Stressed out with clinic - please help

[AnnaSteen]

Hi all,

I have just had one failed IVF-ICSI. I am 32 and DH is 34, my AMH, Thyroid, Progesterone, FSH and Antral Follicle Count all came back above average and I have regular periods and regular ovulation. My DH has a sperm count of 5mil.

However when we did the IVF I barely responded to stims, poor growing follicles and only 4 eggs. Of these 3 fertilized but by day 5 we only had one that wasn’t even at Blastocyt and got a poor grade.

My frustration is with the clinic. I wanted to do a DNA Frag test to see if we also have a fragmentation problem that would explain why our embryos were so poor and I want my meds to be increased as my response was nearly worse than someone with female factor. The clinic say there’s no point in doing a DNA Frag test as it’ll still be ICSI and that they’ll increase my meds from 150 to 175 of Gonal F which seems tiny and unlikely to make much impact.

It feels a bit like the definition of madness to do the same thing over and over and expect different results.

We were constantly told at the start that they expected my response to be great and to get great quality embryos due to our age and no female issues.

Does anyone have any advice? Am I overreacting? Are the clinic being unreasonable?

We don’t really want to change clinic as it’s very close to both our work, linked to the national maternity hospital and I also have a tricky embryo transfer and they’ve done a trial and perfected how to do it. But I don’t want to go through next round with toy bit better stimulations then another increase then another increase with no change to my DH plan (I’ve read taking sperm from testicles can help with high DNA fragmentation)

Hi @AnnaSteen I don’t think you are being unreasonable and tend to agree with you that with an above average AMH and AFC you would expect quite a few more eggs.

Are the clinic willing to up the dose during stimms if you are not growing many follicles? Did that happen at all in your first cycle? I have a high AMH so I started on a fairly low dose of Menopur -150 and did that for about 4 days -then they upped me to 225 for two days then 300 for two days. All the time monitoring and judging how much I should have each night.

It’s a lot to put your body through and you want to come out of it at the end feeling you have got the best results possible for your body.

Thanks so much for your reply. I feel like they’re very much ‘we know best’ and as I’m not a doctor it’s hard to tell what the best action is. I showed poor response from the first scan but they said there’s ‘no point’ in increasing my meds during cycle and that for next cycle it’ll only go up to 175 which seems a tiny increase. Did changing the meds mid cycle help with your stimulation?

Hi Anna

I just wanted to reply to your message because I am in a similar boat to you. I'm 36, DH 34. Unexplained infertility - all tests back normal, only exception being my FSH which was in normal range for age but at the slightly high end of normal range. We were pretty much told we'd get a great response. First cycle before Christmas I was put on a short protocol, 450ml of menopur (because of slightly elevated FSH) with Buserelin on top of it. I had a few decent looking follicles (can't remember how many, but there was no cause for concern) but at EC got no eggs. I was gutted.

Second cycle in February, same drugs but this time a flare protocol and only 150ml of menopur. Got 2 eggs, both fertilised. 1 5 day blast transfer ended in a chemical. The other embryo wasn't good enough to freeze.

Started injections yesterday for my third cycle. I will be doing flare protocol again, same drugs but 225ml of menopur.

They have no idea why I respond so poorly. The only thing they keep saying is it may be an egg quality issue. But no definites. They just say some people don't respond and it's just one of those things. So frustrating.

I've done so much research. And I've spoken to my consultant about lots of different tests but I got a similar response to you - tests are expensive etc and even if the result showed there was an issue we would just continue doing ICSI anyway, so not much point. I also wouldn't contemplate donor eggs at this stage given my age. I'm not quite ready to give up - I would need to be a fair few more cycles down the line. So I get where they're coming from. Part of me just wants answers though.

I feel in a way that the clinic isn't very innovative and that it's always me pushing for tests and different ideas and isn't that what we're paying them for?? Like this time I had to ask for a vitamin D test and to be put on asprin. They didn't even mention them but agreed they wouldn't do any harm when i mentioned them. If they won't do any harm why are they not suggesting trying them???

But on the other hand they're supposed to be a very good clinic and maybe they're right and I would just be told the same thing elsewhere. IVF is an inexact science and sometimes they just don't have the answer. I do trust our clinic and I will be having 2 more cycles there if this one doesn't work because we've already paid. But part of me wants to try one of the famous clinic abroad or the one in London that does the highly monitored IVF (can't remember the name off the top of my head).

I do know that if it's an egg quality issue it is better to go with low doses of stims as you are more likely to produce a low number of better quality eggs. High doses for people with poor quality eggs can give you several eggs but poor quality so they won't result in pregnancies. Or they might be so poor that they don't detach from the follicle wall and you get none at EC, which may be what happened to me on the first go. So that might be why they are reluctant to up your dosage any more. If I were you I would press them for a reason as to why they don't want to give you the higher dose though. They should be able to justify it in some way.

Regarding the testing - valid point with the fact they would continue with ICSI regardless of the outcome so it is potentially a waste of time and money. But if you feel you really want it - that you just need answer etc. despite the cost, then I would push for it. You're the patient and you're paying at the end of the day. As long as the test isn't harmful and they've presented you with the facts before hand they don't really have a valid excuse not to do it.

Then also you have the fact that there may be experimental treatment you could try if there was a fragmentation issue. Your clinic may not offer it so to them it's pointless having the test. You might need to seek other advice on that. It may be worth contacting some other clinics and asking if a) they offer the testing, b) what their approach is if the test is positive and c) what their thoughts are on the treatments you have read about. I really wouldn't trust one clinics advice as they will have a policy on the matter that their staff abide by. Try emailing several clinics - you might find you get some free info or a free consultation.

Hi. One thing a consultant said to me is the best test of how many eggs you have is how you respond to ivf drugs - the figures are all estimates.

I had high fish and low Amh and they expected a poor response but they got 20 eggs (I think I was on 300 menopur age 31). 14 fertilised embryos on day 1 via ICSI - day 5 we had no blasts good enough to freeze but had a BC embryo transferred and a BFN.

I also think of first cycle as prctise and learning for cycle number 2 - they didn’t know why we had such poor quality BLASTS but suggested dna fragmentation test - which was 19.8% (moderately high) so they suggested surgical retrieval of sperm for round 2 as fragmentation generally happens after the sperm leaves the testicles.

Second cycle (now age 32) they gave 225 menopur - got 22 eggs now! 13 fertilised via ICSI and two transferrred day 3. 1 frozen day 5 and 1 frozen day 6. Got pregnant with one baby - he’s asleep next to me now just coming up to 12 weeks with 2 in the freezer

For us surgical retrieval of sperm seemed to help - but we still didn’t have many blasts considering how many eggs I got.

The other thing which gave lots of information was embryoscope/time lapse - showed us most died off day 3-5 which is apparently sperm quality and day 1-3 is egg quality.

Hope that helps a bit - I would also say it’s important to have faith in your consultant! Interestingly we saw two different consultants at the Same clinic and they had very different plans for cycle 2 - other consultant wanted to change me to short protocol to help with quality and didn’t mention surgical retrieval - who knows if that would have worked!

@AnnaSteen I was pleased with the outcome of our egg collection so I guess upping the dose worked for me but as it was my first IVF I have no comparisons. What I would say is the clinic say they are generally good quality blasts but although we got a lot of them none of them are top top graded. So who knows if the amount brought down the quality?!

It’s so tricky when you just don’t really understand isnt it -I felt clueless when I was speaking to the embryologist. I agree with other posters tho -find a consultant you really trust and respect.