How do you know your egg quality is poor?

[ttcrainbowbabypatel]

Hi ladies

I'm trying to think up a plan (to protect my heart, really) just in case our upcoming round is poor just like our first. Most doctors we've seen since our first round (15 collected, 14 mature, 8 fertilised with ICSI, a few made it to blast but only one good enough to transfer and none to freeze) have said that the issues we had with embryo quality could be my husband's dna fragmentation (which we've now got in the normal range)...however, an NHS doctor suggested it could be my egg quality. This is the first time I'm hearing this and it's sent me into a panic.

There's not a lot of data to support that my egg quality is the issue (no notes suggesting this from our notes from our first round, either) but we've had two miscarriages and two ectopics. I'm open to the fact that it could be me.

I'm trying to understand how a doctor or a clinic establishes poor egg quality so that we don't keep going and going on my own eggs (there's only so much someone can take) when we can look into an egg donor.

Can anyone explain this to me? Are there articles or books you've read that shed light on this?

How did you find out that your eggs weren't an option? What were the circumstances? I have an amh of 6.4 and I'm 33 - I've been told this is low for my age.

I don't want to do back to back rounds for eggs that just aren't good enough to make this work but my husband thinks I'm focusing too much on the concept that potentially it's my eggs that are the problem.

Can anyone help?

Thanks you.

[Sarah_a_2018]

Im not a medical expert but I have done a bit of research into egg quality since our first IVF attempt wasn’t successful and nobody could tell us whether this was an egg or sperm quality issue, I went to see a fertility nutritionist who advised on supplements that we could take that would help to improve sperm quality and egg quality, dietary changes that we needed to make for hormone balance, improve gut health and reduce stress because they can all play a role in affecting your body and mind when TTC.

I tried to take a holistic approach rather than focusing on just my eggs and hubby’s sperm, we changed our exercise routine, diet, took supplements and when we came to do our second round of IVF we had better quality embryos and we even had one suitable for freezing which we didn’t have first time around.

Don’t be disheartened by your AMH levels it’s not an indicator of egg quality or your ability to conceive, I’m afraid that egg quality can’t be assessed until they’re fertilised and even perfect quality embryos in the lab don’t make it to a viable pregnancy and there are poor quality embryos that grow into healthy babies there’s just no way of knowing and that’s something I’m working to find out myself is how we can improve our chances of this cycle we’re on isn’t successful.

If you’re able to self fund there’s the option of PGS screening which can give an indication as to the potential for embryos to develop normally, there are different drug protocols to try for stimulation - we had gonal f first time round and menopur second time.

Don’t give up on your own eggs just yet, there’s a few books I’ve read that might help - it starts with the egg, taking charge of your fertility, and the balance plan (that’s for nutrition for hormone balance but can help with TTC for ivf and naturally)

Sorry for the long winded post 🙈 best of luck xx

[ttcrainbowbabypatel in reply to Sarah_a_2018]

Hi Sarah! I saw a fertility nutritionist before we started to prepare and was also on DHEA. I have been told by most doctors not to take DHEA for the second round and that I simply don't need it.

I've also been to a recurrent mc specialist, lost weight, stayed on top of my supplements, etc. I guess what I struggle with is not knowing definitively if it's me and how that's ascertained. I did read the book you've mentioned before my first round (I know there's an updated version), I just feel lost.

My friends have done 6-7 rounds on their own eggs and I don't think I am strong enough for that. My body has sustained a lot already from my two ectopics. I'm just worried that there won't be any clear info and I'll try and try and waste my time and put my body through the wringer.

As far as drug protocol, last time I was meant to be on gonal F only but we observed my LH really slipping around day 6 when menopur was introduced. All doctors I've seen have said that they'd start menopur from day round in this next round with either fembola or gonal f.

This is so hard. I wish I had some clear information and could prevent myself from even more heartache. It's a shame the science just isn't there yet.

Thank you so much.

[Kilk22 in reply to Sarah_a_2018]

Hi ttcrainbowbabypatel, hope it’s ok to jump in here. Reading this post and I’m in process of trying to get best quality eggs 🤞🏽🤞🏽 Would you share some of the dietary changes / foods the nutritionist advised you? I’m already eating healthy but I may be missing some things and I’m taking lots of supplements but I really want to give this chance my all. Cycling in October . Hope all went well for you. Baby dust xxx

[Sarah_a_2018 in reply to Kilk22]

Hi, everyone's Nutrition needs are different but for me I had to reduce my carb intake, increase my protein and fats. I was following a plant based diet however my food intake was predominantly carbs and wasn't getting enough protein or fat so had to reintroduce meat, I have an intolerance to eggs and am dairy sensitive, I take a pregnancy multivitamin and a probiotic, reduced my caffeine intake and started doing yoga to help me relax. I also added flax and chia seeds, sunflower and pumpkin seeds, eating more veg, eating organic chicken. It takes 90 days for follicles to mature and release an egg so any changes you make will take at least 3 cycles to have any impact on egg quality but the sooner you start the better. Best of luck xx

[Kilk22 in reply to Sarah_a_2018]

Thanks for the info. I’ve been doing all of that the last good few months so hopefully it’ll show. I don’t drink coffee or tea. High protein diet has been mentioned a lot around fertility nutrition so I’m lucky I can eat lots of it (eggs mainly and beans and veggies). I was just wondering I guess was there anything I was missing. Thanks again and best of luck to you too x

[Cinderella5]

Unfortunately there are no tests to confirm that egg quality is an issue. I was told the same, I was 38 with an AMH of 7.19 and this was the conclusion my clinic came to after a couple of cycles. We were actually referred due to a very low sperm count. Our first cycle was a disaster, all of our embryos perished. However once we did a couple of more cycles and our embryos didnt do so well and although we had good fertilisation our embryos tailed off around day 3. We did manage to get 3 blastocysts from those 2 cycles after taking DHEA but still got told that our failures were likely due to egg quality given my age and AMH. It is hard to take when you get told its your eggs....I was a bit horrified as like they said, they have no way of knowing and its only an educated guess. However we moved to donor eggs after this and we got 6 great quality embryos so I guess they were right! Have you thought about taking any supplements such as DHEA and ubiquinol which can help with egg quality? These need to be taken for a minimum of 3 months to get the benefit. Might be worth asking your clinics opinion?!xx

[ttcrainbowbabypatel in reply to Cinderella5]

I have been on coenzymeq10 for months and haven't stopped it. I was asked to not take DHEA any more because there was no indication I need it but perhaps I can run a test to tell me whether or not I need to? Thanks so much for your thoughts. I hope using a donor is what brings you your baby.

[Cinderella5 in reply to ttcrainbowbabypatel]

Thank you, I do hope so too! A girl that I cycled with tried DHEA as a last resort and even with having no problems with her AMH/reserve and she has twins now....its something to consider in my opinion but you should defo be guided by your clinician. I see below you also have MTHFR, I also have this and use clexane. Once other thing to consider is if your clinic would allow you to try a low dose steriod like prednisolone just in case for natural killer cells in your uterus. There isnt a huge amount of evidence behind it but Ive seen ladies have success with it on here after miscarriage or implantation problems and I got my first ever BFP after taking it so will try that again next time. Best of luck with everything!xx

[DianeArnold Partner Nurse Fertility Network UK]

Hi. If only we could go into your ovaries and pick out any good eggs, but sadly we can't. We just have to wait until egg collection and the skill of the embryologist. Obviously, if there is a persistent problem, then you may be guided towards using an egg donor. Having lost 4 pregnancies is just too shocking to get your head around. My thoughts of course, it seems as if you may have an implantation problem, I don't know, but it might be worth asking about having Clexane (heparin) injections next time round. This can help with even blood flow to the womb and lining and your ovaries. Also helps to prevent clotting, thought to be a big cause of implantation. Specialists are divided with their opinions on this, but it wouldn't hurt to ask if you haven't tried it before. Oh I do wish you all the best next time round, and of course for a healthy, ongoing pregnancy. Diane

[ttcrainbowbabypatel in reply to DianeArnold]

Hi Diane. I don't know if it's clear that I have an implantation issue just yet but my recurrent MC results have confirmed that I'll need a low molecular weight heparin, baby aspirin and that I have MTHFR so I'm taking methylfolate instead of folic acid. Hopefully these measures can help us.

I think PGS is also something I'd consider but as our next round is on the NHS (fingers crossed) we'd have to see if they'd allow us to pay for it.

Thanks for your help.

[DianeArnold Partner Nurse Fertility Network UK in reply to ttcrainbowbabypatel]

Hi. Pleased to hear that, as it can support an ongoing pregnancy too. Thinking of you. Diane

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Hi it’s frustrating I’ve had 3 mc had tests nothing all they could say was aged eggs I’m 39 but pregnancies were at 37/38 I’ve took for 3 mths dhea ubiquinol pqq amongst other supplements we still mc our last pregnancy so I’m at a loss to how to make my eggs better quality.

[Kari55]

Hi, as others mentioned, there isn’t a specific test for egg quality. However, if the shell of the egg during ICSI is hard to break, the embryologist would then say there is a quality issue. Also, high FSH levels might indicate poor egg quality. As you said the problem might be also on the sperm side. Unfortunately there is a lot of unknown in the life creation process.

I’m terribly sorry for your losses and I hope things will work out for you xx