Egg Quality in IVF



Well everybody talks about egg quality but
there is no uniform way of measuring it yet, in fact one of our embryologists, Emma Lazzaroni,
is doing a study to see if we can actually measure the egg quality in an effective way. At the end of the day, egg quality is something
we know it's there because we get good embryos, so a high quality egg gives us a high quality
embryo and there is a lot of agreement about what constitutes a high quality embryo: blastameres
diving on time, equal cell numbers, low levels of fragmentation. We've known that for years. What we don't know and what we can't, in the
standardized way, predict is which egg when we pull it out is necessarily going to become
that high quality embryo. We are learning ways of trying to score then
each of the embryologists at this point are looking at eggs in the sort of subjective
way that you might go to the store and pick a good tomato or a good peach. A lot of different subjective issues in the
study that Emma is doing, she is trying to quantify those things so we can learn even
better how to do that. But it's all about egg quality because the
egg is the machine really that's in charge of early embryo development. You can think of the embryos as developing
in sort of two stages. The first is sort of the liftoff stage it's
like the rocket just taking off from Cape Kennedy. The first few divisions through that whole
liftoff, that initial development, are completely determined by how good the egg is to begin
with. All of the RNA, all of the metabolism that
leads to those early divisions that makes it a successful embryo are already present
in the egg. The embryo after it's gone through a series
of those divisions does something very magical, but it's farther down the line, it switches
off from that program that is already in the egg, which is actually the mother's program
into the new program that's the embryo's program, and that happens down the line. So the embryo that's a good genetic conception,
that is in a good egg, gets to that first stage and then gets to use its second stage
where its using its own genes, its own program, and then you can have a successful pregnancy. But, even a good genetic program that's in
a poor quality egg will never get to that second stage, they never go through the sort
of early divisions that it needs to to get a high quality egg that has a chance of going
onto the later stages. So the first step in embryo development is
based on having a good, healthy egg. Over the last 10 years there are two ways
the doctor might be making those comments. He may be looking at predictive factors like
your hormone test saying 'Oh you have a high FSH, you're probably going to have poor quality
eggs' or 'You're 42 years old, you're probably going to have poor quality eggs', or he or
she may be responding to what happened in an IVF cycle in which you produced eggs but
they became poor quality embryos, and he's saying 'well most likely this is because you
have bad eggs'. Egg quality is dependent on everything that
it comes before, so the eggs are sitting there sort of on the shelf all of a woman's life
and then they're conditioned and developed through those phases of development that go
on for the weeks or few months before they actually enter the menstrual cycle. So a high quality ovarian environment, a high
quality follicle, all those things lead towards how the egg quality ultimately is and so the
ovary is doing the final production on that egg and everything you can do to improve the
environment in which that's occurring has the potential of improving it. It's one of the differences of our approach
here at CHR is a recognition of that opportunity because many places will say that if you have
poor egg quality it's just because they've been on the shelf for too long and there's
nothing you can do about it, but now there's increasing number of schools of thought of
different ways of trying to influence it and people have tried using nutrition, people
have tried using other forms of hormonal treatments, we've been using androgens. It's likely that many of these different things
may be effective, we haven't studied those nutritional factors or some other hormones
yet; we eventually will but the issue is that there's an opportunity to try to make it better
and we have evidence that we can do that to some extent. Somebody who either historically has poor
quality eggs or have predictors that suggest they are going to have poor quality eggs,
we believe we can improve that quality. We are never going to make them back into
20 year olds, we are never going to make them back into the way they were 10 or 15 years
earlier, we are just going to make them better. Ultimately, chances of pregnancy in a 42 year
old who is going through this process of trying to improve her quality will never be as good
as that that which you might get with a donor egg, but we can improve it so that it's better
than when she came through the door. Well I think it helps the embryologist because
there's probably also an opportunity in the laboratory if you can identify an egg that
needs more help. Maybe you can handle it differently in the
laboratory, maybe you can approach it differently, use different tools, different culture media. At this point we don't know that, but if we
can, the first step in developing ways of trying to treat them better, or different
techniques is to identify who needs the help.

7 Replies to “Egg Quality in IVF”

  1. Please could you help? Iv just had a fresh transfer AA blastocyst textbook womb but it failed. Any idea why please?

  2. Doctor, do you think egg quality deteriorates with age, or is it bad from the beginning (when it is) ?

  3. I HOPE YOU CAN HELP ME WITH MY PROBLEMS, I HAVE BEEN UNDER IVF THERAPY FOR TWO CYCLE NOW, ONE MONTH APART EACH CYCLE. I HAVE TO TAKE A LOT OF INDUCTION INJECTION FOR MY FOLLICLES TO GROW, UNFORTUNATELY, MY FIRST UNDER GENERAL ANESTHESIA FOLLICLE HARVESTING WAS NOT SUCCESSFUL. AFTER THE HARVEST, MY DOCTOR CALLED ME ON THE 2ND DAY AFTER THAT INVASIVE PROCEDURE,AND TOLD ME THAT MY EGGS JUST STOP GROWING. HE SAID THAT MY EGGS DID NOT EVEN GROW FROM M1 TO M2, OR THERE IS ONE EGSS THAT GROWN TO M1 TO M2 BUT THEN THERE IS AN ARREST, ITS JUST STOP GROWING, SO NO ICSI OCCUR BECAUSEHE SAID THERES NO USE OF DOING IT SINCE MY EGGS STOP GROWING, HE EVEN SAID THAT ALL MY EGGS WERE ALL THE SAME THAT NOT EVEN ONE SURVIVED FROM M1 TO M2, THEY ARE ALL IN THE SAME STAGES AND THEN ALL STOPED GROWING. AND THE SAD THING IS THAT MY SECOND INVASIVE PROCEDURE UNDER GA FOLLICLE HARVESTING, IT HAS THE SAME STORY, SO THERE WAS NEVER A FERTILIZATION BY MY HUSBAND SPERM OR ICSI OCCURED.. I ASKED THE DR, WHAT MIGHT BE THE REASON, AND HE SAID IT MIGHT BE GENETIC. I WAS DEEPLY SAD WITH THAT NEWS, DOES IT MEAN I WILL NEVER HAVE A BABY? OR IS IT BECAUSE HE HAS BEEN OVER INDUCING ME? OR WHAT MIGHT BE THE REASON FOR THIS? PLEASE I HOPE YOU CAN HELP ME WITH THIS AND TELL ME WHAT SHOULD I DO TO HAVE A GOOD EGGS.. GOD BLESS YOU!

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