Good responder but low blast rate - egg or sperm issue?

[neonpg]

This is an update I hoped I wouldn't have to make. I arrived at the clinic for my 5-day embryo transfer yesterday full of hope. Unfortunately the embryologist said that I had only one embryo that had made it to early blast-the other six were still morulas. They transferred the early blast and kept the other six embryos in culture.

I just got the news that none of the six embryos were good enough to freeze, so all hope is resting on the little EB we transferred yesterday.

This is the second consecutive IVF cycle that's played out like this:

IVF #1 (300 IU gonal-f)

15 mature eggs retrieved

13 eggs fertilised

2 day-5 blasts (failed implantation and early m/c)

IVF #2 (225 IU bemfola)

10 mature eggs retrieved

7 eggs fertilised

7 still in running @day 3 (all but two at 6-10 cells)

1 early blast at day 5

6 discarded on day 6

So both times basically textbook response to meds, good fertilisation rates... but crap embryos 😭

I asked the embryologist (who was lovely) whether this is an egg quality issue. And after I explained my history he's advised me to check with the sperm bank to see if the donor has a confirmed pregnancy. But he said it could also be an egg issue, and it's something to discuss with our consultant.

Has anyone else been in this situation? It just feels so rubbish that on paper I should be a good candidate for IVF but it's just not happening for us.

For reference I'm 38, my AFC is around 17-19 and my AMH two years ago was 29. BMI 26 but I'm pretty active, a non-smoker, non-drinker and barely touch caffeine.

[Football61]

Hi. I’m quite a bit older than you, but have the same problem. I still produce loads of eggs, but hardly any make it to blastocyst-stage. I usually get a huge drop-off by Day 3. My embryologist told me that was a sign of poor egg quality - and that the sperm kicks in from Day 3 onwards. Wishing you the very best of luck with this embryo - hopefully it’s the one 🤞x

[neonpg in reply to Football61]

Thank you for replying! And I'm sorry you're going through the same thing. The weird thing is that all 7 of my embryos were still alive and kicking at Day 3. They were even still going at Day 5 but didn't quite have that oomph to make blastocyst. This is why the embryologist has advised me to look into the donor as well. Who knew it would all be so complicated?

[Football61 in reply to neonpg]

My consultant recommended Human Growth Hormone - apparently it gives the embryos a bit of energy and ‘ooomph’ to make it to blastocyst. I used it on my second cycle. I think more research still needs to be carried out on it, but might be worth a try? x

[Nabsal]

please change your diet and see improvements. My first cycle failed but embryologists told me it’s due to egg quality or sperm. So now I have changed my diet. So you look in too diet. Add some multivitamins. As in first cycle I dint know any and I was also not using any multivitamins. I was only taking standard folic acid and simple vitamin D which I think for ivf journey is not enough. Need to take more.

[Maria1122]

Hi, I’m in the same situation I’m a good responder but then no embryos on day 5. To me it’s from day 3 to day 5 that they get blocked. Embryologist told me to check my partner’s sperm because this is typical profile when not a perfect sperm and combine with poor egg quality .

[neonpg in reply to Maria1122]

Thanks for sharing Maria, that's the same as what I'm experiencing. I'm sure it's partly egg quality as I'm 38, but our embryologist said to check the sperm too. I may need to switch up our donor to potentially boost our chances. I'm so sorry you're going through it. It's such a blow to go from good news to suddenly having it all go a bit rubbish at the end.

[Maria1122 in reply to neonpg]

Yes it’s very difficult , I’m also 38 and got 17 eggs , 14 were mature and all fertilized , still doctor said to check the sperm . For me the first round got 3 blast , but then the following 2 ivf rounds 0 blasts. And completely understand the frustration I’m same

[Nabsal in reply to Maria1122]

So you mean egg and sperm both responsible.

[Maria1122 in reply to Nabsal]

Hello Nabsal, in my situation yes doctor sent to do some test to my partner to check sperm fragmentation and another one . What about you ?

[Nabsal in reply to Maria1122]

No they didn’t ask me to do . I ask by myself quite often but they simply said no benefits to do this test even if we do this test will gives you same supplements which you already taking

[Tnthketnf]

I would check on how they were doing on day3. In my case they were always slow* on day 3 and I was told it looks like an egg issue because the fertilization was always good. I was also a good responder with high fertilization.

*On Day 3 you should see around 8 cells. 6 or 10 still OK but ideally you want 8. If they have high fragmentation or asymmetric also not good. Mine were 4-5 cells, the best of them had 6 and some high fragmentation.

Good luck.

[neonpg in reply to Tnthketnf]

Thank you! We didn't get a Day 3 report on our first round as the old clinic didn't do them, but for round 2 all but 2 of the 7 embryos were between 6-10 cells at Day 3. In terms of grading we got:

1 x grade 1

3 x grade 2

1 x grade 3 (8 cells but fragmentation)

2 x grade 4 (2 cells each)

So not amazing but also not terrible either. However, it was good enough for the clinic and they advised a day 5 transfer, which is why it's so gutting 😭

[Tnthketnf in reply to neonpg]

The thing with IVF is you never know for sure. Very frustrating! And even if a doctor tells you it's an egg quality issue there isn't a lot you can do. Most doctors will say the quality doesn't improve. I know some people will swear by taking expensive supplements or dietary changes and there might be some promising research but I have had two different clinics and spoke to another three independent fertility specialists, with egg quality being suspected as the problem, none of them mentioned the slightest about diet and supplements to me.

[neonpg in reply to Tnthketnf]

So true, no responsible specialist is going to recommend a treatment that lacks robust supporting evidence. We can only go off anecdotes and this is prone to biases. I'm gonna have one more crack at the IVF whip and then move on.

[evalooda]

I had similar AFC and AMH to you at age 39 and 40. I had 13, 19 and 21 eggs across the cycles, almost all fertilised, then terrible embryo development.Everyone is different I know, but for me, it was an egg quality problem - we've just switched to donor eggs where we got 4 blastocysts from 7 fertilised eggs which confirmed that.

[neonpg in reply to evalooda]

I'm so sorry you've had the same experience, but I'm really happy that you've had success with donor eggs. I asked my wife if she'd consider doing the stims again but she fared even worse than I did (4 eggs, one fertilised, arrested at 8 cells). This leaves us with the donor egg route which my wife isn't keen on so I think that leaves us potentially being child free not by choice which sucks when you have a relationship with two functioning wombs.

[evalooda in reply to neonpg]

Oh lovely that's so so hard isn't it, especially when as you say you've got two functioning wombs! And young donor eggs seem to do really well in older wombs (we're prepping for our first transfer currently so the jury's still out for us, but we're feeling so much more hopeful than we were with my eggs).Genetic loss is a very specific kind of grief so I can understand your wife's reluctance. My partner was a flat no for a good few months before he started to come round to the idea.

I really hope none of this becomes relevant - that this transfer leads to you taking your baby home - sending so much love and sticky vibes to you!

[IVFat40]

Hello hun, I experienced something similar at 40 with poor embryo development, I wrote a post at the time about the things I did to try and address it (this was a few years ago now). For me they did include changing sperm donor, alongside things like getting my testosterone and DHEA-S levels checked and as a result taking DHEA. I found the book 'it starts with the egg' by Rebecca Fett really helpful. My little boy is now 18 months.

[neonpg in reply to IVFat40]

Thank you so much for responding, it's absolutely wild that you saw such a difference between your second and third round after changing donors, and definitely gives me a teensy bit of hope. I've been taking Coq10, vit D, folic acid and a few others for nearly 2 years now, and naively assumed the standard drug store formulas would be enough. But I think it's time to take a proper read of ISWTE and give it a serious go for a few months; throw everything I have at it!

[Nabsal in reply to neonpg]

I am also following the book it’s start with the egg