Cytoplasmic Question


5 Posts
Reply Posted on: Jul 7, 2014 at 7:35am
Dr Braverman,

We have recently cycled twice for family balancing (we have 2 boys conceived naturally).

My pretesting is as follows:

30 years of age for Cycle 1 & 31 years of age for Cycle 2
AFC - 25
FSH - 7.7
AMH - 1.3
Normal Hysteroscopy & Saline Sonogram
Normal TSH
Normal Blood Clotting Basic Tests

Cycle 1 - Long Lupron (150 Gonal F/75 Menopur) - Stimmed for 9 doses. Follciles ranged in size from 18-27 at trigger. With this cycle, we had 14 retrieved, 11 mature, 11 fertilized, 8 biopsied, and 2 were chromosomally normal with Natera. Unfortunately, the transfer of our only xx embryo resulted in a chemical pregnancy (she was only an early blast on day 5). The chemical pregnancy resulted in an initial beta of 47 at 11DP5DT, 111 at 13DP5DT, 252 at 17DP5DT, and 292 at 19DP5DT.

Cycle 2 - Long Lupron (225 Gonal F/75 Menopur for 2 days, then 150 Gonal F/75 Menopur for 6 additional days) - Stimmed for 8 doses total. The day before trigger, there were 20 follicles ranging in size from 10-21. I am thinking the largest follciles were around 24 on trigger day (since we had one more dose of meds before trigger without seeing the doctor). 12 eggs were retrieved, 7 mature, 7 fertilized, 6 biopsied, and one was chromosomally normal. The normal was an xy, which was also donated (so no transfer for this cycle).

With cycle 1, out of the 8 biopsied, we had 2 HB, 2 XB, 2 Early blasts, an 2 morulas. The grading was mostly BB, except one was AB (the healthy male).

With cycle 2, out of the 6 biopsied, we had 4 HB and 2 early blasts. The grading was BB for all embryos.

Cycle 1 we used Natera, which indicated 6 of the 8 embryos biopsied had abnormalities on the paternal side. 5 of the 8 were normal on my side.

Cycle 2 we used IVIGEN so we do not know what side the abnormalities came from.

The doctor for these cycles suspected a sperm issue based on the Natera report so we completed the SCSA test and he had 10% DFI and 11% HDS (excellent). We are currently waiting on the sperm aneuploidy test results. I had another follow up with a more local doctor and had the following reply:

"I called Natera and inquired about the issue of paternal aneuploidy. It looks like the test tells you which part is missing, not whether it is related to the sperm or the egg. In other words, it is the egg that decides how to allocate the paternal/maternal genome. I suspect the eggs are missing the allocation process, probably due to cytoplasmic issues."

I am now confused. Does the Natera report not indicate which side the issues on and the fact that we had so many paternal genome issues could really stem from an egg issue? I tend to respond well to the meds and stim very quickly so I didn't suspect I had DOR. I also create HB on day 5 & 6 so I didn't think quality was an issue either. But, this 2nd opinion was very firm in that they think it is an egg issue. We need to determine which side the issue is on before we proceed. We are comfortable with using a sperm or an egg donor, but I do not want to use an egg donor if he has sperm issues because I feel like it would be a lot of $$ down for little benefit. What are your thoughts on this? We had initially thought we might try another cycle with 1/2 donor sperm and 1/2 his sperm and see how that works. Do you think maybe the Long Lupron is just a bad protocal for me? Which one would you recommend?

Thank you for your help!

Dr. Braverman

2026 Posts
RE: Cytoplasmic Question Posted on: Jul 7, 2014 at 10:04am
You certainly need to rule out other issues as well(such as implantation unerelated to the embryo quality). Many centers spend too much time on analsysis of genetics (which is still unproven) and one on what is still the most likely issues which is immune dysfunciton.
I would be happy to discuss your case with you , fill out a consult form on the website and we can schedule a free 10 minute discussion to reveiw your case.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.