Low fertilisation rate with ICSI - Low AMH

[PPPPPP]

Hi everyone, hoping for some advice.

For background, I’m 32, AMH of 3.3pmol. On 225 bemfola and cetrotide with ovitrelle trigger.

1st IVF : 8 eggs, 6 mature, 1 put in at day 3 - BFN. None to freeze.

Doc said to try ICSI next time due to poor fert rate.

2nd IVF ICSI: decided to bank embryos. 5 eggs, 3 mature, 1 to freeze. One embryo had no ZP and the other fertilised but degraded shortly after being injected. The 1 that survived was frozen at day 3.

3rd IVF ICSI: 7 eggs, 5 mature, 1 fertilised. Two eggs had no ZP and the other 2 were abnormal after being inject and degenerated. Waiting to hear if the one has survived.

I have one more round to go and I’m dreading it.

What do you reckon is the case of the embryos degenerating after ICSI? Is it egg quality? Is it a low AMH thing? I don’t seem to have an issue producing eggs, but sadly I never get any to freeze. I know I should be grateful to get any at all, but I can’t help but feel really disheartened by all this.

Part of me thinks I should get a refund on my 3rd round and go to another clinic who might be more 'experimental' - somewhere like the Evewell where they do human growth hormone?

Thanks for any help you're able to give!

Hi, I'm afraid I don't have any advice, but wanted to let you know you aren't alone - this whole process can feel really lonely and isolating at times...

I had a 50% fertilisation rate with ICSI (3 from 6 eggs) and only 1 made it to transfer - the other 2 weren't suitable for freezing.

I wonder if some sperm analysis might be useful, as there's a lot of focus on us in cycles but we're only half the equation, if that makes sense...?

I had a very similar experience - was getting 12 eggs each time but less than 30% fertilised. I changed to natural modified IVF to target just 2 or so eggs each time - did embryo banking over 3 cycles - fertilisation increased to 100% and now have twins

@Scirocco thank you for your reply, it definitely does feel like a very lonely process.

I do wonder if we need to look at dna frag testing now, but my understanding is that if they don't make it past day 3 it's an egg thing? It's heartbreaking isn't it, because you think wow I've already beaten the odds with low AMH to get any eggs at all, but then this happens.

How many rounds have you had?

@ivfgottwins oh wow! Did you push for natural mod? Or did they suggest it? I had asked about it but they said because I seem to respond to the meds fine, they want to push forward with mild ivf.

Did you have ICSI or IVF for your natural modified round?

@PPPPPP I pushed to do natural modified after 2 rounds of short protocol - on the same protocol as yours actually - 225ml bemfola cetrotide and ovitrelle trigger. Yes I responded great with good follicle numbers but I said what's the point if they are all crap and I only get 2 average/poor blastocysts each time anyway? (I PGS tested 2 of them and neither came back normal) So I pushed to change - end of the day I was paying so made no difference to them?!

My "hunch" ended up being right - that my egg quality is much much better on very low dose bemfola (150ml every other day) and tamoxifen tablets daily (estrogen based and similar effect to clomid)

I did ICSI for all my rounds which is why I was so shocked about my fertilisation rates as everyone says ICSI is supposed to increase it but mine was awful!

@ivfgottwins wow, we're pretty much the same situation. I've got one more round left - this time it's the fresh transfer round, so I'm now leaning towards doing a natural cycle. I pretty much feel the same as you, what's the point of pumping all these drugs into me if my eggs are rubbish and I only get one embryo each time. These embryos haven't been PGS tested though so now idea of they're normal or not.

I am sorry to ask you all these questions, but did you have a fresh transfer for your twins or were they frozen embryos?

It was due to have been a fresh transfer......but the tamoxifen makes my lining too thick so for my 3rd cycle (of the 3 cycle package - 5th round overall) I had to revert back to daily Bemfola......surprise surprise crap results again and nothing made it past day 3. So the clinic thawed a frozen day 3 top quality one which they cultured to day 5 and on the day of transfer also thawed a day 6 frozen blastocyst (from the 1st round of natural modified). Then I have 2 top quality blastocysts still frozen

I had 5 rounds of ivf with ICSI overall - first 2 rounds were the short protocol daily Bemfola ones abs then I did a 3 cycle package of natural modified

I could have stuck with the tamoxifen an just done a frozen transfer but it would have cost more money and I knew I already banked 4 great blastocysts and just wanted to get on with a transfer

@PPPPPP I would definitely do DNA frag testing on your partners sperm. My husbands was always great results on all the standard tests but his first DNA frag just came back as very high. ICSI won't fix fragmentation I believe and the test is way cheaper than ICSI, I really wish we'd done the test before our round of IVF (which failed) but the consultant told me no need 🙃 I also have a low AMH of 2.1 but now I'm wondering if the problem isn't just my eggs