Low fertilisation in IVF/any hope of day 2 update?

[pickle19]

Hi all,

***tw for high follicle numbers/complaining about getting 3 fertilised eggs***

I had my first egg collection yesterday, after TTC since Aug 2020 with various rounds of clomid/TI/IUI. I'm 31, have a very high AMH and PCOS so my consultant said he expected us to need one cycle to get 'enough embryos for siblings'.

All looked good at the scans, I had tons of follicles (baseline AFC was 33, then I had a good 25 by the second scan, and more like 50 by the final one). My estrogen was a little low but we added Menopur for the final 4 days of stims so I thought that was dealt with.

Anyway, they only collected 14 yesterday, and only 3 have fertilised. 12 were mature (but embryologist said maybe only mature today rather than yesterday?) And the sperm was fine apparently. She recommended we do ICSI in our next cycle... A cycle I didn't expect we would need to have.

We are just so shocked - I was disappointed yesterday with 14 but reminded myself how many people on here have far fewer and do just fine. But with only 3 fertilised I'm now completely confused about what's going on, and feeling let down by the clinic who shouldn't have got our hopes up/should have sorted the estrogen issue earlier. I have a gut feeling this isn't our round, though I know on paper it only takes one and we're not out just yet.

So my questions:

The embryologist said they'd call again tomorrow to see if any more have fertilised. Has anyone had a positive day 2 update?

Has anyone had experience in a similar situation and can advise what might have happened? Low estrogen, collection too early/too late, immature eggs? Eggshells too hard? Sperm look good but are actually not good at fertilising?! Our follow up with the clinic isn't for a month!

We're so tired of being sad. My oldest friend is due to give birth on Monday so I'm now dreading that even more, and my beloved grandmother is critically ill in hospital. I don't know how much more I can take.

(Sorry again for potentially being upset at numbers others will be dreaming of ❤️)

[Skittles11]

I can't really help as I am in such a completely different situation but I just wanted to thank you for being so sensitive by putting a trigger warning Xx

[pickle19 in reply to Skittles11]

I've been following your posts and crossing my fingers for you x

[Skittles11 in reply to pickle19]

You're definitely not out yet by the way. My last round was a disaster but prior to that with two fertilised eggs both got to blastocyst. There is every hope though I do know how challenging it is not to get drawn into the numbers. Xx

[pickle19 in reply to Skittles11]

Thank you that does make me hopeful. I know rationally I should be pleased/hopeful but it's hard and I feel like I've gone completely mental with googling in the last couple of days! Thanks for replying. Take care of yourself xx

[LuxFleur in reply to pickle19]

I had only 1 fertilized egg this round and it made it to blastovyst

[soccerkt6]

Hi lovely

I'm sorry to hear about your grandmother, that's really hard in the midst of IVF which is already so stressful. 💔 Three fertilised eggs still means you're in with a chance, so don't lose hope! Though I totally understand your disappointment after your consultant got your hopes up. It's a bit irresponsible to say something like that to a patient especially when it's your first cycle and no one can know for sure how you'll respond...

A few questions for you if you're happy to share:

-What's the reason you're doing IVF? Have they given you a diagnosis or are you "unexplained"?

-Are you taking a myo-inositol supplement like Inofolic Alpha for your PCOS? Inositol can help improve egg maturity in women with PCOS.

The embryologist should be able to advise if the shells were too hard, though I think that tends to be more of an issue with older eggs. And my clinic don't even check oestrogen levels throughout stims, so I'm afraid I don't have any advice on that front. It is possible that your husband has high sperm DNA fragmentation which could explain low fertilisation, poor embryo development and "unexplained" infertility. My husband always had normal semen analyses but we eventually found out that he had high DNA fragmentation and that explained our poor results during cycles. I would suggest having him to do the Comet test to check for fragmentation before embarking on your next cycle (if you even need one...hopefully not!).

I'll be crossing my fingers for you that your three little embryos keep on going!🤞 xx

[pickle19 in reply to soccerkt6]

Hi Soccerkt6, thanks so much for your reply. You and Daisy both saying the same thing about the consultant has soothed me - he absolutely shouldn't have got our hopes up like this!

Answers to your q's -

We're doing IVF because of my PCOS mainly. Hardly have a cycle and have ovulated on my own only once since we started. No other known problems but not many investigative tests (didn't get to HyCoSy etc). We have been doing medicated cycles since Jan/Feb 21 - we have had 7 rounds of Clomid, two with IUI (were living in Amsterdam where they are very hands off and didn't even scan me for 3 of those cycles). I then didn't respond to letrozole properly (tried twice and got periods during fertile window?!). So the consultant said we could continue doing IUI maybe twice more but he was worried about the clomid and my future health so wouldn't do more than that, plus said IVF is much more effective and that comment about getting loads of eggs.

I'm taking a myoinositol complex yes have been for close to a year I'd guess. I think it may have contributed to the one natural ovulation.

That's such a good point about DNA frag - we had asked about it before starting as it had been recommended here but the clinic said not to bother. Can't help but feel it's coincidental they do the bog-standard-don't-bother-with-extra-tests IVF cycle while the NHS are paying, and let us pay for all the extras out of pocket on the second cycle!

Thanks for your kind words and good luck, I really appreciate you taking the time xx

[Hidden]

So sorry you are having to deal with so much, it must be so hard.

I don't have answers for you but I do want to say that the first IVF round is so often a learning round. I think it was really wrong of your clinic to set such high expectations for you and no wonder you have really crashed down now. I am sure a lot of people will have had similar experiences, and I have had a few rounds like this.. but really until you have your review appointment when you can ask what happened you might well just be second guessing. For example they will be able to tell you whether they fertilised abnormally or not at all. I once had a round where I think we got 10 eggs and only 2 fertilised and it was the others did fertilise but abnormally and they put it down to my OH being ill in the 3 months before IVF, so whilst the sperm looked normal that was a common reason. Tons of people on here will have similar stories so hopefully they can start giving you reasons to ask your clinic. But I just wanted to say its not unusual for the first round to not go as well as hoped and its great you still have 3 embryos but your clinic will have learnt so much about your body and how you respond, so if you do need another round (and I am crossing my fingers you won't!) your clinic will have so much more knowledge. My first round I got 3 embryos, they tweaked a few things and the next round I got 9! So whilst this doesn't help you at this precise moment I just wanted to say it doesn't mean it will happen again. Huge hugs xx

[pickle19 in reply to Hidden]

Hi Daisy, thanks so much for this reply. I agree now it was unfair of our clinic to get our hopes up and I'm rationalising it all a bit more. It would have been easier to think this was a test run or data gathering opportunity and anything else is an added bonus. Will try to reframe it for myself.. easier said than done! It's good to hear things changed for you so much with a diff protocol - the doctor earlier sort of blamed my number of follicles for it all and I felt a bit like it would be how I respond next time too. I'll try to remember this isn't a given.Thanks again for taking the time, I really appreciate it! Xx

[MariaHdz]

I have PCOS too. They recommended myoinositol for me (can help with egg quality, by reducing insuline) and metformin. Supossedly together, they increase your chances of good quality eggs and embryos in women with PCOS... what seems a bit strange is the low estrogen (PCOS is over high estrogens and with so many follicles, your estrogens would be soaring... coudl it be that they estimulated too fast? With too much medicine? Or maybe you have lean PCOS and your testosterone is low?). If it is over the treatment, they will adjust it during next cycle.

Good luck!

[pickle19 in reply to MariaHdz]

Hello, thanks for your reply. Yes I'm taking myoinositol, but not Metformin so might ask about that. My BMI is about 22 so probably more in the lean PCOS category but all hormonal tests I've ever done have been normal (except when there's not enough of something during treatment, I mean I don't have excess testosterone or a weird level of estrogen when I'm not pumping myself full of IVF drugs!) Sometimes I see online about the possibility of having pco- without the syndrome but I'm not really sure if that's a thing. The clinic don't seem bothered about treating the PCOS beyond getting me pregnant. Did you go to an endocrinologist? X

[MariaHdz in reply to pickle19]

That happened to me too. They just did not seem to care. I had no natural periods since I was 14, i asked them to check my insulin but they laughed it off "your glucose is perfect!".... i went to the endocrynologist and he found out that all was ok, except low d vitamine and the insuline that was too high. He gave me metformine and now it is controlled. In my case I have the classical A phenotype (it does not matter what my BMI is, it is alwaya the same). But there are other phenotypes and other "pcos" imitating diseases. Like I know someone who was diagnosed with PCOS by fertitlity docs, and actually had a problem in the adrenal glands. In "lean pcos" all seems normal but testosterone is low instead of high and that causes for immature eggs. So mybrecommendation is to go to the endocynologist, not just to get pregnant but to see if there is something else.

[pickle19 in reply to MariaHdz]

Thanks very much. I'm going to call the GP today to get referred. I'm sorry you had to jump through so many hoops to find out what was going on!

[Positivechangeplease]

It could be that your body was producing too many eggs at the expense of quality. If the sperm was good, then all you actually need are good eggs for them to fertilise. The egg attracts the sperm appropriate. It won’t just let any sperm in. That’s why I don’t think icsi would be best if sperm is good. 14 is quite a lot, and perhaps you’d have been better with fewer harvested for better quality which would mean a longer protocol. That said, you have 2… 2 is not nothing. I had 10, 9 fertilised, 5 made it to a good place but 3 actually made it to day 5 blastocyst. Your 2 could definitely make it that far and is only 1 less than I had. I’m afraid it’s a bit of a waiting game. X

[pickle19]

Hi all, thanks for your replies. We had a fourth egg fertilise overnight from day 1-2, and ended up with one very good quality blasto. Not the cycle we had expected but such a relief we have something to show for the physical/emotional trauma of it all. And I've learnt a lot about managing my expectations and handling the process that will be a great help going into a second stimulation round when that happens. Wishing you all well x