ivf - poor embryo development

[Naz_87]

Hi all

Just did my 2nd cycle IVF and the same pattern took place and I'm wondering if anyone was in the same boat and had some answers as I'm at lost.

Cycle 1; long protocol 12 eggs collected, 10 mature 9 fertilised and by day 5 none blastocyst.

Cycle 2; short protocol, 16 eggs collected, 12 mature, 9 fertilised and day 5 again no blastocyst.

I have a healthy AMH - and no known underlying issue. My husband sperm sample always comes back top quality according to the dr. So we're really at lost why this keeps happening. We considered ICSI but our fertilisation rate is good so the embryologist recommended ICSI wouldn't improve outcome as it focuses on fertilisation and not embryo growth. It might be worth adding. By day 3 we usually have around 3-4 good embryos but the growth slows down/stops.

Any advice will really help

[Hope76]

Hi am sorry this must be so frustrating especially with so many eggs collected.

Will your clinic only transfer embryos that make it to day 5?

I have always had 3 day transfers and had 1 live birth, and now on to second BFP from another 3 day transfer. At 3 days it was a top grade 8 cell.

Would your Clinic consider 3 day transfers ?

In 6 years of IVF I have only had 1 embryo make it to a 5 day blasto. We did a frozen transfer & it failed !

Regarding helping with improving quality have you tried ubiquinol? Myself & partner took 200mg in lead up to latest cycle and got our first top grade embryo in 6 years of IVF (am 44)

Wishing you luck going forward x

[Naz_87 in reply to Hope76]

I was taking CoQ10 prior to starting the 2nd cycle as the Dr thought it might be egg issue therefore changing medication and protocol. I was on Menopur and Gonal F. for stims. I think because the embryo was really good on Day 3 the embryologist was confident that it would reach blastocyst.

[Hope76 in reply to Naz_87]

I took ubiquinol (purest form of coq10) for 4 months prior. My Clinic won’t mix the FSH drugs but I had a failed cycle with Menopur yet much better quality with Gonal f. I am surprised if your day 3 had no signs of fragmentation and had divided into 8 cells they didn’t try a 3 - day transfer. My DR believes an embryo can survive in womb sometimes better than in the lab. They say they only grow to 5 days to pick the best quality if there are a good lot to choose from. I usually only had 2-3 viable embryos by day 3 so guess this is why I have 3 day transfers x

[Orla9298]

I believe it’s the sperm that take over at day 3 to 5? We were getting poor embryos, but it’s hard to say as it was with my eggs which also are low numbers. But even though my hubbys sperm was good in the normal parameters (count, morphology and motility) it turned out that he had an E. coli infection in his sperm and also higher than normal dna fragmentation. Antibiotics really improved that result. So you could consider the dna fragmentation test?

[Naz_87 in reply to Orla9298]

Thank you so much. Befofe starting the 2nd cycle we were keen to do a dna fragmentation test but the dr seemed to advise against it. I'm so annoyed - because my gut initially might have been the right choice

[Peony85]

Hi Naz, I’m sorry about your failed cycles. This happened to me although with 2 good cycles in between so it caught us by surprise when it happened again. Do you have the numbers / quality / number of cells per embryo at Day 3?

Generally, higher than normal drops before Day 3 are due to egg quality, and then at that point the sperm kicks in so sperm issues manifest in terms of blastocyst development.

I also have a good AMH so no idea what is causing the egg quality issues. However I have been taking a lot of supplements as recommended in the book It Starts With the Egg, which has helped. I also have better egg quality when I have fewer days of stims (10 or 11) and when I am on Gonal F only (although some ladies are the opposite and do better on Menopur - both of my cycles with Menopur ended with no blasts.

My husband’s normal sperm parameters are excellent, but with our day 3 to 5 drop we got his DNA fragmentation tested which showed elevated levels of fragmentation and little un-fragmented sperm. So he then was on loads of supplements of that and we saw a urologist who specialised in this. It’s worth getting DNA fragmentation tested if you have good embryos on day 3 but a high drop to day 5 as sperm can have fragmentation but otherwise have a completely normal result.

Happy to answer any questions about the various things we’ve done, feel free to PM me if helpful.

[Naz_87 in reply to Peony85]

thank youu! Day 3 - the best embryos were at 8 cells and apparently looked great. And slowed down on day 4 predominantly. I think we're definitely going to get a soerm dna fragmentation done - if you could PM with recommendation of clinic (if you're in London) that would be really helpful. Thank you!

[Peony85 in reply to Naz_87]

Sure, will PM you

[leo1980 in reply to Peony85]

Hi there - sorry to cash in on this thread. But I have a question regarding which doctor you used re urologist. Hubby result came in yesterday and I am scrambling around trying to find a doctor who could see him before we go for the next cycle. Thank you

[Peony85 in reply to leo1980]

Hi Leo - I will PM you.

[leo1980 in reply to Peony85]

Thank you! Much appreciated. The lab we used sent the results to us and our doctor. Which is such a shame as hubby saw it and is now spiralling into despair😥. Our doctor is speaking to us this afternoon to review the results but I just want to be prepared and have a few things lined up to perky dear hubby up... what a damn journey

[Peony85 in reply to leo1980]

Sorry to hear that. If you don’t mind me asking, what are his levels? There are a number of things that can be done for fragmentation, depending on the cause - like if it is caused by an latent infection. Plus IMSI can be used to select the best sperm for injection, to try to get ones with the least fragmentation.

Depending on which clinic you are with, they also have different views on fragmentation and how to solve for it so one thing to keep in mind as not all clinics agree with the urologist approaches.

[leo1980 in reply to Peony85]

his was was almost 50% we are at a clinic in London will PM you.

[MarchieH]

Hello. I have had something similar, Cycle 1 I had 15 eggs, 9 embryos and 1 transferred at Day 5 bfn. 2nd cycle short protocol I had 7 eggs, 5 embryos, all still there at day 3 and then I got a call on the way to my day 5 transfer to tell me not to come in, I was devastated. We have a sperm issue so doing icsi and I’ve been told my eggs aren’t the best quality, so I’ve been taking supplements. This time 15 eggs, 9 embryos, 2 were put back in at Day 3, 5 others were left to culture to Day 5 but they didn’t make it. One made it to blastercast but not good enough to freeze so we are hoping these two inside me are the best! I test on Monday. I’m really hoping the Day 3 transfer has made the difference xx ps. I wish you lots of luck xxx

[fay2399]

I make it to blastocyst but I haven’t got any tested... I don’t think you can do anything for your eggs... ivf is like a lottery.. you should do it on right cycle.. dr thinks I reached to dead end because of my eggs. But I plan to keep going. I say same to you keep going maybe is your lucky cycle 🙏

[leo1980]

Hi Naz87 I am with the ladies on the DNA fragmentation tested. I had two cycles with no blastocysts to freeze. I pushed for the DNA fragmentation test. Results were out yesterday. Hubby has 50% DNA damage. Not all his fault though. I am 40, and have low AMH. It’s worth doing the test to rule out me factor issues! Best of luck love.

[Miracle43]

Would you mind me asking how long the DNA test took to get the results? Approx cost?

I’ve also have a few failed cycles.

I had 2 eggs collected both fertilised and had a day 3 transfer where they said they looked good quality but failed to implant.

I’ve also had 5 eggs collected, all fertilised, all got to day 5, had 2 transferred Which they said were good but failed to implant. The other 3 they kept til day 6 and had grown but they said they would not stand the freezing process.

I’ve asked about implantation issues but told as I have caught naturally ( both ending in mmc) that they don’t think there’s an issue.

Nk cells, again told that research had changed and no evidence that they have an effect.

The only other option is Sperm dna although our clinic is reluctant to test saying that there’s no signs in the egg fertilisation.

Any advise would be appreciated.

[Ketajean]

Hello

I have just gad something similar happen for the third cycle. I'm so sorry to hear you're in the same boat 😢

First two cycles at the end of 2017 were 9eggs, 5 & 6 fertilsed but the cell division is ridiculously slow. Done day 3 and day 4 transfer nothing more than 7 cells the rest in both cycles never made it to blastocyst.

We've just had another round (transfer is tomorrow) and we had 15 eggs collected, 12 mature, 7 survived icsi (apparently eggs are soft and delicate) 4 fertilised. When they called today (day 3) they were only 3 cells so even worse than our first two cycles. So disappointed as we've put so much effort into natropath, accupuncture and kinesology the past two years. My partner had 25% dna fragmentation in February but through the natropath this is now down to 4.9% (normal range) but I'm thinking it's an egg thing if they don't divide correctly before day 3. I have AMH of 20 and are 33 so thought we'd be okay.

I dunno what to do next, i really thought this would be the one. Not looking like we'll get any to freeze. I've put in a request to have two transferred tomorrow given that history is repeating.

[Melrey]

So sorry to hear this it’s devastating and I know how u feel as we had the same issue.

Get your husband to do a dna fragmentation test as this could be the issue as sperm kicks in at day 3 of embryos.

This was our issue. Best of luck xx

[Melrey]

Right ladies I’m going to give u hope re no blasts and dna fragmentation- you will see by my previous posts this was our issue but there is hope I promise as we conceived naturally despite high dna fragmentation and motility and morphology issues plus the rest.... plus I conceived whilst down regulating!

I will gladly send u our diet notes on how to combat dna fragmentation- just send me ur email address.

Hubby changed a lot about his diet and it worked, unbelievable!

He also took the following supplements

Proceive Max

Turmeric

Tomato tablets

Maca

But diet really helped his sperm.

Stick at it for 3 months as sperm takes 3 months to mature.

Believe me our ivf attempts were dreadful never got past day 3 embryos they all died.

Sharing to help whoever this may help.

Also regular ejaculation is essential.

Sending so much love and thoughts. It’s a horrendous journey x

[Muppetgirl]

I had them put back in at 3 days. I now have a beautiful 8 month old boy. Is 3 day an option? After all day 5 is just so they can determine which are better quality - maybe they are yearning for your womb! Sending you good growing and dividing vibes for your future developments

[Cinderella5]

I was always told that development on day 4 & 5 was due to sperm but your clinic may be able to shed a little more light on things for you. Might be worth asking if you should consider a sperm fragmentation test. Sorry to hear you're having a nightmare. Hugs.xx

[Naz_87]

Thank you all. I spoke to the embryologist again. Day 4 and day 5 is usually a mix between the sperm and the egg working together to provide the genes and dna for the embryo to grow. So they said its hard to pin point what caused the growth to slow down. I will ask the OH to do a sperm DNA frag to rule this out.

[Hope321]

Hi Naz, sorry to hear you’ve been having a tough time of it. It might be worth asking your clinic about Artificial Oocyte Activation (AOA), it’s a solution they put the embryo in straight after fertilisation to give it an extra boost with development support. You can only use it with ICSI and my consultant recommended we try an ICSI cycle to give this a go although we have no issues with sperm quality. We got our best quality embryo so far, which might just be luck, but I thought I’d mention it. I was also with a clinic that only did 5 day blastocyst frozen embryo transfers. I have now changed to a clinic where they do fresh 3 day transfers. It has given us a lot more flexibility to potentially use embryos that are developing well at day three. Wishing you tonnes of luck for whatever comes next xx

[Lilly12255 in reply to Hope321]

Hi Hope, may I ask why your doctor recommended ICSI with no sperm issues? x

[Hope321]

Hi Lilly12255 , it was so that we could use AOA to give the egg some extra support at fertilisation. My doctor said you can’t use AOA without ICSI, so that was the reason in our case. I hope that helps. Feel free to DM me if you have other questions x