't really want to go down the egg donation option - but is it worth trying IVF again, or not?

    ReplyDelete
  16. I think your doctor did a bad job with superovulating you.
    This is a common problem with PCO patients. Doctors are often so scared of
    OHSS, that they end up mistiming the HCG injection, as a result of which they
    get few eggs and poor quality embryos.

    They then blame "poor egg quality" for their poor results

    We have extensive experience in doing IVF for PCOD patients,
    and our pregnancy rates are better than 45% per cycle for PCOD patients.
    You can read more about this at www.drmalpani.com/pcod.htm !

    We can also offer you a money-back treatment option.
    You can read more about this at www.drmalpani.com/moneyback.htm.


    ReplyDelete
  17. Hello Dr ,
    I am 30 yr old and staying in SA . My 2 cycles of ICSi also got cancelled due to no embryos left for transfer . As none made to blast stage . My husband has oligospermia and I have PCOD . I Changed my clinic again for 3rd IVF and the second new clinic Dr did ZIFT which again failed . First Dr who did 2 ICSI he said poor embryo quality is due to poor egg quality and second Dr who did ZIFT he said its due to poor sperm quality . I am confused what actually contributes to to poor embryo quality sperm or egg . 2nd Dr also introduced some term Y chromosome microdeletion responsible for embryos not growing beyond day 3 . Dear Dr Malpani i am totally confused what to do . Lates sperm count of my husband is 40 million/ml .
    Please suggest me what to do . thanks

    ReplyDelete
  18. Both your doctors are talking rubbish. Poor sperm do not affect embryo quality when we do ICSI.

    Your eggs are fine. The poor quality of the embryos is because of the poor quality of your doctors - not you !

    I don't think your doctor is doing a good job with superovulating you.
    This is a common problem with PCO patients. Doctors are so scared of OHSS, that they end up mistiming the HCG injection, as a result of which they get few eggs and poor quality embryos.

    We have extensive experience in doing IVF for PCOD patients,
    and our pregnancy rates are better than 45% per cycle for PCOD patients.
    You can read more about this at www.drmalpani.com/pcod.htm !

    We can also offer you a money-back treatment option.
    You can read more about this at www.drmalpani.com/moneyback.htm.

    Should I send you the treatment plan ?

    Your chances of conceiving with the right treatment are excellent because you are young.

    We look forward to helping you to have a baby !

    Dr Aniruddha Malpani, MD
    Malpani Infertility Clinic, Jamuna Sagar, SBS Road, Colaba
    Mumbai 400 005. India
    Tel: 91-22-22151065, 22151066, 2218 3270

    Helping couples build families !

    PS Read our book, How to Have a Baby - A Guide for the Infertile Couple,
    online at www.DrMalpani.com !

    The

    ReplyDelete
  19. Anonymous5:53 AM

    In 2010 I had ICSI

    12 eggs, 9 mature, only 3 made it to day3. One arrested on day3, one was a perfect 4 cell, one was a 5 cell with fragmentation. No pregnancy. & slow developing embryos.

    In 2012 I egg shared they took my eggs 3 days earlier than my last cycle! I got given 4 eggs, only 1 was mature! That embryo stopped developing at one cell.

    I am now 29, I have been pregnant with a previous partner. My fiance has never fathered a child and he is 42, his ex's went on to have children after they had split up (he has 'tried to concieve' with 2 other women & knew more about ovulating than I did when we started)

    His sperm has only 4% normal forms & progression around 20%. He only has one kidney so is missing a vas deferens. We have been trying to concieve for 7 years naturally plus the above 2 cycles.

    Ive been told my right ovary looks 'slightly polycystic' after a nurse gave me an internal scan.

    We may try icsi 1 last time or move on to donor. Any idea why this has happened?

    Do you think the sperm in his testicle without the vas deferens could be any better than the ejaculate?

    He also has a 2mm varicele on his working testicle but NHS do not feel it causes any harm.

    Thank you.

    ReplyDelete
    Replies
    1. There are 3 important variables which can affect embryo quality : eggs; sperm and the lab. The sperm are unimportant; and in young women with good ovarian reserve, egg quality is usually not a problem. The first suspect would be the quality of the lab. My suggestion is that before you consider changing the sperm, please repeat the ICSI cycle at a better IVF clinic

      Taking treatment at a world-class clinic will maximise your chances of success and give you peace of mind you did your best !

      You can talk to some of our patients by email at http://www.drmalpani.com/success-stories.htm


      Delete
  20. Anonymous2:26 PM

    Dear Doctor
    I went through my second IVF with ICSI and did day 3 transfer today. I didn't have grade A Embies. transferred grade 2 and 3 with little fragmentation. And the doctor did not use ultrasound in transferring the. I am worried thinking that he put it in the right place. please advise

    ReplyDelete
    Replies
    1. How many cells did your embryos have ?

      Please send me a photo

      You can see what embryos should look like at www.drmalpani.com/embryos.htm

      We look forward to helping you to have a baby !

      Delete
  21. Anonymous9:38 AM

    Dear Doctor,
    My age is 37 and half.3 year back I suffered from endometriosis in my right ovary. I went for surgery. Right now I don't have endometriosis but still I am not able to conceive. I have taken treatment also but it didn't work. 2 days back I went for my first IVF prescribed by my gynecologist. she prescribed me Gonalf 375 IU 6 injection with citrotide 0.25 IU subcutaneous. 5 citrotide I have taken and inally she gave pregnyl. with the help of these medicine I got 6 eggs. out of them 4 were good. but as she told me that 1 damaged after retrieval. so the 3 remaining were good. after one day she called me and told that there were no growth in those eggs and the quality of eggs were not good. this is my 7th year of marriage and we both husband wife are eagerly wishing to have a baby. I am feeling depressed. And one more thing I want to tell that we don't want child with donor eggs. My husbands sperm mobility was 100%. Please suggest what to do.

    ReplyDelete
  22. Anonymous2:15 PM

    Dear Dr. Malpani,

    I'm from Belgium. Last Monday we had our third ICSI cycle. We did the first two in a different clinic because it is near to where we live. The first cycle was good as they said, they did the half with IVF and the other half with ICSI. Out of the eight eggs that we had 3 were fertilized with IVF and 3 with ICSI. They transferred 1 blastocyst on day give but did not implant. All the other five embryos got arrested. A month later we did another cycle. I was under stimulation with puregon and gonapeptyl. I overstimulated and the doctor decided to stop simulation for three days and a pick-up followed thereafter. We had 8 eggs from which 4 were fertilized. They transferred a 'beautiful' 8-celled d3 embryo while all the rest got arrested and the transferred embryo did not implant.

    So we decided to ask around for a second opinion. The doctors said there is nothing wrong with us. All DNA tests were good as they said. Before we started with the IVF I gave birth spontaneously to a healthy baby boy then I had three ectopic pregnancies which left us with no other option but do it this way.

    So we went to a second clinic and we started with a different stimulation: menopur and cetrotide. I had the OHSSyndrome but they were confident it will go right. Last Monday they aspirated 10 eggs and 7 were fertilized with ICSI. They call me everyday to inform their development. Yesterday they informed us that were have 5 five-celled embryos with a B classification, 1 seven-celled with no fragmentation and a nine-celled embryo with no fragmentation. But I'm worried, today is d4 and they informed me that they will only call me on Saturday to inform how they are and when they will be placed in cryo because we will only do a transfer in May because as they said it will not be viable for implantation since I had OHSS.

    Will the embryo's get arrested at morula stage? Why do you think did my eggs got arrested on our first two cycles?
    Will the embryos get arrested after being taken out of the cryo for implantation?
    Why do you think the embryos during our last two cycles did not implant?
    What do you think are my chances of having a successful pregnancy with this cycle?

    ReplyDelete
    Replies
    1. I agree this is frustrating.

      I can't understand how you could have developed OHSS with only 10 eggs !
      What was your E2 level ?

      Did they coast you ?

      One possibility for the arrest of the embryos is that your doctor did not do a good job with superovulating you.
      This is a common problem with patients with occult PCO. Doctors are so scared of
      OHSS, that they end up mistiming the HCG injection, as a result of which they
      get few eggs and poor quality embryos.

      I need more information to be able to provide you with intelligent advise.

      Can you please test your antral follicle count by doing a vaginal ultrasound scan ? Read more at www.drmalpani.com/afc.htm

      What’s your AMH level ? Read more at www.drmalpani.com/amh.htm

      Taking treatment at a world-class clinic will maximise your chances of success and give you peace of mind you did your best !
      You can talk to some of our patients by email at http://www.drmalpani.com/success-stories.htm

      Treatment can be expensive, but a baby is priceless.

      The fact you have conceived in the past means your chances
      of having a healthy baby are excellent, so please don't get disheartened !

      We look forward to helping you to complete your family !

      Dr Malpani

      Delete
  23. Anonymous9:03 PM

    Hi Dr. Malpani --

    I am on a donor cycle. The mother has 2 children of her own, and another recipient of her eggs is currently pregnant. My cohort of 8 resulted in one Day-5 32 cell morula (not arrested). It actually started to develop fluid in the two hour timeframe I was at the clinic for my transfer. What are your thoughts regarding whether this is good/bad or the possibility of success. Day-5 is usually full blastocyst, but I also know it's not an exact science or fertilization could've taken place later in the day. I'll receive my blood work results today, but in the meantime, I'm unable to focus on work.

    ReplyDelete
  24. I need more information to be able to provide you with intelligent advise.
    Do you have a photo ?

    I agree this is worrisome

    Please remember the Serenity Prayer
    God grant me the serenity to accept the things I cannot change;
    the courage to change the things I can;
    and the wisdom to know the difference.

    ReplyDelete
  25. Anonymous9:47 PM

    Dear sir I am 38 and my wife 30 married in 2003.we are 3rd ganeretion relatives. In 2004 a abortion, in 2005 born a microcephalic malebaby and expired after 7months.next in 2006 a ectopic pregnency and remove left tube.in 2008 repeat the microcephalic and expired after 9 months.we examine the baby in vellore cmc, the chromosomal report is normal.The drs told a few chances are in chromosomal diseases.they give treatment for pregnancy and consiv these also microcephalic female.so they remove the baby. Our coriotypong blood reports are normal.so the drs told these are microcephalic mutations.next we go to a ivf centre they refer for donor egg in 2014 Aug done ET with 1a grade and 2b grade embrois.that is failure.next in2015 they start process newly for good embrois.4a grade and 3b grade embrois are frozen at 3rd day.in march.but wnen we are ready for ET they find the all embrois are arrested.so the ET was cancelled.the drs told next time we will go donor embrio for better chances.sir what is the cause for embrios arrestded.and is the donor embrio is right option? Please clarify my doubt.

    ReplyDelete
  26. Anonymous1:43 AM

    hello Doctor ,
    I am 33 years of age and my husband is 32.He has a good sperm count. I am suffering from PCOD and do not ovulate on my own. After 2 failed IUIs we decided to do an IVF. We retrieved 16 eggs however only 3 fertilized and on day 5 transfer we only had a compacting morula to transfer. The cycle was unsuccessful. My question is why did the eggs not fertilize? and is it even worth it to go for another IVF. Could there be a problem with the eggs since they are not fertilizing? The doctor did ICSI on only 3 of the eggs out of the 3 ICSI eggs 2 fertilized however none reached the blastocyst stage.What could the issue be?
    Your help and answer would be much appreciated. I am currently in US and planning to have another IVF in India if it is recommended.Thank you.

    ReplyDelete
  27. hello dr ...
    i had a ivf icsi on 1st aug 2015 n embroy transfered were 4..[3x4 cell grade 1 n 1×6 cell grade 2] n i got positive beta hcg on 15 aug 260.80 n thn i went for ultrasound n the result was:-
    yolk sac visualized no fetal pole no cardiac activity. n was told to come aftr 7 days
    but i went bck to my ivf centre n got u/s n the result over there was -
    intrauterine small gestation sac seen
    yilk sac n fetal pole seen .
    crl measure .35mm .
    n hcg was 7200.
    again after 10 days i went for u/s n dr said no fetal n yolk sac is there n he said tht baby has stopped growing ....
    n told me to have a d n c ....
    i m shattered n dont knw y the baby stopped growing ..
    i m 31 yrs old n hve pcod n amh is 5.49
    my husbnd sperm count is 40.

    ReplyDelete
    Replies
    1. Dear Seema,

      I agree this is frustrating
      This suggests you have an anembryonic pregnancy ( missed abortion)

      Read more at http://www.drmalpani.com/early_pregnancy_scans_atlas.htm

      Do NOT do a D&C for this. This can cause Asherman syndrome ( intrauterine adhesions).
      Read more at www.drmalpani.com/knowledge-center/articles/asherman
      Ask them to terminate it medically with mifegest and misoprostol

      The commonest reason for a miscarriage is a genetic abnormality in the fetus, and this is Nature’s defense mechanism, to prevent the birth of an abnormal baby. While these defects are often random, they are commoner in older women. This is because the eggs of older women have more genetically abnormalities, because they have “aged” and have genetic defects, which cannot be screened for.

      The fact you have conceived once ( even though you did miscarry) means your chances
      Of having a healthy baby are excellent, so please don’t get disheartened !

      Taking treatment at a world-class clinic will maximise your chances of success and give you peace of mind you did your best !

      Treatment can be expensive, but a baby is priceless. Our charges are very cost effective because of our high success rates !

      We look forward to helping you to have a baby !

      Dr Aniruddha Malpani, MD
      Malpani Infertility Clinic, Jamuna Sagar, SBS Road, Colaba
      Mumbai 400 005. India

      Clinic Mobile: 9867441589

      Tel: 91-22-22151065, 22151066, 2218 3270, 65527073

      Helping you to build your family !

      You can add a google review for us at https://plus.google.com/102706636605134081909/about

      My Facebook page is at https://www.facebook.com/aniruddha.malpani

      You can follow me on twitter at https://twitter.com/drmalpani

      Watch our infertility cartoon film at http://www.ivfindia.com

      Read our book, How to Have a Baby - A Guide for the Infertile Couple,
      online at www.DrMalpani.com !

      Read my blog about improving the doctor-patient
      relationship at http://blog.drmalpani.com

      Delete
  28. Hello Doctor,
    Wondering what my best option is. I have 3 3day embryos frozen since november 2013. We tried 1 day 3. Bfn. Then we grew 4 to day 5 had 2 transferred. Bfp twins. The other two not good enough to refreeze. I would really like 1 more baby, these are from donor eggs. Would my chances be better trying 1 at a time at day 3 no further growing in the lab?

    ReplyDelete
  29. You should grow them to Day 5 before transferring them

    ReplyDelete
  30. Hi Dr.Malpani
    I've just had a failed IVF cycle :
    poor ovarian reserve AMH 7 and antral follicle count 6 .
    Age 35
    No previous pregnancies
    Congenital (familial ) hypothyroidism

    IVF cycle :
    Gonal F 150
    Menopur 300
    Cerrotide at day 5
    Egg collection Day 12
    10 Eggs collected :6 immature :4 fertilised and all 4 showed early fragmentation at Day 2 .
    What factors may be issue here : at tracking scan there were ever only 2 follicles leading the way : all others were small at 1.4 or 1.5 mm .
    Is fragmentation preventable
    What may have caused such a poor cycle .

    Kind regards

    ReplyDelete
  31. Can you please test your antral follicle count by doing a vaginal ultrasound scan ? Read more at http://www.drmalpani.com/knowledge-center/articles/afc

    We look forward to helping you to have a baby !

    Dr Aniruddha Malpani, MD
    Malpani Infertility Clinic, Jamuna Sagar, SBS Road, Colaba
    Mumbai 400 005. India

    Clinic Mobile: 9867441589

    Tel: 91-22-22151065, 22151066, 2218 3270, 65527073

    Helping you to build your family !

    You can add a google review for us at https://plus.google.com/102706636605134081909/about

    My Facebook page is at https://www.facebook.com/aniruddha.malpani

    You can follow me on twitter at https://twitter.com/drmalpani

    Watch our infertility cartoon film at http://www.ivfindia.com

    Read our book, How to Have a Baby - A Guide for the Infertile Couple,
    online at www.DrMalpani.com !

    Read my blog about improving the doctor-patient
    relationship at http://blog.drmalpani.com

    ReplyDelete
  32. Hi there,
    I am wondering what could be the problem with our embryos. I did 4 IVF's before having a Lap which found grade 3 endo and was removed. The first IVF we did natural fertilisation and had 80% rate, with moderately fragmented embryos making day 5 but they grew them to day 6 and then they deteriorated. I then did 3 more cycles of very poor results - sticky follicle syndrome. Since having endo removed I just did a cycle and we had 5 eggs retrieved, 4 were mature and all 4 fertilised with ICSI. They did ICSI because I was wanting to do PGD. My husband has 9-16% normal morphology and the rest of his parameters were normal and the DNA fragmentation test said his sperm was excellent. He is 32 years old. I am 36 (nearly 37). We had 2 embryos arrest at 3 cell stage - i.e. weren't growing from day 2 to day 3 so I think they disposed of them :( The other 2 were only 4 and 5 cells at day 3 which is also behind what they should be. They did say the 5 cell had no fragmentation at all and was perfect 5 cells, and the 4 cell has only mild fragmentation. This is a big improvement for us albeit the cells are growing slowly. The 5 cell went onto day 4 to become 7 cells and the 4 cell became 8 cells on day 4. The 7 cell then arrested and the 8 cell became a compacting morula then stated to disintegrate. They said I have nothing to transfer or test once again. I have had 4 chemical pregnancies so obviously in my body they can implant (hence blastocyst is possible). I am wondering if its possible the eggs were past it as I had EPU on day 17 (I was on 225IU FSH and Femara 5mg day 3-7)? Or do you think the sperm could be an issue? Any advice much appreciated! I want to know what I need to do to improve for my next cycle.

    ReplyDelete
  33. I agree this can be very frustrating.

    What’s your AMH level ? Read more at http://www.drmalpani.com/knowledge-center/infertility-testing/amh
    Can you please test your antral follicle count by doing a vaginal ultrasound scan ? Read more at http://www.drmalpani.com/knowledge-center/articles/afc
    Can you send me more details about your IVF cycle? What was the E2
    ( estradiol) level in the blood at the time of the HCG trigger ? DO YOU HAVE PHOTOS OF YOUR EMBRYOS ? What was the endometrial thickness ?
    Can you please send me the printed treatment summary from your IVF clinic ?

    Repeating the ICSI cycle with better superovulation and careful monitoring and transferring better quality embryos would be your best treatment option
    as it would maximise your chances of conceiving. You can read more about our approach at www.drmalpani.com/knowledge-center/failed-ivf/failedivf

    Treatment takes about 20 days. Should I send you the treatment plan ?

    You can read about how we take care of our patients at http://www.drmalpani.com/knowledge-center/articles/pampered-ivf-patients

    Taking treatment at a world-class clinic will maximise your chances of success and give you peace of mind you did your best !

    You can talk to some of our patients by email at www.drmalpani.com/success-stories

    We look forward to helping you to have a baby !

    Dr Aniruddha Malpani, MD
    Malpani Infertility Clinic, Jamuna Sagar, SBS Road, Colaba
    Mumbai 400 005. India

    Clinic Mobile: 9867441589

    Tel: 91-22-22151065, 22151066, 2218 3270, 65527073

    Helping you to build your family !

    You can add a google review for us at https://plus.google.com/102706636605134081909/about

    My Facebook page is at https://www.facebook.com/aniruddha.malpani

    You can follow me on twitter at https://twitter.com/drmalpani

    Watch our infertility cartoon film at http://www.ivfindia.com

    Read our book, How to Have a Baby - A Guide for the Infertile Couple,
    online at www.DrMalpani.com !

    Read my blog about improving the doctor-patient
    relationship at http://blog.drmalpani.com




    ReplyDelete
  34. Hi dr.
    I am 31 and my partner is 38. We started our ivf a year ago after discovering he has low count and extremely poor motility (0.2%). Dna fragmantatoion was done, and we "still had something to work with".
    Sperm analysis
    - concentration 13.5million
    - sperm per ejavulation 16.2 million
    - sperm motility 5%
    - vitality 12%
    - morphology normal 0.5%
    First cycle
    - 10 eggs retrieved
    - 10 fertilised
    - 6 made it to day 3
    - 2 made it to day 5
    - 1 remained suitable for transfer, but did not reach blastocyst stage
    - chemical pregnancy only

    Cycle 2
    - 10 eggs retrieved
    - 5 fertilised
    - 3 made it to day 3
    - 1 suitable for transfer, but was not blastocyst
    - pregnancy test negative

    Both cycles were done at same clinic. First on normal cycle second on long stumulated cycle.

    We have no idea why all the embryoes arrested before day 5 and why none are making it to blasocyst stage. Could this still be a sperm issue or something else? Please help

    ReplyDelete
    Replies
    1. No, it's very unlikely to be a sperm problem.
      Can you send me more details about your IVF cycles ?
      DO YOU HAVE PHOTOS OF YOUR EMBRYOS ?

      You can see what embryos should look like at http://www.drmalpani.com/knowledge-center/ivf/embryos

      What were the meds which were used for
      superovulation ? What was the dose used ? How many follicles did you grow ? How many eggs were collected ? What was the E2 ( estradiol) level in the blood ? What was the endometrial thickness ?
      How many embryos were transferred ?
      What was the embryo quality ?
      Can you please send me the printed treatment summary from your IVF clinic ?

      We look forward to helping you to have a baby !

      Delete
  35. Hello, Im 41, AMH 3,5. my fiance has very good sperm, he is 45. We had our first cycle, 12 eggs retrieved, 8 mature, 4 fertilized, one bastocyst, biopsy and PGS said aneuploidy. So we ended with zero to transfer. We are very sad. Should we change our clinic? Is this a common phenomenon?

    ReplyDelete
    Replies
    1. Dear Cubana,

      At your age, it's very common for your embryos to be aneuploid.

      This is because the eggs of older women have more genetically abnormalities, because they have "aged".

      Delete
    2. Dear Dr, thank you for your answer, Im a doctor too but different field, this is like a new world for me. I have not kids, and I am running out of time, do you think my Dr should try a more agresive Superovulation? How could I visit you in your clinic if my treatment here in US doesnt work?

      Delete
  36. Preview

    Edit
    Unknown said...
    Hi Dr,
    I had 2 previous ICSI cycles with my husbands sperm 100% fertilisation but no pregnancy as I was told maybe my eggs ran out of energy due to my age. I did produce 2 grade B embryos first time and 3 grade A 2nd time. So I decided to use donor eggs this time. Donor produced 7 mature eggs of which 5 fertilised with ICSI. Now yesterday at day 3 in the embryoscope only one of the embryos was a 6 cell grade 1-2 embryo the other 3 were only 3-4 cells they said it is because of my husbands sperm being not strong because they are from TESE and we're frozen...but how come I made better embryos at 41.5 years than the young donor...is it the donors eggs at fault or are they telling the truth and it is my husbands sperm? My understanding is once the eggs are fertilised then the sperm has done it's job correctly and it's up to the energy in the egg to cause the cells to divide. Now the clinic give a guarantee of 2 good quality embryos on day 3 and if you don't achive this your next cycle is free..but say that because it's my husbands sperm at fault I do not qualify for the guarantee. Can you tell me the right reason for the cause of the poor cell division of the embryos please. I transferred the 3 day 6 cell embryo with assisted hatching and embryoglue under the clinics advice and my endometrium is 14mm. But I am now 42.5 and don't feel very optimistic. The whole point of using a donor was to get young eggs with lots of energy to divide..yet my eggs did much better and they blame it on the sperm quality..plus I also told them to use donor sperm if my husbands sample was not good enough so I feel it's the clinics fault...your advice will help me know where I stand and help me know what to say to them when I go see them in 2 days...it will also help me decide if I should do donor eggs again with my husbands sperm or adopt an embryo in the future should this treatment fail..thank you in advance!

    6:34 PM

    ReplyDelete
  37. No, I don't think the IVF lab did a good job. If they used frozen testicular sperm, there is a high risk they injected dead sperm, rather than live sperm. This would explain the poor fertilisation rate.

    Doing donor egg IVF/ICSI at a better clinic and using fresh testicular sperm would be your best option. Do a blastocyst transfer please

    We look forward to helping you to have a baby !

    Dr Aniruddha Malpani, MD
    Malpani Infertility Clinic, Jamuna Sagar, SBS Road, Colaba
    Mumbai 400 005. India

    Clinic Mobile: 9867441589

    Tel: 91-22-22151065, 22151066, 2218 3270, 65527073

    Helping you to build your family !

    You can add a google review for us at https://plus.google.com/102706636605134081909/about

    My Facebook page is at https://www.facebook.com/aniruddha.malpani

    You can follow me on twitter at https://twitter.com/drmalpani

    Watch our infertility cartoon film at http://www.ivfindia.com

    Read our book, How to Have a Baby - A Guide for the Infertile Couple,
    online at www.DrMalpani.com !

    Read my blog about improving the doctor-patient
    relationship at http://blog.drmalpani.com

    ReplyDelete
  38. Anonymous9:15 PM

    I had 1 embryo transfer it had six cells in one embryo are their changes of pregnancy? They told me it looked healthy before transfer?

    ReplyDelete
  39. I need more information to be able to provide you with intelligent advise.

    Was this a Day 3 embryo ? Do you have a photo ?

    We look forward to helping you to have a baby !

    Dr Aniruddha Malpani, MD
    Malpani Infertility Clinic, Jamuna Sagar, SBS Road, Colaba
    Mumbai 400 005. India

    Clinic Mobile: 9867441589

    Tel: 91-22-22151065, 22151066, 2218 3270, 65527073

    Helping you to build your family !

    You can add a google review for us at https://plus.google.com/102706636605134081909/about

    My Facebook page is at https://www.facebook.com/aniruddha.malpani

    You can follow me on twitter at https://twitter.com/drmalpani

    Watch our infertility cartoon film at http://www.ivfindia.com

    Read our book, How to Have a Baby - A Guide for the Infertile Couple,
    online at www.DrMalpani.com !

    Read my blog about improving the doctor-patient
    relationship at http://blog.drmalpani.com

    ReplyDelete
  40. Anonymous4:06 PM

    Hi...I had my egg retrieval 3days ago and Dr. Collected 12 eggs. Today I went to meet her and she said I have 5good quality embryos. Does it mean other 7eggs cannot be used? I am so sad and please somebody advise me can I have a hope on other 7 eggs? Can they grow and become grade A after day 3? Or do I have only 5 Embrayos from this entire IVF process. I am so upset after knowing there are only 5 good quality embryos. Please advise.

    ReplyDelete
    Replies
    1. Most eggs don't become embryos so please don't worry about this. Focus on the fact that you do have 5 good embryos please !

      Can you send me more details about your IVF cycle ?
      DO YOU HAVE PHOTOS OF YOUR EMBRYOS ?

      You can see what embryos should look like at http://www.drmalpani.com/knowledge-center/ivf/embryos

      What were the meds which were used for
      superovulation ? What was the dose used ? How many follicles did you grow ? How many eggs were collected ? What was the E2 ( estradiol) level in the blood ? What was the endometrial thickness ?
      How many embryos were transferred ?
      What was the embryo quality ?
      Can you please send me the printed treatment summary from your IVF clinic ?

      Delete
  41. Anonymous12:21 PM

    Hi doctor, I am 29year old my husband is 33 year old.we did ivf with icsi and transfered 3 embryos in day 3.2 embryos are 8 celled and 1 is 4 celled bur ivf got failed.planning to do FET with 3 day 2 frozen embryo.my husband is suffering from azoospermia, but we got sperm through mesa.they said the morphology is .5%
    The frozen embryos are day 2 with 2cell,3cell and 4 cell.my embryologist said that blastocyst is difficult as there are only 3 embies and they are slow growing embies.should I go for day 3 or shall I take risk and wait for day 5.

    ReplyDelete
    Replies
    1. Why didn't you grow all your embryos to the blastocyst stage before transferring them in the fresh cycle ? All good labs do this routinely

      It's very unlikely that slow growing embryos will become a baby just because they are transferred into the uterus, sorry. It makes more sense to grow them to Day 5 in the lab before transferring them, provided your lab is good. If they are going to arrest, then why subject yourself to the torture of the 2ww needlessly ?

      Dr Aniruddha Malpani
      Malpani Infertility Clinic, Jamuna Sagar, SBS Road, Colaba
      Mumbai 400 005. India

      Clinic Mobile: 9867441589

      Tel: 91-22-22151065, 22151066, 2218 3270, 65527073

      Helping you to build your family !


      Watch our infertility cartoon film at http://www.ivfindia.com

      You can add a google review for us at https://plus.google.com/102706636605134081909/about


      Read our book, How to Have a Baby - A Guide for the Infertile Couple,
      online at www.DrMalpani.com !


      Delete
    2. Anonymous1:45 PM

      Thanks for your timely reply, I am not very much sure about the lab conditions.if the embryo didt reach blastocyst in lab,does it mean it will not reach blastocyst in uterus if transfered in day 3.Please clarify doctor.I am in very much confused state.some people are saying that day 3 transfer might get blastocyst in uterus thought it might fail to go to day 5 in lab.since I have just 3 frozen embies and am not sure how many will survive thawing process.

      Delete
    3. This depends upon how good the lab is !

      We do only Day 5 transfers in our clinic because we are very confident that if it not going to become a blastocyst in our lab, it will not become a blastocyst in the uterus either !

      Delete
    4. Anonymous6:23 PM

      I highly appreciate your timely response.Thanks for your reply Doctor.I am feeling positive now hope for the best.

      Delete
  42. Anonymous4:56 PM

    Thanks for your timely reply, I am not very much sure about the lab conditions.if the embryo didt reach blastocyst in lab,does it mean it will not reach blastocyst in uterus if transfered in day 3.Please clarify doctor.I am in very much confused state.some people are saying that day 3 transfer might get blastocyst in uterus thought it might fail to go to day 5 in lab.since I have just 3 frozen embies and am not sure how many will survive thawing process.

    ReplyDelete
  43. Sir my doctor tell me that u embryo were not developed properly. They used donor egg and sperm collected through testis

    ReplyDelete
  44. Anonymous1:52 PM

    Thank you very much for creating this blog.
    I just failed ny 1st ivf and would like to know what might have caused it.
    Egg retrieval done last friday, 11eggs retrieved(much lower than the anticipated 12 follicles each ovaries). 9 matures snd icsi was performed. The next day clinic told me only 2 fertilised. 2 no response. 5 deteriorating (the enbrologist saud it looks it looks wacky after icsi)! Today is day 3 and i just been told out of the 2 fertilised ones, 1 looks like arrested since day2 as it has only 4 cells.the other one defragmented badly. The 2 no response look the same.
    My profile: 36, hubby 38. I have mild pcos fsh 6.8, Lh 11.no thyroid. Amh 35.8. I am only 43kgs. Hubby sperm check is ok except low mophorlogy 3%.
    Protocol: top ivf clinic in malaysia. birth control pill for 25 days. Stimm at day 3 after period. 9 days of gonal f 250iu, 6 days of cetrotide 0.25mg each. Trigger shot at stimms day 13 night. Trigger shot 0.2mg.
    On the retrieval day, they managed to 10 eggs only (9 matures) despites the last follicles scan on day10 showing 24 follicles in total. I was having tummy pain few hours before egg retrieval. Doctor found a lot if fluid in my tummy as well.

    ReplyDelete
    Replies
    1. I have a feeling your follicles started to rupture before the egg collection

      What was your E2 level before egg collection ?

      How many hours after the trigger did they do the egg collection ?

      We look forward to helping you to have a baby !

      Delete
  45. Anonymous2:28 AM

    Hi doctor, I am 33 and have just had my first Ivf with Icsi which failed, I have a low amh count for my age which is 6.5 I also have a low follicle count, they managed to get 5 mature eggs from 5 follicles, all 5 fertilised, but they said 2 were abnormal the other 3 were growing well, they all made it to day 5 but not to blastocysts stage the 1 I had transferred they said was showing signs of early stages of becoming a blastocyst and the other 2 were a bit behind we asked them to give them 1 more day to see if they make it to blastocyst stage but by the morning they said they stopped developing, is this a sign that my eggs are not very good?

    ReplyDelete
    Replies
    1. Yes, this suggests you have an egg problem

      I agree this can be very frustrating.

      Can you send me more details about your IVF cycle ?
      DO YOU HAVE PHOTOS OF YOUR EMBRYOS ?
      You can see what embryos should look like at http://www.drmalpani.com/knowledge-center/ivf/embryos

      What were the meds used for
      superovulation ? What was the dose used ? How many follicles did you grow ? What was the E2 ( estradiol) level in the blood ?

      Can you please send me the printed treatment summary from your IVF clinic ?

      Repeating the ICSI cycle with better superovulation and careful monitoring and transferring better quality Day 5 embryos ( blastocysts) would be your best treatment option
      as it would maximise your chances of conceiving. You can read more about our approach at www.drmalpani.com/knowledge-center/failed-ivf/failedivf

      Treatment takes about 20 days. Should I send you the treatment plan ?

      You can read about how we take care of our patients at http://www.drmalpani.com/knowledge-center/articles/pampered-ivf-patients

      Taking treatment at a world-class clinic will maximise your chances of success and give you peace of mind you did your best !

      You can talk to some of our patients by email at www.drmalpani.com/success-stories

      We look forward to helping you to have a baby !

      Dr Aniruddha Malpani, MD
      Malpani Infertility Clinic, Jamuna Sagar, SBS Road, Colaba
      Mumbai 400 005. India

      Clinic Mobile: 9867441589

      Tel: 91-22-22151065, 22151066, 2218 3270, 65527073

      Helping you to build your family !

      You can add a google review for us at https://plus.google.com/102706636605134081909/about

      My Facebook page is at https://www.facebook.com/aniruddha.malpani

      You can follow me on twitter at https://twitter.com/drmalpani

      Watch our infertility cartoon film at http://www.ivfindia.com

      Read our book, How to Have a Baby - A Guide for the Infertile Couple,
      online at www.DrMalpani.com !

      Read my blog about improving the doctor-patient
      relationship at http://blog.drmalpani.com




      Delete
  46. Anonymous9:38 PM

    Hi i am 45 but always had really good embryos but did icsi for the first time this round and they all arrested at day 5 can this happen with icsi? my last cycle i got 3 blast and all normal. My Fs said it was my eggs and that its time for a donor but i have fallen pregnant at 42 and 43 but lost to IC sadly.

    ReplyDelete
    Replies
    1. I agree this is frustrating
      No, ICSI will not cause embryos to arrest

      As you get older, your egg quality does drop precipitately

      You may have poor ovarian reserve .
      You can read more about this at http://www.drmalpani.com/knowledge-center/the-infertile-woman/oopause

      Delete
  47. Anonymous1:10 AM

    What are the current possible options for slow embryo cell division??. Couples are still young of 31 years with normal blood, hormon and semen tests!!

    Two failed ICIS at two different clinics!!?

    ReplyDelete
    Replies
    1. I need more information to be able to provide you with intelligent advise.
      Can you send me more details about your ICSI cycles ?
      DO YOU HAVE PHOTOS OF YOUR EMBRYOS ?

      You can see what embryos should look like at http://www.drmalpani.com/knowledge-center/ivf/embryos

      What were the meds which were used for
      superovulation ? What was the dose used ? How many follicles did you grow ? How many eggs were collected ? What was the E2 ( estradiol) level in the blood ? What was the endometrial thickness ?
      How many embryos were transferred ?
      What was the embryo quality ?
      Can you please send me the printed treatment summary from your IVF clinic ?

      Delete
  48. Anonymous8:33 PM

    Thanks Dr.. I am so happy of your questions where I am always looking for a doctor has such deep investigation.

    I am willing to provide you with full previous ICIS details with printed treatment summary, and I would be happy to have your pernsonal email or whatsup no to provide you everything.

    ReplyDelete
    Replies
    1. You can email ma your details at info@drmalpani.com

      Delete
  49. Hi Doctor -

    I have had 2 failed IVF cycles.

    First cycle retrieved 23 and had OHSS. 10 mature eggs with ICSI, 5 fertilized but all arrested by day 3.

    Second cycle there were 18 on last scan but retrieved 12. 1 fertilized by day 1 and another 6 by day 2, but all arrested before day 5.

    In both cycles, Embryologist said polar bodies were larger than usual, although she could not offer any reason for this, aside from it being any failed cycle.

    Doctor has suggested underlying issue with eggs. What are your thoughts? Is there any hope?

    ReplyDelete
    Replies
    1. I don't think your doctor did a good job with superovulating you.
      This is a common problem with PCO patients. Doctors are so scared of
      OHSS, that they end up mistiming the HCG injection, as a result of which they
      get poor quality eggs and embryos.

      This is what causes the failure !

      We have extensive experience in doing IVF for PCOD patients,
      and our pregnancy rates are better than 48% per cycle for PCOD patients.


      You can read more about how we treat PCOD at
      http://www.drmalpani.com/knowledge-center/the-infertile-woman/how-to-manage-your-pcod

      Taking treatment at a world-class clinic will maximise your chances of success and give you peace of mind you did your best !

      We look forward to helping you to have a baby !

      Dr Aniruddha Malpani, MD
      Malpani Infertility Clinic, Jamuna Sagar, SBS Road, Colaba
      Mumbai 400 005. India

      Clinic Mobile: 9867441589

      Tel: 91-22-22151065, 22151066, 2218 3270, 65527073

      Helping you to build your family !

      You can add a google review for us at https://plus.google.com/102706636605134081909/about

      My Facebook page is at https://www.facebook.com/aniruddha.malpani

      You can follow me on twitter at https://twitter.com/drmalpani

      Watch our infertility cartoon film at http://www.ivfindia.com

      Read our book, How to Have a Baby - A Guide for the Infertile Couple,
      online at www.DrMalpani.com !

      Read my blog about improving the doctor-patient
      relationship at http://blog.drmalpani.com

      Delete
  50. Anonymous4:13 PM

    Im 27 years old. My husband was detected with azoospermia. so did an IVF with tesa protocol in february and the pregnancy resulted in blighted ovum. Did second IVF in august and it also resulted in blighted ovum. 20 eggs were retrieved among them 12 fertilized and 2- 7 cell and 1- 8 cell fet was done due to ohss risk. Rest of the embryos didnt made to day 5. Why this is happening to me? 2 miscarriages in 6 months. Please help.

    ReplyDelete
    Replies
    1. I agree this is frustrating

      Can you send me more details about your IVF cycles ?
      DO YOU HAVE PHOTOS OF YOUR EMBRYOS ?

      You can see what embryos should look like at http://www.drmalpani.com/knowledge-center/ivf/embryos

      What were the meds which were used for
      superovulation ? What was the dose used ? How many follicles did you grow ? How many eggs were collected ? What was the E2 ( estradiol) level in the blood ? What was the endometrial thickness ?
      How many embryos were transferred ?
      What was the embryo quality ?
      Can you please send me the printed treatment summary from your IVF clinic ?

      Please also send me details of your pregnancy

      The fact you have conceived in the past ( even though you did miscarry) means your chances
      of having a healthy baby are excellent, so please don't get disheartened !

      Delete
    2. Anonymous3:36 PM

      sir,
      here is the details:

      Gonadotropins 3975 IU were used for
      superovulation .inj Decapeptyl 2ml s/c was taken at 11.30 pm on 9/8/2016 and inj Decapeptyl 1 ml s/c was taken at 11.30 am on 10/8/16. Egg pickup was on 11/8/2016 .20 oocytes retrieved and 12 fertilized. E2 ( estradiol) level is unknown to me. endometrial thickness was 9.
      2, 7 cell and 1, 8 cell grade 1 embryos were transferred
      protocol was antagonist. bfp but no yolk sac and foetal pole found even at 7 weeks.

      Delete
  51. Please send me the photos of your embryos

    The only tangible product an IVF clinic can deliver is embryos ! All good clinics provide embryo photos proactively and routinely

    You have a legal right to your medical records - every hospital has to provide them by law ! Please make a request for this in writing.

    Any clinic which does not provide embryo photos is a poor quality clinic.

    Please find a better clinic if you want to maximise your chances of success

    ReplyDelete
    Replies
    1. Anonymous7:33 PM

      Sir,

      Actually after my first IVF failure, I changed the clinic and the result was same. Of course im planning to ask for the photos on my next appointment. But I would like to know what is the hidden problem because even by changing the clinic the result was same.

      Delete
    2. Just changing the IVF clinic does not solve the problem. If neither clinic gives photos, this suggests both are bad, sorry

      Delete
  52. Hi dr Malpani,

    I (age 35)had 4 natural conception and missed abortion with unexplained infertility.both partner chromosome test is normal.amh- 5 FSH 4.5 and made 14 good quality embroyos.first fet failed 2nd fet 3 day 3 embroyo have stage early compaction stage,morula and more than 8 cell stage are teansferred in which 1 have implanted and lead to missed abortion at 6 week.
    1. Is all my conception was chromosomally abnormal?
    2. 3rd d & c fish test was came normal.fetal growth stopped after heartbeat seen in that pregnancy.

    Is the 6 frezed embroyo also have the dame outcome? What precausion should be taken in my next fet?

    ReplyDelete
    Replies
    1. I agree this is a very frustrating problem. You can read more about this at
      http://www.drmalpani.com/knowledge-center/articles/recurrentabortion

      Do a complete workup before starting treatment haphazardly.

      You need to do ALL the following simple medical tests:

      blood tests for you for the following reproductive hormones - FSH ( follicle-stimulating hormone),LH ( luteinising hormone),PRL ( prolactin), AMH ( anti-Mullerian hormone) and TSH ( thyroid stimulating hormone) on Day 3 of your cycle, ( to check the quality of your eggs). Do this from a reliable lab such as SRL ( www.srl.in). Day 1 = Day the period starts.
      and

      a HSG ( hysterosalpingogram, X-ray of the uterus and tubes, http://www.drmalpani.com/knowledge-center/articles/hysterosalpingogram) on Day 8 of your cycle ( to confirm
      your uterine cavity is normal);

      A vaginal ultrasound scan on Day 10-11 which should check for the following.

      a. ovarian volume
      b. antral follicle count
      c. uterus morphology
      d. endometrial thickness and texture


      karyotype ( chromosomal blood study) for you and your husband

      Please send me the detailed test results and medical reports . You can scan them in as a single doc or pdf file and email them to me.

      Please send me all the results together, rather than piecemeal, so I can interpret them intelligently

      Taking treatment at a world-class clinic will maximise your chances of success and give you peace of mind you did your best !

      You can talk to some of our patients by email at http://www.drmalpani.com/success-stories.htm

      We look forward to helping you to have a baby !

      Delete
  53. Hi Doctor,

    My husband and I are both 33. No issues with him. I have stage 2 endo and a slightly low AMH. My first IVF was successful - we put back 2 late morulas and were blessed with my daughter. We have just completed our second IVF since then with no luck. I had 12 eggs retrieved and 8 morulas (6 termed late morulas by the clinic) on day 5. We put 2 in without success and none of the remaining 6 made it to blastocyst by day 6 and therefore were discarded. My question is, is it likely an egg issue or would it be worth our while trying a different clinic? As a side I was on CoQ10, DHEA, and growth hormone this cycle).

    ReplyDelete
    Replies
    1. Can you send me more details about your IVF cycles ?
      DO YOU HAVE PHOTOS OF YOUR EMBRYOS ?

      You can see what embryos should look like at http://www.drmalpani.com/knowledge-center/ivf/embryos

      What were the meds which were used for
      superovulation ? What was the dose used ? How many follicles did you grow ? How many eggs were collected ? What was the E2 ( estradiol) level in the blood ? What was the endometrial thickness ?
      How many embryos were transferred ?
      What was the embryo quality ?
      Can you please send me the printed treatment summary from your IVF clinic ?

      The fact you have conceived in the past means your chances
      of having a healthy baby are excellent, so please don't get disheartened !

      We look forward to helping you to complete your family !

      Delete
  54. Hi Doctor,

    I have done a complete blood work for the IVF.So, I am giving the latest test results based on my treatment in past.I have also attaching the reports (may be some are old please refer the latest one from the below list.

    1. Age Husband-35 wife age -34
    2. Clomid cycle (ovulated on clomid in folliculometry) and latest IVF first cycle failed.latest in April and missed abortion in Oct 2016 at 6 weeks.
    3. laparoscopy done in 2016 May and both tubes are overies have no adhesion,right tube is healthy ,left tubal blockage and uterus bulky endometrium normal ,Anterior wall normal,Posterior wall normal
    Dye test: on right tube,left tube block .P.O.D clear , No endrometrosis.



    1. FSH :4.71

    2. LH:5.84

    3. TSH : 1.72

    4. Prolactin: 19.88

    7.SERUM FOLATE - 9.8

    8. PLASMA HOMOCYSTENE- 7.05

    5. HSG : Uterine Cavity is normal in shape and size and outline.No filling defect Right fallopian tube is opacified.Left Fallopian tube is not opacified. No peritoneal spillage is noted.

    6. Torch Test : normal.

    8. Chromosome test for both partners : normal

    9. Chromosome test of fetus(3RD PREGNANCY 7 week pregnancy loss after seen heartbeat) : Normal

    10. Progesterone on day 20 : 10.68

    11. AMH : 5.84

    14. MyCOBACTERIUM TUBERCULOSIS : Not detected

    15.MTHFR C677T - detected Homocystene 5.35

    16. Antinuclear Antibodies - Negative

    18. USG of pelvis: Uterus is retroverted normal in shape and echotexture.One submucus fibroid is measuring 0.98cm x 1.21 cm is seen in the post wall. Endometriium thickness 6.0 Cavity clear.Both overies are polycyctic No major cyst Right overy 18.87 cm3 in vol.Left overy 10.95 in vol.

    19. Siemen Analysis: motility-30mil/ml progressive 15% non progressive 35% immotile 50%

    6. all 4 miscarriages in a row over 7 years in which fetal development stopped growing in after 6-7 weeks .In three pregnancies we able to see the heartbeat and the 4th one is blighted Ovum.
    7. 1st and 3rd D & E done
    8. Is karyotyping of products of conception done in 3rd pregnancy

    I do not find any attachment link from where I will upload the reports.

    Thanks in advance,

    Arpita

    ReplyDelete
    Replies
    1. Dear Arpita, I agree this is frustrating ! Has the submucous fibroid been removed ?

      You can email me your reports. My email is drmalpani@drmalpani.com

      We look forward to helping you to have a baby !

      Delete
  55. Anonymous5:46 PM

    Dear Dr.,

    I just had my miscarriage on 4th Nov from IVF donor egg. pregnancy was 5 weeks. Can you please suggest as do I need to test my progesterone level and E2 before I go for second attempt with donor eggs. Also I have intramural fibords

    ReplyDelete
    Replies
    1. No, there's no need for any further testing

      The fact you have conceived in the past ( even though you did miscarry) means your chances
      of having a healthy baby are excellent, so please don't get disheartened !

      Delete
  56. Dear Dr,
    I am 31 years and my partner is 64 years.
    I had an ivf which 22 eggs were retrieved, 19 matured but 13 were fertilized. On day 4 I was told 9 are still developing but 7 out of the 9 are very slow growers. They ended up doing days 6 transfer with only 2 and the remaining 7 arrested.
    Today is 21 days after transfer and I got a bfn. I am waiting for my AF since I have been asked to stop the medications.

    Please my husband have done a vasectomy for 40 years now so the sperm was aspirated through PESA. They first tried TESA but there were no sperms in the seamen hence the PESA. Also with the PESA the doctor said the sperms were sleeping and needed to heat them up a little. My husband was not given any medications prior to the retrieval.

    The reason the doctor gave for the failed cycle was that my everything was perfect but thinks is as result of poor sperm.
    He now have put my husband on 3 months proxeed plus before we start another cycle.

    Everything sounds weird to me and I have feeling is from their lab. I sometimes get the feeling they killed my chances by carrying me to day 6. Am afraid to do it there again but this hospital is one of the best hospitals in Ghana.

    Please is it possible for my husband to have a vasectomy reversal after 40 years? He had 2 children before the vasectomy.
    The doctor did hormone test and assured us we were fine. I don't know the problem but I also find it difficult that if was from the sperm then why did they use it in the first place for the icsi.

    Reg.
    Monique.

    ReplyDelete
    Replies
    1. Any doctor who blames "poor quality" sperm for failure of an ICSI cycle is a poor quality doctor

      Please find a better doctor !

      Delete
  57. Dear Dr

    I am in the midst of a cycle. My 2 blastocyst were frozen at grade A and B. But when thawed they deteriorated to C, can you give us any insights as to why this happened? The storage duration was only 6 mths.

    ReplyDelete
  58. Rachel10:18 AM

    Hi

    Im in the midst of a cycle. We transferred 2 frozen day 5 blastocyts whhich were grade A and B. However when the embryo thawed they became grade C. Can you share with us any insights why this is so? It was abit dissapointing and we are puzzled why.
    We had to use them even tho we had 4 other embryos frozen.

    Thanks!
    Rachel

    ReplyDelete
    Replies
    1. This suggests your IVF lab is not a good quality lab. In a good clinic, survival rates after thawing vitrified embryos are nearly 100%

      Delete
  59. Hello doctor..

    I am 32 years old and we decided to do ivf for the first time. My husband has a low sprem count so we used a donor sperm. As if for me the doctor checked he said everything looks fine with me and I'm good to go. So on January 27 we did the egg retrieval and with 10 eggs which than he stated 2 survivored than on the embryo transfer day which was February 1 2017 he stated that one was good but the second one not that good but it's growing slowly. So we decided how transfer 2 embryos, the doctor never explained in what grade was the embryos also he never gave a picture. And since it was our first time doing ivf we didn't know what was happening we were clueless. On February 17 I gave my beta test and it came back with a negative he said it was 2 % which I didn't understand how is that possible.. I have searched online and on YouTube even patients with bad egg quality there beta were 20% but mine being at 2% it didn't make any sense now I'm doubting that if he even did something right.. that means the embryos were never even planted something happend. I am really confused on how this can happen can you please help me any suggestions that we can do on our side???

    ReplyDelete
    Replies
    1. You seem to have received very poor quality care, sorry

      Where are the photos of your embryos ?

      This is not correct. You have a legal right to your medical records - every hospital has to provide them by law ! Please make a request for this in writing.

      The only tangible product an IVF clinic can deliver is embryos ! All good clinics provide embryo photos proactively and routinely

      Any clinic which does not provide embryo photos is a poor quality clinic.

      Please find a better clinic if you want to maximise your chances of success - one which does only blastocyst transfers and provides embryo photos routinely to all patients

      Delete
  60. Hi Dr,

    I've had 2 ivf cycles. First cycle I did not stimulate enough so was canceled before egg pick up. Second cycle we collected 7 eggs, 3 fertilised over night and were looking spot on for day 3 on day 5 I got a phone call before transfer saying they didn't grow past day 3.
    My fertility problem is a blocked tube I'm 32 and last time we checked my Amh was 61.
    Any suggestions as to why embryo would have stoped at day 3?

    ReplyDelete
    Replies
    1. You seem to be a poor ovarian responder, and the commonest reason for embryo arrest in patients with poor ovarian reserve is suboptimal egg quality

      Delete
  61. Hi Dr Malpini,

    I recently did an egg donation cycle with a 32 year old donor. She was a proven donor from my fertility clinic, and had done 2 previous cycles in the past 2 years. Both cycles the couples got 13 embryos each (blastocysts day 5). Her second cycle 12 months ago produced a live birth.

    My cycle was a shared cycle; the other recipient was a frozen donor egg bank. She produced 32 eggs which were split evenly. So out of the 16 eggs, 10 fertilised. On day 3 we had 7 embryos, but by day 5/6 we only had 3 embryos. We did PGS on the 3 embryos and they all came back chromosomally abnormal (cause was maternal). Do you think the fact we didn't have any viable embryos was due to the donor's age? Or lab environment, embryologists etc? My husband's sperm sample was very good, we've never had an issue with that, plus we did ICSI.

    I do wonder whether the frozen egg bank received all of the good eggs. Do you know how the lab splits them regarding their viability?

    Thank you in advance.

    Rebecca

    ReplyDelete
    Replies
    1. Dear Rebecca,

      I agree this is frustrating.

      The fact that she produced so many eggs suggests she has PCOD; and this could explain the high percentage of chromosomal abnormality in her embryos

      You can read more about PCOD at
      http://www.drmalpani.com/knowledge-center/the-infertile-woman/how-to-manage-your-pcod

      Delete
  62. hello sir,
    this is my 2ivf cycle and FET transfer with one morula stage and one blastocyst..what is my chances of success ?
    also my AMH is 1.4

    ReplyDelete
    Replies
    1. I need more information to be able to provide you with intelligent advise.

      Can you send me more details about your IVF cycles ?
      DO YOU HAVE PHOTOS OF YOUR EMBRYOS ?

      You can see what embryos should look like at http://www.drmalpani.com/knowledge-center/ivf/embryos

      What were the meds which were used for
      superovulation ? What was the dose used ? How many follicles did you grow ? How many eggs were collected ? What was the E2 ( estradiol) level in the blood at the time of the HCG trigger ? What was the endometrial thickness ?
      What was the embryo quality ?
      Can you please send me the printed treatment summary from your IVF clinic ?

      Delete
  63. Hi Dr. Malpani,

    On Friday my husband and I received a call on our way to our transfer that all 12 of our embryos had arrested and we had to cancel the transfer. I'm trying to wrap my head around this as I only know one other person that it has happened to, which happens to be my sister. She actually ended up having two babies naturally so that gives me hope.

    However, I keep trying to find "an answer" for what possibly could have gone wrong between day three and five. Our clinic prefers to take you to the blastocyte stage if the embryos look good and based on reputation they typically do a good job of this.

    Background info on us. We are both 33 years old and have unexplained infertility. We are personal trainers so they did think the reason for us not getting pregnant on our own had been from my body fat being too low. My husband's numbers have always been great with 95% motility.

    For this IVF cycle they retrieved 19 eggs, 15 mature and 12 fertilized with icsi. However, they did only trigger me with 5000 units of hCG because I was at risk of developing 0HSS.

    They are now suggesting we both get genetic tsetong done as well as having my husband do DNA fragmentation testing.

    Any thoughts on how to move forward or other information I should be getting from my doctor?

    ReplyDelete
    Replies
    1. I agree this is frustrating.
      I believe the genetic testing is useless - it does not provide us with useful actionable information.
      Read more at https://www.drmalpani.com/articles/sperm-dna-fragmentation-assessment
      I need more information to be able to provide you with intelligent advise.
      When did the embryos arrest ? On which day ?
      Can you send me more details about your IVF cycles ?
      DO YOU HAVE PHOTOS OF YOUR EMBRYOS ?

      You can see what embryos should look like at http://www.drmalpani.com/knowledge-center/ivf/embryos

      What were the meds which were used for
      superovulation ? What was the dose used ? How many follicles did you grow ? How many eggs were collected ? What was the E2 ( estradiol) level in the blood at the time of the HCG trigger ? What was the endometrial thickness ?
      What was the embryo quality ?
      Can you please send me the printed treatment summary from your IVF clinic ?

      Delete
    2. Hi Dr. Malpani,

      I do not have all the information you need because it just happened, but I will obtain that shortly to get you.

      Here is what I can answer:

      Can you send me more details about your IVF cycles ? This was my first IVF cycle and we did ICSI
      DO YOU HAVE PHOTOS OF YOUR EMBRYOS ? I do not yet.



      What were the meds which were used for
      superivulation? 3 weeks of BC, followed by 10 days of Lupron. Continued 5 units of Lupron throughout stimulation. Started with 150 units follistim for 4 days, then dropped that to 75 units and added in 75 units of menopur, we kept lowering follistim from there as I kept going in and out of range of estrogen being too high. Stimmed for 11 days and triggered with 5000 units of HCG.

      How many follicles did you grow ? 21
      How many eggs were collected ? 19 What was the E2 ( estradiol) level in the blood at the time of the HCG trigger ? I am unsure of this.

      What was the endometrial thickness ? I believe around 11.4
      What was the embryo quality ? Again unsure because we still haven't been given much information besides that they looked great on Day 2 so planned to do a day 5 transfer. When they called to cancel the first thing mentioned is that ours were put in the best incubator and other embryos that went in at the same time as ours were developing normally. I believe our doctor mentioned they really stopped doing anything by day 3. And of the 19 eggs retrieved, 15 mature, 12 fertilized and 12 still growing by day 2.

      Can you please send me the printed treatment summary from your IVF clinic ? I will try to get that. Where should I send it to?

      Do you think this could be an egg quality issue?

      Again any advice you give me, would be greatly appreciated. Thank you!

      Delete
    3. You can email me at info@drmalpani.com

      Delete

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