Low Blastocyst rate

[Kittykat113]

Hi there

I just wondered if anyone has had similar experience in getting low blastocyst rates in IVF ?

Background, age 36 (started IVF age 35) with good AMH levels etc and diagnosed as unexplained infertility.

I have now done three egg collections and have always managed to get a decent amount of eggs (ranging from 10 to 29 on most recent round) we get a really high fertilisation rate and everything looks good on day 3 but on day 5, I always get the call where they say there is only 1 or 2 that make it to blastocyst.

We have done DNA fragmentation tests. There was fragmentation but this was reduced to normal levels via diet changes and supplements, also done ICSI but still the same results regardless of how many eggs are collected.

I just don't know what I am missing? They don't think it is egg quality as all my stats are above the normal range for age. I have tried long and short protocols and still the same outcome. Of the blastocysts I have transferred, I have miscarried two and two didn't implant. I plan to do PGT-A testing next round but am not sure if it is worth it, if I can only manage 1 or 2 blastos at a time?

Appreciate anyone sharing thier experiences if similar xx

[Orangeflowers]

Hello, I have similar outcomes to you. Double numbers of mature eggs, but only 2-3 reach blastocyst on day 5/6 per round. My fertilisation rate has dropped too though to 5-7 fertilising normally per round. The majority look great at day 3 - right cell number and little fragmentation.

I think you should ask for detail from your embryologist, that helped me. Questions to ask - Did all eggs fertilise normally or did some have the wrong number of pronuclei? What is the level of fragmentation? did the cells divide equally? Did they start excluding cells after day 3? If you use the embryoscope, the embryologist should be able to give you detailed info.

For me, I think the reason is poor egg quality due to my age. The fact they aren't progressing indicates they have genetic imperfections. It may well be that they have problems with the mitochondria and are running out of energy as they develop slowly after day 3, when the whole genome takes over.

I always transfer 2 so PGT-A isn't worth it. I tried one cycle but my embryos weren't ready by day 5, so I transferred so not to risk ending up with nothing. There is a small chance that the biopsy will damage the embryo or it won't survive the freeze-thaw. Also, there's the cost.

Just to state the obvious - testing won't tell you what was wrong with the others. It may give you answers as to whether the remaining are abnormal in some way or not or are euploid. There is every chance they are euploid.

Hope my thoughts help you think through your situation. It's really disappointing to start with great AMH, response to meds, follicle development etc. and for things to progress less well after day 3. You're not alone on that.

There is a lot working for you though and age is on your side, so you should have better quality and chance of euploid embryos. Hopefully your time will be very soon x

[Laura3101]

Hi, I’m not active on here anymore but your post came through on my emails so I wanted to comment as I was in the same position as you, altogether I did 3 egg collection and from those I think I got about 50 odd eggs so a decent amount. Day 3 would see loads still left and day 5 only 1 or 2. In total only 7 were blastocyst stage, no reasoning why either but I sit here with my 5 year old having breakfast before school and it was all 100% worth it even with the one or 2 viable embryos per round. Hope this helps x

[ChloeDE]

Hi, I read that eggs do all of the development until day 3 then the sperm start contributing to development. It does sound like there could be a sperm issue. It might be worth looking into MACS which helps select the best sperm for treatment.

[DianeArnold Partner Nurse Fertility Network UK]

Hi Kittykat. One to discuss with your embryologist. Perhaps ask about transferring two embryos next time? Of course there is PGD but it is very expensive, but you would know they would be storing the best. Good luck. Diane

[soccerkt6]

Hi lovely

Which - if any - supplements is your husband taking currently? I would strongy suggest that he start taking Proxeed and ubiquinol if he's not already. Both of these supplements help increase energy production in cells (in Proxeed, it's the L-carnitine and Acetyl-L-carnitine that are the key ingredients). Even after we fixed my husband's DNA frag we had a cycle where we ended up with no blasts despite 5-6 of them looking good on day 3. I was completely distraught and after doing some more research, I found that embryos can arrest if the sperm (or eggs) don't have enough energy to keep developing. After a few months of my husband taking ubiquinol and Proxeed, we conceived naturally. I can't say for sure that the extra supplements were the magic fix, but it's the only thing we changed between the failed cycle and conceiving.

If he's already taking these supplements, the other thing I would suggest is having you both do a karyotype test to make sure neither of you have any chromosomal abnormalities that are affecting embryo development.

Good luck! xxx