First of all thank you to all my IVF sisters who have been so so supportive even though I have only recently joined.
I am 43 years old with relatively good AMH and follicle count. Had a BFN last year
Currently on a 3 cycle package to bank embryos due to my age
On quite high stims 375 IUs of Gonal F and 75 IUs of Menopur with a double trigger of ovitrelle and buserelin
First cycle: from 6 eggs retrieved, 4 were mature, all 4 fertilised had 2 embryos frozen- 4bb and 3ab
Second cycle- exactly the same stims but triggered later to recruit more eggs. I had 13 eggs collected, 9 mature but only 5 fertilised and no blastocysts!
When I spoke to the embryologist, she could not give me a reason why the outcome was so different. I have a meeting with the consultant next week to review the cycle so wanted some ideas on suggested questions I could ask to better understand what went wrong. I know they may never give me straight answer but I have to try...
Also has anyone had a similar situation- what was your experience and outcome? It will be good to know if there are any suggestions for changes. I am keen to avoid the same outcome on my third and final cycle.
Thanks in advance for your support.
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JoyfulStar
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I’m happy to hear you have two from the first cycle and a bit confused as to what the flip happened in your next cycle? Their plan sounds like the opposite of what they should have done?
My first cycle I was on menopur and got 5 eggs, all fertilised but only one top grade blasto that didn’t work.
Then second they changed to gonal f .... but as my cycle fell across the weekend I think they messed up my trigger shot and instead of 9 eggs they only got 3 normal and one weird one. But they gasped at my scan and asked me to take final gonal f immediately then trigger two hours later. They so messed up!!! But as I got pregnant in the fresh transfer I didn’t get to poke about it!
You definitely should ask! They don’t seem to have your meds right yet? It’s such a game of science isn’t it!!! Wish they could do a blood test that could be used to better predict drug needs! It’s such a guess 😖😣🥺
Thank you so much for your insights. I had a feeling that something was not quite right when only 5 out of the 9 eggs fertilised with ICSI!
My hospital never do blood tests just scans so will definitely be requesting this for the 3rd cycle. I will also be asking for less medication next time.
All the best with your FET too- my thoughts and prayers will continue to be with you. 🙏🏾 😘
Thanks for the reassurance. My previous cycles percentage wise were much better soobviously had unrealistic expectations 🤦🏽♀️
Thanks again xxx
Sorry you’ve had such a nightmare second round.
How recent was your first cycle? I’ve just turned 44 and started IVF at 40, last round was when I was 43 and like you my AMH was relatively good for my age at 9.8 and I generally got around 10-14 eggs collected
I think it’s worth asking how your embryos develop. Mine looked great on day one, pretty good on day three but after day three they really slowed down and stopped developing or scraped to morula but no further... this is my two round at 43 - 18 months before I had good quality blastos and got my bfp but sadly lost it
The only explanation they gave me was old eggs and they know this by how the embryos develop. I sort of didn’t believe them given my AMH etc so went to another clinic but sadly they said the same
I am sure it won’t be the case with you but worth asking how they develop from day 1 onwards and if it tells them anything
Heaps of luck - hope it was just a rogue round as that can also happen!
Thank you so much for your response. Sorry to hear about your loss. But inspired all at once to hear your story. It is nice to know I can keep going if I want to.
My first cycle was in January 2021 as I am doing back to back cycles pretty much with a month in between. Not sure if there is a cumulative effect of the IVF drugs in my system.
I did ask questions about the embryos this time around and the embryologist explained that they divide and keep growing. Even at day 5 yesterday I had an embryo at the early stages of forming a blastocyst but it stopped today. I was delighted with first round so never thought to ask this specific question but will explore this in more detail. Her response was it could be anything!
I hate that old eggs statement to explain every failure. I have even heard them use it as an excuse for younger women citing bad eggs. 😔
It is such a cop out!
Thanks again for taking the time to respond and all the best xxx
Sounds like it could just be a bad round then, anything can cause it. One of our rounds was a disaster - we got about 14 eggs but only 3 made it to day 3, my OH had had terrible flu a few months before and they told us afterwards that was probably the reason.
I wouldn’t lose too much heart, although that’s easy for me to say! Having done six rounds it always amazes me how different the results can be xx
Sorry for your latest round. I’ve just experienced something similar in terms of two rounds with exactly the same protocol - the first a year ago, 13 eggs, 9 mature, all fertilised with icsi and ended up with 4 blasts. Next round I’ve just completed with the exact same dosage of gonal f & trigger, 6 eggs, 4 mature, 2 fertilised and 1 blast. My AMH is measuring the same as last year at 16.5 (I’m 40) and yet completely different results. My specialist (who I do trust) just said that’s the rogue nature of IVF - he said back to back cycles can even yield completely different results. If I’m honest, I do think the skill of the embryologist doing icsi plays a part, but as for the eggs, that’s all on me!
Good luck with the 3rd round, hopefully it’s more like the first xx
Thank you so much Susie_1234 for your thoughts and insight. My husband made the same comment about ICSI but you never really know the answers to the questions do you.
I have learned a really hard lesson this round that while you pay so much for IVF, the process can be completely random. But you don’t give up because your desire to have a baby outweighs all of the pitfalls.
I have had some mini successes and I still have more chances so I do hope I get a better result the next time. Thanks again for your insight and story ❤️
Such a good perspective. Yes I have had the total realisation this round too and it’s quite unnerving as everything with IVF is so outside our control, that you need to assume certain things will go to plan otherwise why do we put ourselves through it! Best wishes, hope nothing but the best lies ahead x
My first IVF round nothing and round 2 much better with. 2 to freeze same amount of eggs as well with ICSi with the average given in NZ sounds about right as hard as that it to hear 😔
Thank you- I know deep down you are right but can’t help questioning especially as in previous rounds I had a better fertilisation rate. Still I know this is quite common with no frosties after IVF so all I can say is oh well and hope for a better outcome next time.
I'm sorry it's hard to hear, when I read the odds was absolutely gutted as well 😞. 🤞 Next time you get a better round. Just remember 2 frozen embryos are hard to make and it's those 2 that could make you a lucky person
Thank you so so much for what you just said! 🤗💗❤️💕Whilst disappointed, I am counting my blessings. I am now aware that maybe I took getting to the blastocyst stage for granted. I said to someone else in another postI may be down but I am not out ☺️
I am very grateful for the success of my previous round as this has made this cycle much easier to bare. Thanks again for reminding me to celebrate the mini successes in this tough journey! All the best with your journey 🙏🏾
❤️ definitely enjoy those 2 successes because they can change everything as you know it 😍 my 2 embryos are now living and breathing and giving me grey hairs at the age of 1 and 2 . I really hope you have the same success and never give up hope ❤️
Hey, I’m sorry to hear it isn’t going to plan. I have only had 1 round so far but I was also on high stims For long protocol as my Amh is 10.8 (I’m only 31). They had me on Buserelin, 450 Gonal F and single ovritrelle. They were really happy with my results, I only took 10 days of Gonal because I reacted so well. Went into collection and they got 13 eggs. I was soooo happy! Got the phonecall the next morning to say only 5 had matured and none of those fertilised! You can imagine my shock and disappointment.
This time, they are swapping me to 450 Menopur. We are actually doing ICSI due to low sperm count and quality so spotting my ‘lower’ Amh was by chance.
The consultant did say to me that my eggs appear to be really tough to strip back in the process (which isn't very reassuring) but that she was very shocked to have none fertilise. We’re due to start our next round next week and she is ‘fairly confident’ (whatever that’s means in this journey) that I won’t have the same outcome again.
Back to my point ha... I would recommend asking things like.. how did the eggs look quality wise, would they consider changing your medication? I will be on menopur this time and have been told it often produces lower quantity but better quality. Could they change your trigger shot timing (mine has been extended by 2hrs).
Hopefully they’ll give you plenty of info next week but hope that is a little more help.
Thanks for sharing your story. Also really sorry to hear about what happened with your last round. That must have been a complete shock!
I have just realised that because my previous rounds had produced frosties, I had assumed the same would happen again especially with 13 eggs but now feeling the sting of reality and facts.! 😭
Your suggested questions are fab! I will definitely be making a note of them. Thanks again and sending you positive vibes for your next round 🙏🏾🙏🏾
Hiya, my first round i only had 5 make it and they weren't great quality as the fresh and frozen didn't work but for the second round of stim my doctor put me on coq10 and vitamins.. As well as putting my hubby on vitamins too.. This time i got much better quality eggs and managed to get 8 to frozen.. I did get pregnant with this lot but had a miscarriage but now on my next frozen cycle and praying it works again. Were you on any vitamins or supplements to help with egg quality? Hopefully the next one will be better with more eggs that go the distance x
Thank you and so sorry about your previous failed round. After my first BFN, I did look into improving egg quality with Coq 10 and got better results second round but latest round was obviously a dud so I am suspecting it is not that.
On the other hand, It is likely this round recruited the worst of the worst perhaps- I am 43 after all but I also suspect something else hence my questions. ..
I do know that at 43 I may be chasing ghosts but hoping to give myself a great shot at catching that ghost 😉
Thanks again and good luck with your next FET round. 8 to frozen is a great number! 👏🏽👏🏽👏🏽
this might have been due to premature luteinization, which is something that happens with older women - basically the eggs become overripe and not of a good quality when they are left in for too long. A clinic in the US who specialise in older women actually make a point of retrieving the eggs earlier than usual. They got a 46 year old pregnant by retrieving when the lead follicle was 13mm! Here is a study by that clinic: ncbi.nlm.nih.gov/pmc/articl...
OMG! Love love love this post! 💗💕This is the closest thing I have been thinking about that comes close to explaining my nagging doubt about what may have gone wrong. The biggest difference between this round and the last one was the length of time I was on stims.
During my 2nd scan, I had one lead follicle but a lot of middling ones and some close to maturing but they asked me to keep going for another 2 days.
The first round where I had good success I was triggered earlier after only 9 days of stims.
This time, they made go an extra 2 days. At my final scan, the doctor commented that I was ready and even asked if I was in any pain. They therefore recruited more eggs this time around.
It may not be the only reason but I can’t help feeling it definitely played a role.
Thanks again and I will look into the research xxx
i convinced my doc to trigger at a lead follicle size of 18mm and there was such a big difference in quality, compared to my previous round. The fertilisation rate was way higher (84% vs 56%) and i ended up with 2 top grade blastocysts, one of which is about to turn 1. And I was also 43 years old when I did that cycle I did end up with fewer eggs versus the last cycle (7 vs 11) but they were definitely better quality. You should also look into DHEA - I took that for 3 months beforehand and am pretty sure that also had an effect. I gave my leftover DHEA to a 43 year old friend with a long history of miscarriage and she got pregnant naturally after 3 months (just before she was about to start an IVF cycle!). Here is a good analysis of DHEA if you wanna discuss it with your doc: ncbi.nlm.nih.gov/pmc/articl... (this was an analysis of studies in women with premature ovarian failure but there have also been good success rates in older women - the clinic that does early retrieval also recommends this... check out their info on their website)
Thank you! Great advice re: lead follicle for my next round. I will definitely be discussing this with my doctor.
Regarding DHEA, I did do some basic research after my very very first cycle and remembered that it should only be used for a certain type of patient and as I was not sure, I opted for Coq 10 then; but will definitely read your article and speak to my consultant about it.
By the way, I will soon be 44- in June! To be honest if this does not work, I doubt I’ll continue mainly due to finances and hubby’s age. He is 13 years older than me snd I have to be mindful of how old he will be when our child turns 18 for example. We decided before this what our cut off point was. It is partly why this disappointing round stings that bit more.
On the other hand, I know I still have another chance as well as my previous 2 Frosties so I can be happyish with that! 🙂
Thanks for sharing your story and it is invaluable as we are very similar in age.
By the way articsnowfox, can you let me know what dose of meds you were on when you had that really successful IVF round aged 43. Also was it Gonal F or menopur or both ?
I was on a slightly lower dose of gonal-f (alone) than for the previous cycle: 175IU for 3 days, then 200IU for 3 days and then 225IU for 3 days then trigger (from memory) - it was kinda crazy because my doc basically gave me control of my dosing and when to increase it! On the failed previous cycle I had been on 200IU, then 225IU then 250IU. But my AMH was pretty good for my age: 2.51 ng/mL so that's why i was allowed to have such low doses...
Hello, I’m sorry this cycle didn’t give you the blasts you were hoping for. It’s heartbreaking. A few questions I’d ask, what was the quality of the eggs like, were they all mature? Would a double trigger help? Did you do IVF or ICSI? Was there any difference in sperm quality between this time & the last cycle? Sometimes pushing our follicles/eggs too hard can impact on quality so discuss this with them too. Perhaps go back to what you did in your first cycle if it seemed to work. Every cycle is different & so much is down to trial & error. I know how tough it is mentally but remain grateful for the two blasts you have frozen. Good luck with the next cycle Xx
Thank you so much Jengi. It was definitely very disappointing for sure.
My husband had a sperm retrieval with frozen sperm so I know it is not that. It was ICSI. They have been using the same sperm from the surgery and my fertilisation rate has been good till now
I suspect it is the egg quality either due to my age, too much stims or a mixture of both.
We definitely kept to the same formula but my body may have reacted slightly differently this time and they chose to push my eggs that bit further which may have resulted in my failure.
Hoping the doctor will give me better answers than the embryologist.
Hi,A few thoughts sprang to mind when I read your post.
1. Sometimes when they push for more eggs, they can push too far and end up delaying the egg collection to get numbers over quality... This can sometimes mean your best quality mature eggs aren't harvested at the right time. My last cycle, they wanted to do egg collection on the Monday, but pushed it to Wednesday, meaning I was over stimulated and borderline ohss.... I really wanted egg collection on the Monday (we ended up with 2 pgs abnormal embryos from this cycle). So, first question is: did they perhaps delay egg collection on your second cycle to get more eggs and if so, query if this would affect quality of the the already mature ones (my experience is that it does).
2. When you get more eggs, what you're really only doing is throwing in some extra ones that would never have made it anyway. The body naturally releases one egg a month, but selects the egg based on how viable it is... In your body there are so many eggs that would just never have been released during your monthly cycle. So my second question would be to do with whether they think more eggs = better quality? Some people have natural modified ivf, which focuses on harvesting only 2 or 3 high quality embryos. Not something I've personally had experience of (and statistics don't support the theory that this is better) but worth thinking about whether you want quality or quantity on your next cycle...
3. I think I saw you had ICSI??? With ICSI or IMSI, it is normal for some sperm to get damaged in the process of being injected into the egg. When we had imsi, our fertilisation rate went down significantly. Our first cycle, out of 18 eggs , 15 fertilised naturally. On our imsi cycle, we got 8 or 9 embryos out of 15- so a significant drop. And both of our two embryos tested pgs abnormal. I'm guessing there's a reason you had icsi (sperm quality??) but bare in mind, if you injected your best embryos with a sperm that was damaged during the fertilisation process, this would impact how many embryos you get. It really is a numbers game: matching the best egg with the best sperm AND the fertilisation going exactly to plan.
As a side note, our last ivf cycle was a disaster, primarily because they pushed us to get as many eggs as possible. As I said before, I ended up with 2 pgs abnormal embryos.... I then got pregnant naturally the following month (chemical) then again the next month- and am currently 25 weeks pregnant. So if I can give you one piece of advice it's to remember that quantity isn't always better than quality. For your next cycle, insist the eggs are collected when your strongest ones are ready, not when the slow 'never-would-have-made-it-anyway' eggs are ready. It is true waht they say - it does only take one, so make sure you get the good ones 👍
Sorry to hear about your setbacks but also amazing to hear about your current pregnancy. Congratulations 🥳 🎊
What amazing insight into what may have gone wrong. Thank you so much. That is exactly what I thought about pushing eggs too hard but could not articulate as well as you 😊
We have ICSI because of my husband’ vasectomy so it is unlikely to be his sperm quality as they have used the same sperm from one surgery. My husband also has kids from a previous relationship.
The concept of quality over quantity is what I will be exploring with my consultant. I know I am already at a disadvantage because of my age but I really don’t want any other factors to jeopardise my chances!
Thank you so much once again. Hope the rest of your pregnancy goes really well! 🙏🏾
The man perspective - you did not mention if your partner is on vitamins. I know the focus is on egg quality but the one which many consultants have recommended is Proxeed. They come in a pack for 2 months, a little bit pricey (....but not as expensive as IVF meds My partner is on this vitamin as a prep for any IVF round we have taken. I am including a link for your here:
The right date to extract the eggs - This has been discussed in the responses above but my addition would be that for me - after having done 4 cycles of IVF with one of the resulting in pregnancy (but I lost it later due to foetal abnormality) - is that the cycle where I was able to get most to turn to blastocyst (and the pregnancy) was one where I aligned the collection date with my natural ovulation date. This may sound too obvious for many but I have now had a egg collection 4 times and some before and some after and the stats seem to tell me that it is good to try to use the natural ovulation date as a good guidance as when your eggs will be mature/optimal. The meds can grow them in size quickly (if given a high dosage) but that does not necessarily mean that they are mature. Doctor's seem to not want to listen to this but the one that did was the best round I have so, oh well... If you have not yet found out what your ovulation day is, do find out and bring that to the conversation. You can do this with the digital ovulation home kits you can buy from clearblue (shops/amazon). Start taking them on day 8, and do morning and evening and see when you get the rise and when you get the peak. The peak is what you will be aiming for the collection date.
Trigger medication - as per someone else mentioning earlier - trigger meds can have a huge effect on the maturity. Discuss the trigger medication on your consultation appointment and ask directly and don't settle with vague answer - "what are the lessons that we can take from our two rounds-> what is our first cycle telling us, and what is our second cycle telling us?" -->force them to give you advise based on your results vs what works in average. Now that you have two cycles behind you, any clinic will be able to get more customised with your next treatment plan.
Get them to give you the paperwork so you have it yourself and that you can bring it with you on your 3rd cycle - "own your own treatment". It is amazing how they don't look at your particular details even when they have it, and practise what they recommended in the consultation appointment. What they need to give you is:
1) the IVF cycle summary -> usually a printout of a excel looking sheet where they have the follicle sizes and how many at a given day of scan. It should also show the medication on a given day and which day you started (day 2 or day 3 of your cycle if on short protocol), and also which day you took the trigger and which meds where involved.
2) the lab sheet -> as them to give you the handwritten lab sheet and then a bullet point explanation which should give you 1) the sperm stats on day of collection, 2) the number of eggs collected and how many were mature (day of collection stats), 3) the number of eggs fertilised (day one in an incubator results), 4) the day 3 rating...and here don't settle without getting clear rating and explanation which rating methods they use as different clinics use different rating scales, 5) and if there are any for day 5..the day 5 blastocyst rating, and if they keep any to day 6...day 6 rating.
Having the above is gold dust - every clinic should give this to all clients as standard but they don't. This is the only way you can truly own your own cycle and keep a watch that what they recommend for you is based on your individual stats and not a lazy application of average.
Consider day 3 transfer as one option (-particularly if your clinic's stats for FET are below average (you can check this on HFEA website if UK based) - Many clinics don't like to do day 3 transfers (...as they like to manipulate their stats to look better...argg) but it can be a good option, particularly if you are with a clinic that has below the average success with FET transfers. The in-vitro may not be the best incubator and your body may do a better job than the in vitro...my day 3 transfer resulted in pregnancy and I am 42 and with a very similar profile to you. Day 3 transfers in our age group has done better than day 5 transfers...again, the HFEA website stats were a goldmine for this analysis, when I did it about a year ago.
Wishing you - and anyone reading this - a good journey ahead 🧚
First of all so sorry you lost your pregnancy. It must’ve been so difficult but thanks for sharing your story.
I am loving your lovely detailed post with lots of information in there worth their weight in gold! Thank you for taking the time to reply.
I love your suggestion about the ovulation date and will be pursuing that angle as well as owning my treatment plan! You usually blindly trust the experts until some thing major goes wrong. I have definitely learnt my lesson
My husband had a vasectomy years ago. He has kids from a previous relationship. We did one sperm retrieval and they retrieved enough sperm for 6 IVF rounds. Up until this round, the fertilisation rate via ICSI has been 80% - 100%. I am less concerned about that bit of the process but more whether they pushed my eggs just that bit too far!
It cannot be a coincidence that the rounds were I got less eggs, I got better results and the one round I got lots of eggs was a dud!
I will be having a fresh transfer the next time- my consultant’ s idea- not mine but I thought it was a good one! I will see if he suggests a day 3 transfer to secretly assess his willingness to give me the best chance of success. I will obviously eventually push for it myself.
Anyhoo thanks again for the lovely advice. I will be checking out the HFEA website! All the best with your journey!🙏🏾💗 💫
Its funny you mention about triggering later to retrieve more eggs as I triggered Monday evening when I wasnt expecting to trigger so early - egg collection on Wednesday and they only collected 3 eggs, of which 2 were mature and none fertilised normally. I'm pretty annoyed (and obviously upset) as am sure they'd got me to do the trigger too early ....
So so sorry for your disappointing results. It can be so annoying when you believe they messed up but can’t prove it. You are so so right about it being a guessing game. I think it is not an exact science and so much is up to nature so the doctors take a chance. I believe they went for quantity over quality and it did not pay off. They took a much more cautious approach the first cycle. If feels like they just went that bit too far
I have had 2 cycles which yielded different results. First cycle 2020 October at 39- short protocol 225 menopur and double trigger. No bloods done during the cycle. 15 eggs collected, 10 mature, 8 fertilised icsi and 1 blastocyst and nothing to freeze. It was a fresh transfer and it failed. In preparation of second cycle at 40 l took Prenatal multivitamins, omega 3 and Ubiquinol and my husband was on preconception multivitamins. On this second cycle in March they increased menopur to 300 and had bloods taken every scan to check my hormones and from that they adjusted one of the trigger injection ovitrelle as my levels was said to be high and was spotting too. The egg collection coincided with the day l was meant to ovulate according to my period tracker. They managed to retrieve 16 eggs, 12 mature, 10 fertilised and 8 blastocysts all frozen. They discovered l have hydrosalphinx so have to get that sorted before transfer.
So sorry your first round of IVF/ICSI did not work. From 15 to 1! 😟
Thank you so much for sharing this with me and wowzers 🤩for the second round eh? 🙌🏾🙌🏾
I will be absolutely thrilled with half of what you had. So great job! 👏🏽 👏🏽👏🏽
I am on the same vitamins you mentioned. But another person mentioned DHEA which I will be looking into some more as I initially explored it and then decided against.
I will be insisting on blood tests going forward especially as I will be having a fresh transfer. I know they will charge me more but it will be worth it I’m sure.
Thanks again. Have you had your FET yet or do you have it soon?
The first cycle was something for me and we are self funding. I did the second cycle when l felt ready mentally and physically.
Yet to do frozen transfer - my tubes have to be cut first and am now on waiting list. If l had the funds would go private but self funding takes every penny.
In your case the best is to trigger when leading follicle is 16-18mm, called early retrieval. Which is earlier than for younger woman. That gives better quality eggs and embryos. Probably your eggs were atretic from waiting too long. Best
Absolutely! Completely agree with this assessment. Unfortunately, I am finding this out a bit late and would have hoped the consultants would have known this and not let me go on so long with the stims.
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I did end up with fewer eggs versus the last cycle (7 vs 11) but they were definitely better quality. You should also look into DHEA - I took that for 3 months beforehand and am pretty sure that also had an effect. I gave my leftover DHEA to a 43 year old friend with a long history of miscarriage and she got pregnant naturally after 3 months (just before she was about to start an IVF cycle!). Here is a good analysis of DHEA if you wanna discuss it with your doc: 
If you have not yet found out what your ovulation day is, do find out and bring that to the conversation. You can do this with the digital ovulation home kits you can buy from clearblue (shops/amazon). Start taking them on day 8, and do morning and evening and see when you get the rise and when you get the peak. The peak is what you will be aiming for the collection date.
No Fertilised Eggs. Devastated. 
No. of eggs
5 eggs collected, none of them mature, no fertilisation
Poor response, despite plenty of follicles. 
