Normal AMH and everything but failed 3 ICSI/IMSI, sperm issue or just number game?!

[avocado2019]

Age 39.5+, I have recently tested different things, (and have been taken the suppliments for 4 weeks now). Here are my numbers: DHEA238, AMH (was 13.5 last March but 16.9 now), day 22 progesteron 32.7 nmol/L, Thyroid hormones normal, Testosterone 0.893 nmol/L, Free Testosterone - Calc.0.009 nmol/L (Range: 0.003 - 0.03). I have 3 failed ICSI (last one being IMSI) between May and November last year. Egg collected between 7-13, have sperm issue low motility and morphology but this can be overcome with ICSI, then also with high sperm DNA fragmentation, partner had been taken Impryl for a few months, and we are seeing urologist on Wed to check the new dna fragmentation and decide whether worth Testicular retrieval. I felt quite doomed after failing 3 cycles, and not easy to turn that page over and embark on a new cycle. I am starting the 4th cycle now and really don't know how to manage hope. It seems that everything's fine with me, is sperm quality REALLY affecting this bad? or it is just the chance of good quality egg that related with our ages and we just need to believe it's the number game and just go cycle after cycle till we get it? Has anyone had experience or opinion with testicular sperm retrieval? Many thanks!

No experience of testicular sperm retrieval but we also have MFI issues. At what stage is the process failing for you? My understanding is that when embryos stop developing between Day 3 and Day 5 it might point to a sperm issue. I also understand that a better quality egg is more able to 'compensate' for lower sperm quality, so it might be worth considering what you can do for your egg quality too - different supplements maybe or trying mild IVF?

How many embryos did you get on each cycle and what was quality like?

Unfortunately at nearly 40 the deciding factor is going to be age and egg quality - women in their 20s can expect that 80% of their eggs are chromosomally normal but get to 40+ and 80% of eggs are forecast to be abnormal and at 45 it's more like 90%

Thanks @MissHoney85 and @itwasalovelydreamwhileitlasted first ICSI 7 eggs, all fertilised, 5 embryos, 1 3BB, 4 others are not viable to freeze, 2nd ICSI, 13 eggs, 12 fertilised, 6 top quality embryos on day 3, 1 3AB on day 6 plus a morula, both transfered failed. 3rd IMSI, 7 eggs, only 1 fertilised, arrested on day 4.

@avocado2019 sounds a similar scenario to mine. We've only had one round so far but had 5 fertilised eggs (with ICSI) with only one 3BC and a morula left by Day 5. The consultant and embryologist think it's a sperm issue. All OHs parameters are low and I wonder if there's some DNA fragmentation issue, though we haven't tested for that. For next round my OH is taking this supplement I found called FH Pro and switching to loose boxers (can't hurt right!) and I'm going to try taking melatonin to boost my egg quality.

Id be interested to hear what your urologist says and especially what impact Impryl had as I was taken between that and FH Pro!

When you say thyroid normal do you have your numbers? Subclinical hypothyroidism can also affect fertility, implantation and early miscarriage I believe. Ideally you would want your TSH levels to be between 0.4-2.5

Also agree the sperm fragmentation test might give a reason as to why your eggs are fertilising but not developing well.

Next month will be my 5th round of IVF and despite trying lots of different supplements over the last 18 months I can really believe they haven't made much difference to egg quality - what has made the difference however is changing my protocol and reducing the drugs right back.

@itwasalovelydreamwhileitlasted what was your protocol before and after you reduced the meds? And do you think you inproved the grading quality or whether the embryo was Euploid or Aneuploid?

@Violet180
Last year I did two cycles of short protocol IVF - 225ml bemfola from cycle day 2 with cetrotide from day 6. First cycle was a freeze all due to OHSS

Cycle 1 - 14 eggs collected 5 fertilised normally - 3 blastocysts frozen - 2nr 3AB and 2nr 5BC
Transfer 1 - BFN
Transfer 2 - double - ruptured ectopic but it could have been naturally conceived as we were still trying during transfers

Cycle 2 - 12 eggs collected - 3 fertilised. 2nr 5bb blastocysts PGS tested - 1 was complex abnormal not allowed to transfer and the other a low level mosaic which was transferred and a BFN

Clinic has said all along how surprisingly poor my eggs are. So we switched to a 3 cycle package of natural modified as I really don't think my body is designed to produce so many eggs.

New protocol is 20mg tamoxifen tablets from cycle day 3 and 150ml bemfola every OTHER day.

Cycle 1 - 2 eggs collected BOTH fertilised - both top quality on day 3 - a 4bb frozen which was very close to an aa and they froze one another Too quality one day 3 which is clinic policy

Cycle 2 - clinic reduced Bemfola to 75ml and added 75ml luveris - 7 eggs collected 6 fertilised. A 4aa blastocyst frozen which is the best I've ever had a 5ab

Cycle 3 - dropping the tamoxifen as it has tendency to thicken lining and I want to do a transfer on this one. Will start 150ml bemfola daily but not until day 4

So for me significantly reducing protocol has changed fertilisation rate from less than 40% to nearly 100% - on day 3 my embryos have all been grade 1 or very close to it (didn't get any of those last year)

@itwasalovelydreamwhileitlasted feeling so happy for you! as you now have s reassurng number of top quality blastocyst in stock! Very best luck for your transfer. that all sounds much more hopeful situation. Thank you for sharing. the milder stimulation does make a huge difference, at least in your case. In my case, my 2nd and 3rd round and the upcoming 4th round is done in the same clinic. The consultant kept saying he think we shouln't change the protocol (long protocol) as he is happy about the number of eggs collected. Although I have a high fertilisation rate in the 1st and 2nd round, the 3rd round is disastrous, 1 out of 7 fertilised. I spoke with another consultant, she suggested keep the long protocol but change from Manopur to Gonal-F. The clinic where I did my 1st round suggest considering donor egg. they don't think it's meaningful to try with own egg (very heart breaking to hear). I am courious if you did your last 3 cycle as freeze all cycles cause you want to bank embryos? And did you do it back to back or with 1 month rest in between 2 cycles? I am considering doing 2 rounds of freeze all then transfer later ( if I am lucky to have viable embies to freeze). Many thanks!

Hi, @Chillichutney1 thanks for the insight. Here are my numbers:
TSH 2.08 mIU/L (Range: 0.27 - 4.2)
Free T3 4.04 pmol/L (Range: 3.1 - 6.8)
Free Thyroxine 14.300 pmol/L (Range: 12 - 22)

Any insights? seem mine is at the higher end of the range you recommended.

@avocado2019
I think clinics are too quick to jump to donor eggs - they do it because of the success rates for older women being so low and repeated failed cycles just brings their numbers down (or maybe I'm too cynical!)

My package means we have to do 2 freezes before transferring on the 3rd collection - I think they do this so they can pick from the best of them rather than only maybe having 1 or 2 to choose from.

Because its very low dose I am cycling back to back - my egg collections so far have been exactly 4 weeks apart - my periods are very regular though which helps so I'm expecting to start final cycle next week - it helps that they are over so quick - I'm usually only on medication for around 7-9 days

@itwasalovelydreamwhileitlasted thank you so much! I really love this: "Because its very low dose I am cycling back to back - my egg collections so far have been exactly 4 weeks apart ". I really like it that I don't have to wait between cycles and don't have to sacrifice the body for constant heavy stim. If this cycle is not with good outcome, I am weighing heavily on this plan. Unfortunately we wont be able to afford doing multiple cycles in UK so considering doing in in Greece after doing some research.

@avocado2019
My package including x3 ICSI, all drugs freezing and storage for 6 months and a transfer cost £13.5k x

Hi, @itwasalovelydreamwhileitlasted. Thanks for sharing the information. That is a very good package cost. Would it be possible to know which clinic? I can PM you if you prefer. I heard CARE is good for minimum stimulation/natural cycles. The two clinics in London that I have done previous cycles are much more expensive. That's why I thought my only hope for multiple more cycles are abroad.

Hi, everyone. I have got some updates today. We have had our consultation with the urologist. The not positive news is that the test shows sperm dna quality in testes is not much better than ejaculated sperm, that means the good news is that partner won't have to go through surgery. So this means the hope for the magic of testicular retrieval doesn't apply to us... we will have to just play the number game ;( So ladies I have learned that if you want to speculate whether sperm retrieval will make a difference you can do the Alkali and Neutral COMET in the dna fragmentation test - that's a piece of knowledge I find worthy today.

@avocado2019
I'm with Create in Birmingham - their London clinic has just been named has having top results in London and I've been to that clinic a few times for scans etc as I work in London a lot x

@itwasalovelydreamwhileitlasted Thanks so much! Sorry I mean CREATE (not CARE) in my previous message. I will definitely find out more with them after this cycle. I start stim today. hope great news come your way with your great strategy!

Sorry OP forgot to come back to this. Your thyroid numbers don't look too bad actually, its recommended to be under 2.5 for fertility and early pregnancy and around 1/2 is optimum. The thyroxine should be in the upper end of the range of 12-22

Have a read of this to see what is recommended, the only issue with mild low thyroid levels is that while it may affect fertility, GPs don't see the problem and wont treat it at all. Speak to someone at CREATE about your thyroid levels as they seem to be more clued up about the issue