Good Eggs Gone Bad: Why Perfect-Looking Eggs Still Fail

Why do eggs that look perfect on retrieval day sometimes lead to poor embryos, failed implantation, or no pregnancy at all?
If your clinic once told you your eggs “look great,” only to later say the cycle failed due to an egg issue… you’re not alone. And no, your doctor didn’t lie to you.

In this episode of Taco Bout Fertility Tuesday, Dr. Mark Amols unpacks one of the biggest misunderstandings in IVF:
the difference between how an egg looks and how an egg functions.

Drawing from real-world experiences and the new research review “Unveiling the Realms of Reproduction: A Reflection of Oocyte Assessment” by Gardner et al. , Dr. Amols breaks down:

• Why egg morphology (appearance) is a terrible predictor of success
• What embryologists can see… and what’s completely invisible
• Why the true egg issues only show up later — during fertilization, cleavage, and blastocyst development
• The “cohort effect”: why some cycles are full of rock-star eggs and others feel like the B-team
• Why a failed cycle doesn’t mean your eggs are bad or that you did anything wrong
• The future of egg assessment: AI scoring, time-lapse imaging, metabolomics, autofluorescence, and more

If you’ve ever wondered how “good eggs go bad,” or felt frustrated when early optimism turned into confusion, this episode gives you the clarity, science, and reassurance you’ve been looking for.

Share this with someone going through IVF, and leave a 5-star review if this helped you.

Thanks for tuning in to another episode of 'Taco Bout Fertility Tuesday' with Dr. Mark Amols. If you found this episode insightful, please share it with friends and family who might benefit from our discussion. Remember, your feedback is invaluable to us – leave us a review on Apple Podcasts, Spotify, or your preferred listening platform.

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Have a question or a topic you'd like us to cover? We'd love to hear from you! Reach out to us at TBFT@NewDirectionFertility.com.

Join us next Tuesday for more discussions on fertility, where we blend medical expertise with a touch of humor to make complex topics accessible and engaging. Until then, keep the conversation going and remember: understanding your fertility is a journey we're on together.

Transcript

0:00

Today we're talking about one of the biggest ivf how your eggs can look great at retrieval, yet somehow be the reason things fail later. I'm, Dr. Mark Amels, and this is Taco about Fertility Tuesday. Many IVF patients are left wondering, did my doctor just lie to me? Because on, my retrieval they said my eggs looked great. Yet later on, when my embryos didn't make it to the end and we weren't able to do a transfer or even a transfer failed, they say all of a sudden it's an ache issue. So which is it? Is it an egg issue or is it not an egg issue? How does that even make sense? Let's break that egg and break it down. The simple answer is going to be no, your doctor did not lie to you, but it's kind of a misunderstanding. See, eggs may be good looking, but that doesn't mean they're good quality. Think Idris Elba in no Good Deed. That guy's always the best looking guy, always the nice guy. And in that one, he is horrible. Really bad guy. And sometimes really good eggs that look really good are actually bad. And that's because looks don't tell the whole story. See, when an embryologist looks their eggs, they look at certain things. One is the shape, is it round or is it oval or kind of weird looking? Then they look at the outer shell. Does the Zona Pelusa look normal? Is it thickened? Is it thin? They look at the cytoplasm or the paravitrean space, which is space between the egg and the shell. They look at the polar bodies, which should be equal size and only be two of them. And when these look normal, we call this a good looking egg. Well, the problem with that is that's an egg glamor shot. It doesn't tell us anything about the genetics, the metabolism, the mitochondria or the DNA health. The point is, we can't judge the journey of this egg based off of an Instagram Photoshop. Instead, we have to wait till the end. I've seen embryos that look amazing that came from eggs that did not look amazing. And I've seen embryos that look horrible or don't even make it to Blastocyst when everything looked perfect at the level of the egg. I'm not saying there's not mild predictability from these things. Sure, extra cytoplasm. It could be an issue, or cytoplasmic defects, or again, morphological issues, extra polar bodies. And if you watch those things, let's say in time Lapse. Then in that situation, you might be able to tell some more information, because then you get the kinetics of the division. But when you just take a snapshot in time, when you're just looking at the eggs, unfortunately, it's like trying to predict who's going to win the race, just looking at the starting line. Because the stuff that really determines success cannot be seen externally. It's in the inside. It's the mitochondrial function, it's the chromosomes, it's the metabolism, it's the things we just can't see. And this concept even goes for embryos on day three. There are many times I have patients say to me, well, why not transfer an embryo on day three? Because it looked better then. And this is the same issue. It's because problems show up later when the egg actually does something. It can look good in the beginning, but later, when it's dividing, that's when more DNA is being used. That's where you can find out if there are spindle issues. If you've ever heard me say before, looking at day three embryos and saying, oh, they're amazing. I'm really surprised they make it to day five. Is missing. The concept of nothing has happened yet, very minimal has happened yet. The embryo has just divided three times, and every single one of those cells can actually become an entire embryo. My analogy would be looking at people who are in the orientation phase versus being on the job for two weeks. If John and Sally both take a job on day one, which is the egg, they look amazing. You're like, wow. John's professionally dressed, Sally as well. Amazing. Now, in orientation days, that's going to be up to day three. You're like, wow, John and Sally are really good. But right now, all John and Sally is doing is passively watching videos and training. And then two weeks later, you reassess them. This is day five. And you realize John sucks at his job. Sally is much better now. why? Because you've had time to see them develop and see who is good and who is bad. Only at the very end of the cycle can you look back and say, oh, it looks like there were problems. And then you try to determine where those problems came from. Did they come from the sperm or were they originally with the egg? Some of that information you can get by looking at the fragmentation or the development. But the point is, the egg itself may have looked good, but the end result was not. And this is because those external phenotypic features only limitedly tell how things are going to go. It's only at the end that you can really put the whole picture together. So in the end, no one actually lied. We just have limited tools. The egg did look good in the beginning. In a recent study unveiling the realms of reproduction a reflective of oocyte assessment by Gardner et al, it was determined that oocyte morphology just isn't cutting it. That oocyte features such as a smooth zona or uniformity doesn't strongly predict fertilization or blast development. They found that most extracytoplasmic abnormalities really aren't harmful. And only a few cytoplasmic abnormalities, such as vacuoles, do correlate with abnormal embryos. And that eventually we're going to need new frontiers in oocyte evaluation, such as time lapse, that allows us to see the kinetics of cell division. Metabolomics should eventually allow us to know more about the metabolism of the embryo. Using artificial intelligence, we might be able to predict things a little bit better. The point of the study was saying this is why a good looking egg doesn't always make a good embryo. One very interesting thing about this study was what they called the cohort effect, which basically means why their cycles vary. Basically, eggs that grow together, behave together, but different cycles can produce very different cohorts. On previous podcasts I've talked about this, where we have regression to the mean, where one cycle can be good and the next cycle bad. And it's still normal because it averages out. But the reason there's cycle to cycle variation is, is because sometimes those cohorts are good and sometimes they're not. And what's interesting is that when one cohort seems to be good, they all seem to be good. And we see this as well in practice. There are times I've seen people where every single embryo they transfer, they get pregnant with. They have five embryos, five babies. And then you see other people, they'll have a whole cohort of eggs. They look fine, they do a transfer, it doesn't work. They go through another IVF cycle before even using all their embryos. And they do better with that next cohort, even though everything was still exactly the same. It's because the things we can measure that have changed between the cohorts are, what made those embryos better. Now, I'm not saying that changing things doesn't help, but what I'm saying is the cohorts themselves, the eggs, the DNA in them, the metabolism, whatever it was, was different and affected all the eggs at the same time. So what this Means is eggs in the same cycle behave similarly, but eggs across cycles can behave completely different. And that is the cohort effect. One month, they'll race, recruit a group of rock stars. The next month, well, we get the B team. The point is, it's not your fault. It is just the cohort. And if anything, that should bring some optimism because that tells you, okay, I can make good eggs, even when maybe one month my embryos weren't good, because the next month your eggs may be better. Now, what gets me really excited is the future. This is where it gets really cool. As I mentioned, there is new technology coming out, and this new technology is going to help us predict which angs will do better. There's going to be a day where we're going to be able to say, hey, we checked the metabolomics of this embryo and it doesn't look good. Put this one back, even though it looks like your ugliest embryo, and it will work better. Because all we can do with morphology is have a general idea of the implantation rate, but not the success rate. And so when AI scoring comes around, it's going to be able to predict which eggs are going to become blast. It's also going to standardize grading. If you've ever had an embryo taken from one clinic to the next clinic, one clinic calls it an A, the next one calls it a C. That's because there's a lot of subjectiveness when you're looking at morphology. This is going to help in so many ways. When you talk about donor eggs now, when people purchase donor eggs, it's not, oh, I hope these eggs are good. Now we can have AI tell us, don't sell these eggs. They aren't good. Use these. These have a better chance at making the BLAST assist. It will literally change the game when it can happen. It's in its infancy right now, so it's not prime time yet, but it's getting there. And today we're kind of living in the future because right now we do have time lapse. Now, time lapse is not very efficient right now, but it does allow us to look at those kinetics and those kinetics of division and cytoplasmic movement. Those allow us then to figure out which embryos are going to be best. Now, it hasn't had the ability yet to tell which ones will be genetically normal yet, but it's getting close. When using time lapse and AI, eventually, we may not even need biopsies in the future. Another thing that's being looked at is media metabolomics. What they do is they take the spent media, so this is the media around the embryo that's been growing, and they measure the nutrients that the egg was using and identify viable metabolic patterns. And again, this might be more predictive than even just looking at some pictures of the eggs and embryos. Another cool future technology is autofluorescence. This is going to allow us to read mitochondrial and metabolic states. It's extremely promising. And the best part is it's not very invasive. Essentially, your embryo is going to have a full gray report, both AI and looking at things like the mitochondria and the metabolism. The future literally looks bright and I for myself, am very excited about it. In the end, when you feel like you've been duped, when you're told that your eggs look great, but at the very end you're told, oh, it's an egg problem, understand the difference. Yes, they look good. And unfortunately, that tool using morphology is not the best way to predict success. The good news is there is stuff coming around that's going to help us. And eventually what we'll say is, let's hold off on how they look, let's wait till the data comes, and that's really going to help us predict the. Your chances. So, as I said in the beginning, your doctor didn't lie. Your eggs look normal based on what humans can evaluate. But normal doesn't mean genetically healthy. Sometimes these problems are invisible until the technology can see them. We are blind to it. But what can you take from this? Well, it means that failed cycles are not your fault and that, even when a cycle is bad, cycles vary. And that means you have hope. And the best thing you have to look forward to is that better tools are coming. AI is showing tremendous potential, and there is work that is constantly being done to improve the predictive rate. So in the end, your doctor didn't lie. Our technology is just a little limited, but the next generation of egg assessment is coming and it will change everything about how we predict fertility success. Maybe you have also thought about this once before, wondering, why did the doctor say it was good and then later say, it's my eggs? And that's very confusing if, this happened to you. Well, hopefully this episode helped you. Maybe you have a friend who went through the same thing and even left clinic saying, well, they told me they were good and then lied later. But as you see, no one lied. It's just a limitation of what we can say at the point of the eggs. It's really important to know that everything you do to try to help improve the egg quality, it does help, but it's still very minimal. And that sometimes the eggs are just bad and we can't see it. If you found this helpful and think this can help someone else, let them know about this episode. As always, I greatly appreciate everyone who listens to these podcasts. It's the reason I keep doing them. Having this knowledge allows you to be a better advocate and allows you to have a little bit less stress when going through this process. If you like this episode or this podcast, give us a five star review on your favorite medium. Tell your friends about it, but most of all, keep coming back. I look forward to talking to you again next week on Taco Belt Fertility Tuesday. Sam.