So I’ve had my results from the implantation clinic/uterine biopsy where results came back normal, which is good but also opens up ‘a can of worms’ as to what’s actually going wrong as we thought it was implantation.
They have suggested to check out our embryos (round 1= 5 eggs, 3 fertilised only 1 top grade and transferred bfn and round 2 8 eggs and none fertilised) and were surprised when our main clinic hasn’t suggested ICSI or any further testing for my partner/ embryo testing. (Although we don’t currently have any embryos to tests!! I have low AMH)
I was wondering if you know of any other tests for embryos which may be good and whether you feel ICSI is worth the extra? Only 3 of the 8 eggs in second round were mature but still didn’t fertilise.
Suggestions/experiences welcome
xx
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Mlove12
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Hi babe! It's a strange feeling when results come back clear isn't it. Like you don't want problems, but you want answers!
Can't speak to embryo testing as it's something (I think?!) I'm not going to do. But I can say icsi made a big difference for us. First round ivf 13 eggs, 2 fertilitised. Second icsi round, 10 eggs, 7 fertilised. Perhaps it was a combination of icsi and a new drug but either way it got me 3 blasts. Maturation seemed to be an issue for you in the 2nd round, did the clinic discuss that?
Hey lovely, thanks for replying! This gives me a bit more hope with icsi after hearing a positive experience. Glad it worked for you! Nope they didn’t say anything, just it’s hit and miss and that to keep going and feel we will be successful because we’re both young. Encouraging but also annoying! Only other thing they suggested was double trigger which I think we may go for x
i would definitely recommend testing the embryos cos sometimes they look good but are actually uneuploid and will lead to a neg cycle, iv had blastocyst that looked great and came back abnormal after testing. It will spare u the heart ache. I also read that ovarian pro is sthg that helps with quality. I have not tried it but maybe look into it?
Speak again to your clinic about your concerns - they know your history , blood results and how you responded to treatment etc - so should be best qualified to give you some answers/ advice regarding your way forward with treatment
So you've transferred one embryo so far? I think with normal tests you can assume it isn't an implantation issue (normally recurrent implantation failure testing is considered after 3 or more failed transfers of good quality blastocysts) Most likely it was a problem with the embryo. It is worth asking the clinic about sperm and egg quality, and definitely worth thinking bout ICSI - it's often used if poor fertilisation rates with IVF xxx
Hey, thanks for replying. We just assumed implantation as we’ve been trying for nearly 3 years so was just an initial assumption I guess. Yes definitely going to give icsi a go I think! My clinic didn’t suggest any issues with male factor and didn’t suggest any extra tests but I’ve taken it upon myself to ensure my partner has the dna fragmentation test just to double check. my egg quality isn’t great as out of two cycles, 13 eggs total, 7 of those have been immature and 3 for some reason where mature but didnt fertilise however again, my clinic doesn’t think further tests for eggs or embryos needs to be done right now, annoying! Xx
From talking to a couple of consultants (including the Warwick professor) it is thought that most failed transfers are due to embryo problems. We've had 5 good quality blastocysts fail and the consultants still believe we've been unlucky and said only 5% of recurrent implantation failure cases are due to problems with the womb. We decided to go for the testing though as for my age and the embryo quality, statistically it is very unlikely to have none implant.I think ICSI is a good idea for you, hopefully you will have more embryos that way and more chances. It seems for a lot of people it takes a few embryos to find the right one xxx
Clinics in the UK don't seem to investigate possible sperm issues prior to IVF (which seems to be the standard elsewhere). Do DNA fragmentation test and whatever else wasn't done to evaluate sperm quality. If all good, then at least you know that it's egg quality. If you aren't getting many blasts, testing may not be that useful but if that's an option, I would test the embryos.
Hi Marissa, yes dna frag test is the next step before our consultation next month. That was exactly my worry is that most we’ve had is 3 blasts so we don’t really have many to spare and never had any to freeze anyway x
There is no test for egg quality, so it's really determined through a process of elimination. If all the sperm tests come back good then they just kind of assume that it's an egg quality issue. However, I do want to point out that immature eggs are not the same thing as bad quality eggs. The maturity of your eggs really comes down to the protocol that was used during your cycle and this is something your clinic should be able to improve upon. Some women do better on long protocol while others do better on short, the amount of stims you were taking and the length of time you were on them will affect it, and the type of trigger you used, all factor into egg maturity. So don't assume the egg maturity issue is a 'you' problem...you should push your clinic to suggest some changes to your next cycle to improve your percentage of mature eggs.
Also, you may want to consider karyotype testing for both yourself and your partner. This is a blood test that looks at your chromosomes to ensure there are no genetic abnormalities with either of you. It's not a super common problem so most clinics in the UK don't recommend it unless you've had several miscarriages, but if everything else comes back normal it might be a good next step. I've just moved to the US from the UK and I found it interesting that my new clinic here did a karyotyping test straight away along with all the other standard blood tests. So they obviously think it's important to do! xx
Thanks for your reply thats really useful, will definetely look into the blood test! I’ve been joking with my partner that we’re both all over the place- maybe that blood test with give us an answer to that lol! They suggested that we could try long protocol but also said overall I have responded well to short protocol and to maybe try a double trigger this time. Will have another chat with them to see!
I would say try ICSI and see if you can get a couple more embryos if you’ve only transferred one or 2 and not getting many per cycle I would probably try another without testing at this stage but go for ICSI. It might also be worth looking into sperm a bit more first too as not always the egg. Good luck xx
Hi Mlove, ICSI worked for us all mature eggs fertilised using it, not all made it to blastocyst though. Egg maturity is usually down to the protocol you do and timing of trigger make sure you discuss this with your clinic and make changes for your next cycle, ask about testosterone gel might help in your case. As for PGT testing its not really worth it if you only get a low number of blastocyst. Are you and your partner taking any vitamins? If not look into taking a conception vitamin daily and a high dose coenzyme q10 with each meal as there is some evidence it can improve follicle numbers, egg quality and sperm quality. You need to be taking it for 3 months for it to have an effect. Good luck x
Hey, my clinic said we could try long protocol which we haven’t done or short again. They said as I’ve been responding well they feel short will be fine and could do a double trigger shot. I’ll look into the gel, do you know what this supports with? Yes my partner is taking a pre conception vitamin and I’m on coq10 but my clinic said only 200, i was taking 600 before and sadly that’s when most my eggs were not mature, not sure if that’s just a coincidence though. Thank you for taking the time to reply it’s really appreciated x
The testosterone gel is prescribed by clinic its used during stims to change the environment eggs grow in my egg numbers massively improved when I used it on a long protocol got 16 mature eggs vs 6 and 5 on previous cycles. Short protocal didn't really work for me. But I can't say for certain if it was the testosterone gel that helped as I had also been taking extra coq10 before cycle 900mg a day as advised by clinic previously was only taking 200mg. Definitely worth asking about it, I also wouldn't want to do the exact same protocol with same meds if its not producing mature eggs.
Hi. Definitely investigate what is going on medically with you and your partner, with egg/ sperm health and with embryo health. I'm all for embryo testing when you have your new batch, but I definitely think you need to check some other things first (various blood and sperm tests) and probably change the treatment plan (eg extra supplements/ adjuvants, if not even different stimulation drugs) before even getting to the stage where you are creating and testing embryos.
I'm really concerned to hear that after two rounds of IVF, including a round where only 3 out of 8 eggs were mature, your fertility specialist/ clinic is advising going straight into another round of IVF, especially with no proper explanations or changes planned.
I believe that we should be able to trust the fertility specialists as the experts in this field and feel secure that their advice is the best option for our personal medical needs, however, the unfortunate reality is that there is a huge variation in clinic procedures and in the interest that the consulting specialists have of actually figuring out the problem at hand and personalising treatment to the medical needs of each patient. Some clinics have more of a 'get the numbers through the door' attitude than others (you pay them the same for a failed cycle or a successful cycle).
Although different women do respond differently to the stimulation drugs, the number of mature eggs you had is a really low proportion of what they collected (in the second round). Whether an egg is mature or not has nothing to do with the quality or genetics of the egg, it is from the medication the clinic gives you and how your body responds to it. The doses of the medications, tracking hormones through blood tests, ultrasound tracking, and timing of collection are very important because your ovaries need to be stimulated so that you are maturing multiple follicles at the same time, so that they will all be ready and collected at the same time (there may be a couple that aren't ready on collection date, but that should be the minority).
Regardless of the total number of eggs collected, there is normally a quality/ quantity balance. Many women find that if the egg numbers go too high, the quality can be compromised, but it varies a lot from person to person. Don't be disheartened, there are so many variables you can change to improve your response. Did you have higher doses of medication during the second IVF cycle to try to get more eggs? Perhaps it was too much for you and the quality reduced or your body didn't have the energy/ nutrient reserves for that many eggs at once (it is a very intensive process at a cellular level). Perhaps you did respond well to the higher drugs but you needed more time to mature that many eggs and the doctors collected them too soon. Perhaps you will respond better to other medications or supplements. This is something you need to discuss with your specialist, finding the best medication programme for your body. Some part of the treatment plan is clearly not the right balance yet though.
You may find that due to your AMH levels or just how your body responds to added hormones, you may not get as many eggs each collection as some other women, however, that doesn't mean that the amount they do collect can't be mature. An immature egg can not be fertilised, so you will never get to the stage of accurately discovering your fertilisation rates and euploid rates if they keep collecting immature eggs. Did your specialist address the fact that they collected the eggs when so many were still immature? Based off what you've written, I would personally strongly be considering changing clinics to somewhere with more success with their medication programmes and a more thorough investigative approach before putting you through an IVF cycle. Finding the right clinic can truly make a massive difference.
It is really weird that they are not testing your partner's sperm or blood. His sperm and genetics are going to form half of your embryo, so are pretty essential to your embryo's health! I can give you a list of everything we had checked, if you like.
The value of ICSI depends on what the problem is. If your eggs are healthy and collected when they're mature, but your partner's sperm has poor motility or morphology, ICSI helps because they are fertilising the eggs with the best looking sperms, so the theory is you're less likely to have a dud sperm fertilise an egg. Keep in mind though, that the sperm is assessed visually only, not genetically, so you can still have a sperm that looks good but is genetically abnormal (as with eggs, and resulting embryos too). The best option is of course to have your partner make changes to make his sperm healthier. If the eggs are not mature, they won't fertilise, with or without ICSI.
Because you only had one viable embryo and haven't had a lot of tests done, you really can't know whether there is a problem with the eggs or sperm, both or neither, if it's just quality (from the health and nutrition of you or your partner) that can be improved, or genetics. Considering that you have been ttc for years and nothing has happened, but you have eliminated some implantation issues as the cause (but not immunological factors), and you know for a fact that mature eggs came into contact with sperm but didn't fertilise, it would seem to be an egg/sperm quality issue (assuming that you naturally ovulate, which means that each month you tried to conceive naturally there was an egg there to fertilise and it was mature).
Doing more thorough testing for you and your partner is much cheaper and easier on your body than another IVF round (especially if you're not getting many embryos) and in the long term will save time too because you won't be going through round after round for no reason.
(P.s. sorry about the massive wall of text! I felt quite upset reading that your clinic is willing to throw you into more IVF without even bothering to find out what's going on or what caused the previous poor results. Not much point suggesting ICSI if they are using damaged sperm or embryo testing if you don't get any embryos. You deserve better care, especially for such an emotional topic as trying to start a family, and there are many, many tests out there that are easy to do and can be very helpful.)
Hey, thanks for such a detailed reply, it’s really appreciated!
In terms of blood tests, is there anything in particular you recommend? We’re doing DNA Fragmentation test for my partner and then will have our consultation so suggestions welcome
We did have higher dose in the second round, i was on 375 gonal f in first round and went to 400 then 450 in the second round. My clinic did say we could try a long protocol but it’s just sooooo long on meds and also very expensive. Do you think from what your hearing long protocol would be better? We were thinking short protocol and then a double trigger but I haven’t heard much about people doing a double trigger and if this makes much of a difference.
In terms of them collecting the eggs when they are still immature, I honestly haven’t even thought about that. They just told me that they take all eggs which are present.
A list of things you had checked for your partners health would be great thank you! I think due to my low AMH we always assumed I was the big issues and fault of our own, never considered testing my partner that much until the failed fertilisation. I think we’ll go with icsi for an extra safety net at this stage, something else to rule out I guess!
When I had my uterine biopsy, this was at a different clinic and was actually that consultant that suggested we test further for sperm/ egg/ embryo quality and not even our own clinic- bit of a worry! So all of your advice and information is most welcome and I’m very grateful to you for taking the time to respond💖xx
No worries 🙂 The IVF "journey" to parenthood can be so difficult, I'm utterly fed up of the whole thing personally, so if I can offer any help to someone that will help their success in even a small way, I'm happy to do so.
I can't give you any advice re. best medication protocol for your situation (I actually hadn't even heard of the terms long protocol/ short protocol or of double trigger shots tbh) because I have a good AMH and respond well to the IVF drugs, so I haven't had to explore different options in this area. It is something I would recommend that you thoroughly discuss with your specialist (current or new) before committing to another cycle though.
I know that there are a variety of medication options and women can respond very differently, but the results you have had are not what would be considered normal for IVF, i.e. there is a problem with whatever they are doing and you should expect better results and find a specialist who can manage your medication programme so that at a minimum you're starting off with mature eggs to fertilise (your first cycle wasn't too bad). You might not get that many eggs in total, but they are meant to be collecting the eggs when the majority are mature, otherwise there's no point because they won't fertilise. (I know someone who was messed around a lot at the first clinic with similar problems of not getting the meds right a couple of times, low success, and she ended up having lots of immature eggs collected and hyperstimulation. She changed clinics, had better management of medications, and now has a healthy baby boy. Just because one clinic or specialist hasn't hit the right balance for you yet, it doesn't mean that is how every cycle has to be or that your body isn't producing good eggs.)
Yes, it is the normal procedure that they collect all the eggs that are developing even if they know they are not mature (so that you don't go on to mature and ovulate the smaller ones naturally after the egg collection if they only took the big ones), but the timing of the collection should be when the vast majority are mature. Too early and you have a bunch of unfertilisable eggs, too late and they will lose them because you will ovulate them naturally. Having the correct stimulation means that a bunch of eggs start maturing at the same time, continue developing at pretty much at the same rate (tracked by your ultrasound scans measuring the follicle diameter), and are mostly all mature and ready to collect at the same time. If there are problems after that, you need to address egg and sperm health and embryo genetics.
If you find that nobody seems to be getting the stimulation medication balance to work for you and you are still not getting mature eggs to use for IVF, maybe look into finding a clinic that offers IVM, which is in-vitro maturation. This is a process where you undergo the egg collection procedure while your eggs are still immature, and they are matured in the lab. Then they go through the same fertilisation process, etc, after that. IVM is easier on your body because you're not pumped full of all the hormones of an IVF cycle. It apparently generally results in fewer mature eggs than a stimulation cycle for IVF would for a woman who responds well to the medication (because the growth medium used doesn't give a perfect success rate for maturing the eggs), but in your case the total mature eggs from the growth medium of IVM might still be a higher number than you're getting now from your body's response to the IVF meds. Just a back-up idea for you to look into if you need it.
I do know the frustration of specialists being happy to go through transfer after transfer without doing further testing for the problem. After going through years of this myself, all I can say is push to find out the actual cause of the problem earlier rather than later.
For us, it is an implantation issue and, to our great sadness and frustration, we haven't found a reason or solution yet. However, we have done a lot to rule out egg/ sperm/ embryo factors, so, I can help you with lists of tests, supplements, embryo testing and possible causes on the gamete side of things. I will have to find the details in my medical file because I can't remember all the tests off the top of my head, but when I do I'll post dot points for you. TBC when I get all the info...
Hi Mlove12, so I've always had a double trigger for my cycles and I've always had a good proportion of mature eggs. I can't do a comparison with a single trigger because I never used it. For me because I'm older, 44, I've had better results on the short protocol and only did a longer one once because it shuts the ovaries down before stimulating them and that's not great for older eggs but can work if your eggs develop at different rates because doing it that way tends to allow the eggs to develop roughly at the same rate. I also pushed to do a retrieval as early as possible just to avoid over maturing them which happens much quicker for older eggs, so this has always been a gamble for me to get the balance between getting them when they are mature but not overmature! Thankfully I have tended to have about a 90% maturity rate so I do think a protocol tweak would be able to improve on this for you and then you can think about ICSI to work on the fertilization side of it. The trigger does give them the final push and helps with the dividing of the chromosomes that's needed but they do need to be mostly there before the trigger so good sized follicles but not too big. It's all such a head melt and I think you're doing great by looking at different options and questioning the clinic because we all have to advocate for what works for our own bodies too. Wishing you all the best with the next round.
Thank you Axel! It’s all such a whirlwind isnt it, feel like we really do have to advocate and this forum especially helps me understand and open my eyes up to other things, really appreciate you posting your journey and advice, means a lot xx
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