An IVF clinic that has a good lab, is generally good at making good embryos. However, there are times when we encounter patients who have very poor quality embryos. A poor quality embryo is one that divides very slowly or one that is highly fragmented. If you have been told that your embryos are of a poor quality, keep in mind that there are not more than 3 variables that influence the quality of the embryos:
- Poor quality eggs
- Poor quality sperm
- A poor quality lab
Surprisingly, from experience we know that when it comes to the quality of the embryo, the sperm doesn’t have much of a role to play. Thanks to ICSI, all we need is one good quality sperm to fertilize one egg and it’s not uncommon to get excellent quality embryos even from poor quality sperm. Once the sperm has been injected into the egg and fertilization has been achieved, the sperm doesn’t play an important role in the further development of the embryo.
This is extremely counterintuitive and surprising since the sperm do contribute 50% of the embryos DNA! Though this is an oversimplification & there are certain exceptions, it holds true for a large percentage of patients. This leaves us with only 2 possible explanations- either the eggs or the lab conditions are suspect.
Poor quality eggs
Since the egg provides the machinery for the embryo division process, it doesn’t come as a surprise that the most common cause for poor quality embryos, are poor quality eggs. Typically, older women and women with low AMH (and high FSH levels); and poor ovarian responders are more likely to have poor quality embryos. At times the poor quality eggs could be a result of a clinical problem- for instance, the patient may not have been superovulated properly. This could happen due to:
- Poor quality drugs used for superovulation
- Using the wrong protocol for superovulation
- Not using the right dose of meds for stimulation
- Not timing the HCG properly (giving it too early, or too late)
Poor quality lab
This has a major role to play in the quality of embryos, but it’s also a topic that is kept under wraps. Patients don’t really know exactly what is happening behind the scenes; doctors don’t care to explain and the documentation is also very poor. But this situation is one which can be rectified. If you have poor quality embryos, it's crucial that you ask for documentation such as:
- The meds that were used for superovulation
- The dose used
- Number of follicles you grew on ultrasound scanning
- Their sizes
- The endometrial thickness and texture
- The E2 (estradiol) level in the blood
- Number of eggs collected
- Number of embryos transferred
- Embryo quality
- Photos of your embryos
It’s important that you ask your IVF clinic for a printed treatment summary. This can prove to be very useful if you need to get a second opinion.
Not happy with the attention you are getting from your IVF clinic? Need more information? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you!