What Makes a Healthy Egg?- Todays Parent

What are doctors looking for?
Doctors can’t really tell if an egg is high or low quality simply by looking at it. There may be abnormalities, such as discolouration or open spaces in the eggs, but these irregularities may not affect the egg’s ability to be fertilized, says Robert Casper, a fertility specialist at Trio Fertility in Toronto.

All mature eggs are fertilized and the embryos are cultured for five days (until they reach the blastocyst stage). If the embryo makes it to the blastocyst stage, there is an estimated 50/50 chance that it will have normal chromosomes and result in a baby. “What we’re really looking at is how the egg fertilizes and develops into an embryo,” says Casper. “If the embryo implants, it doesn’t really matter what the egg looks like; it means the egg was normal and the quality was okay.”

“The primary determinant of egg quality over the course of a woman’s reproductive life is her chronological age,” says Ari Baratz, a fertility specialist at the Create Fertility Centre in Toronto. As women age, the quality of their eggs diminishes, and so do the chances of getting pregnant without assistance, he says. Typically, the peak of good-quality eggs is around the age of 25, with quality declining after the age of 35.

What matters more: quality or quantity?
Both quality and quantity matter. It’s possible that a woman could have difficulty conceiving if she has a large quantity of poor-quality eggs or a limited number of high-quality eggs. But having a good supply of eggs can be helpful, says Baratz, because having a large quantity usually implies that some eggs will be viable in women under 35. In any given egg population, not all the eggs will be healthy, so it’s good to have a decent number to work with. (Women over 40 may experience egg-quality issues, even if tests show that they have lots of eggs.)

What is ovarian reserve, and how do you test for it?
Ovarian reserve is the technical term for the number of eggs a woman has. A woman’s ovarian reserve is assessed via ultrasound and various hormone tests. One of these hormones tests is for Anti-Mullerian Hormone (AMH), a hormone that helps indicate if a woman has a lot of eggs or not. The higher the amount of AMH found in a woman, the more eggs she has. “If the AMH is quite low, that doesn’t necessarily mean that the remaining eggs are poor quality,” says Casper. “It doesn’t predict pregnancy. But it does mean that people may run out of eggs early or may not respond well to fertility medications.”

Can you still get pregnant if you have poor egg quality?
As Casper says, it isn’t an all-or-nothing situation. “Usually the percentage of normal eggs decreases over time, but it doesn’t go to zero necessarily until people probably get into the age range of 44 or 45,” he explains.

While there really is no single treatment to improve egg quality, you still have options. “One could move to donor eggs, or eggs from another female, as another treatment for very poor egg quality,” says Baratz, “but that would be after multiple times of treating a woman with her own eggs if all else failed.”

What can affect the quality of an egg?
Smoking, drugs, prolonged exposure to environmental contaminants or pollutants and intense radiation or chemotherapy can lead to a decrease in healthy and normal eggs, as well as a reduction in the number of eggs.

Are there ways to improve the quality of an egg?
Some studies have shown that coenzyme Q10 and vitamin D can help improve the quality of eggs. Coenzyme Q10 increases energy production by mitochondria (the battery of the egg), which increases the likelihood of a good chromosomal makeup for the eggs and boosts the chances of pregnancy, explains Casper. Also, research has linked a vitamin D deficiency with lower pregnancy rates.

What I’d Wish I’d Known Before My IUI- Todays Parent

HomeTrying to conceiveInfertilityWhat I wish I’d known before my first IUI
What I wish I’d known before my first IUI
From how long it takes to what it feels like, here’s a first-hand primer on IUI.

Jun 21, 2016 Sarah Kelsey 0

When our doctor first suggested that we try intrauterine insemination (IUI), I was actually excited. My husband and I had been trying to conceive for a while without any luck. Our tests turned up relatively normal and we were told that we should be able to conceive, yet month after month, I failed to conceive. The diagnosis was frustratingly vague—unexplained infertility (with potential male factor)—so IUI offered a bit of hope. Here was something that could potentially help us have a child.

IUI is one of the first assisted reproductive technologies typically recommended by a doctor. It’s commonly used when the male partner is experiencing low sperm count or decreased sperm motility, but it can also help those suffering from unexplained infertility, endometriosis or cervical mucus issues and assist same-sex couples. I liked that the procedure is relatively non-invasive: It simply places healthy sperm as close to the Fallopian tubes as possible, giving them a bit of a head start in the race toward the egg.

Like all things to do with infertility, navigating the IUI process was overwhelming. I quickly became emotionally, physically and financially invested in something I didn’t know a whole lot about. I had a ton of questions: What happens? How does it feel? Will it work?

Here’s what I wish I’d known before doing my first IUI.

What happens?
Step 1: The checkup
On Day 3 of my cycle, I did blood tests that checked my hormone levels, and my husband had his sperm analyzed to gauge the concentration, motility and morphology of his little guys. We had two options: a medicated IUI or a natural one. The former involves taking fertility drugs so that more than one follicle (typically two or three) matures and improves the odds of pregnancy; the latter doesn’t involve medication (so only one egg is released). Because it was my first fertility treatment and we didn’t want to do anything too invasive, we chose a natural IUI.

Step 2: Cycle monitoring
I began daily cycle monitoring at my clinic on Day 10. I had to arrive early—between 7 and 8:30 a.m.—for blood work and an internal ultrasound every day for a week. Though I knew the process would give my doctors insight into how my hormone levels and follicles were developing, I couldn’t help but feel like a pincushion. By Day 17, my nurse let me know that a mature follicle was ready to ovulate. (It was about time—I found this gruelling.)

Step 3: Trigger shot
My trigger shot was the first hormone injection I had ever received. I was given the pregnancy hormone hCG, which helps follicles mature and ensures that ovulation occurs within 36 hours. Doctors administer this hormone to help time insemination—they want sperm to be waiting for the mature egg (an egg survives for only 12 to 24 hours post-ovulation, while sperm can live in the Fallopian tubes for days). I don’t mind needles, but I was used to getting them in my arm, not my abdomen. While the trigger shot didn’t hurt, I know I flinched because it felt so weird (my hubby maintains that I took the injection like a boss).

Step 4: Pre-procedure
On Day 18 around 7 a.m., we arrived at the clinic for IUI day. To say that we were nervous is a bit of an understatement—neither of us was sure what to expect. Would the procedure hurt? Would my husband be allowed in the room with me? There was also this great sense of anticipation—we desperately wanted the IUI to work.

I did my usual blood tests and internal ultrasound and my husband produced a semen sample. We were told to return to the clinic around noon—this gave the andrologist time to “wash” his swimmers. (Sperm washing is the procedure that separates the sperm from the semen and weeds out the low-quality “tadpoles.”) To ensure that there is enough sperm available to wash, men are typically asked to abstain from sex or masturbation for two to four days before an IUI. One hour before the procedure, I had to consume one litre of water, as a full bladder helps the doctor guide and angle the catheter into the uterus.

The wait between our early-morning appointment and the procedure was odd. At around 8 a.m., we found ourselves wandering around Toronto with nothing to do for four hours. For a while, we had no idea how to spend our time—it was clear that we both wanted the IUI to be over. We filled up our car with gas, bought groceries and treated ourselves to brunch (an awkward meal spent talking about everything but what we were thinking about). We laugh about the weirdness of it all now.

Step 5: In the ultrasound room
Once back in the ultrasound room, I sat on the exam table and placed my feet in the stirrups. We were shown a vial of my husband’s sperm and asked to acknowledge that the information on the label matched ours. I remember thinking “I sure as hell hope so!” but all I did was laugh out loud. It was such a funny—but important—request. I think I read the information 100 times before saying “Yes.” I was then asked to lie down and the doctor inserted a speculum into my vagina.

Step 6: The insemination
As the technician performed an external ultrasound, the doctor inserted the catheter into my vagina and my cervix. Using the ultrasound screen as her guide (which I watched closely throughout the procedure), she pushed the catheter through the cervical canal and pointed it toward the top of my uterus and right Fallopian tube (the side with the mature follicle). She injected my husband’s sperm through the catheter and into my uterus and advised me to stay seated for a few minutes. The process lasted only about 60 to 90 seconds.