We had our post-IVF - or more acurately IVZero - consult. We were happy to get it over and done with, and we suspect so was the doctor, though he was kind and generous with his time as ever. DH reckons he was expecting a tearful production and was relieved when I just peppered him with questions as per usual. (This might be my husband projecting his own relief though.) At one point the doctor did remark we were down-to-earth people before delving deeper into one issue or other. I'll take that as a complement.
I really appreciated that the doctor remembered one of my main concerns: is it an egg or a sperm issue? In preparing for the consult he called the embryologist that worked on our case to find out. Read on for the answer.
This is what we learned in question - answer format. Any similarity with our actual conversation is accidental.
How many eggs did we have?
Good, 10 were mature, which is a good rate.
The polar bodies in some looked wonky, but they can't say that this means anything. It's just one of those observations embryologists like to put in their reports.Sperm quality?
Scored normal in all aspects: count, morphology, motility. No indication at all that ICSI was necessary.So, what went wrong?
The problem seems to be the binding between sperm and zona pellucida. Normally, one would expect to see a swarm of sperm around each egg, all trying to get in. In this case, the embryologist saw the sperm swimming about cluelessly in all directions.Is it the sperm or is it the egg?
We can't say for sure. The egg may not be sending the right 'come hither' signal to the sperm. The sperm may just be too clueless to respond to the signal.Are we just incompatible?
There's no practicable*
test available.-- Well, what did you expect, that he was going to tell you each to have an affair and see who procreates first? --What now?
With ICSI you should have a good chance of creating embryos.Is our condition hereditary?
Well, you've been tested for know genetic causes of infertility (Y-deletion, fragile X, balanced translocations, CF) and you have none of these.
Of course, there must be a gene somewhere that is the root of this problem, and the odds are you would pass it on, but we don't know what gene. Nor do we know whether the trait is dominant, but that is unlikely since it's such a rare condition.What if the same happens again?
Then we'll have exhausted all our treatments options ...... with our own genetic material.
Correct.What kind of donor options does the clinic offer?
Anonymous donation of sperm or eggs is a possibility, any form of known donorship is not.Really?
Yes.-- Perhaps an affair is not such a bad idea after all. --Moving back to matters at hand, how soon can I start again?
After one rest cycle. The cycle after that you can start with BCPs again in preparation of the next attempt.Protocol changes?
Actually, yes. This time you can use G0nal-F, the synthetic drug, instead of Men0pur, a human derivative.Why the change?
G0nal-F being synthetic has the advantage that we can accurately measure the dosage. In Men0pur, the vials all supposedly contain 75 IU, but in reality it ranges from 60 to 90 IU.Don't some doctors claim Men0pur works better because it contains trace amounts of LH?
Yes, but those claims haven't been adequately substantiated. Your body will produce some LH throughout your cycle. We monitor this and can influence it by altering the Supre.fact dose.
What could have come up, but didn't:*So, there are unpracticable tests?
Why yes, I'm so glad you asked.
In theory, after TFF, you could pipette the eggs into a fresh petri-dish, leaving behind all dh's sperm and add a fertile donor's sperm. Now mind you, no embryo's would form, because the eggs past their sell-by-date. But the zona pellucida is still fully functional for a while, and if the new sperm did make it through ...
Likewise, we could take some of dh's sperm and put it in a petri-dish with someone else's leftover eggs, and see if they can get in there. Of course, 'leftover eggs' are a rarity in practice. In future, we hope to mass produce artificial zona pellucida, so we can test sperm for their ability to hack it, so to speak.
Nice, swinging it in a petri-dish!
If any of the issues in this post have affected you, please don't call me, check out these great resources:
Labels: IVF#1, QA