IVF, Cancer & ICSI

[Libsie3103]

Hi ladies, I'm looking for advice and thoughts on our situation as I'm struggling to know what the right thing to do is and I'm petrified of a repeat of my last cycle. Here's a summary of what's happened to us:

September 2018 - Cycle 1, 19 eggs collected, 10 mature, 3 made it to Day 5.

November 2018 - FET of 2 embryos (was borderline OHSS so couldn't have a fresh transfer), failed.

November 2018 - My husband was diagnosed with lung cancer and then had surgery in December 2018.

January 2019 - my husband was told that although the cancer had all been removed he would need chemo as a precaution. We therefore arranged for his sperm to be frozen for future cycles.

February 2019 - Cycle 2, 19 eggs collected, 10 mature, ICSI used and only 1 fertilised abnormally.

Our clinic have no idea why the ICSI didn't work - all they can say is that they think it might be because of my husband's cancer affecting sperm quality. However, based on his symptoms we know he would have had it from at least June so surely if that was the case it would have affected the first cycle?

Has anyone had successes with IVF or ICSI using frozen sperm because of cancer?

Has anyone had a successful round of IVF or ICSI after a round which failed to fertilise? Did your clinic make any changes to your protocol?

I've asked to review my protocol but the clinic are reluctant to change anything and I'm scared we'll repeat the last cycle. I'm debating meeting another clinic to explore treatment options but I'm just not sure what to do. If we do it'll delay it by a month but as I was 42 last month I'm starting to panic this will never work. (My husband is 47 and has 2 children from a previous relationship.)

I know you ladies have a wealth of experience and expertise so I'd be grateful for your thoughts and advice!

Thank you!

[CAS2]

Hi. sorry to hear what a tough time you are having

With the sperm did they identify any issues with it in terms of count, morphology etc?

I am 40 and just had round 3, which was so much better. My first two rounds my egg quality wasn't great and I got to blasto stage but they didn't take, never had anything to freeze. BUT the protocol was affecting my egg maturity and fertilisation rate. Turns out when my eggs are small they don't fertilised well or are very mature or good quality in general.

Fast forward to round 3. I took loads of vits and things for egg quality (so DHEA, Melatonin, Vit C, B, D and E, L'Argenine, Ubiqionol and Omega 3. On this last round they pushed me quite hard, I down regged and had Menopur 450IU for full 12 days and a longer trigger (38 hours). Collected 20 eggs with follicles much bigger (up to 23mm). Ended up with 7 blastocysts this time, with 5 suitable to freeze. I swear the difference was the protocol and trigger shot. Just hoping one of them is genetically viable but on the whole a much more positive outcome so far!

I know we're all different but I thought it would be useful to share my journey as it seems like we are of a similar age and antral follicle count looking at your egg quantity.

I find it strange your clinic are reluctant to change your protocol, as this is what IVF/ICSI has been all about for me. Finding the right formula and learning.

Also I know the age think it stressful and puts pressure on, but I don't think a delay of a month or two will matter much.

Good luck with it all xxx

[Libsie3103 in reply to CAS2]

Hey, sorry for my delayed reply! They’ve not identified any issues at all with the sperm, said it all looked good - in fact they even questioned why were we’re doing ICSI and not IVF. I’ve wondered if my protocol is the issue as well so it’s encouraging to hear your story. My clinic are denying this could be the case so we’re going to get a 2nd opinion as I can’t believe they won’t even look at it. Totally agree it’s all about the right formula and learning. Thank you again for sharing your story it’s really encouraging xxx

[CAS2 in reply to Libsie3103]

No worries If you have a review, get them to go through your follicle sizes each time and see if you can spot any patterns (are you getting a few big ones and a few small or are they consistent size). If you are not already, then I'd really recommend the above vitamin regime (you can get decent quality DHEA and melatonin (3mg) from biovea.com) as long as your clinic haven't identified a reason for not doing so, of course.

I was told that a change in protocol by loads of experts at the fertility show wouldn't change the outcome significantly, but my consultant had a theory about my egg size and maturity - a slightly higher dose, not peaking too soon and letting my follies get nice and big and the longer trigger shot made a monumental difference.

Good luck, I hope you get some answers with your second opinion. Do keep us posted on what they say. And glad you OH is well now xxx

[Libsie3103 in reply to CAS2]

Thank you! DHEA is the one I’ve wondered about but not taken. I’m on lots of others! I’ll look into it. It was an expert who I consulted with who recommended talking about my protocol but my Consultant wasn’t interested. Made me feel uneasy, hence the 2nd opinion!! Last chemo was yesterday so a horrid 2 weeks then it’s all uphill!! xxx

[CAS2 in reply to Libsie3103]

Oh no, does it take two weeks to get over the chemo? how gruelling. I hope he hasn't too much left to have?

I read below about them giving you a refund and the sperm sample. Did they give you any info on the sample defrosted (count, morphology, numbers after they've washed it down the best ones). Sounds like they could have messed it up a bit somewhere. Never know a clinic to do a refund, they prefer to take as much £££ as they can usually! Hope you get some more ideas at your next consultation on 1st May x

[Libsie3103 in reply to CAS2]

About 2 weeks yes til he starts to feel better from it. It was his last one though so maybe slightly longer but at least it’s done!!

Sorry they didn’t do a refund they gave us money off the next round. £500 as a good will gesture. You’re right though I thought it was odd as they normally take as much as they can get!!

No info on sperm sample, only what they said which was it all looked fine and they questioned why we wanted to do ICSI and not IVF.

We’ll see what happens on 1st then go from there I guess xxx

[Cinderella5]

Sorry to hear about your recent cycle, I am pleased to hear that your husband has had all the cancer removed! Im not sure I can really help but I didnt want to read and run. I think I would be thinking along the same lines as you, why was the first cycle not affected as you know the cancer would have been there at that point. Unless its only affected the sperm as its progressed however fertility preservation is used for lots of cancer patients and I cant think they would do it if the sperm wouldnt fare well but I do know that sometimes defrosting the sperm can cause harm (and some are usually lost along the way). Can you have a word with your husbands oncologist or specialist nurse to ask if they have knowledge of lung cancer affecting sperm quality to get their point of view? Im sure your Clinic is used to using frozen sperm so wouldnt imagine they havent done it properly but if you have any doubts then I'd be thinking about getting a second opinion from another clinic and you could ask about the possibility of sperm being damaged due to cancer also along with asking about your protocol but Im not sure that changing your protocol would necessarily help fertilisation rates. What I would say is we recently used my husbands frozen sperm and our fertility rates were just as good as frozen. I hope your husband continues ro recover well!xx

[Libsie3103 in reply to Cinderella5]

Hey, thank you for this! I agree with what you’ve said about fertility preservation - if it was an issue that cancer had affected sperm quality pre chemo I’m sure they’d say and warn you. I’ve chatted to MacMillian and his Oncologist this week and neither knew which made me think it can’t be a known issue. I think the clinic are hiding behind it. They’re also not admitting that egg quality can be impacted by protocol. We’re booked for a 2nd opinion which has made me feel a whole lot better! So glad you had good results from your frozen sample. Enjoy the long weekend! xx

[Cinderella5 in reply to Libsie3103]

I kind of feel like they are hiding behind it too from a gut instinct and it did sound like that's what your thoughts were too! Im glad you've had a chance to speak to the professionals. I had a bit of a google and I did see some studies that have looked into this but I coudnt see any with enough evidence to support that but didnt have an indepth look. On the egg issue/protocol, I asked my NHS clinic is the drugs can affect egg quality and they agreed that the higher dose you are on for stimming may affect egg quality but they have no way or knowing as there are no tests to show this. The only thing that is making me think sperm is the issue is the fertilisation rates werent good and although my eggs were thought to be poor quality due to my age we always had great fertilisation rates. Glad to hear that you are getting a second opinion. Hope you have a good weekend too!xx

[Libsie3103 in reply to Cinderella5]

Thank you so much for looking into it! I did the same and couldn’t find anything either. I was on a mild IVF so it was meant to be fewer, higher quality eggs. But I got 19 which makes me wonder about the drugs and whether they compromised quality? I’ve got an appointment for a 2nd opinion on 1st May so we’ll see and fingers crossed get some answers! If it is the sperm we’re in trouble as it’s all we have 😢 xx

[Cinderella5 in reply to Libsie3103]

19 is a big number! I know it always good to hope for lots of eggs but for example but my DE clinic try to aim for a smaller cohort of eggs (9/10) in order to not overstimulate as they feel too much drugs isnt good either. Perhaps you could ask about a smaller dose of stims next time?! I had a quick research as I was interested and it just somehow didnt sit right with me. The only thing I wondered about was if the defrosting of the sperm was maybe not done as well as it could be?! Its difficult as you need to have faith in the clinics but so hard to do when cycles go so wrong. I had a really bad cycle when I first used my OE and the next two were better, my clinic didnt admit to any wrong doing but clearly something wasnt right as we did much better in the next 2 (and we got an extra cycle that we werent supposed to be entitled to). Good luck with your consultation, Im really hoping they have some good answers for you!xx

[Libsie3103 in reply to Cinderella5]

My clinic always talk about quality and not quantity which is why I was surprised they weren’t concerned with 19. My Consultant wasn’t receptive to discussing protocol at all which surprised me. There was a strange comment the clinic made on EC day - she said I’ve defrosted one of the samples, I asked why they’d not used them all, her response was “I wish I’d known”. In my head if they’re picking the best sperm for ICSI if they’d had the whole sample they’d have more to pick from? The clinic knew we had more elsewhere for the future. They’ve offered us £500 as a “good will gesture”, which surely they’d not have done if there was nothing wrong?!?!! We’ll see! Appt is 1st May so fingers crossed it’s encouraging xx