High Drop Off Rate

[unknownscot]

Hi

I'm looking for advise regarding drop off rates.

Cycle 1: 22 eggs collected, 21 ICSI injected, 14 fertilised, 1 blast
Unsuccessful FET

Cycle 2: 34 eggs collected, 31 ICSI injected, 5 fertilised

Wondering if anyone has had similar and can share information?

We have unexplained infertility

X

I have no personal experience but I'm given to understand, after extensive lurking on these boards, that a very high drop off rate is not uncommon when you produce a large number of eggs. Which is why some clinics focus on mild or natural (or natural modified ? Don't remember the name) IVF to focus on quality over quantity. Maybe you could mention that to your consultant and see if it might be a good option for you ?

Anecdotally I've seen that too @Marty13

This seems to be a contested area in IVF papers/summaries that I've skimmed over. Some studies have said 15-20 eggs are optimal with worse outcomes above; others have found continuing increased live birth rates the more eggs you get.

(e.g. www.fertstert.org/article/S0015-0282(18)30431-X/fulltext )

Something to ask your specialist about probably - maybe having less stim and lower egg goal in hope of more maturity.

@Marty13 @indub

That's interesting. Thank you.

I had heard of "mild" IVF and not sure what it was. I'll write that down in my notebook to research it and ask the consultant. Thanks

X

The high drop off rate does suggest poor egg quality- i had similar low fertilisation rates (less than 30%) - I changed to natural modified IVF focussing on far fewer follicles and fertilisation increased to 100%

@ivfbeenbusy

Wow, that's an amazing change.
What exactly is natural modified IVF?
X

@unknownscot

It's basically very low dose drugs - tamoxifen tablets daily from cycle day 3 and 150ml Bemfola stims every OTHER day from cycle day 3 - egg collection around cycle day 12/13.
Idea being to not force your body to produce follicles it would never have chosen in the first place but just give a nudge to ones that your body had selected as the best. It is a gamble though.

Over 2 cycles of short protocol IVF I had 28 eggs - less than 30% fertilised with ICSI and 4 average/low quality blastocysts. PGS tested 2 - neither normal

Over 2 cycles of natural modified IVF with ICSI I got 9 eggs. 100% fertilised and 4 top quality blastocysts- 2 are my twins which were born just over a week ago and we have 2 more blastocysts frozen

Not many clinics offer natural modified though as they can be a bit snooty about it - their entire business model is based on quantity not necessarily quantity

@ivfbeenbusy

That's very interesting. I'll try and read more about it. We're in Scotland and don't believe anywhere offers this but would happily travel to Manchester as I see create allow natural modified.

I wonder why most clinics don't allow it?

Congratulations on your twins ❤️👏🏽
Xx

My question is at what day do they drop off at?

@WhatKatyDidNxt

My question is at what day do they drop off at?

I have low fertilisation rate - as posted in my original post.

In cycle 1 - 7 made it to day 3 but very fragmented

Cycle 2 - 4 are very fragmented today (day 3)

Hey I’m no doctor but I did some reading on this and understood that if the fertilisation rate is low initially then it’s likely to be egg quality. If they’re dropping off around day 3 then that’s the time point the embryo genetic material is “activated” whereas before this point it relies on the egg more. The embryos genetic material is of course from the egg and sperm so if they’re dropping at day 3 it may be sperm quality. Do you have male factor at all? Maybe if you haven’t already you can check out dna fragmentation for your partner. Yours seem to be going ok until day 3...so have a read of some papers and ask your dr

Again I am not a dr, this is just what I understood from reading a bunch of papers whilst in a panic on my waiting during day 3!

My question wasn’t about fertilisation rate, it was about when the fertilised ones arrested. As ohpeanuts said if it’s around day 3, then that’s normally a sperm issue. As before that the egg drives them forward

@WhatKatyDidNxt @OhPeanuts

Hmm, I'd say it's a mixture of fertilisation and day 3.

Fertilisation
Cycle 1: 66% fertilised
Cycle 2: 16% fertilised

Day 3
Cycle 1: 50% made it
Cycle 2: 80% made it but all fragmented

Day 5
Cycle 1: 14% made it (of the ones that made it to day 3)
Cycle 2: we aren't there yet.

I think it's so hard when the embryologist states on day 1 that they aren't sure if it's a sperm or egg issue regarding fertilisation rate.

I feel at such a loss just now.

[quote unknownscot]@ivfbeenbusy

That's very interesting. I'll try and read more about it. We're in Scotland and don't believe anywhere offers this but would happily travel to Manchester as I see create allow natural modified.

I wonder why most clinics don't allow it?

Congratulations on your twins ❤️👏🏽
Xx[/quote]

I was with Create Birmingham

It's not that other clinics don't allow it it's just that generally their business model is based on numbers - if they admitted that actually lower dose drugs and fewer numbers is just as good if not better than maximum follicles they'd have to change their whole ethos

[quote unknownscot]**@WhatKatyDidNxt* @OhPeanuts*

Hmm, I'd say it's a mixture of fertilisation and day 3.

Fertilisation
Cycle 1: 66% fertilised
Cycle 2: 16% fertilised

Day 3
Cycle 1: 50% made it
Cycle 2: 80% made it but all fragmented

Day 5
Cycle 1: 14% made it (of the ones that made it to day 3)
Cycle 2: we aren't there yet.

I think it's so hard when the embryologist states on day 1 that they aren't sure if it's a sperm or egg issue regarding fertilisation rate.

I feel at such a loss just now. [/quote]
It really is so difficult, I completely empathise with this. Did you have any changes between the two cycle protocols that could have meant a lower fertilisation rate second time?

I think on day 1 if there is a sperm issue it can also mean even with ICSI the sperm don’t decompress so the egg doesn’t fertilise. But could also be the egg causing trouble at that point so that’s maybe what the embryologist meant. You are getting loads of eggs each time so maybe they’re not maturing properly? You could ask your dr about that potentially.

Just wanted to update and say we have zero day 5 blasts 😢

Oh no 😢. I’m so sorry to hear that. I hope you’re doing as ok as possible and being kind to yourself. This is all just so unfair.

If you’re having a consultation with your dr I hope you get some sort of answers 🤞. I don’t know if you’re ready to think about it but if so some of the things I’ve read about which seem to have made a difference are double triggers, hcg triggers, proxeed for sperm...? Of course you probably already know this or may have already done this so I’m sorry if I’m not being helpful, just feel like I want to say something. Xx

@OhPeanuts

Oh no 😢. I’m so sorry to hear that. I hope you’re doing as ok as possible and being kind to yourself. This is all just so unfair.

If you’re having a consultation with your dr I hope you get some sort of answers 🤞. I don’t know if you’re ready to think about it but if so some of the things I’ve read about which seem to have made a difference are double triggers, hcg triggers, proxeed for sperm...? Of course you probably already know this or may have already done this so I’m sorry if I’m not being helpful, just feel like I want to say something. Xx

No, although I've heard of these things I've not looked into them or discussed them so thank you x