Questions- poor egg quality, growth hormone, day 3 transfer, and PGT testing. Sorry for the long post but hoping for some advice/encouragement.
After 1 year of infertility and 2 failed IUIs, I started banking embryos at age 32 (I'm in medical training and was worried about getting pregnant before my new fellowship, stupid me) and have since had suboptimal results and one failed FET. I am turning 34 next month and slowly realizing my idea of having 3 kids (let alone 1) may not be in the cards for me
-January 2023 (menopur 150, gonal F 150); 13 eggs, 6 mature, 5 fertilized, 2 embryos frozen (4BC day 6, 3BC day 5)
-Started CoQ10 300 mg and DHEA 75 mg. Moved to a new city for a fellowship. New clinic...
-Nov 2023 IVF w/ FET (m 75, gF 75, ICSI): 17 eggs, 8 mature, 6 fertilized, 1 early blast transferred on day 5 but failed, nothing left to freeze
Clearly have poor egg quality as sperm analysis has been normal x3. My testosterone was mildly low and Vit D was severely low. Otherwise my AMH is normal x2, karyotype testing normal.
After the recent failed FET, I started acupuncture and a variety of supplements (fish oil, vitamin D, acai, goji berry, and melatonin per my acupuncturist). Starting another round next week and REI is making no changes to my protocol. He will not start growth hormone. To my surprise, he is offering to transfer 1-2 day 3 embryos, as my embryos all seem to arrest after day 3.
My questions are: 1) Should I push harder for growth hormone? 2) Should I consider a day 3 transfer of 1-2 embryos? 3) Should I push for PGT testing? Neither of my REIs have recommended this because "I'm so young" and only have 1 blast per cycle. While I could use my frozen embryos, I was told they are poor quality and unlikely to give me a child and I've always wanted 3 kids. 4) Any dietary changes people recommend? I have a normal BMI and eat a balanced diet but definitely enjoy snacks like chips and sweets and could always eat healthier
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nf2952
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I am so sorry to hear all this. As a fellow medic I understand how you feel too. I didn’t find my other half until around 30 due to training etc and then we got married fairly quick after meeting and started trying, but 32 has quickly turned to 37 with all our failed IVF attempts. And still no baby. And as you say once we had a dream of at least 2 kids.
anyway, if you’ve not read it starts with the egg it’s worth a quick look. I’ve done all the ubiquinol and dhea stuff with no clear benefit. I try to eat a really healthy organic Mediterranean style diet especially in run up to cycle (3 months before egg retrieval especially) but do allow myself some sweet treats. I’m lucky I don’t drink caffeine or alcohol anyway.
However main thing I came here to say except empathise is - don’t be so sure there isn’t a male element just because semen analysis normal. Sperm dna fragmentation could be high still. This needs a separate test. We really don’t do enough male tests. I would definitely explore that more. For us my DH sperm dna fragmentation wasn’t too bad but was improved by a shorter abstinence period (he had great numbers on standard semen analysis).
I don’t think PGTA necessarily adds anything at this point for you and you would need to have a decent day 5 blastocyst to safely biopsy and freeze.
I think the day 3 question is a personal decision but for me, I wouldn’t do it vs ensuring the embryo can reach day 5 as all the specialists I’ve spoken to have said it’s false sense of security to transfer a day 3. Even when we’ve only had one egg/embryo from a cycle we’ve pushed to day 5. But I’m sure others will have different opinion.
Hi, I just wanted to tell you, I'm in a similar situation. I'm a doctor too. I was always busy, always with personal profesional projects. And now I'm 34 and struggling with infertility. It's definitely hard.I also think the male factor can't be ruled out, from what I've read dna male fragmentation happens mainly from day 3.
Hi fellow medic. 1. Sorry, no idea about the role of Growth hormone for egg maturity. 2. Some doctors advocate that embryo has better chances inside than outside. I personally wouldn't go for a day 3 transfer. 3. I never did PGT testing because of the cost, but one can opt for it as per our embryologist, the benefit it has is saving one from emotional damage and has no role in increasing the chances of a live birth. 4. I think you are covering the basics quite well. I never go too strict. Also, if you want to go through any possible implantation failure causes, I came across this talk by Dr Tim Child. You may find it beneficial. (From Instagram page of Dr Tim Child)
After two early losses I made my consultant go through all our options and he too was of the opinion PGT was not worth it or relevant because of our ages and other results. He also said seemed to favour just playing the odds, which was hard to swallow but has now worked for us. But I wouldn't rule out male factor based on your results- on our first round we got 9 eggs but poor fertilisation and then a drop off which was a bit of a shock as my OH's sperm had been perfect. That turned out to be a one-off sperm issue on the day. The next round we got five eggs and all to blast. I think diet helps to an extent and supplements can too, but if they had a really measurable impact I think all clinics would recommend these and IVF would be way more successful overall. Personally I wouldn't do a day 3 transfer as I was persuaded to do one last year when we only got one egg (ironically on what was meant to be a last ditch banking round but went very wrong) and it ended in a PUL and I can't help feeling it wouldn't have lasted to day 5 in the petri dish or they would have been able to tell by then it wasn't developing normally and not gone ahead, and saved a lot of physical and mental trauma. But i cant be sure and many women have day 3 transfers and success. Also, you're still young in IVF terms - we started TTC when I was 30 and only got to an IVF round when I was about to turn 37, then had 5 pregnancies in 3 years (having never been pregnant in the prior 7 years). So although I entirely understand the worry that you'll never have one, let alone the number you dreamed of, that was how I was feeling when I was 3 years older than you and things suddenly went very fast, and we're due our second baby in a few weeks, so it could definitely happen.
I just want to echo the wise ladies here who have mentioned the importance of further testing for your partner. My husband's sperm analyses always came back normal but finally after 2+ years of infertility and an underwhelming IVF round, our clinic mentioned DNA fragmentation testing for my husband and it turned out he had fairly significant fragmentation which was the reason we were having trouble with our embryos developing. As Kiara89 said, eggs pretty much power embryo development up until day 3, but after that point the sperm comes more into play, so when you have a steep drop-off in embryos after day 3 it's often indicative of a sperm issue.
I know the urge to just push forward with more rounds is strong, but I’d suggest delaying your upcoming round until you get further testing done. If your partner does have high DNA frag, you're likely to just keep getting the same result until it gets fixed. ☹️ Best of luck xx
Hi, sorry to jump in here but if there is an issue with fragmentation, what’s is the solution or what is it we can do it improve /minimise it? Thanks x
Heya, if you discover high fragmentation you want to go to a urologist who specialises in male fertility (like Jonathan Ramsay) to have investigations done to figure out the underlying cause. Varicoceles are the most common cause and those can normally be fixed with embolisation or surgery, but frag can also be caused by infections in the urinary tract or hormonal imbalances, both of which can be addressed with appropriate treatment. Supplements like Proxeed and dietary changes can help with general sperm quality (improving count and motility, etc) but fragmentation is a deeper issue that lifestyle changes alone normally won't address. xx
hey I am a similar age to you but with lower AMH and we are lucky to get an embryo from each round.
We were advised to increase antioxidants in our diet and also cut out all processed food, preservatives and additives, try and reduce sugar. I did also reduce caffeine. Following the changes we got 100% fertilisation for our three eggs (we had never had three eggs!!) wether it was the diet or wether it was something else we will never know, personally I feel the diet did play quite a part. Don’t get me wrong it’s hard to start with but you get used to it.
I also went to Tommys for a biopsy to test for NK cells due to recurrent implantations failure, we both had further blood tests and we had a sperm dna fragmentation test.
I know all this prolongs the treatment, but I would honestly do the tests first but it is everyone’s own opinion. I just wanted to know if there was something we could do better or change to give us a better chance of success I wanted to do it.
I think there is a lot to be said about natural conception. I had 2 rounds of ivf which failed. First was a top quality blast but ended in a chemical 2nd was a failed round with only morulas. Then one month after that failed round a natural conception with the help of mira ovulation tracker. Tells you 7 fertile days and confirms ovulation with your progesterone levels after ovulation. I think there is still a lot unknown about how the sperm runs a gauntlet in the uterus and fallopian tubes and only the strongest gets to fertilise the egg. In ivf. Well icsi which we had a human being is choosing the sperm. We don't have the science to say that sperm would definitely have run the gauntlet as well. Please let me know if I can be of any help. I also had coq10 for years made sure it was life extension brand and was also ubiquinol. I also had dhea but since heard u need to be careful with that and get dhea-s tests and testosterone tests as sometimes that can hinder rather than help. I think gym and keto or med diet helps. X
Hello, i second all the above about sperm quality… husbands need to cut out sugar, alcohol and smoking. Also keep it cool down there, dont have hot showers, can also use a daily ice pack too. Cycling is bad for male fertility.
Secondly, have you tried dhea? It can help with egg quality. You can start with low dose. Also get your thyroids checked regularly.
Melatonin before ivf is also really good for egg quality. I have gotten pregnant naturally twice before starting a cycle, each time i took melatonin. I suffer from recurrent miscarriage (thats another problem!), so kind of lost hope for a family now (plus im beginning to recognise that kids are hard work and not sure ill be a good parent anyway!).
hi, I’m not an expert but after reading many researches paper and discussing with my clinic we have opted for MFSS/zymot as an advanced sperm selection method. As the others told you up to date 3 is the egg then the sperm. MFSS is showing to significantly reduce DNA fragmentation as it mimic the fallopian tube and doesn’t stress the sperm. I would advice to look into it for next cycle.
hi lovely I hope you’re well xx like many others have said male testing is also super important, DNA fragmentation test could be a good option. Your partner also needs to improve his diet and take supplements like impryl/ proxeed for 2-3 months to improve the chances. Regarding pgta testing I’m on the fence ! We have a call tomorrow with the person that heads this at our clinic , my main concerns are the mosaics being discarded whilst there are stories about mosaics resulting in perfectly healthy babies ! And it doesn’t increase live birth chances, I’ll see what I think once we have had the chat with the specialist, but not convinced by HFEA rating. You’re still young , hopefully your dream will come true soon xx keep strong, and positive sending you all the best of luck!
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