How can a CGH normal embryo end up as empty gest sac?


#1

I am not too familiar with all the terms yet but I supposed empty gestational sac is also known as a blighted ovum? I transferred two CGH normal chromosome blasts. My RE thinks I either have ectopic or a blighted ovum? I told her yesterday I do not understand how normal chromosome blasts end up as a blighted ovum?

She said she doesnt know either. Very comforting indeed. She said we did the steroid, endometrial biopsy, the only thing she could think of doing for next cycle is doing intralipid infusion. How can intralipid infusion prevent your blasts growing into a beautiful gestational sac with yolk sac and fetal pole inside?

We only have two frozen blasts left also CGH normal. To be honest before I see this doctor (I switched to her in January this year), I didnt think we would even get any normal blasts because of my previous history of chemical pregnancies. I cried when she told me we had 6 normal blasts and starting to build up my hope again but now this… It is hard for me to keep my faith that this will ever work after all this.


#2

[QUOTE=alexi]I am not too familiar with all the terms yet but I supposed empty gestational sac is also known as a blighted ovum? I transferred two CGH normal chromosome blasts. My RE thinks I either have ectopic or a blighted ovum? I told her yesterday I do not understand how normal chromosome blasts end up as a blighted ovum?

She said she doesnt know either. Very comforting indeed. She said we did the steroid, endometrial biopsy, the only thing she could think of doing for next cycle is doing intralipid infusion. How can intralipid infusion prevent your blasts growing into a beautiful gestational sac with yolk sac and fetal pole inside?

We only have two frozen blasts left also CGH normal. To be honest before I see this doctor (I switched to her in January this year), I didnt think we would even get any normal blasts because of my previous history of chemical pregnancies. I cried when she told me we had 6 normal blasts and starting to build up my hope again but now this… It is hard for me to keep my faith that this will ever work after all this.[/QUOTE]

I think your doctor knows why embryos in general can become blighted ovums, but no one can tell why any SPECIFIC embryo might become a blighted ovum. Any number of things could cause a blighted ovum other than chromosomal abnormalities, and almost all of those things you have no control over. This is just my insight, but a blighted ovum could be caused by an egg that is initially missing important organelles or cellular mechanisms, if mitotic cell divisions begin to fail, if conditions in the uterus aren’t nourishing the embryo, if something is wrong with the sperm… It could even be DNA issues other than just aneuploidy, like a freak accident translocation mutation (where the DNA from your mother and father make an exchange, but the “cut” in the DNA happened someplace important). These are just a few of the thousands of unlikely ways things might go wrong, but when you add up all of those unlikely things, then it ends up being a common occurrance for everyone. In your case, if you have a blighted ovum, then its just probably a freak accident.

I’m sorry if I’m not saying any of this gently. I find that when I’m searching for answers from doctors, having them try to “break things to me gently” results in omission of important information.

It’s not over for you yet. It may not be a blighted ovum or an ectopic, but even if it is, you have very good AMH levels, so most embryos you make that end up as 5 day blastocysts are probably in tip-top shape. You mentioned you have 6? I would kill for 6. My wife and I wouldn’t get 6 five day blastocysts if we did 6 cycles, and we’re only 30 years old. IVF was made for people like you. It’s like you’ve got a bicycle in a foot race. Regardless of the outcome, I think you can take solace in your advantages.


#3

I agree with Demain. This process is so hard and when you expect that it should work it is probably even harder when it doesn’t. I think we can have all of the testing done on the embryos and it still does not guarantee success. There are things that are frankly outside of our control and the doctors control. One thing that my RE said is that the downside of testing embryos is when the test come back “normal” the expectation is that there is nothing wrong and that it should work. When that doesn’t happen it is hard to explain why. The testing is great and also limited in that it can’t make you a 100% guarantee. I don’t know what the outcome is going to be for this cycle for you, but luckily you have blasts left to try again. With your AMH even if you had to do another fresh cycle your chances for success are still good.


#4

You give me a much more thorough explanation than my RE. Okay it could be a freak accident, but why does it happen for two cycles now. My fresh cycle with also 2 CGH normal blasts was a complete BFN. My RE explanation, “it just happens”.

I do feel grateful that we could get that many blasts after switching to this RE but that egg retrieval where we got that many blasts was our last retrieval, there will be no more. No, not most of our blasts were in tip top shape. I was at another RE before this one, had 20-30 eggs at a time, but all resulted in chemical pregnancies. RE explanation was chromosome abnormalities so that was why we did CGH for our last one. I had immune testing done at a lab in chicago, i think probably i need to get a more extensive immune testing done. I just feel exhausted with all of these. Thank you for responding though. I wish you and your wife will get your BFP, and not have to go through so many cycles to get it.


#5

You need to see sb who would test your reproductive immunology.im saying this because of many chemical pregnancies you had in the past.


#6

Hi Alexi, I am sorry you have to be going through this. Its hard enough going through all of the fertility treatments, but then having to wait and wonder on something like this after the BFP makes it worse.

Its possible you may not have an ectopic or a blighted ovum. Your HCG is quite high to have an ectopic without noticing, also it may have been an embryo that stopped developing and is being reabsorbed while only the sac remains visible -that happened to me a few months ago. I mention this only because you had your blasts tested before transfer, and if it isn’t just a blighted ovum you may still be able to get embryonic tissue to have it analyzed so you can get an answer of what caused this.

I hope you get your answer soon! BTW that is awesome you get blasts, sounds like you’ve got lots of chances to look forward to.


#7

I got a second opinion from my obgyn who ordered an abdominal and vaginal ultrasound from a hospital (they have better machine) and they found nothing in the sac and could not find ectopic in my ovaries or tubes or anywhere else and echoed what my RE said, “just because we dont see ectopic on your ultrasound does not mean you don’t have it”. I am having right groin pain and leg cramp so I am getting scared now and since it is confirned that the sac is empty i feel better to take the methotrexate shot tomorrow.


#8

Can you get the mtx shot today? An ectopic is very serious. I’d hate for you to wait & be in pain. Also take note that it may take weeks for the mtx to run it’s full course. I had to have 3 shots in order to bring my levels down to zero. It took two weeks for me to start spotting, followed by one week of spotting and a few days of a heavy bleed. Hopefully the nurse can see you & give you the injection today. Big hug, I hope your able to get the lab work done to determine whats causing the failed cycles.


#9

Yeah i am going in to get the shot today.


#10

What makes your doctor think it is ectopic? An empty sac in your uterus definitely sounds like a blighted ovum. I also had a blighted ovum last year and I remember my doc said that if they had [U]not[/U] seen an empty sac they would have suspected an ectopic given my rising beta levels. It went up to 17,000 and then started going down very slowly. Have they been checking your HCG every 48 hours?


#11

I had two blasts transferred. Got opinions from two doctors. Even though there is an empty sac in the uterus it may be a fake pseudo sac caused by an ectopic. I did get an ultrasound done at a hospital where they have a better machine. They could not find ectopic anywhere but both doctors say even if they cant find it doesnt mind it’s not there. Even if the sac in the uterus is a true sac and a blighted ovum, one of the blasts may still be implanted elsewhere. So I feel at peace now that I got two opinions and three ultrasounds from three different places. Plus i am having pain on my right side so not gonna take any chances since there is no baby anyway. At this point i should see at least a yolk sac. There is not even a yolk sac today 7 weeks. Yes the ectopic ruling was initially based on my slow rising hcg levels


#12

I am glad that you were able to get more opinions in time for you to take some action and to be comfortable with moving forward. :pray: are with you.


#13

Hi Alexi,

I had 6 ectopic pregnancies in the past due to tubal issues. Please double and triple check that there is nothing in the sac- if you take methotrexate it will be quite hard to conceive for 6 month ( I would not do IVF) I do not know if they told you that- the methotrexate is toxic - and reduces fertility (egg quality etc. for 6 months). Also if there is nothing to see in the tubes it can’t be very big and it might resolve on its own- if hcg levels are going down- sometimes my body flushed the ectopic out on its and sometimes I had to take the shot ( that was ALWAYS at 6.5-7 weeks after last menses) Also my ectopic was always seen as a mass in my tube when I had excruciating pain in my side ( always in the right tube). How many weeks are you along according to last menses or transfer date- if not that far along and not constant pain you might be able to do it on your own -good sign is if you start bleeding and hcg levels are going down. Are the levels falling as of right now? How strong is your pain? Is it constant?

The docs just say methotrexate but know that my hair sometimes starting falling out- it is a chemo drug and if used it can save your tube (maybe but sometimes it does not work) but it will poison your body for 6 months. It works by inhibiting the metabolism of folic acid - which is needed by early embryo for cell division.

Also in my humble opinion you hcg levels seem quite high for an ectopic- I never went much above 2500 at any pregnancy and that was in week 7 and then the ectopic was quite large and visible on Ultrasound ( like 1 cm). Sometimes they did see a pseudo yolk sac in uterus- this is true. If pain starts of ectopic it is a constant pulling on one side which gets increasingly wore and later radiates into the leg-but again usually at that time the mass was quite visible.

I hope this is not the case - I feel bad for you. I just had a chemical pregnancy myself and have only one frozen embryo left - too old to do a new cycle (turn 40 in 2 days).


#14

I already took the shots today. Thanks all for your advices. I understand the risks but we will not be doing anymore egg retrievals. Just one last transfer whenever i am ready again. And if that does not work we are going to adopt. If you say the pain starts on one side and radiates to the leg, I have that and it has gotten pretty bad last night i could not sleep. I am 7 weeks today but i have read that it can take up to 8-10 weeks for the tubes to rupture. I am at peace with my decision :slight_smile:

Thanks all.


#15

[QUOTE=alexi]I already took the shots today. Thanks all for your advices. I understand the risks but we will not be doing anymore egg retrievals. Just one last transfer whenever i am ready again. And if that does not work we are going to adopt. If you say the pain starts on one side and radiates to the leg, I have that and it has gotten pretty bad last night i could not sleep. I am 7 weeks today but i have read that it can take up to 8-10 weeks for the tubes to rupture. I am at peace with my decision :slight_smile:

Thanks all.[/QUOTE]

Sorry :frowning: Honestly, I was hoping you’d come back and tell us that you learned we were wrong. I wish the best for you.


#16

Just wanted to say how sorry I am for you. I had to have the MTX shot last year and it was saddest part of my infertility journey. I wish you much happiness and success growing your family.:grouphug:


#17

Some of you guys are right, i had a blighted ovum, not an ectopic. I asked my nurse what my hcg level was the day of the metothrexate shot, she said it was 1700. Two days before that it was 7000 plus. And i had stopped my meds the night before. How fast it dropped really surprised me.


#18

[QUOTE=alexi]Some of you guys are right, i had a blighted ovum, not an ectopic. I asked my nurse what my hcg level was the day of the metothrexate shot, she said it was 1700. Two days before that it was 7000 plus. And i had stopped my meds the night before. How fast it dropped really surprised me.[/QUOTE]

I know it sounds absurd to say “that’s a relief,” since both outcomes are heart wrenching. However, if it had been an ectopic, it would mean that you would be much more likely to have another ectopic in the future and each one can damage your fertility. It won’t be any solace to know this now, but it will be in the future. I wish you the best of luck.