Poor Embryo Quality

[BellaBellini]

Hi,
We found out that our round of IVF did not work earlier this week - I was never optimistic due to the very poor quality of the embryos, but I am wondering what can cause such poor quality. I am early 30's with an AMH of 15, and had 8 eggs collected (which were frozen and then thawed at a later date due to a round that had to be stopped previously) 7 of which fertilised (we used donor sperm due to severe MF). On day 3, we were advised we had 2 top grade embryos and a grade 2, two grade 3's and a grade 4 so were feeling a little optimistic. On day 5 we were advised that we had 2 embryo's remaining which were now a 4cc and a 1-- (not sure if that was a typo from the clinic). They advised neither could be frozen so would transfer both and neither worked.
When I asked on transfer day about the poor quality the clinic advised that this kind of situation just happens and I was in such a stress I just went with that at the time, but now I'm thinking it over I'm worried that I have poor egg quality. I will talk this through with the clinic but I want to be prepared with the right questions to ask them beforehand - can embryo quality just drop like that, or should I be asking for tests to check whether there is something going on with me? I would be so grateful for any advice!

From what I've read it's reasonably common to not have any embryos that a clinic think are good enough to survive freezing/thawing, but clinics will often put these embryos back into the womb anyway in the hope that in a more "natural" environment, they could still eventually implant.

If you are in your early 30's with an AMH of 15 and have only had 1 IVF cycle, I wouldn't assume you have poor egg quality yet. I also don't know of any tests that can really tell egg quality? From what I understand it may be that your med protocol needs to be tweaked for next cycle, or that you could have better success with a day 3 embryo transfer rather than risking losing more embryos by keeping them all in culture to day 5. Hopefully your clinic can advice, good luck.

Hello, I think you may need another round before considering further investigation, as embryo quantity and grading can vary from cycle to cycle. Perhaps a change of protocol may help, ask your clinic their opinion on that.

I’ve had a 4CC frozen though, so I’m not sure why they said it wasn’t possible. Maybe because it would mean freezing & thawing twice due to your cancelled cycle, so with fewer cells it might have been risky. Under normal circumstances, you can freeze 4CC. Not the ideal grade, but they can still lead to live births.

@BellaBellini I had a very similar issue, although out of my 11 eggs collected 2 were immature and 2 abnormal. Then 5/7 fertilised and all top quality day 2/3 and by day 5 2 cc's and a grade D.
From my reading (others can correct me if I am wrong) low rates of initial fertilisation can be a result of egg quality but after day 3 sperm is more important for embryo quality. We have MFI but I assume with the donor sperm that shouldn't have been an issue?
My consultant said whilst they thought it was more likely a sperm issue in our case given some of my eggs were abnormal there could be an egg issue too, they are changing my protocol from long to short for the next cycle and say it theoretically boots egg quality, and have also suggested embryoscope and more in depth analysis of the sperm. Xx

Sorry I should add similar age and similar AMH xx

And sorry last thing sorry about your failed cycle I had a double transfer too due to the poor quality of the embryos which failed too, hope you are looking after yourself it's a horrible thing to go through xxx

There is some evidence/studies which indicate that it's sperm quality Which takes over on day 3 and makes the difference between your embryos reaching say 5 blastocyst or not. I'd be asking the clinic about your donor sperm first and foremost - it may be that you need to choose a different one?

@BellaBellini could it be because your eggs were frozen and thawed before being fertilized. I know that embryos thaw better from eggs, could that have affected the quality? You’re the only person that I’ve seen on these threads who has frozen eggs rather than embryos, so I haven’t seen it spoken about much.

Can you try a standard fresh round where the eggs are fertilized and incubated into blasts and see what outcome you get with that? You are young with a good AMH so I would say try again in this kind of cycle.

Very sorry about your failed cycle, it’s so hard. Like a PP I have a frozen 4CC. Also like another PP I heard that drop off after day 3 can be more linked to sperm issues.

According to a paper 4CCs have a 27% live birth rate and 1- -s (think that’s correct as the embryo is too undeveloped to grade further) have a 6% live birth rate so both of your embryos had a chance (the same paper puts the LBR of the best possible 4AA embryo at 47%).

What you can do to change egg quality is quite limited. The main factor is age, which you can’t do anything about. Presumably you already don’t smoke, and it helps to have a healthy BMI. I’ve heard a lot of support for using supplements (personally I took coq10) and the book It Starts With the Egg, maybe that’s worth a read?

Ps when I say you can’t do anything about age, early 30s is young in ivf terms so she shouldn’t be a significant factor.

Thank you so much for your replies, I have put together quite a list of questions for my clinic! That's really interesting to hear about the sperm possibly taking over on day 3 and is definitely something I will query and we will look at potentially changing the donor. I have also ordered It Starts With the Egg to see if there is anything else I can do to improve things for a fresh round.
@Gardenlady543 I think you may be onto something regarding the frozen eggs - the clinic advised that they were originally left out for a while before freezing as they were trying to find any live sperm from our frozen sample after TESE, none were found so they put them in the freezer, but I am wondering if the time in which they were left outside has affected the quality, we will definitely be using fresh eggs next time.
I went into this very naively, I think I thought that the hardest part was us deciding on going the donor route and it was a bit of a shock watching the situation go down hill! Thanks so much for your advice, it's really helped, I'm going to have a good chat with the clinic and keep doing some research so we can start to prepare for another round x

@BellaBellini ah that makes sense, so you’d hoped to fertilize the eggs during the fresh cycle with your partners sperm, but there was an issue so they froze the eggs to try and save them. All I know is that if there’s a choice between freezing eggs and freezing embryos, it’s better to freeze the embryos. In your case it sounds like it was the only option though and it gave you time to consider the option of a sperm donor and the opportunity to give these eggs a chance.

In my fresh cycle I had to transfer my least viable embryo and it didn’t work, and it was obviously upsetting, but it wasn’t freezable and I gave it a chance. It sounds like you did the same.

I think that if you moved forward using donor sperm which is able to fertilize your eggs after they are collected (the usual practice) that you will be giving yourself a higher chance of success, you’ll have to chat with the clinic to get their opinion on it.

I am almost at the end of my 2ww with my 2nd transfer, I’m pretty sure it’s unsuccessful. But something that helps me to move forward, is analyzing what went wrong and changing the situation to better my chances moving forward. I really hope you can get a lot from your review appointment to move forward too .

Thanks @Gardenlady543, the review is tomorrow so hopefully that should help with some answers. I'm hoping that the issue was the frozen eggs and that doing a fresh round with fresh eggs might be more successful. I hope that you are doing ok in your 2ww, it's the hardest time isn't it x