Failed 1st IVF cycle – what now?

[Hobbes39]

I just started my period yesterday 2 days short of my OTD so I know this cycle has failed.

I am to go in tomorrow for my blood test anyway supposedly, which seems a bit pointless, but I figure I will use it to ask what happens now and try to figure out where it all went wrong, but it went pretty wrong all the way through to be honest.

I was just wondering if those of you on here who have had more than one cycle (and hopefully success in the end!) can help me with what I should be asking, what info I need to have? My head is all over the place at the moment, so any advice appreciated.

To explain our situation - we have ’unexplained secondary infertility’. I am 39, DP is 42, we have a 3.5 year old DS who took a while to conceive (almost a year) but was naturally conceived and I expect part of why it took so long was because once I started to track ovulation I discovered I ovulated earlier than I expected, so we had been missing the window some months.

Anyway, since having DS my periods have been shorter (were about 28, now 22-25ish days) and I often have spotting for 3-4 days beforehand, and have a relatively short luteal phase of about 10-11. We have been trying for no2 almost 2 years now, and had investigations and tests and all came back normal – DS sperm was fine (although I don’t know the exact numbers), my FSH and LH were nice and low (3.9 and 2.9), my AMH was pretty good for my age: 15.4, and AFC was 13-14.

I was put on the Long protocol, had 2.5 weeks of microgynon, followed by a week of buserelin, then 10 days of Bemfola 150. Despite the fact that with my numbers they were mentioning needing to be cautious about OHSS (ha!), at my first scan after starting stimming I only had 5 follicles on one side and just 1 on the other, but lining was a decent 10mm then, so they didn’t up my dose of stims. Next scan, still only had 6 follicles in total, lining was 15mm. Had trigger shot and they collected just 5 eggs, of which 4 fertilised, but only 2 of them did so properly, so we had only 2 embryos on day 1. They were 3 and 4 cell by day2, but were quite fragmented, so the 2nd lowest grade our clinic give. The 2 were both transferred back, I was put on crinone gel, but I only made it to 10dp2dt, when the bleeding started first thing.

I feel gutted that not only did I not produce many eggs, we also didn’t get good quality embroys. I am reasonably healthy, not overweight, don’t smoke, gave up alcohol for months (had a large glass last night though!) and had acupuncture from a couple of months before starting. I don’t know what we could do differently. I know age is a big factor, but I refuse to believe it isn’t possible for me. I have heard that maybe it would help to change protocol and have much better success, but does anyone know how? Has anyone had the same thing and changed to a short protocol or higher stimms and had more eggs and/or better quality embroys? I need some hope and some focus to stop me sobbing every time I see my DS playing all by himself…im so heartbroken for him as well as me and DH.

Thanks x

Hobbes sorry to hear of your failed cycle - its such a tough thing to go through both emotionally and physically so be kind to yourself.

Your clinic should arrange a follow up appointment with your consultant so you can have a "de-brief" and ask any questions/agree next steps

Our first cycle failed and sounds relatively similar to you. We were unexplained and my bloods were all good so I was put on a long protocol but only had 5 eggs collected and only one fertilised. It was good quality when we transferred on day 3 but no pregnancy.

We completely changed things for my second cycle - short protocol, much higher dose of stims (which was dropped down half way through - my consultant thinks its better to start high and then drop down if needed rather than vice versa). I had 18 eggs collected but as my husband's sample wasn't great on the day, we opted for IMSI (a version of ICSI) and only 10 eggs were mature. Of the 10, 9 fertilised and all 9 made it to day 5 and were of a high quality. I then had one transferred and am now pregnant (still pre 12 weeks so early days and v v cautious). We had PGS on the other 8 and 4 were genetically "normal" which have been frozen so feel extremely lucky.

So as you can see though, completely different result between the two cycles - my consultant thinks that your body will often respond better if you only leave it a few months between cycles (I had two natural periods) as it gives everything a kick start so that can often be a factor. Also, although my husband's sample was always good, we now think that might be the problem (DNA fragmentation most likely but we've not tested further). I had short cycles like you/short luteal and spotting so convinced it was me but consultant now doesn't think so given our crap fertilisation the first time and much better result with IMSI the second time.

I felt very negative after our first cycle and was convinced it was my egg quality despite not drinking or smoking, organic diet and supplements - I went into the second cycle thinking we were doing it to tick it off so we could better decide what to do next/move on from it all.

What I would say is be prepared to challenge your consultant and not stick to the same protocol. Also, move clinics if you're not happy rather than go again with them because it seems easier. A lot of clinics seem to stick to the same rigid protocol which just doesn't make sense.

A wise poster here once advised me that IVF, especially first cycle, is another diagnostic tool. When you go for your debrief they will chat about what happened and next steps.
Hang on in there and sorry it didn't work out.