IVF cycle cancelled due to enterococcus faecalis

[Goodluckjonathan76]

I had my first cycle of IVF cancelled on Friday evening which was CD7 (day 4 of meds) as the clinic found heavy growth of enterococcus faecalis in DH's semen sample. We were given the choice of proceeding with ICSI otherwise the clinic would have to cancel. We only had a few hours to decide before taking next dose of meds so decided to cancel as DH and I had agreed at the outset that we did not want to do ICSI. Now feeling really upset at the wasted cycle as I had 12 follicles and everything looked good. The clinic did not say that if the result from the semen analysis was problematic that they would have to cancel or offer ICSI and if they had we would have definitely waited for the result before starting the cycle. The clinic seems to have just assumed that we would be happy doing ICSI which we weren't. Does anyone know if those 12 eggs are "wasted" as such or would those eggs have been lost anyway. Also, does anyone have any experience of enterococcus faecalis? Apparently it is resistant to lots of antibiotics and so there is a chance that DH will never be cured and that ICSI will be our only option. Even weirder if that the clinic (CRGH) said they were the only clinic to test for this bacteria. Does this mean we could move to another clinic and proceed with IVF?

Sorry to hear about your stressful cycle.
Why aren't you happy doing ICSI?
What reason does your clinic give for this test? (I.e. What is the evidence of benefit?)
Yes you could move clinics but better to explore why they think this bacteria will cause a problem.
Good luck

Thanks so much nan0. We would stick with this clinic IF we could get answers quickly but we keep getting told different things and it seems that DH will have to be referred to a urologist which will take ages so I am not sure we have time. We just decided to start IVF - took us ages to get our heads around doing it and now just want to get started as I am nearly 41 and DH is 47. Can't face waiting months more.

The clinic hasn't said a huge amount about enterococcus other than they don't want their equipment exposed to this bacteria (completely fair enough but not sure how it isn't exposed when doing ICSI?) and that it lowers the success rate. Again, not sure how/why this is. Doesn't seem to be much on the internet about this either.

I think in your shoes I would get a second opinion from another clinic.
I would have a low threshold for ICSI assuming you have unexplained infertility (or any element of male factor) though.
You don't want to waste any eggs with failed fertilisation...

Nano, does that mean that you would consider ICSI? We have pretty much ruled it out as it removes any element of natural selection and gives an increased risk of abnormalities in the baby.

Jonathon, I had ruled out ICSI also and was given the option of traditional ivf or ICSI. At my next appointment they told me that ICSI was all they are doing now and we had no choice. Long story short is that they said they'd honour our decision if we wanted trad Ivf. I ruled it out for the same reason as yourself and then ruled it back in as I don't want to be in this same position this time next year.
I think with the ICSI they will strip down your DH sperm so the bacteria will be removed?

There is no evidence at all that ICSI gives an increased chance of abnormalities for babies. None at all.

In fact, in most clinics, success rates with male factor cases (using ICSI) can be slightly higher than for IVF, but that is more to do with the additional complexities in getting and sustaining a pregnancy with female factor issues, but it really does show there isn't a connection with ICSI and abnormalities.

Have they offered him antibiotics?

You can also do something called PICSI, which is where the clinic puts the sperm into a dish where one part of it is coated with the hormone given off by a freshly-released egg
They watch which sperm swim towards it, and select those to do the ICSI, as it points to which ones are naturally more likely to have swum towards the egg.

The other option is IMSI, where they use a very very high powered microscope to select the sperm based on a number of factors.

Also bear in mind that there is plenty of 'natural selection' taking place with the fertilisation process, and then again as the embryos grow. Only around 20-25% of eggs will make end up as fertilised blastocysts, which shows how much the process weeds out abnormal eggs, sperm and embryos.

My consultant informs me there is evidence, abnormality risk doubles from 3% to 6% with abnormalities to kidneys and eyes being the main ones.

Thanks both.

TheGamblers, yes, that is my exact worry. We don't want to now but what if it ends up being our only option? Clinic said they often have to do ICSI, not just due to bacteria in semen. However, DH and I discussed again and think that we would rather have no baby than conceive this way. We each have 2 kids each though with other partners so maybe we lack some incentive. And who knows, we may feel differently in 6 months or a year.

Sparechange, there is evidence I'm afraid. Just google ICSI risks and it will come up plus it's outlined in our clinic's brochure as well as on the NHS website. It's not a massive risk but it needs to be factored in, I think.

And thanks Sparechange for the info on PICSI and IMSI. I hadn't heard of these but they could definitely help us. Do you know if they do these procedures at most clinics?

There really is no conclusive data to say ICSI increases the risks of abnormalities... either in base studies or meta analysis

gamblers i would be really interested to see the study your consultant referred to because I can't find it

There is a little bit of evidence to suggest IVF pregnancies have a higher rate of abnormalities compare to natural conception.

If you are genuinely worried, it might be worth doing a sperm DNA defragmentation test which will tell you what % of sperm have normal DNA. If it is within normal parameters, then there is no reason ICSI wouldn't work especially if you want to combine it with IMSI or PICSI

Check the price list and website of your clinic - they'll list it if they offer it.
I think the Lister is the only place that has the IMSI microscope but I could be wrong. PICSI is fairly widely offered as an add-on for about £350

It would also be worth speaking to the embryologist about your concerns and they can talk you through how the ICSI process works

OP, you said the NHS website says there is a warning about ICSI risk?
I can only find this story which says a study found that ICSI pregnancies have lower level of complications than IVF pregnancies

www.nhs.uk/news/2014/01January/Pages/Risks-of-infertility-treatments-overhyped.aspx

I suppose I'm only trusting what he's telling me as there's lots of conflicting information and he has access to more information than we will ever have. We only know of the current published research whereas he'll be party to so much more.
Ivf should have no greater risk of abnormalities as the sperm and egg meet in the same fashion.
It's a total minefield and as much as I try to put it to the back of my mind I'm the same as OP, will I be able to cope with always thinking did I cause X abnormalities to happen just for my need to have a baby.
I guess we all have our individual worries about the process, this is mine.

I'm happy to explain a bit more about the main theories on why there are more abnormalities with IVF than natural conceptions if you want, but don't want to worry you if you'd rather not know...

But for the sake of anyone stumbling across this thread in the future, I really want to put to bed the idea that there are added risks from ICSI...

A fertility consultant really won't have access to lots more information. Very few (I only know of one) clinics will track patients beyond a confirmed clinical pregnancy (when they see a heartbeat on ultrasound) so simply won't know the outcome of the birth.

Some clinics will try and track live birth data, but that is by writing to patients and asking them to confirm if they have had a live birth. It won't account for a live birth with abnormalities, nor is there any mechanism in the HFEA follow ups to track this.

The only way this can be done is from studies, and then any meta analysis of the studies. These have all shown that there is no statistically significant risk from ICSI over IVF

There is some evidence to show sons born to fathers with sperm problems may inherit the same sperm problems, and you can argue this is a risk from ICSI, because those sons wouldn't otherwise have inherited their father's faulty sperm gene if they hadn't been born

But this isn't relevant to the OP, because ICSI isn't being proposed as a way of overcoming male factor infertility, just to wash the sperm and remove the bad bacteria

Sparechange, as much as I wish it wasn't, it appears widely documented that there are increased risk. See links below. There is also a mention on the HFEA website although I can't acess at the moment.

www.nhs.uk/news/2010/02February/Pages/Top-IVF-doctor-ICSI-talk.aspx

www.ncbi.nlm.nih.gov/pmc/articles/PMC2424218/

argc.co.uk/treatments/an-important-note-about-icsi/

Wording from the website of ARGC (a leading IVF clinic in London) below:

An important note about ICSI

Due to the more invasive nature of ICSI, there is a small risk of damage to eggs being injected(approximately 5%). Not all eggs collected will be mature enough or suitable for injection.

ICSI also carries a slight increase that chromosomal abnormalities could be passed onto ICSI children (about 2% above the rate that occurs in the natural population). It is also possible that male children of men with severe oligospermia may inherit this sub-fertility from their fathers.

Two-thirds of men who suffer infertility due to a congenital bilateral absence of the vas deferens (CBAVD), are also carriers of certain cystic fibrosis genes. For this reason, men inflicted by CBAVD, and their partners, may wish to undergo genetic testing before embarking on fertility treatment.

They think part of the risk could be due to the pre-existing MFI but cannot rule out that is it also due to the process.

Spare change, it's hard to say put across in text without being rude as I in no way mean to be rude

Are you medically trained/working within medical / fertility profession, as you seem to have different info as to what we have been given by our specialists which does lead me to wonder who to trust. I will always trust the info from the specialist unless I feel more knowledgable about something or if I've got a second opinion else where.

I work in the medical world and there are often invites to certain conferences where we are privy to more information than is published.

Agreed not the purpose of OP post the ICSI thing just interested me as I've had this dilemma myself and couldn't find a thread on it.

We did ICSI for male factor (plus pcos) to get DD so I'm biased.
My understanding is that there is a 2% increase in risk of abnormalities as quoted above but that the mechanism is unknown.
It is worth remembering that abnormalities covers a huge range of conditions (so an extra toe or a birthmark would all count as well as big things like a missing kidney!)
ICSI improves fertilisation rates dramatically.
We had no children and no chance of pregnancy without ICSI. We have no regrets, so I am biased.
I am not sure that you can class anything natural about ivf though, sorry.

(I'm a consultant obstetrician)

Nano, agreed. Clutching at some straws!
That's more like what my consultant had said however claimed 3% more but still more.
I imagine we will go with ICSI, we were 100% no then we were changeable as time went on and then I read this thread and it reminded me of my initial feelings.

The moral of that story, stop reading!

Hi,
just to add to what nano said, what is reported is an increase in risk with ICSI. So if average risk of birth deformities for pregnancy is 2%, Increase in risk of 3% means an actual total risk now is 2.06%. Which is actually a smaller increase then it initially seems. I calculated these as we have MFI and our consultant thought we might have to go for ICSI. Totally up to each person what they decide to do in the end, but sometimes the numbers sound scarier then they are once you work out absolute risk. Of course, age, family history, etc might effect your personal risk, and even a small increase might be too much for you personally. There are so many decisions to make with this process, i just want anyone reading to have all the info.

Thanks all. Nano, understand your points entirely. In your situation, I would probably have made the same decision. We don't have MFI though and, if DH can get rid of this infection, we don't have to do ICSI. I think if it can reasonably be avoided then it should be.

Does anyone know anymore about this infection? It's come back on husbands semen analysis. We're still waiting on DNA fragmentation results.

I've googled it and it's associated with infertility. However we've never had any issues with sperm levels etc and successfully made 15 embryos over 3 rounds. However I've had 3 miscarriages from a total of 7 transfer (9 embryos as some were double).

I imagine if Enterococcus faecalis was cussing male factor infertility, we wouldn't have good sperm levels and we wouldn't have made the embryos?

Thanks