IVF eggs vs. 'Natural' eggs

Areej76

Ladies,

I have a question but I don't know if it makes any sense, but I can't help thinking of it: Are eggs that are 'made' by IVF generally less healthier than a natural egg? I can't help but think that because IVF is 'artificial' and you make several eggs, the one egg that you produce once a month is healthier. I read somewhere that our bodies do their best to produce one natural healthy egg. I am asking because I decided to go the IVF route after only 2 months of trying naturally and now I can't help but think I am compromising the health of my eggs since my IVF did not take and produced eggs of poor quality we had nothing to transfer. Please help and thank you! xoxo

Twinkie0612

Sometimes the protocols (which meds, dosages, when you trigger) can affect the quality of the eggs, but there is also no guarantee that an unmedicated cycle egg will be "healthy" either.  

Areej76

@twinkie0612 Thank you for answering. I thought that as well until I read somewhere that our body "strives" to make the best possible egg every month. Do you know how true this is? Or if it is true?

Mrs.McIrish

I read your into a few weeks ago and now this post. I know the place you are in right now- you didn't expect to be infertile and thought you'd do IVF to get a baby faster. But then you got terrible news from your cycle and you are looking for answers. But sometimes it is just a bad cycle and that's all. Sad to say but IVF is a "practice". They try stuff and basically experiment. A lot of times the experiment doesn't work. I truly wouldn't look too much into one failed cycle. 9 eggs isn't a lot to go through to find a good one at 38. Your options are to just try naturally and hope for the best or try again. There's no "right" answer.

To answer your original question, one of my doctors(I've had a lot over the past few years) said that your body does naturally select the "best" egg . But if you ovulate one egg a month for a year at 38-39, You might not find a good one in that batch of 12. Sadly most of our eggs are aneuploid at 38. If you do a few iVFs and get 9 each time, you have a better chance of finding one. I started at 37 and never was able to find that good egg in 4 OE IVFs but I only made a collective 7 mature eggs in those 4 cycles.

Areej76

@mrs.mcirish Thank you so much for answering. Right on target on all the above...There is just too much to take in all at once it is overwhelming. I just want to make sure I arm myself with all or most of the correct information there is out there. Sadly, I have seen a lot of Doctors to tell me that sometimes it is not always about the best interest of the patient. My RE is changing my protocol for this cycle now that he says he "knows what to target." Does that make sense to you? I feel like I ask him so many questions that by the time I am done I forget to ask the correct one. If I tell you the med protocol I am on this cycle as opposed to the last one, can you guess at what he is trying to do? All I get from my nurse is "he is being very aggressive" with this cycle but I don't know what is going on. Thank you

Twinkie0612

Mrs.McIrish is right, one cycle isn't much to go on. My first cycle was a disaster and was canceled because my embryos stopped growing before transfer. My next two cycles were better, we at least had one or two blasts to transfer.

Even with some obvious egg quality issues and maybe a slight sperm issue (3% morph) and 3 failed IVF cycles, the doc I consulted with today still thinks we could be successful with our own eggs and sperm.  He had some ideas for protocol changes that might help us get better quality embryos.

At 38 a high percentage of your eggs are likely aneuploid.  It could definitely take a few tries to find a normal egg.

Areej76

@twinkie0612 Thank you very much for your reply. I guess I am just lacking in faith. Some days it's better and others it's terrible

Mrs.McIrish

Sure tell me what protocol and I'll comment on it if I can. You are correct that you have to question stuff and be your own advocate.

Areej76

@mrsmcirish Thank you very much! First IVF I took menopur from day one, together with gonal F, then on day 3 they added the ganirelix, and triggered with ovidrel. This time I am given menopur only on day 3, but starting only with gonal F the first two days, then menopur and ganirelix on day 3. Triggering this time with Lupron to avoid OHSS. Now if this information sounds ridiculous without numbers let me know and I'll dig them out. Thank you xo

Mrs.McIrish

Adding ganirelix on day 3 seems really, really early. Did you only stim for 3-4 days?? Menopur is half FSH/half LH. When your LH starts to rise and ovulation is about to occur, you start producing progesterone. Since you had pre-mature luteinization, it makes sense to me to not start with menopur and just do the gonalF.

Areej76

Mrs.Mcirish~ I stimmed for 12 days, but ganirelix was added on day 4 I am so sorry, not day 3. This cycle he added it on Day 3. Do you think there is a chance I would not have PL if I only do gonal the first 2 days? My RE thinks there's a strong chance I will always have PL so he called in a Freeze-all. However, I spoke to the nurse who spoke with him and we changed it to fresh transfer provided I do not have PL. I also think this cycle he is going for more eggs? Thank you so much for all your help

Mrs.McIrish

Hard to say about the PL. I've learned that you never know what will happen. 12 days is a long time to stim. Did they increase your dosage this time?

Areej76

Really? What's the average on stimming? I always thought it was 12 to 14 days. Nope, they didnt change anything. Only pushed them around. That said, I go in on day 4 for a blood test, and only then they would adjust the meds accordingly. So is it possible my PL is from stimming for too long?

pblge

Let me add here something my doc told me yesterday that was very different from what I understood. Maybe I'm the only one who didn't know this, but just in case. Apparently your body normally prepares way more eggs than will ever be released maturely. So the antral follicles are the eggs that are normally brought forward for a given cycle, and at that point they've already been "cooking" for a few weeks (50-60 total days to maturation, he told me). In a typical cycle the egg (or is it follicle? not sure) with the most FSH receptors would be the one that would "win" the race to maturation. I guess the FSH receptors are nature's indicator of the "best" follie, but of course that's not necessarily related to other types of quality, including genetic euploidy. (I'm sure someone's studied that, but I don't know the answer.) So in an IVF cycle, all the eggs that would normally be competing for genetic competence get pushed to maturation. One of the consequences of this is that, despite the common misconception (pun not intended), you're not losing eggs more rapidly during an IVF cycle than you would normally--you just have more that are mature because you're overriding the selection process your body uses.

Anyway, I'm not sure whether this is really germane to your question, but I thought it relevant and interesting.

I'll echo what the other ladies said--IVF can produce great and poor eggs from the same woman on different cycles. They say "problems in stims" can cause poorer eggs. This can be length of time stimming (11 is perfect, 12 still okay, beyond 13 is related to poorer outcomes), the amount of FSH required to bring your eggs to maturity, erratic estradiol rise, and probably other things. I also agree that adding Ganirelix the third day sounds very early. 

So it's another antagonist (Ganirelix) cycle next time? Hope it goes better!

katib77

I will add in that my REs plan for my second cycle coming up is to add ganirelix earlier than before.  He wants to start it on stim day 5 now (I *think* last time I started it on day 7 of stims).  The reason he gave for starting it earlier is because I had to move to a freeze all due to the fact that my progesterone was above 1 by day of ER.  His hope, is that by starting it earlier we will keep my progesterone low enough to have a chance for a fresh transfer and if needed do a 3dt because all of mine (but one) arrested before freeze.  

OP, if you have not asked (or don't remember what he said) on why to start the ganirelix so early def. bring it up.  Hear his reasoning.  It might be something similar to why I will be starting it early.  As for your length of stim days, yes that does seem long.  If I remember correctly I stimmed for nine or ten days.  Admittedly, for AMA I stim fairly quick but still 13-14 days does seem long.

Areej76

@pblge Hi! Thank you very much for the above information! It does help me understand the whole process a bit better. I did speak with the nurse today and asked her how long am I going to stim, and she said 14 days. So I told her what you and Mrs.McIrish told me, and she said that was absolutely not true. She said there is no such thing as 'bad', that they simply follow what my body tells them, whether it is 11, 12,13 or 14 days. They follow my body's cue. Does that make sense?

Areej76

@katib77 Hi!! Thank you for your reply above! I DID get on the phone and asked the nurse why were they pushing the ganirelix up to day 3, and she said they were going to try and prevent pre-luteinization!! I am so happy you brought this up or I would never have known what to ask. We were going to do a freeze-all but I told my RE I wanted to try and have a fresh transfer. Last time I had 9 eggs retrieved, 8 fertilized, 6 arrested on day 4, and i blastocyst and one morula that were both PGDed and were abnormal. I truly hope it is different this cycle...I just don't know why I don't have much hope. I feel like if all 9 eggs were rotten, what are the chances any of them are good? Thank you for your help xo

poohniki

I have not read the replies yet but my clinic did a natural egg study. I happen to have a rare (1/3000) condition that makes the ivf meds ruin my eggs and was seen at ER. For the study I finally had a blast using this natural cycle but my RE said the overall study was hugely unsuccessful. So much so that they wouldn't recommend a natural ivf cycle to anyone.

poohniki

Areej76 said:

@twinkie0612 Thank you for answering. I thought that as well until I read somewhere that our body "strives" to make the best possible egg every month. Do you know how true this is? Or if it is true?

I was told your lead follicle is usually the best one and the one you would have ovulated that month - which is why my RE doesn't like to throw away that follicle by letting it get past 20mm in hopes to get more small ones to grow.

Mrs.McIrish

Yes, stimming follows your body's cue but 14 days is not typical. One other thing I would check is your RE's IVF stats. https://www.sart.org/find_frm.html. Look at your clinic and yor age group. You can also sort by diagnosis. I've been to some crappy clinics and you can get really bad advice at some places.

Areej76

@MrsMcIrish: Wow! I just checked the stats. If this cycle doesnt work I'm going elsewhere where the success rate is very different! Thank you!

pblge

Areej76 said:

@pblge Hi! Thank you very much for the above information! It does help me understand the whole process a bit better. I did speak with the nurse today and asked her how long am I going to stim, and she said 14 days. So I told her what you and Mrs.McIrish told me, and she said that was absolutely not true. She said there is no such thing as 'bad', that they simply follow what my body tells them, whether it is 11, 12,13 or 14 days. They follow my body's cue. Does that make sense?

Oh no she didn't!!!!!

Sorry, but your nurse is either not aware of or is denying good research on this topic. Multiple studies have found that long stims have reduced success rates (depending on outcomes measured and control variables), and everything that I've read suggests it's more or less accepted as part of the science of IVF. If she hasn't heard that, I'd beware all information I got from her.

Take her this paper and ask if she's familiar with it:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2997954/
Note that this paper found success rates were HALVED for stims>12 days.

Also, I came across this paper discussing the very question of your original post. It's not conclusive, as it says much of the science is still ambiguous, but IVF certainly can result in poorer quality eggs:
https://www.reproduction-online.org/content/139/1/23.long
It was worth a read, I thought.

Note that all this doesn't mean that everyone who stims longer than 12 days has poorer outcomes. Some studies did not find significant differences on live births, although those were smaller and didn't include covariates. Here's one that looked at outcomes with just antagonist cycles and didn't find a difference:
https://www.ncbi.nlm.nih.gov/pubmed/23091989

So FX this will work for you!!!

Areej76

@pblge I am calling my nurse first thing tomorrow morning. I spoke to the one on call. This is frightening.

Areej76

@pblge Hi there! I hope you are having a nice evening. I had a lengthy conversation with my head nurse today. She told me that every single person is different. They treat people based on what their body says. She says they have had people stim for 8 days and some for 20. It depends on the woman's body- how well she responds to stims. She says this is why they monitor us closely. I remember going for U/S and Blood work every other day then daily at the very end. I hope this helps.