Can you help me join the dots?

[lmno]

Our first IVF cycle ended abruptly the day after egg collection with a phone call to say none of the 11 eggs fertilised. We had our follow up appointment on Thursday with our consultant which didn’t really answer any of our questions. He said ICSI was our only option and was fairly pushy about doing it soon. After asking a lot of questions and asking for a copy of the embryologist report it seems (if I’m reading it right) likely that we have a number of issues - my AMH level is low for my age (12.4 and i’m 33), I took a long time to respond to the stimulation hormones (16 days and still not great, plus my E2 number at day 6 was 100 when he said it should have been 1000) which apparently indicates there might be a problem with the number and quality of eggs I have, and there was no sperm/egg recognition. I don’t understand all the possible causes of that but one thing he said was that my eggs might have hard shells (any idea of the cause of this or any tests to see if this is the issue?) Reading the embryologist report considering all factors (my age, numbers of mature eggs collected and the good quality sperm) what happened to us apparently only had a 0.4% chance of happening. I guess I’m just trying to understand what the problem is but feel like I’m having to read between the lines a lot. Our consultant has zero compassion and basically avoided most questions or said they don’t know to everything and just pushed us to do a cycle of ICSI (and suggested doing it next month). When I said I wasn’t ready to make decisions because we only got the no fertilisation news 2 days before he said “well don’t do it if you’re depressed but time is of the essence for you and there are plenty of people on the waiting list if you don’t want treatment”. We live in Scotland so are eligible for 3 NHS funded cycles which I know is amazing, but it seems that they are very concerned about reducing waiting times and less so about helping us understand the process and the possible problems. Any thoughts or sources of information which could help me understand what’s going on?

[Orla9298]

I really feel for you as can imagine how there is so much going through your mind at the moment. Your consultant is wrong to push you, and I’m sure there is no actual requirement to rush. You amh isn’t that bad at all, yes it’s a bit low but it’s not shocking! I have friends who have 3 funded rounds and some of them have had an 12-18 month gap between cycles and there are no issues with that. Did he mention trying a different stim for the next round? Since you didn’t respond very quickly it could be a factor. And did you do short or long? And I don’t know whether you did much to help egg quality before or did this round, perhaps a 3 month gap would be beneficial if there are things you can try to help your egg quality.

It’s amazing that you are getting 3 funded rounds and don’t feel pressured to rush ahead if you aren’t ready xx

[lmno in reply to Orla9298]

Thanks. It’s weird how different it is in different clinics. No he didn’t seem interested in debriefing how it actually went which is a shame as I felt horrendous on the injections I was on so would have hoped there might be other options to try.

[Orla9298 in reply to lmno]

What stims were you on?x

[lmno in reply to Orla9298]

300 Gonal f for 16 days

[Orla9298 in reply to lmno]

Maybe they will start with a higher dose from the beginning next time?

I had a really horrible consultant for my first nhs round, he was very cold and actually told me I was unlikely to ever get pregnant. Starting to feel like he was right, but that was no way to deliver that to someone who didn’t even yet know what AMH meant!

I rang PALS at the hospital and explained that I didn’t feel that the consultants manner was right for me and had left me feeling very distressed and could I see another, they were amazing and I saw a lovely and compassionate consultant instead who took over. Maybe you could consider this? It doesn’t sound like the consultant has taken any time to make you feel confident or hopeful. Xx

[lmno in reply to Orla9298]

Sorry to hear that. Yeah I was wondering earlier what the process would be for requesting someone else. He genuinely looked shocked and really uncomfortable when I cried in our last appointment and I just sat there thinking surely he must have been hundreds of people get emotional about this?! I think there are only 2 consultants at the clinic and to be honest we had one appointment with the other when we came in for a scan early on and he wasn’t much better :/

[kumkums]

Sorry for what you have gone through. I totally agree with Orla, also you can ask for a second opinion. Another consultant can and should attend to you if you are not convinced about the current one.

I also live in Scotland and in suitations where there are no fertilization, they dont count it as a round, so in essence you should still have your three rounds intact.

[lmno in reply to kumkums]

Really? I don’t think that’s the case at our clinic - he said on Thursday we have 2 tries left

[lmno in reply to lmno]

I am going to ask this clinic about this - thanks for the heads up!

[Katty_Holz]

Hi there, so sorry to hear that your IVF session ended abruptly due to the eggs not getting fertilised. Yes, the not getting fertilized in-vitro is a rare case can't tell you in numbers but it's rare. As far as I've found an explanation for this it's that the protective layer of the egg cell is either not responding to the acrosome of sperms not letting it to enter the egg or the acrosome is rendered insufficient to get through as there might be extra protective triggers. FYI acrosome is the proteolytic enzyme that helps the sperm to penetrate the egg cytoplasm or what you'd call the periphery of the egg cell. I hope this clears up what's happening a bit and you get a better insight into the situation. I don't know what's the matter but a few people also mentioned rather complained on the forums about this very unempathetic, non-responsive and asshole-ish attitude from attending NHS clinicians as well as consulting Doctors. Yes, the time is ticking for everyone... irrespective the age and reducing waiting time demands more effective scheduling (talking from the perspective of women who are on wait). But in the medical profession where it's a benevolent service to the good of mankind, it's not accepted that they'll haste on the ongoing patient. Literally, saying you make the decision right now or step off the queue... these things require time to decide. Also, I'd support your decision to not haste because even if you do ICSI it's necessary to try and improve your egg quality to assure not just fertilization but full term. Now that will require medications like DHEA CoQ10 Ubiquinol etc..

It's best to rule out the odds and then go for next round. Wish you Luck!