MFI advice

[UnicornPuff]

We have MFI azoospermia due to genetic absences of vas. Had a surgical sperm retrival and had a whole 6 vials to play with! A sample survived a test freeze and thaw and we were really happy.
In addition I have low AMH (9.6 at 32) and AFC 12 (have not been told if that is low or not). During the cycle everything seemed to be going better than expected, responded really well to the drugs. 9 eggs retrieved, 8 mature and 5 fertilised with ICSI. All 5 were doing well until day 5. 3 had stopped growing. 1 was still at morula and 1 was a poor/ungraded blast. They decided to transfer both and unfortunately they didnt stick.
I had a telephone review today, the poor nurse was left to call me but couldn't really answer any questions as she was just reading the embryologist/consultants review. However all that she could tell me was they they felt the poor development past day 3 was due to sperm quality and that we should do another cycle and again plan to transfer 2 back.
I feel that doing the same and planning for a bad result is a really poor plan. I am aware a SSR is not fun (neither is IVF) but should we not look at sperm quality and trying to improve that and have a second SSR and see if it is better quality or am I missing something obvious?
Any experiences or advice will be warmly welcomed. TIA.

Hi, sorry to hear about your unsuccessful sample. Can they do any tests on one of the vials to look at morphology/ dna fragmentation? If so maybe with more information you will get a better idea of what to do.

Was your DH trying to improve it prior to the SSR? Ie taking supplements, no smoking/alcohol/caffeine lots of nuts for at least 3 months. If he wasn’t then maybe there is scope for some improvement?

Has a urologist ruled out any infection or antibodies?

@UnicornPuff we are so similar, we also have MFI, I also had 8 mature eggs with 5 fertilised, and only a poor quality blast and morula left by day 5 which were both transferred. And we're at the same clinic with our treatment a couple of days apart! 😆 Haven't had my review yet but guess they will tell me the same as you that it's probably sperm quality. Like you I am really not thrilled about doing the same again for potentially (probably?) the same result. My OH doesn't need surgical retrieval but I can't think of any really significant changes he can make unless we go down the DNA fragmentation testing route, which I don't know whether the clinic will do. Started him on Co Q10 but it seems to upset his stomach and doesn't seem likely to make a big enough difference anyway. It's just all so frustrating.

Did the clinic give you any idea when you will get to go again?

@pennylane22 I am so glad you said that. I did ask the nurse about testing a vial and she seemed really unenthusiastic. We didnt prepare prior to SSR we had a date we had to have started stims for NHS funding and just rushed getting it done. We didnt even think about it. We had quite a few events so drank more than i would like to admit. My husband also cycles and we didnt even look at supplements. I feel that we were massively under prepared but just assumed the clinic would advise if we did need to do anything which is probably very naive.

@MissHoney85 I was thinking of you today and hopefully having a better plan than me! I am so disheartened to hear they really want to do the exact same thing and expect a poor outcome that they are already suggesting 2 to be transferred back! If your OH gave a sample on the day then from reading it starts with an egg I think trying to cut out BPA can help plus CoQ10, fish oil, r-alpha lipolic acid and l-carnitine. I found it quite a good book in that I felt like I had a plan. I suppose if he is not well with the CoQ10 then not really sustainable but she also says a fair amount about diet, alcohol intake and keeping them cool!
I asked about starting again and she said as we are long protocol to call on the 1st day of my next AF and then the 21 day wait. After feeling like we got no real info I have booked an appt with Mr Curtis to discuss before starting as I really cant believe this is actually the suggestion!
They called me today so call on monday to chase it's not fair to make you wait.

@UnicornPuff yes I will call on Monday, I was in a bit of a daze when I called them last week and didn't really take in what they said about how/when they would contact me.

I think it's all symptomatic of how the IVF process treats MFI, especially in the NHS probably. There's very much a cookie cutter approach and it's all focussed on the woman. The only 'treatment' they seem willing to consider for MFI is ICSI. You have to really push for a proper investigation of MFI, or pay for it out of your own pocket. As I've seen pointed out elsewhere, it's the only time you will find doctors treating one person for another person's condition. The feminist in me wonders if the system would have developed like this if the sexes were reversed! Boo. Rant over. I will let you know what they say on Monday!

@unicornpuff most women here with MFI see an improvement with supplements etc. Not enough for natural but enough to improve sperm quality. Min 3 months is recommended. And cycling is supposed to be a big no no.

If you don’t want to proceed with the sperm you have or test it and find a high fragmentation then maybe you could commit to 3 months no cycling and all the above I mentioned re supplements nuts no alcohol and then retrieve sperm again?

Aside from that you’re only option is probably as the clinic said which is to go again with the existing sperm.

@MissHoney85 we were the same as you ending up with a morula and poor blast. We got dna fragmentation tested and it came back very high which is why we are now doing Surgical removal as apparently it’s less fragmented when removed from the testicles. My DH also had a Varicoele so that got embolised as it also wouldn’t help with fragmentation. @unicornpuff did they rule out Varicoele for you?

I agree @MissHoney85 re how they ‘treat’ MFI. I had to push for urology referral and dna fragmentation test. They say the ‘treatment’ is ICSI without even investigating underlying causes.

We were lucky in that our journey started with a urology referral as the first thing the GP did was sperm sample which had no sperm to assess. The consultant examined and then confirmed via ultra sound that DH does not have the tubes that connects the sperm/testicles to the rest of the system. I am not sure about a varicoele but I am not sure it would make a difference.
Unfortunately although my husband seemed very up for me to take lots of supplements and starting again he is less enthusiastic about himself! I think we will stupidly go forward have the same result and then maybe once he has had the time to process he will hopefully change his mind! It was quite a big shock yesterday as after the SSR they were really positive said a sample had survived a freeze and thaw and then out of the blue yesterday it was all back in his shoulders.
I know that MFI is really poorly assessed. I read that on average sperm quality has decreased by almost half in comparison to the grandfathers. Not sure how they got that figure but that is a scary number. I am guessing it is the same with lifestyle BPA/plastics and you wonder if that is true for 2 generations down and we dont have a lot of treatments for it then when are we going to look into it?

Hi I just wanted to reply to this as it may or may not help..we have MFI and after 2 failed ICSI decided to use donor sperm. With a tested high count donor we only got 2 5 day embryos and both were short of blast stage. I am currently in the 2WW but it's unlikely either will develop as all the other embryos stopped growing (we had 7 fertilise out of 9) so a poor embryo may not necessarily be down to the Sperm. I have borderline low AMH am 36 and have a suspicion now that my egg quality must be poor. I take supplements, exercise regularly and my only vice is a few glasses of wine/ciders at the weekend.

Hi Stace999 that is interesting! Ive asked to use embryoscope this time round so we can see when they stop going. Did you use this before to see when the growth slowed? If this round doesn’t work for you would you ask for DHEA?

@Pennylane22 hi my clinic use embryoscope as standard they were good until day 3 then slowed which I've read is usually down to the Sperm. I'll need to have a chat with the clinic if the result is negative but know the donor sperm is good as he has been successful in other rounds including for me with an iui (early miscarriage)
Is DHEA as supplement? I'm already on proxeed but will try anything.

DHEA is apparentltcto improve egg quality. You should get the book ‘it starts with the egg’. Lots of information in there on improving egg quality. That’s interesting re the embryoscope showing fine until day 3 which I have heard is sperm! It’s such a mind field isn’t it!!!

Sorry - a medication

@stace999 I would get the it starts with an egg. It goes into lots of supplements which I have gone and got myself everything apart from the DHEA and melatonin. They both require a prescription in the UK. Also she suggests getting a blood test prior to starting DHEA and I have done some reading and if your bloods are not on the low side then supplementing with DHEA can actually cause the opposite so reduced quality and number of eggs.
Unfortunately the research into MFI seems few and far between but there does seem to be some suggestion out there that increased egg quality can help reduced sperm quality. So it is worth a try. Plus increased egg quality shouldn't hurt anything!

@Pennylane22 is the embryoscope like the time lapse imaging? From our telephone consultation it seemed pretty apparent they made it to day 3 and then started to drop off.

@MissHoney85 have you heard from the clinic?

@UnicornPuff yes called yesterday and they are still waiting on the consultant's part of the review, guess we might have a different consultant to you. Also mentioned that my period kind of vanished after OTD and I never got the heavy period I was told to expect. That is apparently odd so I need to go in for a scan tomorrow to see what's going on. Now worried that I've messed up my body forever! 😢

@MissHoney85 you will not have messed it up forever it will just be adjusting after all of the hormone manipulation. I am still having cramps and although my AF was slightly heavier it only lasted 2 days instead of my normal 5.
Good luck for tomorrow. Maybe they will be able to give you more information.

@UnicornPuff thank you I will have a look at it. Awaiting otd then if negative I will speak to the clinic see what their thoughts are. We shouldn't have an issue with reduced Sperm quality as we are using a Sperm donor, DH has very low everything and high fragmentation so after 2 failed ICSI we decided to take this route..fingers crossed its worked but I am not overly hopeful!

Hi just wanted to join and get a bit of advice.
I’ve just had a first round of icsi for male factor. Out of the 13 eggs collected we only had 5 fertilise and then only one day 5 good quality blast transferred yesterday. I’m not getting my hopes up too much as it’s a first go but just wondering if it’s normal with male factor to only have one embryo to transfer and none to freeze? We were told there was another blast but wasn’t good enough for freezing.
I’m wondering whether to stay at the nhs hospital and fund our next round but ask for some more testing on my oh? Or just have another full round and not question it x

@Littlebb2020 congratulations you have a good one on board.
I am not sure exactly what is 'normal' but I know how disappointing that is. If the cycle is unsuccessful then your cycle will be reviewed. I am waiting for my official review as I didnt feel I got enough info over the phone. I also think some clinics do NHS and private so you may not need to move clinic and you may be able to 'top up'.
Stay positive you had a good quality blast at the end which is hopefully burying in now.

@UnicornPuff I went to the clinic today for my scan. They couldn't see anything nasty lurking in my uterus so guess that bleed was my period 🤷 I had my review face to face with a nurse while I was there. Apparently the embryologist said embryo development was 'variable' and has suggested using a solution called Spermslow next time to help choose the best sperm. Not sure why they don't do that as standard, but there you go. The consultant recommended by OH take Wellman which he already does (well, Zita West conception vitamins). The nurse recommended Proxeed or Impryl, kind of unofficially - she said they don't formally recommend them at the clinic but she used to work elsewhere where she saw it make a difference. They are expensive but at least it's something different to try! Weirdly going to the clinic made me feel.... I don't know, nostalgic or something? Really want to start again asap but guess we should probably give it a few months for any supplements to work. Hope you get more info at your meeting!

@MissHoney85 that was a good outcome then and you got some good information. I have been looking at PICSI and couldn't see that they did it so that is encouraging that they offer slowsperm as my understanding is it is a very similar.
I have been feeling the same and wanting to wait and now I just want to start straight away! It's like I am forgetting the sad part and focusing on the baby! When did they say you could start again?

@UnicornPuff she said I can pretty much start when I want, just call before the start of the cycle I want to begin on. She did recommend giving about three months for the supplements to work though if we are going to use them. I figure if I wait for this period and the next one, by the time EC comes around it should have been about 3 months... Waiting is by far the worst part of this process, give me injections any day over waiting!

I'd suggest seeing Mr Ramsey to see if dna of the few sperms that you have can be improved with supplement or medication. We had a very low sperm count and this did improve the quality for our second IVF. We were told that our sample was too low for Picsi or Macs (SA was ~400 000), but even without it our fertilization rate went from 5/9 and 1 embryo on day 3; to 9/9 and 3 blasts on day 5. Good luck!