IVF protocols for poor embryo quality?

jandj2005

hi ladies,

as i posted over the weekend, we had our ET and transfered 5 so-so embryos on day 2. ?2 were grade C (A being best) and 3 were fragmented. ?3 didn't fertilize, even with ICSI. ?anyways, it doesn't look good, and i wondered whether any of you know if there are protocols or treatments that help with embryo quality, especially for someone with diminished ovarian reserve? ?i am trying to stay positive for this cycle, but also trying to plan realistically.

j?

smeyer

I believe antagonist protocols are commonly used for diminished ovarian reserve and quality issues. ?(I don't know much about them as I've always done long Lupron.) ?

Previously, we had questionable quality, nothing better than a 6-cell on day 3, few embryos, and none to freeze. ?After switching clinics, we saw a massive difference. ?One of the key things we added this last cycle was co-culture. ?My new clinic has had a lot of success with it but not all clinics offer it. ?In our case, we didn't have do an endometrial biopsy; they have a lab-grown co-culture medium. ?

malex

Embryo quality was a concern for me too after our failed cycle.  I switched REs and my new RE explained that poor embryos come from either (1) poor eggs, (2) poor sperm, or (3) poor culture conditions.  In case it was poor eggs for us, my RE put me on Metformin, a medication typically used for those with PCOS.  I do not have PCOS but I am a high responder, and my RE thought that would improve my egg quality.  He also changed my stimulation protocol.  I had done the long lupron protocol before, and this time we did the antagon protocol.  The hope was that I would produce fewer eggs which would become higher quality embryos.  And it seemed to have worked.  They retrieved 10 eggs this time (as opposed to 15 before), but about the same number fertilized (7 this time, as opposed to 8 before).  All 7 made it to Day 3, so we decided to wait until Day 5.  We had two blastocysts and one morula.  The others didn't make it.  But in my previous cycle, we didn't even get to Day 5.  So I think this new protocol was better for me.  Basically, yes, I think there are ways to work on improving embryo quality, although the right way for each person will be different.  In any case, good luck with your beta and keep us posted!

trilady2

Lupron works for some... not so well for others. It's been my experience that some women seem to do best on the microdose lupron protocol while others do best on the antagon protocol (no lupron, ganirelix instead).

After three failed IVFs where we only got a few good quality embies after getting lots of eggs, we're switching to an antagon protocol after three long lupron protocols. The hope is the same as pp.... that I stim slower and get better embies as a result.

 I can't say whether it worked yet, but that's the idea. Good luck to you.

Temp848906437505510

Two protocols I was put on to try to get more eggs were estrogen priming and co-flare.  EPP was an utter disaster for me, but, has worked wonders for many other women.  Co-flare was moderately successful for me.

As for poor embryo quality, beyond getting better eggs and better sperm, one thing they can do is called co-culture.  Essentially, they take a piece of your endometrial lining and culture it.  Then, they lay your embryos on this "carpet" of your own genetic material.  It is known, in many cases, to improve embryo quality.  Sadly, I can tell you it didn't for me.  My two embryos this cycle were 20-25% fragmented, the same level of fragmentation in all of my previous cycles without co-culture.  But, it might be worth you exploring!

jandj2005

thanks for the responses ladies. ?i have diminished ovarian reserve, so the issue with stimming slowly for fewer eggs at higher quality is definitely not for me. ?i'm still in the 2ww, so hopefully by some miracle i'll get pregnant and not have to think about it, but i just want to be well-informed in the case that i have to have yet another WTF appointment with RE. ?i really was not prepared for it last time.