Total fertilisation failure

[Fabsco]

Hi Ladies,

I thought of sharing my first IVF experience here as there aren't many threads on total fertilisation failure on MumsNet. My husband and I have been trying to conceive for two years now. I got pregnant in October 2020 but had a miscarriage one week after getting a BFP. It was heartbreaking for us, so we decided to start IVF treatment in December 2020.

I had my egg retrieval procedure yesterday and was told that nine eggs were retrieved. Later in the day the embryologist phoned to advise that all nine eggs were going to be fertilised via IVF. It was excellent news for us as we were told that around 80% of eggs are mature enough to be fertilised.

Today we got the devastating news that no eggs were fertilised in the end. The embryologist said that the sperm 'had been swimming around the egg' but none attempted to fertilise them. The suggested ICSI at the next cycle and that was it. He gave us no hope that they would continue to monitor fertilisation or go for a rescue ICSI. He simply said that they don't perform ICSI unless there is evidence of infertility from either side.

We are confused because we were advised to choose the ICSI option at consent stage in case it was needed in our treatment. We don't understand why it wasn't used in our cycle or performed at a later stage. We got no follow up phone calls from the clinic, apart from a nurse asking me to stop taking medication as I had a failed cycle.

I would be interested to hear from anyone who had a similar IVF outcome on the follow-up steps you've taken after being informed that none of the eggs were fertilised, please.

Thank you so much for sharing the info with me. It gives me reassurance that I am not the only one.

I'm sorry you had such devastating results

My experience isn't quite the same and is actually the opposite in that my fertilisation rate with ICSI was awful - clinics throw about stats which say fertilisation should be around 90% with ICSI and mine was less than 30%.
I asked about doing half and half - so half IVF and half ICSI on the next round but they said they couldn't do that as the egg has to be prepared for ICSI by removing the outer layer or something like that so that's maybe why they couldn't do rescue ICSI on yours as there wasn't the time by the time they realised that fertilisation had failed by normal means?

Anyway I changed to natural modified IVF and focused on far fewer eggs and fertilisation with ICSI jumped to 100% so something to consider for the future

@ivfbeenbusy Thank you for sharing your experience and I'm sorry to hear that your first cycle wasn't successful. I happy to hear that your second attempt was successful and have taken note of your suggestion. We haven't had our review appointment yet, but hope to have it in the next week or so.

The senior embryologist at the clinic phoned us this afternoon and explained to us exactly what you said. It was too late to perform ICSI but he would recommend that this is performed in the next cycle. He also said that the clinic doesn't test the sperm or the egg for abnormalities after total fertilisation failure as the solution for whatever issue that they may have is ICSI? Not too sure about that, but I guess we'll ask the consultant about further tests once he calls us.

Thank you so much again for sharing your experience. It's been a hard day today, but tomorrow will be better.

Hi Fabsco

We got TFF news last week too, it is absolutely heartbreaking. I have low amh & hubby has low motility. 1st ICSI cycle, 5 eggs retrieved, 1 wasn't mature, non fertilised. The embryologist said the staff do a medical review on Thursdays & will be discussing our case to try to figure out what went wrong (but that doesnt help much when you are left with your own thoughts & google in the meantime) This was our 1st cycle so im afraid I can't offer any pearls of wisdom but I hope you get some answers soon

@Catmum7 I understand what you're going through; it's just heartbreaking. Even though the clinic discussed their success rates with us, we had hope that they would be in the 20-30% that get pregnant in the first cycle. I got the news a few minutes before joining a work meeting on Zoom and honestly don't remember anything that was discussed at that meeting. It just felt like a bad dream that I was trying to wake up from.

The little that I remember from the embryologist phone call was that the sperm had been swimming around the petri dish and didn't even attempt to fertilise the egg. So strange! Doing some research on Mr. Google, I found that the sperm might not recognise the egg if they are not mature enough or if there are genetic abnormalities with the egg or sperm. I'll ask the consultant tomorrow about those and will share that they say.

We'll have our review appointment tomorrow, so I'll ask them lots of questions and will get back here to share the answers. To be honest, I think that they won't share much more than what they already did, but we'll ensure that we have a lot more info than the first time before committing to a second cycle.

I hope you also get some answers in your review appointment and please don't lose hope!

Hi Fabsco

It's so difficult trying to work with all this going on,
Im really struggling to concentrate. I know what you mean about the phonecall, you hear the bad news & the rest is a blur.

A song keeps going round my head, the lyrics go 'nobody said it was easy, no one ever said it would be so hard', ain't that the truth!

I really hope you get some useful feedback at your review to help plan your next steps

Hi! I'm so sorry to hear about your pain. On my second round 10 eggs were collected but only one fertilised. It didn't make it past day 3. This was after I had two embryos the first round and the consultant and embryologist couldn't understand what had happened. They suggested I did ICSI the following round but after reading a lot about fertilisation issues I also asked for my trigger shot to be increased to 10000 Hcg. The clinic said it wouldn't make a difference but in my third round I only had 5 eggs collected- but all fertilised and all made it to day 5.
Good luckx

@Catmum7 Thank you so much for your kind words. I feel like I need to take some time off work, but also worry about not completing the tasks assigned to me as I really need this job in order to pay for treatment!

I had my review appointment today. As I expected, there wasn't much more to what they had already shared with us on the day after egg retrieval. They don't really know why none of the eggs were fertilised, as both the eggs and sperm had good quality and quantity. They recommend ICSI if we decide for a subsequent cycle. The stimulation protocol that I was on seemed to work and there's nothing that they would do differently apart from ICSI.

I asked the consultant about hard egg shells and she said that there was no indication of that. One thing that she said that contradicts what the embryologist told me is that the sperm tried to fertilise the egg but there was no fertilisation after 24 hours of observation. The embryologist had told me over the phone that the sperm were swimming around the petri dish and away from the egg, which could indicate some sort of immune incompatibility. She said that it wasn't the case.

I then asked her what our chances of pregnancy were if we were to commit to a second cycle with ICSI, and she advised that they are the same as before as total fertilisation failure doesn't mean that subsequent attempts will be unsuccessful. She even said that, before ICSI procedure was created, couples were advised to go for another round of IVF as the chances of repeated TFF were very low.

She advised me to take a couple months' break and go back to them if we decide to go for another cycle with ICSI. OH and I will have a think about everything and see where we are financially and emotionally before committing to further treatment. I kind of want to request information about this failed cycle and take it to another clinic to see what they say. I am just not totally convinced that it was just bad luck and there's no explanation to TFF?

@Matilda128 Thank you so much for sharing your experience with me. I'm happy to hear that your third round was successful and well done for standing your ground! I did ask the consultant at my review appointment if they would do anything different in my second cycle (i.e. choice of meds, dosage, length of protocol) and she said that they would use the same protocol as it worked as expected. OH and I may consider other clinics as we are not totally sure TFF is down to bad luck? We worry that we will have the same outcome if we continue with the same variables.

Hi Fabsco

Im wondering if its maybe a good thing they dont know why it happened (although frustrating when you want answers to do all you can to prevent it happening again) as it means they couldn't find any obvious causes & it was just down to rotten bad luck??

I was thinking about getting a second opinion before starting our next cycle too, I dont see how it can hurt 🤷‍♀️ Sometimes I just feel like a number to them, I've been called the wrong name on 2 separate occasions & the nurse who ordered my meds hadnt a clue who i was or why i was there, she also made a mistake on the prescription & i was charged for prostap even though id already taken it & paid the clinic directly. It doesnt really inspire confidence 😔

@Catmum7 I suppose it could be a good sign that they don't know what has caused it, but I also feel that it doesn't hurt to get a second opinion. I was a bit disappointed as well that they deactivated my Patient Portal account today, as I wanted to submit some additional queries to the consultant. She told me that I could contact her via the portal if there was anything that I had forgotten to ask.

I'm sorry they messed up with your medication order; that's not acceptable. My clinic outsources all medication orders, so patients have to pay for the medication directly. I suppose it works best as you receive a list of all medications that you're getting before payment. I was on a high dose of Menopur and spent nearly £1200 only on meds.

I have just found out that the NHS practice that does fertility treatments in my city also takes private patients, so we might see if we can book an appointment and hear from them on available treatments for us. Good luck with following appointments as well and please let me know how they go!

I know this is an old thread but I also had total fertilisation failure with IVF and struggling to find much info on it. We got a good number of eggs but none fertilised and have been advised to try ICSI but I am wondering what the chances are that we get a different outcome with it. @Fabsco if you are still around on the forums I wonder if you tried another round and what the outcome was?

@Hopefulhedgehog1 I'm sorry to hear that you had total fertilisation failure; it's devastating news that we never ready for. After our TFF, I contacted a good number of IVF clinics in Europe and got the feeling that most clinics would go for ICSI as a standard procedure if the woman is over 40, but that is not the case with clinics in the UK, where ICSI is only done if there's a male factor or if the first cycle of IVF fails. One of the European doctors that I contacted after our TFF said that 'it seems that they are still doing IVF over there like we did in the nineties...'

We did two more cycles of IVF with ICSI after our first one and got good fertilisation results: we got four out of six eggs fertilised in the second round and three out of four eggs fertilised in the third round, and got four good grade embryos (5AA, 5AB, 4AA, 5BB). Unfortunately I had two miscarriages from fresh transfers in each round and had to take some time off everything to recover, both physically and psychologically. We still have two embryos left andI hope to transfer them in the new year.

My piece of advice is to look after yourself and take time to process everything before starting a new course of treatment. I have been in and out of IVF clinics since September 2020 and made the treatment my priority. However, if I have learned anything from the process is that my priority has to be myself above everything else. I felt like I was a time bomb and needed to do as many treatments as possible before I run out of eggs or the quality decreases, but my perspective has changed a lot over the years. Feel free to contact me via DMs if you want to chat about your treatment, and I wish you all the best!

Thanks so much for your reply @Fabsco. I have struggled to find much information on TFF and especially the success rates of ICSI after TFF with standard IVF.

We got 16 eggs so were absolutely floored when told that none had fertilised. We haven’t had a formal review yet but they do not seem to know why as lots of the eggs were mature and the sample was good. I feel like I have gone through so much in that round to not even get one embryo to transfer seems such a waste and a huge thing to embark on another round again with egg collection etc. Luckily in our area we get 3 full rounds on the NHS so money does not come into it yet.

i am so sorry to hear about your losses. After all you’ve been through to get that far it must have been devastating. Wishing you lots and lots of luck when you feel ready to transfer again.

@Hopefulhedgehog1 Just a little hope, hopefully. 1st try- IVF , we got total fertilisation failure. So they tried ICSI next and we got very good fertilisation. No pregnancy as yet, but the fertilisation was good. Best of luck.

@Fabsco Sorry to hear of everything you went through. All the best.

Thanks @Thelotusflower i really need this right now 🙏

@Hopefulhedgehog1 Absolutely. Hope is certainly not lost! Many people are lucky when IVF works first time, but for others the first time is almost a test run as doctors will have no way of knowing how any of us will respond to anything. So second time round they will tweak things amd gopefully get a better outcome. Wishing you all the best. Its a tough process, but hang in there.

Hello! We had TFF on our first round, we were devastated. We then got 4 top quality blastocysts on our second round, one of those is asleep next to me as I type! We added artificial oocyte activation to the eggs which may have may have helped the sperm to fertilise them second time round. X

@Raggity19 thanks so much for your post this is just the hope I need right now. For your second round did you do ICSI or just repeat IVF with the added activation? I am NHS so I’m not sure if that will be available but useful to know as I can ask about it at my review. I am so happy there was a happy outcome for you.

@Hopefulhedgehog1 we did ICSI both times. Good luck, it absolutely broke us so I’m really sorry that you’re going through this. But it was all worth it in the end and we have a beautiful daughter, actually welling up writing this! Defo worth looking into, it was an add on but only around £140 so I can’t imagine they would refuse you it, especially if you pay for it x

Hi hope you don’t mind me jumping in! @Raggity19 it’s so good to hear a AOA success story after TFF with ICSI. Most of the cases of TFF I’ve read about have been with IVF so ICSI has been the solution. We’ve just had two rounds of ICSI with zero fertilisation so going to use AOA next time. Can I ask whether the reason for your TFF was known and whether AOA was recommended as a specific solution? Our embryologist was quite negative about it, saying they don’t know enough about who it helps etc but I just think why not give it a try!

@Hopefulhedgehog1 further to what Raggity said about costs / availability, of the two clinics I have experience of, one doesn’t offer AOA at all and at the other it’s free (for patients where it’s been identified as a potential benefit)

@GreyZebra not at all! So ours was MFI due to my partner having cystic fibrosis (asymptomatic so we had no idea). He had his sperm retrieved and frozen. They said they think the thaw killed the sperm but they still injected my eggs anyway, then no fertilisation…second round we did a fresh sperm retrieval at the same time as my egg collection and then used AOA. My consultant was sceptical and said he didn’t know if it would make a difference - it may not have but I would definitely use it if we do it again. I had just researched and researched and read that some sperm lacks a specific type of calcium that prevent them from fertilising eggs, and that AOA overcomes this - again, no idea if this is right or not!

Thanks @Raggity19 that’s really helpful. I know a tiny bit about CF (have a relative with it) but never heard of asymptomatic CF, must have been a real rollercoaster for you both so I’m so pleased you were successful! We have MFI too (Y chromosome microdeletion) so great to hear AOA (maybe!) made the difference to you.

Hey.
I know this is a pretty old thread now so might not be active anymore..but as what happens when you fall down the Google rabbit hole looking for answers you come across certain things..
hubby and I have just been through our first round and only round of nhs funded ivf. Sadly it was cancelled following egg retrieval as 0 fertilisation from 14 eggs. We were absolutely shattered mentally from this. Had no idea what to expect throughout but after retrieval and the confidence behind them afterwards the embryologist herself said she was shocked. She also mentioned there had been no interaction between the egg and sperm and suggested icsi next time. We are now facing the decision of how/when to go forward considering the cost and how our first journey ended 😔
thanks in advance and hope you’ve all had positive news since this thread x

Hello, I know this post is old but I was so grateful to read your stories @Fabsco @Catmum7 @GreyZebra @Hopefulhedgehog1 @Jeseusprest @Matilda128 @Raggity19 @Thelotusflower @ivfbeenbusy Thank you so much for sharing. I recently got my egg collection results and from 10 none fertilised. I’m heartbroken. I have two more rounds on the NHS and the embryologist advised ICSI next cycle as the sperm didn’t bond to the eggs. If any of you have any success stories following your posts I’d be grateful to read them. Thank you x

Hi @Toots27 no success story here I’m afraid but just wanted to say I’m sorry you’re going through this. It really is devastating so I hope you are taking care of yourself. Whilst we still haven’t had any success, we haven’t had another round with zero fertilisation so hopefully this is a one-off for you too. Good luck.