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?

Oh no, Shell - so sorry to hear :( Quite a crappy cycle to be fair! Hope your clinic has learnt a few things, and your diet plan sounds good. That's great that your clinic offer the cheaper cycles - do they definitely mean a calendar year, or a financial year? or maybe even cycles within 12 months? That would be even better! Would be good to hear what your Dr has to say with regards to the benefits of back to back cycles as well.

Yes, due to all the googling I had done I was expecting a long needle with my pregnyl, but only had the short insulin syringes that I used for the burserelin, and was expecting them to tell me how to do the trigger shot at my final scan, but they didn't mention anything and I forgot to ask! So in the end just did it the same as all my other injections - 90 degress in around belly button area. Luckily for this next cycle I've got a single dose pen with the trigger shot, so don't need to worry about a thing.

My scan today showed that my endometrium was a flat line and that there was nothing happening in my ovaries, so all good. Start my stims on 1 Oct, but won't know anything else until 10 Oct when I go in for the 'final' scan. Hope it is wise for them to double my dosage and not even to check up on me during the stim phase!

Hope you are able to have a mental break from IVFing in the mean time, and that your appointment on the 1st is informative and helpful!

It's not actually that my clinic offer cheaper cycles. I still pay the same to that money hungry company, but rather I get a higher rebate from our Medicare system for subsequent cycles in the same calendar year.

Yes, quite a crappy cycle indeed. I am disappointed as I am usually a poor responder so was quite happy to have 8 mature follicles - best response to date - and then for the wrong trigger instructions to stuff it all up. Done now and just trying to move forward and work towards better outcome next cycle.

Glad to hear your scan went well. But yes, you would think they would scan some time during the stim phase. It's not like it costs them any more money to have you come in for an extra scan since they have the machine sitting there.

So now you just start your injections on the 1st and the next update will be over two weeks away on the 10th. I guess despite if you make 7 eggs or 14, you just want them to fertilize this time. So the real update will be the day after EC.

Yep, it's until I find out if we get fertilisation really. I remember saying to my dh on the night of egg retrival that at that moment in time there were living things in this world that were half me and half him for the first time ever. Well, that turned out to not be the case at all. So that is what I'm waiting for - to see if that ever happens.

I'd definitely imagine that your next cycle will go much better - that messed up trigger shot was just incredibly unlucky, and that wont happen again! So even if things (other than the trig shot) went exactly like this last cycle - you should be in with a great shot. Please come back with an update after your appointment to let me know what happened and what the plan is :)

As I read your post, I remember feeling exactly the same way on my 2nd last IVF. I had produced 5 eggs and recall thinking that night that I had 5 little babies growing in a petri dish and trying to send them loving vibes. Well the next morning only 1 was alive - which is better than 0 - but still I was devastated. So it creates a very different feeling for this time when you will spend that night at home with every minute taking forever until you get the phone call the next day.

Oh, and perhaps I shouldn't be stressing you out right now that your IVF plan needs to be changed, but because I don't produce many eggs, my new Dr suggested adding calcium to the eggs with the sperm to up the fertilization rate. It has some technical name that I can't remember, but when I read about it online, I only read promising things. I remember one study where a woman produced lots of eggs over a couple of IVF's and each time 0 fertiisation. This calcium thing fixed it and she ended up with triplets. Just thought I'd mention it while I think of it in case it is any help to you in the future, but hopefully I am not stressing you out more than helping!

Ooh that may be assisted oocyte activation? I think you mentioned it in your first post to me! I mentioned it to one of the nurses but he didn't know what I was going on about, so I don't think this clinic offers it. If I get a bad fertilisation rate this cycle, I'll make sure I have it for the next one - even if it means driving to the clinic which does provide it which is hours away!

Oh okay, I already mentioned it. My Dr gave it some technical long name - but I am sure you could Google it. Different countries seem to have different names for things and different ways of doing things in this IVF world.Anyway, hopefully PLEASE PLEASE PLEASE let you get some fertilise this time and you never have to worry about seeking out another clinic

Meanwhile, my appt with my IVF Dr next week is taking forever to come around. I just want to have a plan in place and a new date to work towards. After this last failure, I am just sick of it and want it to work so I have got real strict on myself with my high protein low carb diet. I hope I can stick at it. It's amazing how hard it is to avoid junk food when you ban yourself from it.

Hey Shell - sorry I've been away so long! How did the appointment go? Do you have a plan of action? My scan is on Friday so will know then what my plan of action is. :)

Hello Blue

Now I am the one apologising for not replying. I think because my last post was 26th Sep and you didn't reply til 7th Oct, this thread dropped off my list of threads that I am on. For some reason today I had a random thought about you and wondered what happened to this thread. So you were starting injections on the 1st of Oct? That means egg collection should be about now!? I am super curious what is happening so I hope you get this message.

As for me, I am about day 14 of my current cycle and just have to wait until day 20 of next cycle to start estrogen and then IVF the cycle after. So it's just a waiting game. My sister has just had a baby and it's got me really depressed and teary about my whole situation. Really want to try feeling positive about my next IVF so I need to somehow be a loving sister yet forget her at the same time!

Hi Shell :) I was reading other threads and saw a post from you there, and that you were going to have a bit of a break from here while you waited, so I completely understand! (Hope your writing is going well!!) The beginning of Oct was completely hectic for us as my dad had had a stoke and has now come to live with us, which has at least take my mind off all the ICSI stress.

Yes, last Friday I went for the final scan - last time I had five follicles on the left, three on the right. This time 8 follicles on the left and 23 on the right!!! So I only did a 50iu shot on Sat morning and the trigger that night. Egg collection was yesterday - out of all those follicles I had only (but not only) 11 eggs, but still better than last time's 7 eggs. Got call yesterday afternoon to say that one wasn't mature enough, and two didn't survive the injection process (just like last time) but now I'm left with 8 which is better than last times 4 at the same point.

So now I'm still in bed (it's 8:30am here), nervously waiting for the call to say if any have fertilised. They said that they will call between 9:30 and 10:30. I'm expecting the worst to be honest

Gosh, at least I don't have to deal with a newborn niece - it must be so hard!! Hope the diet is going well, and good luck with everything else!!

Ok so I have 2 embryos - better than nothing! I get another call tomorrow morning and if they have lasted until then, they'll be but back in around lunchtime. The embryologist went through what happened to the others, but I've completely forgotten what she said. I think at least 2 had more than two pro nuclei, she said there could be an egg issue or a sperm issue there. I feel a bit deflated that after so many follicles, then a good number of eggs, that we've only got 2 embryos - I'm not even sure about the quality of them. But at least this time some fertilised, I just really hope that the two that were good are going to hang in there!! Eeek!

How many eggs did they initially retrieve Blue?
So Wed 15th is transfer day - is that day a day 2 or 3 transfer?
I was just so worried for you that there was some issue and it was going to be 100% fertilization failure again so I am happy for you that you got two - although I can understand how deflated you would feel if you had so many follicles.
Hopefully you feel more reassured tomorrow once they tell you that they look good quality and you have two little babies safely tucked back inside.
Then it's the longest two weeks of your life.

I don't start my IVF until the end of Nov - this feels like the longest wait of my life!
I normally jump straight back into IVF because I am so impatient but I thought it wasnt working so perhaps this time it's better to give my body a break and a chance for all my hormones to recover. But I am going insane waiting!

I haven't read the whole thread (I'll save that for bedtime reading tonight) and I have no advice to offer except that I also had a fertilisation failure. Six follicles, two eggs collected, zero fertilised. Such a waste of money.

Shellster - just saw you are with Monash. Are you in Victoria or Queensland?
I was with City Fertility but due to the cost we have changed to a bulk billing clinic for the next cycle. Have you tried those?

Hi Shell - Thank you so much :) I was so worried too - almost convinced that, again, none would take. Not sure if you read my post previous to the last? I waffled on a bit in that one about everything - I had 31 follicles!!

Hi Serenity - sorry that this has happened to you, too! Have you had the follow up appointment yet? I had an NHS funded cycle and as there was zero fertilisation, they offered me another free go. Hopefully your clinic could do the same?? With zero fertilisation from two eggs you may find that it is just an unlucky cycle - rather than there being some horrible underlying issue, which is what we were worried about. Will you be on increased stimms for your next cycle, or are you already on a max dose? Hopefully with more follicles your chances will increase dramatically.

Soooo, even though only two of my eggs fertilised, just got a call to say that they are both doing well :) :) Today is only day 2, and my embryologist said they like to see them at 2 to 4 cell stage by now, and I've got one at 4 cell and the other at 5 cell stage. She said they were both 'good' quality embryos (I'm trying not to dwell on the fact that she did't say 'excellent'). And as I am fine with having two transferred, there is no need to wait any longer, so I'm going in today to have them both put back.

It does kind of suck that I didn't have any left over to freeze, but I do feel so lucky that any took at all. I'm sure I have mild OHSS - my stomach feels really bloated and sore - like there is a fiery brick in there, but hopefully this cycle it will be worth it! I know there is still a chance for things to go wrong, then there is the 2ww. That will be agonising! Hope your waiting game speeds along, too, Shell.

Hi Blue I have changed clinics so no idea what will happen next.
In in Australia so have to pay for all mine. I started in 225 of gonal-f.

I have unexplained infertility. Three rounds of clomid failed. No endo, no pcos, AMH 12.9, ovulation is pretty regular, tubes are fine and DH has textbook perfect super sperm. We did ICSI also but nothing happened.
The new clinic does chromosomal tests so awaiting the results.

Serenity hope the results come back ok. I was on 300iu gonalF this last cycle and I produced waaay more follicles than last time, but not even half of them contained eggs. It did increase my chances though, so hopefully on an increased dose you'll get the same.

Hopefully these two embryos are all I need to get a BFP! Both are back in and I need to test 29 Oct if AF hasn't arrived by then. I am suffering from mild OHSS - when they did the ultrasound to guide to embryos back in you could see loads of follicles (cysts, now). I can barely stand upright and have to walk very slowly. I feel very bloated but don't look it, thank goodness - I've heard how lady's can look 4 month pregnant from bad bloating! Get bad cramps now and then, but generally just a dull ache. OHSS was always a possibility with so many follicles! I was a bit shocked when the nurse said that if it was too bad, they'd cancel the transfer and freeze the embryos (I really didn't want this to happen!) Apparently OHSS goes away when you get your period but can get worse if you get pregnant - yikes.

I didn't realise you had posted two posts in a row Blue until you pointed it out. So I read your post - wow 31 follicles! Just doesn't make sense to only get 11 eggs?!?!

Blue and Serenity, did they give a reason why you got less eggs than follicles? Were a lot of the follicles smaller and not all of them above 15mm? Just gets me worried because last time I had around 8 mature follicles and only 1 mature egg. I thought it was because I did the trigger wrong but the clinic doesn't think so and now this has happened to you two and someone on another thread. Would just love to understand what went wrong as I already don't make many follicles and don't want this to happen to me again next time so if the clinic gave you any insight, I would love to know.

Anyway, to have two put back Blue is absolutely amazing. Funny how you stress out over even positive things with IVF - two well developed good embryos and you stress you weren't given the word excellent. But I do the same thing! So the torturous 2ww begins.

Serenity, so lovely to meet someone in Australia!!!! I am in Victoria. What state is City Fertility? I was with The Fertility Centre last year which is a cheaper clinic in Victoria. But there did seem to be a reason they were cheaper. For example, I had a trainee do my transfer who had no idea. That embryo was top quality and I still wonder if this is the reason that cycle failed. Also, they don't use ultrasound to put the embryos back. So I decided to try a couple of cycles with Monash - but so far I haven't even made it to transfer! I have heard of the bulk billing clinic in Sydney and am interested in finding out about it, but after my experience with The Fertility Centre, I am suspicious there must be a reason why they are cheaper.

City fertility is Brisbane based. It's one of the big companies. Expensve but good...unless you are me. I'm starting the cheap clinic cycle next month.

Fertility centre is cheaper I think as they bulk bill, you do the cycle according to their schedule not yours, less treatment options, more nurse then doctor based, EPU under local not general and no male infertility or donor patients.

Don't you wish we had free ivf a la NHS? Some days I do miss my free gp appointments

Serenity, when you say Fertility Centre is cheaper, are you expanding on my comments about my experience at The Fertility Centre, or is that where you are now attending?

Yep, that funded NHS sounds amazing - although I am about to embark on IVF number 9 so I would have used up my NHS freebie long ago!

Don't know if you flicked back through this thread as your bed time reading, but Blue and I discussed adding calcium when they inject the sperm into the egg.

I read a case study about a couple with unexplained infertility, went through IVF, got lots of eggs each time yet 0 fertilize. They did calcium assisted oocyte activation and ended up with triplets. A friend of mine has been TTC for 17 years (started quite young so age wasn't her issue though she is now 37). Did IVF, got 10 eggs and 0 fertilize. So to me, the failure of the egg to activate with the sperm seems to be what is causing her infertility as like you, they have no other issues. Just thought I'd mention it in case it is something you want to discuss with your clinic. I don't make many eggs so my Monash Dr suggested doing it to at least up the number of my eggs that do fertilize. I have read about it on Dr Google and it sounds promising.

Shell the first cycle they included the two follicles at 11mm - so really the proper count should have been 6 (proper sized follicles). All the same, at least they all had an egg. This cycle they only counted the follicles that were already at 14mm. I think she didn't include the follicles that would be overripe by time of retrieval, which was quite a few of them to be honest, so I must have wasted a few eggs with that. Overall there were 24 promising follicles that would be at the right size come retrieval. Every one has pointed out that there were a lot more follicle to eggs, so I know it is unusual, but no one has said why this could be. I'll definitely ask when I have the chance!

I thought I'd be back at work by now, but was told to take the 2 weeks off due to the OHSS. So I don't even have work to distract me, and I am soooo uncomfortable! And only 2 days in - this is going to be agonising!

haveababy.com/fertility-information/ivf-authority/empty-follicles-explained

I think I remember you mentioning this, Shell. So basically it is just a regime failure? - the FC need to take this into account and tailor our regime with this in mind?

haveababy.com/fertility-information/ivf-authority/repeated-ivf-failure-due-empty-follicles-poor-egg-quality-case-report

Ooh, this page is more informative.

Shell I've probably confused myself
I was at City Fertility Group but I've jumped ship to The Fertility Centre (parent company is Queensland Fertility Group). I think there is one in Melbourne too.

I have skim read the thread. I've got a lot of catching up to do!

Calcium....will have to find out more.

I've had a read of the first link Blue.
I know that my trigger went bad last IVF and that's the reason for the follicles not 'coming loose' from the follicle wall and hence they didn't release when the follicle was flushed, just as this article describes.
Very interesting about the trigger dose the first article mentions.
Did you change trigger medications or dosage between first and second cycle?

Serenity, so I have been to the Melbourne Fertility Centre that is affiliated with your QLD clinic you are now attending. Although the Fertility Centre here seems to do things different to your clinic. I still had EC under general - not local. And you say yours does not deal with male infertility while they accepted us with my husbands diagnosis of 100% abnormal morphology (although it turned out I am a poor responder to IVF meds too).

I am coming up to QLD from 24 to 30 Dec. Lets hope we are both carrying and extra bundle inside us by then. When are you planning on doing another cycle? How did your chromosome testing go?

Shell my appointment with the doctor isn't until the end of the month. Haven't had results about testing yet.
It's just sit and twiddle my thumbs time.