After a year of attempting to become pregnant through natural means, my wife and I just went through our first use of assisted reproductive technology. We had an IVF/ICSI. Six eggs were produced, my fresh semen sample was used, three eggs became embryos, two embryos were transferred on the third day after retrieval and no sac was ever found. Is there any other information that would be helpful?
We plan to try again and would like to learn from this experience and our personal medical data to improve our chances. We would like to know:
1. What happened that terminated the process (no sacs were found) and why? What are the possibilities and what is the most likely possibility?
2. What could we do differently now that might be better?
3. What is the quality of the embryos overall and in terms of their number of cells, cell appearance score, fragmentation and cells being of equal size?
4. What might have contributed to any problem with the embryos?
5. What can be done to improve the quality of the embryos?
6. What is the quality of my sperm overall and in terms of motility, morphology, round cells, agglutination, debris, etc.?
7. If I abstain for 5 or more days, there are no motile sperm. Is that normal?
8. What might have contributed to any problem with my sperm?
9. What can be done to improve the quality of the sperms?
10. Is it unusual or problematical to have a sperm concentration of 0 whenever abstinence is 5 or more days?
Welcome to icliniq.com.
Following are answers to your queries,
1. The process you experienced is likely biochemical pregnancy. It mostly happens when embryos do not have the potential to grow and give healthy live birth as outcome. The cause of many such losses is unknown, but most likely lies in the genetic aberrations in the embryo.
2. The success rate of any ART procedure is not 100 %. As there was pregnancy in the first attempt and most of the things appear fine, there is good chance of pregnancy in subsequent cycle. For oligoasthenospermia (low sperm count, motility), we generally prescribe antioxidants to male partner to improve sperm health and to reduce oxidative stress. You can discuss with your doctor for the same. The simplest nonprescription antioxidants are vitamin A, C and E. You can take supplements containing same for not more than three months (Vitamin C not more than 15 to 30 days). Co-enzyme Q is another good antioxidant.
3. The images of embryos you attached is 2-dimensional. To assess quality we need to see 3D view to be able to see all the cells in embryos. But still, looking at the first embryo, it appears to be of good quality, with cells of equal size and almost no fragmentation. The second one has unequal cells, though it might happen when cells are dividing. There appears around 10 % fragmentation in second embryo, still it appears fine. Both appear suitable for transfer (attachment removed to protect patient identity).
4. The answer lies in point 1.
5. The quality of embryos looking at morphology is already good. Still, if ovarian reserve of wife is on lower side, DHEA 75 mg daily might help, though evidence supporting its use is not so strong.
6. Quality of sperm in terms of morphology cannot be assessed from the given video. As far as round cells, agglutination, debris are concerned, all these do not affect ISCI outcome, as sperm processing takes care of those factors. Regarding motility, it appears fine.
7. The more the abstinence, lesser will be motility in semen sample. As the baseline motility itself is low, this phenomenon is normal. Nothing to worry about it.
8. There appears to be no problem. So cannot hypothesize any reason.
9. Please refer to point no. 2. Also you can reduce exposure of heat to testes if it is there.
10. Sperm concentration generally does not become zero after increased abstinence, but motility might reduce.
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Thank you doctor,
1. If there is a genetic issue in the embryos, what would be the most likely cause?
2. Why should vitamins A, C and E be taken for only a limited amount of time?
3. Why would sperm concentration reduce after increased abstinence? Does that mean they are not surviving for the larger amounts of time?
4. Why do so many doctors recommend abstaining for at least 2 days?
5. Do you think the discharge is an embryo? If so, why was there only one?
Welcome back to icliniq.com.
Following is answer to your queries:
1. Most of the genetic defects happen during fertilization without any cause. Even in natural conceptions, around 40 to 50 % embryos are genetically defective and nature takes care by not allowing them to grow, the result is biochemical pregnancy or early pregnancy loss. There is normally no need to dig deeper unless there is family history of genetic or hereditary disorders or there is history of recurrent miscarriages. Single biochemical pregnancy or miscarriage does not demand genetic investigations. So, there is no need to worry about that.
2. Vitamin A and E are fat soluble and long term excess intake can lead to accumulation in body leading to toxicity (though that rarely happens in low therapeutic doses). Regarding Vitamin C, if taken excess it itself acts as pro-oxidant, which is harmful. So, better to limit intake of those to therapeutic doses.
3. The sperm concentration does not reduce abstinence, but motility can reduce after prolonged abstinence. This happens due to exposure of sperms to oxidative stress in male genital tract. In your case too, its motility that is reduced. Also, fertilizing ability can be reduced with prolonged abstinence due to oxidative stress.
4. Abstinence of two days is necessary to avoid false low sperm concentration in semen. Also, uniform abstinence helps in deriving normal values in patient and population.
5. Embryo normally is not visible with naked eyes at this early stage. What is visible is the endometrium surrounding embryo (along with embryo in it); what we call as products of conception. So, you will not be able to derive number of embryos from mere visual inspection. Also, not all embryos which are transferred do implant. It can happen that single embryo implants even when we transfer multiple embryos.
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