# testing egg quality



## clotted cream (Jan 8, 2007)

We had our 2nd attempt at ICSI this week - but unfortunately no suitable embryos to transfer.  Follow up appointment next week, but the embrylogist suggested that it could be that because of my age my egg quality isn't good enough.

I've spent a long time on this site today, trying to work out what we should do next.

We want to try again, and of course, ideally I'd like to use my own eggs.  I didn't know about AMH testing before - as well as giving me an idea to my egg reserve, would this also give any indication to the quality?

Also, does anyone know if my eggs had been left for too long before EC would this effect quality?  In my first ICSI it was found that I couldn't do long protocol as my body didn't stop ovulating when I was given burseralin, so I did a short protocol cycle.  This cycle was also short protocol and I had Menopur as the stimming drug and I was given burseralin to stop me ovulating too soon - I was just wondering as burseralin didn't stop me ovulating when I took it during my first attempt, would it have had any effect this time?


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## astra (Jan 20, 2008)

Hi clotted cream

I'm no expert but I believe that the most effective way to test egg quality is to check each egg's chromosomes through CGH which is available at Care Nottingham.

Sorry to hear about this cycle

luv astra x


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## clotted cream (Jan 8, 2007)

Thanks Astra - although we'll probably change clinics now, I'll ask about that test at our follow up on Tuesday.

When I say that we'll probably change clinics I don't want it to sound like we were unhappy with the clinic, and I don't blame them at all (all the staff were lovely) - but I think at my age we need to find somewhere that has a better proven success rate with older women.


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## annacameron (Dec 16, 2008)

CC, having tried every clinic in london, Id go for UCH if you can possibly get up here. I know it's a nuisance. my reasoning is the following:

1. argc - few women have immune issues, your age indicates it's egg quality (like me). too mnay trips required (each day for 8 days)
2. lister - currently cycling with them. they are rubbish frankly. no thought process going or individualised treatment at all. i am aBIG question asker too so i dread to think whyat it's like for others. 
3. Chiltern - too far away and consulantna there i had 2 iuis from at Chelsea/west - agony. 
4. uch - they are clever people bascially. They are open to technical ideas. (eg split transfers where emb 1 prepares the interaction for embr2) also becuase they are nhs based too they are closer to some idea of value for money than eg lister. UCH only test when nec. lister wastes my money dreadfully ive found. Also, they are realistic. they will send you away if you don't fit their profile for the restults they want to get. I see this as a good thing. there are MANY women who have gone there, been told it's too unlikely we cannot treat you in all conscience, gone to the lister and had 4 failed tx. 50k later they regret it. Good individualised treatment. Also, good embryology. I had 100% fert each time and I noted your issue with that. 
i expect UCH would be honest with you. to the point of blunt.

good luck xxx

Just need to add that the opinions expressed on this thread are personal opinions and not ff opinions - (board mod)


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## clotted cream (Jan 8, 2007)

Thanks annacameron

I did consider UCH after our first ICSI failed, but opted for Guys as that's very close to where I work.  I suppose Guys put us off trying another NHS hospital - they really messed us around by cancelling appointments at short notice, and running really late with appointments.  I'll have another look at the UCH website.

can I ask you why you're now at the Lister rather than UCH?


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## annacameron (Dec 16, 2008)

of course and it's a good question....
having had 3 failures at UCH i thought that perhaps the issue was the hospital  (though i coudln't identify what I thought they were actually doing badly). i thought I must try out the Lsiter to see if it can get me a better result somehow. 

well....the results are awful, terribly dear and a lot of stress Im sorry to say. :-(

do give UCH another go - Saab adn Ranieri are vg in particular. but tougha s I say. 
god luck xxx


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## clotted cream (Jan 8, 2007)

thanks for such an honest reply!

Sorry that things aren't going well for you - it's difficult to know what the "right" thing is to do isn't it?  When we have a dream and we can't achieve it.


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## Caz (Jul 21, 2002)

Hmm, interesting to hear you say that about The Lister annacameron. I did 6 cycles with them and found them to be very competent and show a great deal of thought and flexibility as well as testing and tailoring to my individual circumstances. Admiteddly I don't have egg quality issues but I cycled on the Lister thread besides many ladies who did or who had age against them and it always seemed to me that they were particularly adept at dealing with poor repsonders/low egg reserve cases and they seemed to be quite forward thinking in treating those ladies. 
I also know one lady who had 4 cycles with deadful results, regarding quantity of eggs, went to the ARGC and ended up with 
loads more eggs and even enough for frosties which she'd never had before. She put this solely down to the very intensive protocol they do - yes it is very intense and very expensive but they do seem to get the results from that approach.

I guess it just highlights that you can't always rely on other people's experiences to determine which is the most suitable clinic for you. 

Clotted Cream  I wouldn't be put off the UCH just because they are NHS and you're not happy with another NHS hospital's approach - as I said above, what works for one may not for another and maybe you could look in the Clinic reviews board for some other opinions about all the clinics you mentioned. Perhaps wait until after your follow up and see what, if anything, your current clinic can do to improve your results next time before you look elsewhere. One option might be that you have a consultation at two of the possible clinics and see what they say/how you feel about them - that way you only lose out on the cost of a consultation if it doesn't suit.

Good luck for your follow up.

C~x


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## cwsg (Nov 10, 2008)

Hi,

just found this thread and thought I'd post.
I've just had a cycle of controlled natural IVF at Create health. 
Unfortunately the folicle was empty.
I am now looking for answers about egg production and quality being 42yrs old.
This clinic said that it was unnessesary to have a AMH test done.
They go by blood flow to the ovaries, FSH level. My progesterone level is hard to interprete as I have a short luteal phase of ten days, but it is between 15.4 and 21.8, which is low.

I now must decide whether to move on to mild ivf or continue with natural. The success rates for my age group is 27% with natural IVF at create, which is higher than conventional or mild ivf.

glad to be joining you on this thread

cwsg


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## clotted cream (Jan 8, 2007)

Caz said:


> Perhaps wait until after your follow up and see what, if anything, your current clinic can do to improve your results next time before you look elsewhere.


Many thanks Caz - that's just what we've done 

We had our follow up this afternoon, and although I had virtually decided to move elsewhere, we've decided to have 1 more go at the same clinic, but with Gonal F instead of Menopur as the stimulation drug. I know that my first ICSI was 18 months ago, which at my age is quite a long time ago in terms of depreciating egg quality for IVF, but for that cycle I used Gonal F and we got to the stage of having ET with a grade 1 and a grade 2 embryo. The consultant really stressed that the results that we had with the 4 eggs that fertilised all having 3 nuclei instead of 2 is apparently EXTREMELY unusual. I don't know if it is unusual, but it seemed to make sense that it could be the drugs.

I was still tempted with the Lister, ARGC - and now UCH - but we're both very comfortable with the clinic that we're at, and they were very good at fitting treatment in with us, and changing dates at short notice when my mum was taken ill.

I hope we'll eventually be as lucky as you with our own little miracle


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## clotted cream (Jan 8, 2007)

Hi cwsg - you posted at the same time I was writing my last message.

I asked about an AMH test today, and the consultant said the same as you, that it wasn't really necessary.  (he could have told me to have one done just to get more money from me )

I've read a bit about Create, but I didn't realise that their statistics are as high as that for our age group.

Sorry that it didn't work out for you this time - do you have to wait long before you can try again?  It does sound good not to have to inject all the drugs of conventional IVF/ICSI


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## cwsg (Nov 10, 2008)

hi caz,
no , I can start another cycle straight away if I like as i only took 3 days of drugs.

They have just released these figures, which are a shift from their 2007 figures where mild IVF had better results than natural.
cwsg


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## cwsg (Nov 10, 2008)

oops, sorry I meant to write to clotted cream, sorry


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## Caz (Jul 21, 2002)

Interesting what you say about AMH. One of our members have posted some links to research on AMH and stimulation here which could back up both your consultant's approach: http://www.fertilityfriends.co.uk/forum/index.php?topic=189257.0

I moderate on cycle buddies so I've seen a lot of people on all sorts of protocols and I've often seen multiple cyclers respond completely differently depending on which d/r and stimulation drug they have been prescribed. What suits one person does not another so a change in drugs can improve (or not) the number of eggs you get. I would have thought, quality wise and the issue with three nuclei was not necessarily something that would be affected by the actual drugs and more likely a genetic issue but... who knows! Did the clinic say whether it was caused by the egg letting in two sperm do you know? or something in the splitting process in the embryo? If it was genetic it would make sense that "old" (sorry I know it's a horrible term!) eggs might be a cause and perhaps not much you can do about that but try and produce as many eggs as possible and hope you have a decent amount that are chormosomally normal and fertilise well. You could ask about PDG on the embryos but clinics only seem to want to do this in the UK if you have a good number of embryos to do it with - I know one lady who had PDG on 3 embryos (from 4 eggs) and only got one good embryo that results in a biochemical pregnancy (early m/c) so there are no guarantees but it does mean you don't "waste" time putting back embryos that are doomed to fail before you start. 
You might also want to look up DHEA - not entirely sure if it's relevant for you but some poor responders have had success with this, and also some with Viagra, aspirin or clomid in addition to stimulation drugs to boost blood flow / improve stimulation response. There's a whole poor responders thread on FF so worth looking at that for some advice and inspiration. If you glean anything useful from it then you can always go back to your clinic and see how open they are to the suggestion.
The poor responder thread is here: http://www.fertilityfriends.co.uk/forum/index.php?topic=182099.0

And this thread might be helpful too: *What can improve egg quality and quantity ~ * CLICK HERE

I would certainly agree that if you are otherwise happy with your clinic and happy with the treatment they have planned for you then it's perhaps in your best interests to stay put as upping and moving to another clinic does not always make the difference you long for. I did once consider changing clinics after my 4th cycle failed just because I felt like I needed to do something. Had they not suggested changes to my protocol I might have gone elsewhere but all the while they were genuinely looking for a way to make it work and while I was otherwise happy and settled with them, it just seemed like change for changes sake, IYSWIM!

Wishing you both loads of luck! 

C~x


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## clotted cream (Jan 8, 2007)

Thanks for posting all those links Caz - I'll look through them all.



Caz said:


> Did the clinic say whether it was caused by the egg letting in two sperm do you know? or something in the splitting process in the embryo?


The clinic said that because I had ICSI they are sure that it was only 1 sperm in each egg, so they said it must be the egg.


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