Total fertilisation failure

[BlueBirdy]

Hello,

My husband and I have just gone through our first IVF (with ICSI - we have male factor issues - bad count and morph, motility is ok). At my final scan I was only showing 8 follicles (was on 150 units gonal f) 6 were a good size but two were smaller ones. I thought this was on the low side but the FC said they were happy with how I responded and pleased with the amount of follicles. Had pregnyl 1000 trigger shot on Saturday and went for egg collection yesterday (Monday). They collected 7 eggs but only 6 were mature. Got a call yesterday eve to say that of the 6 they injected, 2 didn't respond very well, so was usually an indication that those two did not have the best chance of fertilising, but overall there is a generally a 70% rate of fertilisation. Got a call this morning to say that sadly NONE had fertilised. They said this was very rare (I later googled it and apparently there is a 1 - 3% chance of it happening with ICSI) and said they could not tell why it happened (or rather, didn't happen) but could be down to either the sperm or eggs or drug regime I was on. I'm really gutted. This was our one and only NHS funded cycle.

I've got a follow up appointment on Thursday morning, not sure if I'll find out anymore then. Was just wondering if anyone else has experienced this, and if they had any success with further cycles?

Thanks Steph, glad to hear you got a positive outcome :) That is what we are hoping for really - a lot of follicles - as with our low numbers, the chance of ours fertilising, and then surviving, and then transplanting, seem very low indeed. But it does only take one! :)

Shell I start the Buserelin the same day I start the Norethisterone, cd21, which will be 4 Sept. I only start the Gonal F on around cd20 of the next cycle which will be 1 Oct. I didn't have day 2 follicle count last time, but this time I have a 'down regulation scan' where they check to see if the lining is thin enough to start the stims. My 'final scan', which is also normally the 'only' scan is on 10 Oct, which is when he'll tell me when to do the trigger. So again I won't find out how many follicles I have until I'm at the end of the stims. Gosh, so you'll be starting pretty soon - and your day 2 isn't far away at all! Do you think you'll cancel again if not enough follicles? Do you have a cut-off point in mind? I guess that adds a whole lot more stress to things, too!

Blue, I am surprised that your final scan is normally the only scan you have. I guess I am starting soon - although to me it still feels like forever away. I just want to know now if this IVF is going to produce better results rather than 3 weeks until egg collection while I wait and wonder. I start the estrogen tomorrow (CD20) so that will make me feel like something is happening. I read estrogen is most effective when taken on an empty stomach - 2 to 3 hours after food and 1 hour before food. So I have to starve for 3 hours before I take the tablet, then wait another hour after it before I can eat - twice a day. Knowing I can't eat makes me want to eat all the more, but I will try since I want to get the optimal IVF result possible.

Will I cancel again if not enough follicles? Mmmm, not actually something I had even considered. I did 4 IVF cycles at a cheap and nasty clinic last year where the Dr was crap and I felt like I had to research and take control and tell him what to do. So when I changed to my new clinic I automatically started doing the same thing. But my Dr has proven that she knows what she is doing so for the first time I am going to try to stop being a control freak and leave all decisions including if I cancel or not. Hoping that relaxing will produce a better outcome. But I doubt I will be able to relax regardless. Watch me as I start stressing in a weeks time. But I shall try.

Shell maybe it's because I'm only an NHS patient, and I wouldn't have the option to cancel anyway if i didn't have many follicles. I've not been prescribed estogen either, but i suppose my lining was thinck enough last time. It does sound like quite a headache to try and plan the tablets between food - i graze throughout the day so would also struggle with that aspect of it!

OK so now you are at a good clinic, the Dr has sussed out any issues and tweaked your regime accordingly, and you are doing your best to relax this time round - so really it is bound to be time that you got your positive! It will happen. And if you do find yourself stressing, if it is at all reassuring, I did read one report somewhere that said stress DOESN'T affect IVF at all. Which is what I keep reminding myself as I tend to get very stressed at work.

The estrogen isn't actually to thicken my lining.
I am taking it from day 20 the cycle prior to IVF as that is when your body starts preparing the strongest few follicles for the following cycle.
Taking estrogen stops this from happening, so all follicles are of a more consistent size at day 2 of the IVF cycle when I start the injections.
There are several research articles online showing that after doing this, the follicles are of a more consistent size during the stimming phase. For me who normally doesn't produce many eggs, that's important! But I am sure it doesn't matter for you who managed to produce a whopping 6 eggs on only 150 Gonal. Last cycle, I produced only 5 on 300 Puregon plus 150 Menopur.

Funny, I must be so used to failure by now that I am too scared to be positive. I hadn't even considered the positive spin you put on everything for my next IVF. What you say makes sense and when I did start to consider that I could actually get my positive this time, I got scared that I am getting my hopes and and will have further to come falling down, so I immediately stopped myself from thinking positive again!

How's your high protein diet going?

Hey Shell - sorry been away!

Well that'll teach me to assume :) That sounds really good! You really will be an expert in your field if you go ahead with the nurse course! How's the studying going? And the no goggling?

My high protein diet was a bit a of a sham. All I did was buy protein shake powder. And it's quite expensive so I'm only going to continue using it closer to when I'm about to start stimming. Right now I am munching on Werthers. I think I need to have a word with myself.

With the whole 'getting your hopes up' thing - I was the same, and was stressing about our first cycle way before we even started on it. My husband then said something that really put things in perspective. He said not to look at it as individual cycles, but rather a process, and at the end of the process, we will have a baby. There is no telling how long the process will take, how many cycles it will involve. I wasn't even expecting the first cycle to work (though how badly it didn't work was a bit of a shock). It's all just part of the process, and we will keep going until we get our baby. But then this is easy for me to say, I'm not yet on my eighth cycle.

So anyway, it will all be worth it in the end, right?

That sounds like a very supportive husband you've got yourself there... so he's willing to soldier on until it happens for you. But it feels a bit different for me as I am 37 and running out of time, and scared it will never happen after 8 failures and being on high medication doses and not responding well.

Yes, that protein powder is expensive isn't it. I have it because I am vegetarian - so you are probably already getting a lot more protein than me anyway.

I'm really not enjoying the study all that much to be honest! I think it's different when you live at home with your parents and don't have other commitments. Now I am working and like to cook healthy dinners (so my husband doesn't eat junk and worsen his already 100% abnormal sperm!), make our lunches for work the next day, dishes, clean,, blah blah blah and study just seems and extra cumbersome thing on top. I am doing well staying away from Google... I think I have read everything there is to read and my mind is out of things to Google!

Well today is day 3 of my cycle so here I go again. I started the injections yesterday. Monday is my first scan which is a bit nerve wrecking. Some cycles I have 5 follicles and other cycles I have 15 - so I am hoping for the latter but worried I could come out crying if it's a poor response again.

You must be starting the Bruselin any day now? How long do you take that for before you start the

... injections?

Hi Shell - been thinking of you and hoping your scan has gone well! I suppose it is the first indicator of a promising cycle - but it's not the only thing that matters!

Yes it must be tough trying to find the time to study - I found it hard enough to get into it even though I have every afternoon off. I found my favourite time to study was from 5-6am, felt like I had gained an extra hour from the day, and it's nice and quite then, too.

Yip, I started the Bruselin on the 4th, but I only start the Gonal f on 1 Oct, so will be on it for well over a month in total. I barely feel them, so don't mind them at all, but the gonal f ones I'll need to take morning and night, and I'll be going to London for 2 nights early Oct, which will make storing them and taking them an extra pain in the arse.

So are you an extreme night owl or from a different time-zone? :) How are things going otherwise?

Different time zone. I am in Australia.

Well my scan was crap crap crap. Last cycle, I started with 19 follicles but I only ended up with 5 eggs. Dr suggested upping the dose to get more follicles growing. Mad sense. But all that has happened is that it gave the dominant follicles even more to feed off. So I had 3 mature follicles were 19, 17 and 15mm already at day 6. I thought either they are going to

a) tell me to trigger now - in which case it's only day 6 and I know growing them hard and fast like this is really bad for egg quality.
b) postpone and allow these to over mature and hope the 2-3 little ones grow - but I know the first maturing follicles contain the best egg
c) cancel.

Well they took option B and told to come back Thursday for review. But it just feels like they are dragging this torture out further.

Oh that is crap :( So sorry... So what about what you want to do? Hope they can take some sort of responsibility, and that they are not using you as some sort of guinea pig. Hang in there!

Thanks Blue. Follow up scan is tomorrow morning. I really just hope that things are crap and they cancel me instead of dragging this torture out. I know it sounds weird that I am willing my IVF to fail. It's just that I know the first follicles to mature are the ones your body is naturally trying to select for that cycle and contain the best eggs. Mine were already mature at day 6 so I don't want to be offered to go ahead with EC for one-two poorer quality eggs. If I get the choice and then it's my decision to cancel, perhaps IVF will never work in the future and I will always be left wondering 'What if I went ahead with EC that cycle...' So I would rather them just make the decision to cancel so it's final.

Hope things are coming right, Shell? If the cycle is cancelled, will they fund the next one? Have you ever bee on a 'long protocol'? For me they said that there is not much they can do to improve egg quality, but to increase the amount of follicles they said that long protocol would be best. It will still be another 4 weeks before we can see if it has worked, though!

I don't get funding here in Australia Blue. The day 9 scan results showed my follicle sizes smaller than my day 6 scan! Obviously they scanned something wrong on day 6? So after thinking they were over mature at my day 6 scan (and eating Hungry Jacks and drinking bourbon to drown my sorrows!), it turns out they are not. However, I still only have 4 follicles growing.

Yep, tried the long protocol and it didn't work for me. I then tried estrogen priming protocol (EPP) and it worked a treat. So I have stuck with that, but it hasn't worked as well since and I always wonder why when it worked so well the first time. But I did FSH alone for first EPP IVF and have since added Menopur. Just read a study the other day showing that Menopur causes dominant follicle unlike FSH alone. So will be leaving out the Menopur next time!

But hopefully there won't be a next time. I feel disappointed with only 4 follicles but I just want this pain over with so as long as all 4 are mature on Monday, I will go ahead with the large cost of EC and hope that I get a good result.

Shell that's good news (at least better than it could have been)! That's interesting about the Menpour - the FC have a lot to learn from you! Oh my gosh - it's Monday today! Hope it went well!!!

We are so lucky to get funded cycles here in the UK - some areas fund 3 cycles, sometimes including a FET per cycle! We 'only' get one go, including a FET if there are any embryos left to freeze, but still I'm very grateful for that. I had always wanted 4 kids (if we could afford to), but now the actual cost of conceiving, and time, make that not so likely.

So I was on norethisterone from the 4th - 10th, but still no sign of AF. Last time it arrive on day 3 after the last tablet. My periods have always been so regular so had been tempted to not even use the norethisterone. I have read how it can take up to 14 days sometimes - hope it doesn't mess the schedule up too much!

So will you be doing the trigger shot soon?? Best of luck!!!!

Yesterdays scan showed follicles at:

20, 15, 14, 14, 12, 12, 7 and two less than 7.

They are going to re-scan me Wed and I am sure by then they will tell me to trigger Wed night for EC Friday morning. No way the 7 and two less than 7 will catch up, and the 20 mm will be over mature, so that leaves 5 eggs... IF the two 12 mm catch up.

Bluebirdy, you are right. I have been very disappointed with the low numbers, but you are very right; the result is at least better than it could have been. Just depends if those two 12s catch up to know if I go ahead with EC and have a minute possibility of a baby, or it's all over and I have to face bums at Christmas who are pregnant while I am not (dreading it). So my scan tomorrow will reveal all.

The hurdle I really want to get past is the day after egg collection when I find out how many viable embryos I have. Last time I only had 1 out of 5 eggs become a viable embryo. I know that's better than your 0, but it does make me fear the same or worse result this cycle.

It's sad that our family dreams have to be limited by the size of our wallets. I hope things go better for you and the increased dose means more eggs and embryos left to freeze to give you some hope for another child in the future. Yes, you are lucky to get NHS funding over there. A bit unfair that some areas get 3 and you get 1, but I think it was lucky that they didn't count your last go.

So you're just waiting for your period any day now and then you start stimming?

Sorry for the long rant. My mind is just on overdrive at this point of IVF. You started this thread to help you, and instead you are helping me! Thanks for listening.

Whoa Shell, that's a great improvement! So you will find out Saturday morning! Will you try and get the embryos to blast stage again?

Well I think AF has finally arrived, but the stimming will only start on what will be CD 14 (they had decided 1 Oct before they even knew what cycle day it would be) - they wanted me 'shut down' for a loooong time before I started stimming. I'm not sure if long protocol is usually this long! Guess we'll have to wait and see if it is any good! I have a scan next Tues, I think to make sure that things are properly shut down? To be honest I have no idea.

You are helping me too! No one knows that we are going through all this, so have no one else to talk to. I felt somewhat lost on the large group threads, so it's nice to have someone to talk to like this!

I too have joined large group threads and felt exactly the same.

Yes, it does seem like I will at least get a few mature eggs tomorrow. I am fine with EC tomorrow. I just want the phone call the following day over with, when they tell me how many little embryos I have. Most women seem to get a few good embryos with one or two at day 5 to transfer. We don't. So it's nice to chat with someone who has the same anxieties about your next IVF as me.

I did say I would do day 5 only again. I thought I would rather have them die in the petri dish so I can see what went wrong than have it die inside me while I have my hopes up for two weeks. But now I am wondering since it died overnight before day 5 last time, would it survive better inside me? Perhaps I should try something different? I can't decide. Guess I will see how many if any I have alive then and take it from there. Does your clinic do day 3 or 5 transfer?

With my poor IVF history (this is my 8th attempt!), I was given the option of taking FSH along with trigger as recent research shows it improves oocyte competency and fert rate. Well I got so involved making sure I mixed the trigger right last night that I forgot the FSH! I remembered this morning-8 hours later and decided to inject it then. Wondering if I have now done more harm than good and I should have just stuck to standard IVF protocol and not taken it. Making me dread Saturdays phone call even more!

I have no idea about the long protocol either as I have never done it myself. I don't quite understand how it works. I guess it must at least feel good to be doing something a bit different since your last IVF didn't work. Things are starting to happen for you now. So your scan on Tuesday, then my embryo transfer on Wednesday... please let me have a day 5 embryo to transfer Wednesday!

Hope it's gone well Shell! What a mind-boggle with the FSH! Hope it doesn't make a difference, but sure it can't have done anything to negatively affect things.

My clinic don't normally do blast transfer, unless it's asked for and there are loads of embryos to gamble with. They did say to me that although the success of a 5 day transfer is greater than that of a 3 day transfer, the actual overall success is still higher when they do a 3 day transfer. Can they transfer one 3 day embryo and then if there are any left at day 5, transfer one then as well?

I think that the long protocol does the opposite of consecutive cycles, in that there are absolutely no follicles primed from the previous cycle, so that you are completely starting from scratch. If this doesn't work for me, I'll try the consecutive cycles!!

Good luck for your phone call!!!!

What a complete waste of thousands of dollars. Of those 8 follicles I expected a potential egg, they got one mature egg.

Been on Dr Google and I think I know the reason. The trigger injection is to mature the follicles and release them from being stuck to the follicle wall. If the trigger doesn't work/is done incorrectly, the result is immature eggs and fewer eggs than follicles as they have remain stuck to the follicle wall when the follicles are flushed. Well that is my case exactly - I had 8 mature follicles yet only got 1 mature egg and 3 immature ones.

I use the Pregnyl trigger injection. Last time hubby made it up so I didn't read the instructions as I just injected it in to myself at a 90 degree angle on one side of my navel the same as the other meds. This time hubby was away when I did the trigger so I carefully read instructions. It said the best place is below the navel and at a 45 degree angle to the skin. I didn't do either of these things last time but this time I did as instructions said. Well this time it hurt a lot going in and it was real hard to press down the plunger. The next day the site was red, swollen and very sore, with a hard lump under the skin - as though the medication was sitting there. This didn't happen last time.

Nurse will call today to update if my one measly egg fertilised and I will ask her what went wrong. But whatever the answer, it doesn't help the fact that I am now in debt on my credit card thousands of dollars for a big waste of IVF. I will have to work hard to pay it off so I can do it again, with all the while my eggs continuing to age! If this never works, I will now always be looking back to this cycle and recalling how all my eggs went to waste and this could have been the one that ended my infertility.

I hope your cycle goes much better than mine!

Hi Shellstar

Just wanted to de-lurk to reassure you that you didn't do your injection wrong, irritation/lump at injection site is common/normal - the lump is most likely a bit of bleeding, definitely not the medication 'sitting there'. Didn't like to think of you beating yourself up about that.

(I am a nurse - an infertile one, ha!)

I told the Monash IVF lady when she phoned to update on my one egg.
She thought the same thing.
Sounds more realistic coming from you as of course the clinic isn't going to say their instructions are wrong.

Even if the lump is a reaction from injecting into skin instead of under the skin, perhaps because it was injected into the skin it took longer than the 36 hour time frame when they do EC for the medication to reach my ovaries than if it had of been injected at 90 degrees
Really seems like something went wrong though.
I've done this lots before and never found it hurt that much going in of been difficult to push the syringe plunger in like that, nor ever had such a red hard swollen lump, nor ever had my mature follicles not contain a mature egg, nor ever had eggs still stuck to follicle wall and not retrieved from mature ovaries.

I was really hoping with more eggs this round, that I would have one or two make it to day 5 for the first time so I know it's made it all the way to blast, and then after transfer, all it has to do is implant at day 6
But now with just one, doing a day 3 transfer - tomorrow morning.
Will get a phone call if it dies before hand.

Oh Shell - so sorry to hear all of this! :( I had a nightmare with my trigger as well, and have always wondered if I didn't do it correctly! Reassuring to hear what Cardy had to say, though. I'm keeping my fingers crossed for your one embryo - hopefully this ordeal will be over soon xx

Thanks Blue. Hopefully all goes well at transfer tomorrow and then there will be no more hick-ups for two weeks - just a waiting game.

What issues did you have with your trigger? I guess to to have 6 mature eggs from 6 good sized follicles shows that you did it right. You'll be a pro this time. Your scan isn't far away now. Hope you get good news that everything is shut down so you can get things underway instead of all the waiting.

With my trigger there were two issues: the first being that as I had googled everything before hand, I had expected to be doing an intramuscular shot at the top of the bum cheek, but the clinic had never gone over this, so i didn't know where I was supposed to inject. The instruction sheet that came with the pregnyl had instructions for both sites, so I was a bit clueless. Didn't help that I only realised this 5 min before shot was due to be injected, so wasted time panicking and googling until I decided to go with the usual stomach shot (due to fact we only had the short needles). The other issue was that, again due to the fact that we only had the usual short needles, mixing the pregnyl was an absolute nightmare. The needle was too short to reach the bottom of the liquid, so we had to tip the vial on its side and draw it up from the top corner, trying not to tip it all out in the process! Then, after we had drawn up as much as the liquid as we could, my husband squirted it into the powder in the other vial, but must have done this to quickly, as more than half of it just turned into foam! Luckily we needed the 1000 dosage, so had an extra amount of liquid, which we used to try and combine all of the bubbles, and had to draw it up and slowly squirt it back in again a few times to get rid of most of the foam (while trying not to tip it out of the tiny bottles!). So we ended up injecting most of it about 10 min late and what we could salvage from what remained went in about 5 min after that. It was a VERY stressful 20 minutes or so! Not sure if this affected how things turned out!

Hope the transfer has gone well?? Holding thumbs for you!!!

Wow, that really does sound like a stressful trigger shot!
I got a long needle with my Pregnyl for drawing up the liquid and squirting it into the powder. Once I was done, I then changed the syringe from long to short needle for injecting.
Did your IVF clinic instructions say to inject at a 45 degree angle like mine or did you inject at 90 degree angle?

Sadly, as I was about to walk into 'pre transfer acupuncture' appt, I got a call saying that embryo had died.
I guess better for it to happen that morning before transfer than a few hours after transfer while I have my hopes up for two weeks. But of course better if it didn't die at all and I can get off this horrible infertility journey.

I read a study some time ago that a diet of more than 25% protein and less than 40% carbs for two months prior to IVF increases blast rate from 30% to 50%. I used to be vegetarian but since started eating fish for protein but haven't kept track of exact % protein makes up in my diet. So far with all my IVF's combined I have had 0 blasts make from the 6 eggs that fertilised. So I need to do something about this.

So I have joined the 'Calorie King' website and am going to record all my daily food to ensure I meet the protein and carb requirement in this study. Also going to lose the 6kg I have put on over last two IVF's.

I get cheaper IVF for subsequent IVF's in the same year. So makes sense for me to try one more time before this year is out. Probably better to have two cycle break so I can follow this diet for two months as per study and have more time to lose weight, but not sure I can keep up my motivation that long. Will see my IVF Dr on 1st Oct and decide with her when to try again.

So now it's your turn while I watch you go through the madness of IVF!