Egg fertilisation disaster- so confused

[Matilda128]

I had my EC yesterday for my second round of Ivf. The first round went relatively well and at 375 menopur I got 9 eggs- 6 fertilised and ended with one 5AA (early miscarriage) and one 3BB (early bleed due to progesterone issues). For this second round and last one funded by the NHS, I was on the same dose and I did everything I could do increase egg quality- high protein, no snacking, lots of water, Q10, vitamins and avoiding stress. I thought I was doing so well and I got 10 eggs. Then this morning I got a call and only 1 has fertilised. I cannot say how absolutely devastated I am.

But I am also so confused - what could have caused this? We had to use donor sperm and we got the same as the first round. But just before we got started we were told by the bank that our clinic rejected the sample purchased and suggested we got a better more expensive sample. Then after many emails the clinic got in touch to say that because the first round was ok with the same level of motility it was fine to proceed with the sample that they first rejected. The embryologist said this morning that the sample they prepared was fine so they are suggested it isn't this that has cause it to go so wrong. But is it my egg quality that has just plummeted from the first round 5 months ago?

I'm just so confused and so heartbroken. We haven't really told anyone about doing IVF so I'm just feeling so lonely coming to terms with this news. Thank you for readingxx

[Malyshek]

I don't really have an answer for you as it does seem strange. I've read that overstimulation can affect egg quality but you had the same doses as last time and 10 eggs isn't a ridiculously high number.
What was your donor's motility ? My clinic told me that optimal mot is 20.

[Malyshek]

Also, do you know at what stage the embryos failed ? I've read (but could be wrong) that day 1-3 development is egg quality and day 4-5 is sperm quality.

[JoJoSM2]

I’m really sorry. Personally, I wouldn’t use a poor sample to jeopardise the whole process.

If you try again, I’d probably go with a top private clinic and get the best sample possible,

[Matilda128]

Thank you for your reply @Malyshek . The eggs failed to fertilise overnight so didn't become embryos at all. The motility was 23% so just above the threshold but the website of the spermbank says that these samples are suitable for ICSI - the ones a step above (more expensive) for IVF- and the one above that (top quality) IVF and IUI. I think that this is why the clinic originally rejected them.

In terms of stimulation- I did have 20 follicles but a lot of these measured too small. Might that have been an issue? Could I have responded stronger to the medicine this time round in terms of follicle production and have resulted with less quality eggs?

Thanks again

[Matilda128]

We tried everything to get the better sample (suggesting we pay extra ourselves) but according to the clinic this wasn't possible due to NHS rules and then they assured us it would be fine and there was always ICSI for backup.

[Didthatreallyhappen2]

I'm confused - did you use ICSI this time around? I haven't got anything useful to help you I'm afraid, but even with "normal" sperm from my DH, they used ICSI to help make sure that, in my clinic's words, "the two bits got together" and we had a good chance at fertilisation.

I am so sorry, I understand how disappointed you must be (been there, done that). There's no point in my saying that you only need one - of course you know that, but in an ideal world you'd want several (let's face it, in an ideal world you wouldn't need IVF at all).

Sending the most enormous hug - you really are not alone, even though you might feel it at the moment. Hopefully your doctors can explain why this has happened, and give you some positive directions for the future.

[JoJoSM2]

www.who.int/reproductivehealth/topics/infertility/cooper_et_al_hru.pdf

Have a look at the reference values. Motility of 23% is absolutely shit and would qualify the donor for ICSI for his own infertility. Other parameters are likely to have been awful too.

Don’t blame yourself or question your eggs: the semen was rubbish.

[Malyshek]

I'm really sorry as this really is a shit situation. Failure to fertilise at all is odd. If this was your first attempt I'd think there was an issue maybe with the shell of the eggs (too thick to be easily breached by the sperm) but I doubt this is it as it seemed to work fine the first time around. And since this is donor sperm it's supposed to have been thoroughly screened. But I also don't think your egg quality could have been so badly compromised in only 5 months.
Maybe you didn't react the same to stimulation, were you anywhere close to OHSS ?
Hopefully your clinic can figure out what happened. In the meantime, fingers crossed for your remaining warrior embryo !

[Malyshek]

@JoJoSM2 - not sure what 23% means ? The sperm I got was mot20, that is to say 20 million active sperm per millilitre. It was sold in straws of 0.5ml or 10 million sperm, basically. I had very good success with those through IUI.

[Matilda128]

Thank you all for such lovely replies. @Didthatreallyhappen2 No they didn't ICSI it at all- even though they suggested this would be a backup plan. It was so hard to make sense out of it this morning when the embryologist called- she just said the solution prepared fine and as some sperm is stuck to the sides of the eggs it means they just didn't fertilise.
@JoJoSM2 I saw exactly the same and this is part of why I am so confused. I blame myself for not arguing with them more- demanding ICSI or a better sample. It was so hard to find this donor and we felt he was ideal. The most horrible thing is that there were better samples from the same donor but as the NHS in our area sets £1000 as a maximum cost- the clinic didn't want to purchase it.
@Malyshek they tested my blood and it was fine so I don't think OHSS. I hope the clinic has answers but I am quite sure they will say it is the quality of my eggs. They don't seem to really look into these kind of things- they do the opposite of a customised approach.

[JoJoSM2]

Sorry, we used DH’s samples for ICSI so I’m not actually sure how these numbers work in the contest of buying prepared samples.

I’m sorry if I’m talking nonsense. OP, will you have a follow-up for the doctor to explain what exactly happened? And explain the scale and numbers they use?

[Matilda128]

Thanks @JoJoSM2 you're not talking nonsense at all. Because the London spermbank changed their pricing structure we found that there are different categories of different MOT quality (before it was just the same price). It leaves me in such a bizarre place where I somewhere hope it was the sperm and not me so I still have a chance in the future- if that makes any sense. This has just been so awful and I'm so scared- I hope the doctor gives us some more information. However it can be quite a while before we have the follow up and I don't know what to do with myself at the moment.

[TwistofFate]

23% motility seems low for ordinary IVF, my husband had 32% motility (borderline) and the clinic recommended ICSI. Motility refers to the sperm's ability to move, find and penetrate the egg so just putting the egg and sperm near each other doesn't always work. I'd guess it was the sperm sample that was the problem rather than your eggs that resulted in poor fertilisation rates. Ask your consultant for a full break down of the process to try to understand where it went wrong. In the meantime, take care of yourself. I'm really sorry.

[Matilda128]

Thank you so much for your reply and advice @TwistofFate. I've been thinking about it all night and barely slept. I really hope I can get some answers and an idea of how to carry on from here. Thanks again x

[Matilda128]

I got a call from the embryologist this morning to say that the one fertilised egg has only 2 cells- it is considered poor and probably won't make it to day 5. I felt that if at least this one was developed OK then maybe my eggs were not totally a lost cause but now I'm just thinking the worse. This time I spoke to the lab director so I asked again about the samples and Mot. She said the solution prepared fine and it was actually 40Mot- she suggested that the sperm banks rating of 23 was not right. My eggs looked fine as well so it must have been, as she said, 'just one of those things'. For me that's just the absolute worse- if there were any answers or even tentative suggestions- I would feel there is a point in moving forward and trying again. Now I just feel hopeless.

[Didthatreallyhappen2]

Oh you poor thing, you must feel like you're in limbo. If the little fighter you've got doesn't make it, once the dust has settled and if you choose to have another go, I'd strongly push for ICSI. At least you'll then KNOW that the eggs have the greatest chance of fertilising.

I've always heard that the first one or two goes at IVF are considered a learning curve. That's no help whatsoever when we invest our time, money and hopes into it. However moving forward you and your clinic will be in a better place to tailor make your treatment even more in the future.

[Matilda128]

Thank you @Didthatreallyhappen2 I really hope that this will lead to more success next time. My current clinic seems to really sticks to the same short protocol with little monitoring. I don't know if I have to go to a different clinic. At the moment I guess I just have to let the dust settle (that's a good way of putting it) and make sense to this all. X