Advice please - failed cycle

[Irishgirl2015]

Hi all,

I’m devestated this morning as we found out that none of our embryos from this cycle have made it to blastocyst for freezing and I was hoping for your advice or experience.

So this is cycle 2. Cycle 1 was cancelled pre collection last year due to a poor response which was unexpected as I have a high AMH (and PCOS). Roll forward to cycle 2 - change in protocol to long and upping / different meds. EC last Friday - collected 18 eggs, 16 mature, ICSI (due to small amount of volume, sample looked fine otherwise), 9 fertilized. Given the high risk of OHSS, I was advised to do a freeze all cycle (we knew this was on the cards possibly from the beginning).

Day 3, 8 embryos looked good, progressing well 7+ cells, one slightly behind. Call today from the clinic to say none reached blastocyst so nothing to freeze.

Totally unexpected as we thought that with 8 on day 3 we had a very good chance of having 2+ to freeze - how wrong were we!

I would be so grateful if any of you have been through something similar would share your experience - is this due to egg quality, sperm quality, bad luck? Where do we go from here? And especially any success stories after having gone through this?

Sorry for the long post - thanks in advance for any replies.

How devastating. I’m sorry this has happened. I am not medical in the slightest so would not attempt to give you any advice that may not be accurate. However, I think you should arrange a review meeting with your consultant when you feel ready. I hope you get some answers and wish you every success for the future xx

Thanks Windy - I very much appreciate your reply xxx

Clay jones - what a trite and insensitive thing to say. You sound like a spammer.

Hi Irishgirl,

I’m sorry to hear your story. I too have PCOS/PCO (they can never decide) and had similar problems. We got 24 eggs, 18 mature, 14 fertilised, but just 2 made it to day 5.

We are so lucky, as one of the two is a baby due in 11 weeks, and the other is on ice. I can’t begin to imagine how hard it is to have a failed cycle, but my clinic did give me some help with why we had such a large attrition rate (as I did find it upsetting before I knew we’d been lucky with the bfp).

The consultant said that although PCOS can result in a large number of follicles, and eggs, the quality can be affected by androgens in your body. If we needed to go again, he would suggest that we both try to do as much as possible health and nutrition wise. For me that means cut the sugar, low carb diet, lots of veg, cardio exercise, healthy weight, no alcohol or smoking (neither of us smoke or drink anyway, but I admit to living on Galaxy chocolate). He also said I could try Ino-folic, but stressed that there was no strong evidence for its success. My DH has no problems, but the consultant still recommended he exercise more, eat healthily and generally look after himself and his tackle.

I’m not sure if that’s any help to you. Will you get a chance for a debriefing with your clinic? They should be able to tell you medically if it’s worth trying again (i.e. were they as shocked by the results as you were?), but emotionally it is totally different, and really only you know if you want to try again.

The same thing happened to my sister during two cycles.

She's just been told to keep trying but tbh she can't deal with the disappointment.

The doctors don't seem to be able to tell her very much and she's now thinking of looking for donor eggs.

Hi @Irishgirl2015 ,

I'm in a similar boat - IVF Age 31 for MFI. (So actually ICSI). I have a lowish AMH so they gave me lots of drug and on cycle 1 we got 20 eggs - 14 mature and all 14 fertilised. 8 got to day 3 and we only got two poor quality blasts on day 5 - neither would have been good enough to freeze. We put one back in and got a BFN.

Consultant follow up basically said there is a quality problem - this could be egg or sperm. He said possibly a bit mixed for us so has told me to start DHEA, coenzyme q10, vitamin d and melatonin. He said he was most suspicious of a sperm problem as this kicks in from day 3 onwards and we have now tested DH for high dna fragmentation - this has come back moderately high so on the next cycle (which is start next week) we will be taking sperm directly from the testes as this can minimise the fragmentation.

Just hoping that with all this we will get a decent blast to put in at least! He's advised to go for long protocol again but reduced my dose of meds as there's no point in getting >15 eggs and lower my risk of OHSS. He was very clear would not want to risk a freeze all cycle as "were unlikely to have anything good enough to freeze". He's also suggested putting 2 back.

Hope that helps - I'll let you know how I get on?!

Hi Irishgirl, sorry you've gone through this horrible experience.
I haven't had the same but my first cycle was also cancelled pre EC due to poor response, though I have low AMH.
I'm currently on my second cycle.

On a practical note push to have follow up as soon as you feel able to. Ask what they would do differently in a future cycle. It sounds like as hoping says a fresh transfer would give you a better chance.
Also have a think about whether you are sticking with that clinic or moving elsewhere.
I would recommend the sperm DNA fragmentation test, you can book direct with Sperm comet (cheaper than through other clinics but depends where you're based /what is convenient for you).

It might not be time, but in case the clinic suggest donor eggs there is a section here on donor conception, you could have a read of it and see what you think.

Look after yourself, I hope you can come back and share your success story in the future. 💐

Like @JeNeBaguetteRien I agree push for follow up - I was given follow up 5 weeks later and I phoned and said I'd go mad by then and had lots of questions. I was initially told a nurse would tell to the consultant and call me back and then they made me an appointment for two days one with the consultant which was a god send!! He recommended the dna fragmentation test which would take 3 weeks to come back and we kept our follow up.

Everything always feels better when you have a plan of action for the next time! Xxx

So sorry you've gone through this. I've find the information on reddit's infertility board very helpful and well informed. Some is a bit US-centric but still quite useful. www.reddit.com/r/infertility/comments/62j7o8/info_post_why_did_my_embryo_transfer_or_fet_fail/

Hi all,

Firstly apologies for not replying sooner - I was reading your messages and greatly appreciate them but just wasn't in the head space to reply until we got some answers.

This is long but bear with me - I want to put as much down as I can in case it helps anyone else!

So, met with our consultant this week, he is utterly shocked at the outcome as are the other consultants in the clinic and the embryologists. He reckons this is something that they have only seen very rarely in cases like ours. Broadly everything looked really good and he would have been expected 2/3 blasts on day 5. He reckons the fact that there were both so many mature eggs (16/18 collected) and the fact that there were 7 strong embryos on day 3 indicates good quality eggs and he doesn't think egg donation is needed. On the sperm side, the sample looked really good (60m count, good mobility/morphology). Also hubbie had a SA including DNA fragmentation last year and all was normal with that. He even said that at the numbers from the sample, hubbie would be a canditate for sperm donation (the irony!). On the flip side, he would have expected slightly higher fertilisation rates (we got 9/16).

The long and short of it is he can't be sure but the indications are either it is a sperm issue (as the sprem DNA is thought to take over the embryo development on days 4/5) or our embies don't like the standard culture process or it was just incredibly bad look.

Their proposal is that we wait 3/4 months for the next cycle - use that time to get both of us as healthy as possible (nutrition, exercise, supplements etc.). Immediately before we start the cycle, hubbie will do an up to date SA with DNA fragmentation test. Then broadly same protocol for me (going to start on a slightly higher dose of Gonal F and then hopefully lower towards the end of the stims) with PICSI this time instead of ICSI (with the aim of improving the sperm selection) and then embryoscope (to rule out any culture issues).

I think we just have to go with it and see what happens. It is so frustrating but the clinic and my consultant have been very helpful so far so I think we need to give it and them one more go before we move on.

@hoping2018 - please do keep me in the loop on how things are going for you. I will do the same - maybe we can compare notes! Very best of luck with the next cycle. Out of interest, what does the DHEA and melatonin help with for you? Just wondering as my consultant has not prescribed them for me and I'm wondering if I should go back to him on it.

Again, sorry for the long post! I am very thankful to you all for your kind messages. Its an awful journey, one I would not wish on anyone, but the kindness of strangers is incredibly uplifting.

Namaste all xxx

Hi Irishgirl, glad you were able to come back with an update. You’re situation was truly terrible and I hope you are getting to a better place. I’m so glad that you were able to meet with the consultant and get feedback. Also very glad that you feel you can give it another shot. I hope your dreams come true x

Thanks windy2909 - gotta be optimistic for now! It’s shit but the alternative is worse so fingers crossed - I’ll keep you updated. Xxx

Hi @Irishgirl2015 ,

Thanks for the update it's really interesting to hear of someone in a similar boat. My consultant and Embryologists were also "very surprised" sadly you never want to be the person surprising doctors!! - this is definitely one situation where you want many people to have been in the same boat before!

It's interesting yours said about the lab not suiting your embryos as I wondered that for us? We've signed up to 3 more cycles with them and if no baby at the end we get our money back (access fertility) if we aren't pregnant by then I would use the returned money to try a cycle elsewhere I expect.

Did they use timelapse / the embryoscope for your last cycle ? We did and it was very interesting - it showed 6 of them went straight from 1 to 3 cells and therefore they knew on day 3 they were a "bit dodgy," though if they hadn't had the timelapse information they would have thought they were fine! That led them to think there is probably an egg quality issue as well as a sperm quality issue (as the rest died off day 3-5).

The DHEA and melatonin are to improve egg quality but I wouldn't take them unless the consultant advises.

I start stimming on Wednesday if the scans are ok so I'll let you know if a couple of weeks if we had any quality improvement - ideally we would have been taking the supplements for 3 months but I'm too impatient! I'm just hoping the surgical sperm retrieval and not being as overstimulated this time will help too.

X

Hoping2018 - thanks for your reply - really interesting.

No - we didn’t use the embryoscope last time. Consultant didn’t think it was needed (wrong now obviously). We will definitely use it this time round. He mentioned that maybe our embies need more or less of the additives that are part of the general culturing process (he mentioned specific ones but I can’t remember now) - if this is the case he think maybe we have been getting pregnant naturally at different stages over the past 3 years but then the embryo hasn’t developed.

Interesting what you said about the jump from 1 cell to 3 - i don’t know what’s worse at this stage - knowing there is something wrong with one or both of us or not having a clue why it’s not working 😒. The logical part of my brain knows we need to find out so we can at least try and fix it if possible.

Is you DH on a max strength supplement? Consultant recommended Fertilix to us - capsule instead of powder so much easier to take.

Please do keep in touch - it’s such a lonely road as we haven’t shared any of this with our families and only 1 of my close friends knows all the ins and outs. Happy to be a sounding board for you at any stage also! Wishing you all the very best of luck with the next cycle - stay positive my dear - the best things come to those that wait ( that’s my little mantra when I want to scream and throw crap at people - usually those that have gotten pregnant at the drop of a hat and quiz me on why we “still” haven’t had kids 😡). Xxx

Hi @Irishgirl2015 ,

I think the embryoscope is great though frustratingly after being told how much information it gave them last time we've been told it's broken and unlikely to be mended by the date we'd need it. Very frustrating but hopefully we've had useful information from it and we're unlikely to have lots of good quality embryos to choose from so we'll put back what we've got either way! (Hopefully we make it to that point!)

My DH is on wellmans and then omega 3 which the consultant suggested. Nothing else.

More than happy to let you know how I'm getting on! There's not many in our group of lots of embryos initially and then none so it's nice to know I'm not the only "unusual case".

X

@Irishgirl2015 also meant to say I'm sorry to hear you've not told many people! It really has helped me lots (though everyone is different)

As people know we've had friends who've been trying a year coming to us for advice and support and knowing we're not alone and statistically this should and will happen to people you know.... my sister is pregnant and lots of my friends are and by telling them they know why I'm possibly not myself and keeping my distance compared to what I would do normally xx

@hoping2018 - just said i’d Check in and see how things are with you. Any update?

We are hoping to try again in late July/ early August. Wanted to give the supplements some time to kick in. Also planing a stringent diet and exercise regime for the new few weeks - hopefully I haven’t left it too late!

Anyways, I hope all is well with you xxx

Hi @Irishgirl2015 ,

How are you getting on with the waiting for your next cycle?

Good news from us the changes we made worked - I'm 5 weeks 5 days pregnant and we also got two frozen! So we're obviously over the moon but I'm slightly terrified as it's taken so long to get to this point and I'm just keeping everything crossed. But the changes we made def helped.

In case it helps you I'll write what we did differently - I took supplements in the lead up, they gave me a lower dose of drug and DH had surgical sperm retrieval.

The first part of the cycle was pretty much the same as cycle one - despite the lower dose of drug I was still overstimulated and I got 22 eggs though this time 100% were mature (last time 14/20).

However we got a lower fertilisation rate which is apparently expected with sperm straight from testicles and so started with 13 fertilised embryos when last time we had 14.

We used the embryoscope again and found out that loads of them once again divided funny or were multinucleated so on day 2 there were only 4 at the desired "2 cell" stage (we were feeling pretty devastated at this point)

Day 3 ideally they would have been 8 cell and we got a call in the morning saying 2 were 6 cell and two 7 cell and they thought the best place for the embryos were in me so we went in for a day 3 transfer. By the time we got there one had made the desired 8 cell stage and graded as an A grade and the other looked like it was imminently about to split into an 8 cell. Given our poor quality embryos before the consultant still recommended transferring two, so we did.

I called on day 6 expecting bad news and found out the two remaining 6 cells had both made blasts good enough to freeze (albeit one didn't do it til day 6) which I cried endlessly about as it confirmed we could make good quality blasts!!

All my symptoms of OHSS returned and so I just knew I was pregnant and did a test on 9dp3dt at 9pm at night and got my first ever BFP! I've been super tired and don't fit in any of my clothes but waiting for a scan to check it's ok and how many.

I hope my story helps and gives you some faith changes work and NICE recommend 3 cycles for a reason as it take a while to work out the best plan.

Is it worth getting your DH dna frag done again - my husbands was 19% which is really borderline but SST seemed to make all the difference.

Sorry for the length!!!!

Best of luck xxxx

hoping 2018 - sorry for the lack of reply. I just wanted to say congrats and I hope all is well. Great that you have 2 frosties as well.

We are back on the merry go round and on stim +3 today. Fingers crossed it goes better this time around. Not overly hopeful to be honest as my great plans for stringent diets, weight loss and supplement taking for the past 3 months didn't go to plan. I would have preferred to delay until October but hubbie wants to rock on so we'll see. I will keep you posted.

@hoping2018 - just tagging you to make sure you see the above if you are still around :-)

Don't know how to edit the other post!

Hi @irishgirl,

Great to here from you - and good that you're back on the IVF train!

I'm getting on well - 14 weeks today - we had two embryos transferred but just the one in there and so far so good (fingers crossed)

Keep me updated with how you get on - there's not many in our boat of lots of eggs but no good quality blasts so I'll certainly be interested to hear how you get on.

Wishing you all the best and hoping you're managing to stay cool, calm and collected in the heat and with stims!

x

@hoping2018 - that is great news! Hoping it’s a good omen for us too. EC will either be Thursday or Friday so I guess we will know soon enough.

Wishing you all the best over the next weeks and months. I hope you are taking care of yourself and baba!

I’ll keep you updated on progress xxx

@Irishgirl2015

Good luck for end of the week!