Embryos die day 3

[Londongirl84]

I am currently in my 2ww. We went from 18 fertilised day 1 to 11 good embryos day 3 to one morula and one early blast day 5. Why did so many due on day 3?
I can't stop panicking about this. I'm devastated :(

Why did so many die, not due x

It's trite to say, but remember you only need one and it is great news that you got to have a blastocyst transferred as you know it's a fighter.

I was told that the normal expectation is for only one in four embies to make it from day 3 to day 5. It really is a brutal natural selection process which people who get pregnant the conventional way are able to stay blissfully ignorant of, as they never have to know about their eggs which fertilise but don't grow. So your experience of 1 in 5 isn't so very far off the average, but I understand you'd be worried and disappointed after 13 on day one which raises hopes so much. Can you ask for a consultation with the embryologist to find out more?

Best of luck for your test day.

Sorry, typo, I meant 18 fertilising on day 1.

We feel that if it fails then we will seek further testing. We are soooo desperate for this to work and I can't stop crying. Can't imagine how I will cope with waiting another whole week. It's so hard isn't it...

I hadn't heard the 1 in 4 statistic before. That's interesting...

Thank you so much for your lovely reply x

Hi, that must be awful but sounds like it's normal and just wanted to say you have such a great chance with the ones that did make it. It really does only take one at blast - I'm on my second pregnancy from single blast transfers, DD is about to turn two and her little brother should be here Monday. Try to focus on what great odds you've got from the blast - wishing you loads of luck xx

Thank you so much for the luck. Huge congratulations to you. The perfect family!!
I just hope our early blast picked up some pace... X

We were told at our clinic that it is the sperm that carries the embryo forward from day 3. I haven't seen the research behind that though. Has your partner had a DNA fragmentation test in addition to the usual SA? It might be something to consider.

Good luck.

He hasn't had a dna frag test. Since this happened to us, I've googled it to death and dna keeps coming up. It scares me horribly. Google is such a negative place, isn't it. If this cycle doesn't work we will have to have further testing :( x

Anyone else with any reassurance/advice? X

Hi again. Like euroshaggleton, I've also heard that the paternal DNA starts contributing to development after day 3 so DNA fragmentation testing is something to enquire about if things don't work out this time. And I think that's positive as having a plan of where you're going next can really help.

I don't know your situation but we are unexplained and we embarked on our first round of IVF with the thought it might give us some answers, at least. Knowledge is power.

I haven't been where you were on day 5 because we were very lucky and more than one made it to blast. But we had a low fertilisation rate on day one from 13 eggs, so can empathise a bit with how it feels and how scared you can make yourself speculating what the numbers might mean for your hopes (especially with the help of evil Dr Google).

Like galwaygirl says, you can get a bfp from a single blast. My cycle sadly ended in chemical pregnancy after transfer of our one "textbook perfect" blast, but on Thursday I had a scan and saw for the first time the heartbeat of our other, less than perfect slow-starter, blast which had been frozen (SET both times). It is very early days for us - and the news is that it gets no less terrifying after the 2ww is over - but I hope that gives you some encouragement for now. And if it doesn't work out for you the way you want it to this time, you have some questions and things you can do to help you both make a plan of where to go from here.

Ceara that's such good news and I wish you so much luck. I hope our slow starter (s) give us the same wonderful result. I can't imagine how I'm going to get through another week of waiting!
We have MF issues- low everything. I just wish that they would have suggested a dna frag test before all this to save us this worry. Hopefully this will work for us and it will all seem irrelevant! I just wish I could believe that... It's so hard to be optimistic.
Does anyone know how they get round dna fragmentation issues? X

You can't get round DNA frag issues easily unfortunately, and all it will tell you is what proportion of your partner's sperm on the day of the test showed fragmentation - there isn't a way to pick the sperm without fragmentation to fertilise the egg as the test destroys the sperm. If you have had ICSI then there is a link with morphology in that the sperm with the best appearance have a lower chance of DNA damage but this is by no means 100%. The jury is still out scientifically on what is a 'normal' level of DNA damage and there are a few different tests around. One paper I read suggested having a shorter period of abstinence (24hours rather than the recommended 2-5 days) before producing a sample for treatment if DNA damage was suspected as the sperm have been waiting around for less time in the epidiymus which is where the damage is picked up.
Up to day 2 of development the embryo is developing using the energy reserves in the egg. Around the 4 cell stage the embryo's own genes activate so it is true that this is when the sperm start to play a role but the egg needs to be good quality too.
The lab is a stressful environment for the embryo so growing day 3 to day 5 is a good way of selecting strong embryos if you have a lot that appear to be good quality on day 3. Having said that in a future cycle you may opt to have embryos replaced on day 3 and the others frozen, as some embryos may have the capacity to develop in the womb but can't cope with lab conditions.
Good luck.

Hello Londongirl, I'm currently 23 weeks following IVF with ICSI. We only got 4 eggs, 2 fertilised but only one made it to day 4. My mantra that week was It Only Takes One. And it did! My husband had a chromosome issue which caused low motility & fragmentation. It is possible. Crossing everything for you.

Freelancescientist do you mind if i ask whether you had dna frag issues? Is that how you know all this? So if a good few of our embryos did make it to 8 cell before arresting, does that suggest that dna frag might not be our problem then do you know? That's also interesting about lab conditions. I suppose we should take comfort that they didn't all arrest...
So many thoughts! Thank you for your interesting reply!!

JethroTull that's such a great positive story. Congratulations!! How did you get round the dna frag issues? X

The issue affected some of his sperm and not others hence the low count. Having ICSI meant that the embryologist 'picked' the sperm to inject into the egg so it's all down to her!!

That's amazing. We are in an icsi cycle. I'm hoping that our morula and early blast were well picked too. X

P.S can I ask which clinic you had your icsi?

We were at Care in Nottingham. They were brilliant. We didn't get to blast stage before Egg Transfer so were very lucky. Where are you?

So did you have a morula transferred?
We are at Chelsea and Westminster hospital. They have seemed good so far, although we wish we had been offered dna frag test before the cycle.
When did you discover the dna frag issues? X

Yes, day 4 it had split into 9 & was a grade 2. We found out as a result of a chromosome test.

So sorry everything isn't going as you hoped, but must reiterate getting one to blastocyst is great. Everything was looking good for my cycle, I'd my mind set on SET, ideally by blastocyst transfer. However as they all started to degrade badly I agreed to have the 2 left put back on day 2 (I think I started out with 12). My 4yo twin boys are arguing with DH right now that it can't be night-time as it is too light out.

However I realise we were very lucky with our outcome - it is very much a numbers game. If you do need to try again, hopefully your clinic will have gained info to improve results next time?

Wishing you all the best.

To answer your question - it is professional rather than personal experience.
DNA frag MAY be part of your problem, but if there are severe male factor issues then these will be really important too. There is some evidence that good eggs can repair sperm DNA damage - certainly in animal studies (very difficult to do research on humans!).

JethroTull I really hope we have the same incredible result as you. Thank you for filling me with hope.
Rattling your story fills me with hope too. Can I ask what is SET? I hope my morula and early blast are as successful as your lovely twins. X

Freelancescientist thank you so much for your reply. How else can MF issues effect the embryos after icsi? X

Men with MF issues - esp low counts- have been found to produce a higher proportion of sperm with genetic abnormalities - problems with the chromosomes in the sperm. This is a separate issue to the DNA damage, (which is when the DNA in the sperm head is broken up). Also if you have fewer sperm to pick from then you have less chance of finding a good, healthy sperm.
Genetic abnormalities are far and away the most frequent reason for embryos growing poorly in the lab - they can arise from the egg or the sperm but with MF infertility it is more likely to be the sperm. Generally ICSI embryos are more likely to arrest in culture - either because of problems with the egg or sperm, or because of the invasive nature of the procedure itself.

Please also remember that it has been estimated that only 1 in 10 of all embryos created (after assisted conception or 'normally' ever become a live birth)