Fertility Network UK
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Assisted Oocyte Activation

Has anyone had this along with their ICSI procedure?

Got not so great news today at our followup.... they think even with Icsi the fertilisation might be low so they are adding this procedure called assisted oocyte activation. I'm grateful but petrified... our clinic only knows of 2 cases in the UK like ours meaning the type of fertilisation failure they saw. Also 3 of my 8 eggs had polar body fragmentation which we were told is rare as well.

It's so hard to find hope again. We are relatively young and healthy. We have no history of infertility or disease in our families. I'm devastated.

We are switching to the long protocol and starting In January. I need a lot of work mentally before then 😔 I'm heart broken and shattered into a million pieces.

This is soooo hard

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Massive hug. You know where I am if you want to chat xx

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Massive hugs lovely xx

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Have you asked about having chromosome testing for both of you and sperm dna fragmentation testing before you go ahead with another round? It might give you some answers? We thought there was nothing wrong with my Dh’s sperm but it turned out he has a chromosome problem and we had low fertilisation without icsi (one out of three).

Is the procedure they are talking about also known as assisted hatching or is it a procedure that happens earlier than that? I haven’t heard of the term.

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Thanks. We did ask about DNA fragmentation but our doctor said there are a few different tests for that and there is no consensus about which test to use and how to use that information. In the end it wouldn't change how they approach this next cycle anyway.

They don't know if it's the egg or the sperm or both and there are no diagnostic tests to figure it out. Given our age and other markers it shouldn't be this hard!

The sperm was able to swim to the egg, digest the cellular layer around the egg (zona pellucida) and even bind to the egg... it just couldn't start the reaction to release the DNA, to start fertilisation and kick away all the other sperm. This is simplified terms and this is all getting quite technical. It likely has to do with the protein and enzyme communication channels. So assisted oocyte activation is where they dip the egg in a solution and that helps kick start the reactions for fertilisation (by giving the egg the molecules it needs) with the hope that with Icsi, the reactions will start. Dr said they need special approval for this and the solution comes from Germany... so i can appreciate they are trying hard to make it work but of course it's not guaranteed and not a simple problem... and with this much effort, chances just don't seem that great. There are no stats or success stories that I can even grab onto.

Assisted hatching is once the embryo is made and just before transfer. So it's different.

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I googled it and read some of the scientific research on your procedure and there are definitely success stories in the scientific literature if that helps?

Good luck with this, it’s awful when you feel like you are getting bad news at every step! At least there is something else they can try.

I would still recommend chromosome testing if you can afford it- but that’s because my husband and I were in the 1 in 500 for whom this was a problem even though the clinic did not think this was causing our fertilization problems. But then, if they’re still going to do the same next steps no mater what then I guess there’s no point spending more money on tests at this point.

I’m sorry you are going through this and hope you have success next round x

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Thank you - I have read studies as well and they do seem promising. My concern is that usually this procedure is used to overcome male factor like with extreme morphology issues. But my husband's sperms is 'normal' so I just have this doubt that maybe this won't be the solution. And if it isn't, then there aren't any other options.

Thank you for your support and I will have to focus on the reasons it can work and just hope for the best. I just feel like I need a Miracle.

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Thank you - I have read studies as well and they do seem promising. My concern is that usually this procedure is used to overcome male factor like with extreme morphology issues. But my husband's sperms is 'normal' so I just have this doubt that maybe this won't be the solution. And if it isn't, then there aren't any other options.

Thank you for your support and I will have to focus on the reasons it can work and just hope for the best. I just feel like I need a Miracle.

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My husbands sperm is “normal” too. Normal count and motility. But it turns out most of his sperm will be carrying faulty chromosomes. I guess this is only useful info if you might consider using a donor for either eggs or sperm.

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I just pray we don't have to consider that but it seems more like a possibility now 😔 one step at a time I guess.

The one case like ours that my doctor has first hand experience with found success with sperm donor in the end after there was failed fertilization with egg donor. So my doctor said if this next round doesn't work, sperm donor will be the next recommendation. That's too much to take in right now and my husband doesn't want to do that but again one step at a time 🙏

Thank you so much for your help

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Yes one step at a time is the only way to cope.

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Where can you get chromosome testing done?xx

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We had ours done privately through our fertility clinic. Some recurrent miscarriage clinics do it on the nhs. It’s called kareotyping.

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Ahhh ok I’ve heard of that. I’m going to ask for it 👍🏼 thank you xx

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hey honey... Im so sorry your feeling this way. I will pray for you. Loadssss of hugs for you.xx

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Hi abcgirl. I hope you don’t min mind me reopening this old thread but I was wondering what decision you made on this. We have also been asked to consider it but i can’t decide whether it may actually make a difference or is just another expensive add-on. Thanks!

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Hi, I’m now in round 2 and we will be doing Icsi with AOA. We got my husband’s semen analyzed as part of a study out of Oxford into the PLCZeta protein. He was found to have low levels of this despite having otherwise great numbers. But since this protein is believed to initiate fertilization this may be the cause for our failure. So based on this AOA is the way to go and will be applied on 100% of our embryos.

We didn’t have icsi the first round and usually aoa is applied when there’s failed fert with Icsi but that testing we got done proved we need it as his sperm is consistent with other patients who have had failure with Icsi. Hope that helps.

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I just read through some of your old posts and you had 50% fertilization with you last cycle so not sure AOA would help you. There’s a number of scientific papers written about this so I was investigate and do some research. As far as I know AOA is used to overcome sperm issues (lack of PLCzeta) when they can’t fertilise even when injected in the egg. It isn’t proven to help any issues with the eggs. Anyway something to think about... would had you to get your hopes up thinking this add-on would make the difference.

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Hi there. Thanks for getting back to me. We had 50% in our first cycle but only one embryo fertilised last cycle which is why they’re now suggesting it. We’ve since been diagnosed with DNA fragmentation issues but there has been no mention of the test your husband has had so I’ll definitely mention that tomorrow.

Thanks again, it’s been really helpful. X

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It’s not really an official test. We signed up for a study (contact Dr Kevin Coward) and therefore got the test done. Where did you get DNA fragmentation test done? We haven’t done that ourselves. What is the issue if you have DNA fragmentation?

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Although if your clinic is suggesting it, sounds like having the test won’t change your ncourse of action. In our case we did IVF (not ICSI) in round 1 and I wanted to avoid another potential failed cycle. So the test proved we needed Icsi with AOA. If his levels of the protein came back normal than we would have just done ICSI.

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Hi there. Sorry for the delayed reply. Have been going back and forth a lot with the clinic over the past two weeks and still haven’t made a decision!

The suggestion of AOA was nothing to do with the DNA fragmentation apparently. It really feels like they’re clutching at straws as to what to suggest and because of our low fertilisation on te last cycle thought this may help.

Apparently there’s nowhere in the UK for us to have the enzyme deficiency test and we’d have to go to Brussels which would cost more than the AOA would!

So we’re none the wiser really. My head tells me this isn’t relevant for us and it’s a waste of £500, my heart tells me I don’t want to look back and wonder what if we’d tried it. This is such an emotional journey isn’t it?!

Thanks so much for all of your help and advice. I really appreciate it. X

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Yes I’m aware of Brussels - they do a mouse oocyte activation test where they inject sperm into mouse eggs to see the fertilization.

£500 seems like a lot for the add-on.

I’m NHS funded so I don’t know the costs but I read or saw somewhere that it would be more like £100.

You might find more info on the Fertility Friends forum. There is a whole thread that is really long dedicated to AOA. fertilityfriends.co.uk/foru...

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