Confused about call from embryology lab today

[Anonymous]

I’m 38. Has 56 eggs. 34 fertilized. Did not hear from lab until today, Day 5. From what i understand, 4 embryos made it to blastocyst stage and have good ratings. Those were biopsied and frozen (I’m doing PGS testing). 5 or 6 are just shy of the blast stage - not sure about their ratings.

Does 56 eggs yielding potentially 4 viable embryos a poor outcome? Are they supposed to tell me more? I didn’t get much other info, and it sounds like it was a lab tech who called me.

Disclaimer: this is my first time doing IVF. I’m blown away by the level of these discussions and how smart many of you must be. I’m smart, but not like you all, so excuse my not understanding all of this. There’s discussion about “trials” before implantation that my doctor has never discussed with me, Day 6 and 7 embryos (also never discussed with me). You all are so smart!!!!

[Anonymous]

Do you have PCOS? And did you suffer from OHSS during this cycle. Only asking because those with PCOS tend to yield high numbers of eggs (not necessarily high quality eggs) during retrieval coupled with the fact that there is egg quality issues with PCOS (due to hormonal imbalances such as insulin resistance & high androgen levels) which in turns affects quality and growth of embryo. It’s not unusual with those numbers although it is frustrating. I had 39 eggs retrieved, 19 matured, 14 fertilized by ICSI and 5 embryos made it to day 5 blasts. The remainder embryos arrested (stopped progressing) at the morula stage. Mind you I was 32 at the time and was my 1st IVF. Right now not much you can do but to keep faith and hope FET will work in the near future. I am doing my first FET in couple of weeks and hoping for the best. And PGD/PGS was not recommended for me as I was young and never been pregnant before so not medically necessary at the time. having may cut your embryo numbers down as some may come back abnormal & they will not implant those. Wishing all the best and keep your fingers crossed. There might be good news soon.

[Anonymous]

So you're aware, 15-20 is a pretty good # of eggs from someone young. 56 is usually associated with PCOS. Also, for those in danger of severe OHSS (with 56, sounds like you are/were), REs will try to mitigate the risks during the cycle by adjusting meds. I'm sure your RE wasn't aiming for 56 mature eggs, so ending up with 34 fertilized is probably a good # all things considered. I think you'll find that you'll get more blasts on day 6 (or day 7 if your RE allows them to go that extra day). From a percentage basis, the # of blasts you get from the 56 eggs might seem low if you compare it to a cycle where OHSS isn't an issue, but for PCOS, I think you get a large # of eggs, but not necessarily a proportionally large # of normal blasts. When you get your final #s, though, it sounds like you good end up with a good cycle.

Your RE should go over the results with you once all the testing comes in. IVF can seem very disheartening - there are so many stages and it all just seems to get worse as it goes on and the #s get lower. Good luck!!!

[Anonymous]

Regardless of starting with such a high number (and i think 56 is the most I've ever heard of!) ending up with 4 good quality blastocysts is a good outcome. It's just that most people more typically start out with between 8-20 eggs to end up there.

[Anonymous]

Thanks everyone. OP here. Just heard from the lab, and none of the others made it to the blastocyst stage. I'll hear from Natera, the lab doing PGS testing, in about 10-14 days. I keep thinking what if all four embryos come back abnormal?

As far as PCOS, I don't know. The whole reason I started this is that when my OB did initial testing, my AMH came back at 11.4, which said made her worry about PCOS. But when I started seeing the RE, she and all other doctors said I couldn't possibly have PCOS, because I'm not overweight, have normal periods, and have no facial hair. I'm not sure why no one will discuss PCOS with me!

They were worried about hyper stimulation, and I was pretty uncomfortable during this process. I think I made it to Day 7 on stim meds, and ended up having to have ultrasounds more frequently.

I have gotten pregnant normally before - does PCOS ever develop later in life? I guess I don't really understand it. My RE looked at me in the face and said "it doesn't really matter if you have PCOS, which I doubt you have - it's not like something we treat."

Thanks for the reassurance everyone!!!

[Anonymous]

I have PCOS. I also don't have facial hair, am not overweight, and have mostly regular cycles. I'm non-IR.
With your egg retrieval results and AMH, I'd assume PCOS, too. Have you had androgen/testosterone levels checked? What was your AFC before starting IVF?

I was put on a VERY low dose of stims, that was then adjusted downward almost every day, and we got 25 eggs. 12 were fertilized. 7 made it to blast, and 3 were normal.

[Anonymous]

Anonymous wrote:I have PCOS. I also don't have facial hair, am not overweight, and have mostly regular cycles. I'm non-IR.
With your egg retrieval results and AMH, I'd assume PCOS, too. Have you had androgen/testosterone levels checked? What was your AFC before starting IVF?

I was put on a VERY low dose of stims, that was then adjusted downward almost every day, and we got 25 eggs. 12 were fertilized. 7 made it to blast, and 3 were normal.

I'm not sure what it was this last time, but at other times, my AFC has been around 40. Not sure re my androgen/testosterone levels. Is that something they'd check every month at the clinic?

[Anonymous]

Studies show a link between PCOS and low vitamin D levels. At a minimum I'd supplement, and consider getting tested and getting your levels up to the high end of normal.

[Anonymous]

I’ll just say that 4 blasts is excellent. I usually had a lot of eggs at retrieval (highest was 32) and a low maturity rate and fertilization rate. I had two make it to blast and go for Pgs testing. Both were normal and resulted in my now infant son and daughter. Good luck op

[Anonymous]

I don't understand why you're RE isn't considering PCOS and would see if your obgyn can run some tests. Just b/c you don't fit in the standard definition doesn't mean you don't have it. How many times have we heard of someone getting lung cancer yet they've never smoked before?

[Anonymous]

Anonymous wrote:

Anonymous wrote:I have PCOS. I also don't have facial hair, am not overweight, and have mostly regular cycles. I'm non-IR.
With your egg retrieval results and AMH, I'd assume PCOS, too. Have you had androgen/testosterone levels checked? What was your AFC before starting IVF?

I was put on a VERY low dose of stims, that was then adjusted downward almost every day, and we got 25 eggs. 12 were fertilized. 7 made it to blast, and 3 were normal.

I'm not sure what it was this last time, but at other times, my AFC has been around 40. Not sure re my androgen/testosterone levels. Is that something they'd check every month at the clinic?

No, I don't think that's part of the standard day 3 testing. My OBGYN ran that bloodwork when he first suspected I had PCOS. I was in denial because I didn't have issues with weight or insulin resistance. Mine was confirmed via high testosterone levels (although apparently not high enough for facial hair to be an issue), high AMH, and what I was told was a high AFC after my first vaginal ultrasound. My OBGYN immediately referred me to an RE. I don't remember the testosterone level at that time, but my AMH was 7, and my AFC was nearly 50.
I agree with one of the PPs who suggested that you get your Vitamin D checked and start supplementation if necessary.
I sort of see where your RE is coming from...they aren't necessarily going to treat you differently than they do now if you do indeed have PCOS. Other than maybe change your protocol to help prevent OHSS (PCOS patients are more susceptible to this after ER due to the usually higher numbers of eggs retrieved). But, PCOS can have implications on your future health. There is some relation between PCOS and an elevated risk of development of Type II diabetes, heart disease, and certain forms of cancer as you get older. Women with PCOS may also have a higher risk of miscarriage. Not trying to scare you, but these are things you should be aware of.
4 blasts is good. I wish you so much luck with the PGS testing! FWIW, our first FET stuck and resulted in our DC. Second FET also worked but was later determined to be ectopic. We're gearing up for another FET with our final embryo in another month or so.

[Anonymous]

OP, your numbers are somewhat lower than average, but all you need is one good one. Good luck!

[Anonymous]

where are you a patient?

[Anonymous]

Anonymous wrote:I have PCOS. I also don't have facial hair, am not overweight, and have mostly regular cycles. I'm non-IR.
With your egg retrieval results and AMH, I'd assume PCOS, too. Have you had androgen/testosterone levels checked? What was your AFC before starting IVF?

I was put on a VERY low dose of stims, that was then adjusted downward almost every day, and we got 25 eggs. 12 were fertilized. 7 made it to blast, and 3 were normal.

+1. although you don't have the classic signs of PCOS, the evaluation doesn't stop there. the average individual will not yield that many eggs without PCOS. Hence most on this post are flustered as to why that wasn't even considered. agree that androgen/testosterone levels should be checked at least to r/o out PCOS completely. low Vitamin D levels as previous post indicated has also been linked to PCOS as well. I have PCOS but I wasn't diagnosed till my late 20's. My younger sister was diagnosed years before me and had a normal cycle, not overweight at all (size 0-4). only symptom she was having was getting frequent pelvic abscesses from ingrown hairs on her pubic area (TMI), however her PCP diagnosed her in like 20minutes. I think its up to you if you want to get a 2nd opinion on the PCOS piece of it or just simply go with what you currently have and waiting on the results of the PS testing. and some people are diagnosed later in life even after kids. just remember PCOS is an hormonal imbalance that can stem from a variety of factors.

[Anonymous]

I have pretty severe PCOS and yielded 26 eggs at age 30. Your egg yield seems quite high.