Is it possible to get grade A embryos from eggs with poor quality after IVF procedure?

Question

Hello doctor,

My wife is 33 years old. We had six IVF failures. Recently, she had undergone a third pick up cycle. Nine eggs were retrieved, out of which eight eggs were mature, five were fertilized and three embryos reach day 3 stage with two embryos grade A (eight cells) and one embryo grade B (six cells). I was disappointed to hear that only three embryos are developed because in her previous two pick-up cycles 10 embryos each were developed which were of either grade 1 or 2. However the worst part was our doctor told us that the egg quality was not good and there is very little chances of implantation with these embryos and asked us to go for donor egg. Doctor is planning to transfer our own embryos as well as donor egg embryos in single cycle to enhance success rate. I am surprised to hear this as I believed that grade A embryos have a very good chance of implantation. I would be grateful if you could answer my below queries:

1. Can poor egg quality produce grade A embryos?

2. If yes, does chances of these grade A embryos getting implanted are minimal?

3. What would be your recommendation in our case? Should we go for IVF with our own embryos or donor egg embryos?

Answer 1

Hi,

Welcome to icliniq.com.

How are you doing today? I would like to put forth a few facts of IVF or embryology.

1. Your wife is in the perfect age for pregnancy. 19 to 35 years is the best age.

2. Her body weight is normal, so a hormonal imbalance is ruled out.

3. She has given nine eggs, which is perfect. Of course, 15 or so would have been great. But 9 to 10 is excellent. Of these 8 are mature, so it means egg quality is good, otherwise, they would not have matured.

4. Out of 8 mature eggs, only 3 embryos formed, so I would be more concerned about the health of sperms. Some problem in sperm is not allowing good embryos to be formed. The egg has a lot of corrective capacity. Even if the sperm is damaged, it can correct it. Sperm movement and number may be normal, but if the morphology or health is not up to the mark then there is a lot of chances for the sperm factor to be evaluated and treated. Mixing of donor and self-embryos especially if self embryos are good grade is not a good idea.

For your queries:

1. You are right. If eggs are not good, embryo quality will be bad, you cannot get grade A.

2. The grade is only to classify embryos. We get a healthy pregnancy from poor grade and no pregnancy from the best grade of embryos. It alone cannot be used to predict pregnancy chances.

3. I would suggest you have semen factor re-evaluated. You need examination, good antibiotic cover and hormonal priming of sperms, then if needed, go for IVF or if no other causes IUI or ovulation induction, try for few months, you never know, she may get pregnant with these simple, small but very effective methods. An indication of IVF also needs to be thought of.