AboutEdward Joseph Ramirez, MD, FACOG Expertise I am a specialist in infertility and advanced gynecological care. I can answer questions about infertility, gynecology related ills, menopause...virtually anything that affects women's health. PLEASE tell me where you are writing from as I am always interested.
Experience I have been practicing as an Ob/Gyn and Infertility Specialist for over 23 years. Gynecology, advanced laparoscopic surgery, basic infertility, IUI's, IVF, reproductive surgery, and ovulation induction are all areas of my expertise. I am Board Certified. I have been doing In Vitro Fertilization in my clinic for 15 years.
Organizations American College of OB/GYN, American Board of Obstetrics and Gynecology, American Society of Reproductive Medicine, Society of Assisted Reproductive Technology, American Association of Gynecologic Laparoscopists, Fellow of The American College of Obstetricians & Gynecologists,Resolve-National Chapter, Open Path - Northern California, Board of Directors Monterey Medical Society
Publications American Journal of Obstetrics and Gynecology
Education/Credentials Medical Degree from Stanford University, Residency at Tripler Army Medical Center, Reproductive Training at Pacific Fertility Center, San Francisco
Question QUESTION: Dr Ramirez my husband and I went through Ivf and had 6 eggs fertilize but on day five when we were suppose to have the embryo transfer our Dr called and said the embroys quit growing we went for a follow up and he did a sperm chromomsom test the came back poor to fair would you say the problem was most likely with my husband ?
ANSWER: Hello Kris,
The test that was done was not a sperm chromosome test. There is no such test. It was a sperm fragmentation test and looks at a specimen to see what percentage of the sperm are fragmented. That can indicate that there are sperm problems and if the rate is high, ICSI is usually recommended. This does not have an effect on the embryo quality or the number of embryos that survive.
First let me say that there is risk going to blastocyst. Part of that risk is that you did not have enough eggs to start. I would not have recommended it. I require a minimum of 8 good quality embryos (7 cell - 8 cell) to qualify to proceed to blastocyst. I also require that your age is less than 35 years old. In addition, there is the risk that the embryos won't make it, and part of that, as you have experienced, may be due to the fact that we have not perfected the culture media or environment for all embryos to make it to blastocyst. That may lead to embryos not making it that would have survived in the uterus. For those reasons, I still prefer day # 3 transfers, as the majority of IVF centers do in the U.S.. Thirdly, I will only go to blastocyst if the couple absolutely does not want to take the risk of twins or more. In that case, I need a method to reduce the number of embryos so that I can choose just one and give the couple the best chances with just one. Then, I will proceed eventhough I only have a small number of embryos.
I don't know how many eggs were retrieved, but only 6 fertilized is a low number, and I am sure that not all of them developed into good embryos at day # 3. I would not have recommended a day# 5 transfer to you. Abnormal sperm can certainly contribute to poor embryo quality, but you would have known that by day# 3, which would also have made you ineligible to proceed to blast.
I hope this helps,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
---------- FOLLOW-UP ----------
QUESTION: I was 31 at the time of the ivf I had 17 eggs removed and 10 were mature enough to fertilize out of 10 only 6 fertilized and when they checked on day 3 they seem to be growing just fine and then stopped growing after that would you say since all my test are normal and we tried 6 inseminations with donor useing clomid and one round of femara that are best chance would be ivf with donor
Answer Hi Again,
Based on the new information you gave me, the fertilization rate looks good. Generally, we use a 60% fertilization rate as our threshhold and you had exactly 60% (6 of 10). The number of eggs retrieved was good also, so that means you were stimulated appropriately.
Again, I would not have taken your embryos to blastocyst. I, and many programs, require 8 good quality (8 cells) embryos as a minimum to proceed to blastocyst. As I mentioned previously, the culture media to grow embryos to blastocyst is not perfected so there is a fairly high loss rate. That could have been the reason yours did not progress.
You certainly could try donor sperm, but I would try at least once more as you have with your husband's sperm. In the next cycle, I would transfer 3 embryos on day# 3 and NOT go to blastocyst, as long as you don't mind taking the risk of twins.
Sincerely,
Edward j. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
