Day 3 quality and where to go from here...

[Iloveevie]

Hi ladies. Hope you're all ok 😊

I'm 40, and on my 3rd fresh round of ICSI, due to male factor and my low AMH. First round got 3 eggs, none made it to day 5, round 2 I had 1 egg and cancelled the cycle, which strangely resulted in pregnancy but then a MMC. This round I've got 3 embies but today been told they are all grade 2 (1-4, 1 being worst) and slow growing - expect them to have perished by the day 5 call on Monday 😔.

Has anyone had any success with similar grading on day 3?

Also, my next step was going to be naturally modified ivf with my own eggs on a 3 cycle package, but I'm starting to wonder if it's worth the time/expense given outcome so far or whether moving to DE next is better. I know it's an individual choice but I'd appreciate any insight/advice from people that are going through this journey....or have experience similar.

Thank you! Xx

[Hidden]

Oh lovely what a difficult time you have had. The first thing I would say is having been on this forum for years I have seen loads of successful pregnancies from ‘poorer’ quality embryos. It’s only a snapshot in time and not demonstrative of what happens five mins later. So don’t give up hope!

I am a bit older (was 43 when I did my last round) and I was advised to go into donor eggs because my eggs weren’t developing particularly well after day 3. And whilst I still had a good AMH for my age (11) and getting 7-9 eggs each round they all totally slowed up after day three and my fifth and sixth rounds they never made blasts (still managed a chemical one of those rounds) I ended up getting a second opinion and that clinic also told me the same and said with my history of MC as well the chances were it was ‘old’ eggs.

You are a lot earlier in your journey than I was at the time so maybe try something different but I would advise if DE is something you are considering it’s worth starting to think about it in the back of your mind now as it took me quite a lot of time to get my head round it

Good luck with this round though - this could be the one! xx

[Iloveevie in reply to Hidden]

Thanks for getting back to me Daisy, what you've said is really helpful. Think I need to prepare a list of questions for current and new clinic around odds.

Am trying to hold on to some hope, as you say it's not over yet for my 3 embies, but from past experience I'm conditioned to think/plan for the worst!

Hope you are recovering ok from the op and feeling positive about next steps xx

[ebonyebene]

Hi Iloveevie,

I'm so sorry for your losses, IVF is just one long shit show!

Clinics love to estimate success by AMH when it's one of the lesser hormones to measure success as AMH only determines how many ACTIVE follicles you have available that month. Clinics also likento bang on about AMH levels, especially when you're older, and try and push for DE, which I frankly find offensive, especially when the reason for infertility is male factor.

In terms of your cycles, what days did the embryos arrest? If an embryo arrests on day 1-2 or fails to fertilise, it's usually egg quality as on those days, the egg has its own set of instructions. On day 3, the eggs either except or reject the sperms instructions. If an embryo arrests on day 3 or 4, it usually indicates poor sperm quality, which you've mentioned. On days 3-4, the egg and sperm have a 'conversarion' then either agree to make it to day 4 (morula stage) and hopefully to blastocyst or arrest on day four.

The thing about eggs is that since we're older, a higher percentage of our eggs are abnormal, but that doesn't mean all our eggs are abnormal.

Getting good quality eggs/embryos is largely down to the protocol. Older women usually have higher levels of LH, most of the down regulation drugs spike this level, resulting in poorer quality eggs/embryos.

Re sperm, have you looked into DNA fragmentation? Unfortunately, so much emphasis is placed on the women, especially when where older and a round fails but men are hardly even investigated. I'd suggest seeing a urologist.

I started IVF at 40, first NHS round 8 follicles, 4 mature eggs collected, and none fertilised. Second NHS round 7 follicles, 6 eggs collected 3 mature, 2 2-day embryos transferred, BFN.

Third private round in Prague was cancelled due to poor response to new medication, which was too high in LH. I turned 41 just before this cycle.

Fourth round 7 follicles, 5 eggs collected, 3 mature and all injected. One arrested on day 4, one made it to blastocyst and is frozen.

Fifth round 4 follicles, 3 eggs collected, 2 fertilised, one arrested on day 3. I requested a day 4 transfer for the last embryo. My rationale was if it was going to arrest, I'd rather it happen in my that in a lab. No lab is as sophisticated as a womb!

The lab were instant that it reach day 4, I barely slept on day three!

We made the transfer, and I'm currently in the tww.

I hope this information is useful.

Feel free to DM me xx

[Iloveevie]

Thanks very much for getting back to me, really helpful. You're right, it's a complete shit show that completely messes with your mind! 🙄

I've had 2 cycles that have led to egg collection and the fertilisation rate has been 75 and 100%. I understood the rate was typically high with ICSI but perhaps I have that wrong 🤔.

By day 3 they are all fragmented and graded as low quality, by day 5 on round 1 they had all arrested and I'm waiting on the day 5 for this round... I have no clue whether this suggests egg or sperm issue but the clinic insists it's my old eggs!

I was told by clinic that DNA fragmentation was irrelevant if you were doing ICSI? Perhaps that isn't the case!

Great that you're in your 2ww. Wishing you lots of luck for a positive outcome 🤞

Thanks again xx

[ebonyebene in reply to Iloveevie]

DNA fragmentation sounds like sperm fragmentation to me. Clinics feel it's too complicated to investigate male problems (welcome to the patriarchal society), so you may need to look into it independently or use MACS in addition to ICSI, but hopefully you wont need to! Yes, ICSI overcomes the majority of fertilisation issues but inadequate protocols don't yield quality eggs. At our age we're in it for the long game and I'm happy to celebrate small wins.

Best of luck for Monday. If you feel like it, do let us know how you get on xx

[soccerkt6 in reply to Iloveevie]

Hi lovely

I'm so sorry to hear you've had a rough go of it so far.

I agree with ebony that you should look into having a DNA fragmentation test done. ICSI can help overcome "standard" male factor issues like low count or low motility, but it doesn't actually help with DNA fragmentation because no one can tell whether a sperm has damaged DNA or not by just looking at it through a microscope. Your clinic would need to use a sperm sorting method like MACS, PICSI, IMSI or Zymot - in addition to ICSI - to help sort out the good sperm from the damaged.

I'll be crossing my fingers that your embryos keep on going and make it until Monday. 💛

Good luck xx

[Iloveevie in reply to soccerkt6]

Thanks for getting back to me and for your thoughts - really helpful. I've been looking into the Comet test and where to access this.

If there is an issue (my partner is 48 so I've read that this can naturally equal fragmentation) guess it would be finding out if next clinic do PICSI or MACS as an add on.

Have you used such procedures and has this led to success/improvements? Sorry if that's too personal to ask (I've not DM'd on here before but let me know if that's best for you).

Thank you! Xx

[soccerkt6 in reply to Iloveevie]

Hi lovely

Not too personal at all! We didn't know about my husband's fragmentation during our first round so we just did normal IVF (no ICSI) and only ended up with two average quality blasts from 14 fertilised eggs. I was super disappointed.

On our second cycle we did PIMSI (PICSI + IMSI) and out of 5 fertilised eggs we again ended up with two blasts. So same ultimate outcome but a waaay better proportion of fertilised eggs made it to blast in the second round. My husband also was taking quite a few supplements ahead of our second round which I think helped, but I'm confident that the PICSI and IMSI played a huge role.

I just saw your update below about the call from your doctor. 💔 I'm so sorry. My clinic is skeptical of alternative treatments as well but they actually offer PICSI and IMSI because they’re convinced there's benefit to it in certain situations. And since it doesn’t have a green light from the HFEA they actually offer it at no extra cost. So don't let you doctor fob you off! I would have your husband test for DNA fragmentation so that you know whether or not that's an issue and change clinics to somewhere that will be more supportive of you trying again with your own eggs.

Good luck! xxx

[IVFat40]

I wondered if you've looked in to approaches to improving egg quality, or maybe a better way to put it is to energize eggs (sorry if you've already been down this road, I don't want to be insensitive going over things you've already tried). I feel DHEA, a fertility diet and various supplement really helped to improve my embryo development (I started IVF at 40). I found the book 'it starts with the egg' helpful, and also saw a fertility nutritionist. If you're considering using DHEA I would recommend getting your DHEA-S and testosterone levels checked first (the book has advice on this, and also other supplements). Wishing you so much luck.

[Iloveevie in reply to IVFat40]

Hello. Thanks so much for getting back to me 😁.

I used DHEA for second round and although this resulted in only 1 egg, and a cancelled cycle. I triggered and actually got pregnant naturally (or more so, without ICSI).

However, I've continued on DHEA for this round, but wasn't on it for as long, so I don't honestly know if it makes a difference or not for me.

Also on a cocktail of supplements as per the egg book.

Dr seems to think that as I only get a max of 4 eggs (and he insists it's the quality that's the issue) that there is no point in continuing with my own, but I am thinking of going down the naturally modified route - it feels too early to give up on my own

Thanks again xxx

[IVFat40 in reply to Iloveevie]

Ah it sounds like you've already put a lot of work in to things that might help energize eggs. And it is so hard to know for sure isn't it what has or hasn't helped. I've no experience of it myself but lots of people on here have spoken really positively about natural modified.

[Iloveevie]

Just had the call from patronising Dr to say none have made it to day 5, so 'obviously this is an egg quality issue my dear'.

He's pushing me into donor, after seeing the counsellor of course... Was again dismissive of sperm DNA fragmentation and said that ICSI was the answer, which we're already doing for low morphology. I mentioned PICSI and MACS but was told their effectiveness is not proved so it's a waste of time.

Happy valentine's day! 😅 xxx

[IVFat40 in reply to Iloveevie]

Oh hun I'm so sorry, that must feel devastating, and today of all days. It does sound like a new clinic is in order, I'm sure these guys are perfectly skilled in what they do, but it's so hard when they're not open to thinking outside the one box.