My clinic 'forgot' to do ICSI - no eggs fertilised

[TheSnufflet]

I'm absolutely overwhelmed with anger.

We're undergoing IVF for male factor (poor morphology). We moved straight to IVF rather than investigate any more potential problems with me precisely because we had two dodgy sperm analysis results. Due to this, we were prescribed IVF/ICSI (I'm looking at my consent portal right now, with "Treatment Type: IVF/ICSI Long" written down) .

Had my egg retrieval yesterday, got 7 mature eggs. Got the phone call this morning that none of them had fertilised under conventional IVF. I queried this and asked if they had performed ICSI. The embryologist said that this hadn't been performed and that she would need to ask a doctor some questions. Apparently the doctor had written "Conventional IVF UNLESS sperm parameters are bad, in which case ICSI" but it was always communicated to us that we would have ICSI. On the day, my husband's sperm sample was the best its ever been in terms of numbers, motility and morphology, but not good enough to fertilise any of my eggs.

What the actual fuck do I do? This has used up one of my NHS cycles - do I complain to the HFEA? My CCG? The clinic themselves? I'm in shock and so angry I can't cry.

@TheSnufflet this is really infuriating. Yes they can check the sample on the day (number and motility) but they can’t check morphology- it takes more than a week to do the complete analysis! So I doubt they will have seen the morphology result before taking this decision. They should have gone by the previous results to know that morphology was bad and also consulted you on the day even if they wanted to switch to conventional IVF. Usually its the other way around-switch from ivf to icsi and not the opposite as they are risk averse: icsi reduces the chance of no fertilisation significantly!

Thats awful. The right thing to do would be offer you another funded cycle but I've rarely found a fertility doctor who will admit to their mistakes. I'd give them a chance and complain to the HFEA if you don't get anywhere.

OMFG I am absolutely enraged for you!

I agree with @jolly86 that they should have gone for ICSI regardless of what your results were on the day.

Personally, I would write a stonking complaint to the clinic demanding that they give you an additional round for free and that you’ll take things to the HFEA etc. if they don’t comply.

I am so very sorry this has happened to you. ❤️

I'm so sorry - that's awful! I would definitely complain and insist on being guaranteed another funded cycle; you shouldn't be penalised further for their error.

The clinic should have a complaints procedure you can follow, and if they aren't helpful through that, I'd escalate to both the HFEA and CCG.

@thesnufflet I'm so sorry that's happened, it's outrageous you should definitely complain - first to the clinic and give them the chance to redeem themselves and if no luck with that then escalate it to HFEA/CCG.

Do you mind me asking what his morphology was on the day? We're in a similar position and our clinic have also said IVF but to check the sample on the day and if morphology is less than 4% then we'll have ICSI and if not then IVF but morphology on my husband's samples has been between 1-3%. So this has nerved me a bit! But they can check morphology straight away on the day, just sounds like they didn't bother.

@Hanopolis They normally check in with you about it on the day as ultimately it should be your call.
e.g. We were advised 50/50 split. On the day the sample was good (so could have gone full IVF if we wanted) but they suggested sticking to the split and we agreed.
If you’re at all worried, ask them before you go in for EC.

@TheSnufflet Can't believe I'm reading this after all you've been through to get to your EC as well. I have no words, other than being really shocked for you.

Absolutely complain!! So sorry this has happened to you x

I'm so sorry that's so frustrating! :( keep at them, especially if they told you it would be ICSI

We had 1% morphology, no other issues found. They technically wrote us as 'unexplained' and went ahead with IVF. I asked if it would be ICSI due to the 1% and was told nope, would just be IVF.
Luckily for me it did work and we ended up with four to freeze and I'm currently 12 weeks pregnant from one of those from an FET. I have no idea if they tested the sperm on the day or just went ahead and did it

They go through simple procedures and follow a process for everyone, and sometimes that doesn't work. We have to be our own advocate in these situations and push for things because a lot of the time we know more.

@TheSnufflet I'm so sorry to hear about what happened on your cycle. I can definitely relate to your story as a similar issue happened to me in my first IVF cycle. We didn't have a diagnosis of male factor infertility but were told that they were going to perform ICSI if sperm parameters were poor or borderline on the day of collection. I had nine eggs collected, of which six were mature but none fertilised with standard IVF. I still feel PTSD from that phone call to let us know that our treatment was going to cancelled due to total fertilisation failure. Infertility is hard! At our review appointment, I asked the consultant why ICSI wasn't performed as it said 'IVF/ICSI' on our documentation and the consultant said that they don't perform ICSI on the first cycle unless sperm quality is really poor but recommended that it is performed on our second cycle. We are self-funded and were gutted to learn that the clinic had this 'trial and error' approach for the 1st cycle, but I guess all clinics are like that?

We started a second cycle in May with stims in June and it says 'ICSI only' on our documentation. We also paid a higher fee for ICSI upfront. This time I had fewer eggs (6 collected, of which 3 were mature) but 100% fertilisation with ICSI. I couldn't sleep at all from egg collection to the embryologist's phone call the next day as I dreaded to receive the same news as before! Today I am waiting for my day 3 call and happy to know that we have gotten to that stage.

You should check if your documentation says 'ICSI only' somewhere due to an MFI diagnosis. Unfortunately, if it says 'IVF/ICSI', ICSI is performed if sperm parameters are poor on the day of collection, but you may be able to claim that the advice on the notes was incorrect as it wasn't a case of unexplained infertility.

Total fertilisation failure is devastating news after so many injections, scans, blood tests, etc. I don't remember much from the days after receiving the news as I just got numb. Counselling has helped me tremendously and I don't think I would be able to go for a second cycle that soon if it weren't for counselling. Look after yourself and ask all the questions that you can think of! Good luck with your future cycles!

Hi all,

From various back-and-forths with the clinic and a follow up 'WTF' appointment with a consultant on Monday, it seems as if the issue was a cock-up with communications. We never got sent a write-up of what was discussed in our first consultation/treatment plan, only a PDF calendar of the drugs and the instructions to take them, so we were relying on notes from our meeting rather than seeing an overview of our actual plan, and the terminology in our consent portal was fairly opaque, to say the least. Apparently clinic policy is to always do standard IVF unless the sperm sample is terrible on the day (in which case they do ICSI), so it was never on the cards for us in the first place. I feel absolutely numb one second and then tearful the next. I just feel like it's never going to happen for us. At least we've got a few months off until the next cycle.

@jolly86 This is strange as they did seem to know his morphology on the day? The thing is, even his previous results didn't quite count as male factor - despite poor morphology his numbers and motility have always been good. It's been the only thing close to an explanation that we've had.

@StillTTC @Scirocco the consultant did say that we could apply for a third round under 'exceptional circumstances' - hopefully they would support us in this.

@RiverRiot stonking complaint has been sent in. It's not just this to be honest, they made loads of fuck-ups like sending me two cycles worth of meds by accident; missing scans off my calendar (and ringing me while I'm in the middle of Budgens asking me if I'm waiting outside clinic in my car ); monitoring me 11 days into stims meaning I had to go for 17 days and have retrieval at another clinic way further away; even my address was wrong and said I lived in Norway! Just lots of little admin fuck-ups that led to an incredible amount of stress, that could be solved if they had something simple like a patient portal.

@Hanopolis his morphology was 5% on the day, which is within normal parameters, and he had an amazing count of 185 million and after various filtering procedures, 75% progressive motility. Donor quality really! My poor husband has been internalising that the problem has been 'his' (even though it's very much ours).

@2mumlife thank you we've both been through the wringer in different ways haven't we? How are you holding up?

@Fabsco yes, this exact situation is the same as ours, although the MFI was always a very 'loose' diagnosis, as in reality he ought to have been able to get me pregnant with his overall numbers. Did your clinic ever give you any feedback as to why your failure occurred? We were told that there was little to no sperm binding to the zona pellucida, which means essentially his sperm just ignored my eggs (or my eggs gave off some sort of hostile signal telling them to fuck off?). I can't bear to think of it to be honest, how can two people love each other so much yet be so fundamentally incompatible in a petri dish FFS? They can't tell us whether it's a sperm or an egg problem, all they said is that we're both perfectly healthy on paper and that ICSI should solve it next time. How was the day 3 call? Did you make it to day 5 transfer?

@TheSnufflet Hello my dear, I hope you're feeling a wee bit better today, even though I know that it is quite impossible after a total fertilisation failure. You need time to process everything and I am glad that you're taking some time away from the IVF world to heal and get back to it stronger. My first cycle was in February and my second cycle started in May/June, and to be honest, I would have started later if I could but wasn't in the right frame of mind when they phoned me to confirm my next cycle. As I said earlier, counselling and acupuncture has became my go-to treatments to get back to my normal self after all that IVF madness!

At our review appointment, the consultant told us that they can't explain why we had total fertilisation failure. In our case, the sperm was still trying to fertilise the eggs after 18 hours, but there was no sign of fertilisation in the eggs, i.e. two pronuclei. I asked the consultant why they didn't perform rescue ICSI as they do in other parts of the world, but she explained that they don't do that in our clinic. Moreover, it could have been that sperm penetrated the egg but didn't activate it, which is one of the many causes of fertilisation failure. The six eggs that were mature and were placed in the petri-dish to fertilise looked fine and my husband's sperm was also very good, so she didn't think there were issues there. She is a very experienced consultant and said that, thirty years ago, when she started working with IVF, they would simply advise the couple to have another go and, more often than not, fertilisation would happen in a subsequent cycle. Of course, we now have ICSI and she recommended its use in any further cycle. To cut the long story short, no real answers from the consultant, as you also experienced in your review appointment.

However, I had a chat with a couple of friends who are in the medical field about this, and they had different views. Our clinic recommends 2-5 days of abstinence, but 5 days might be too long and lead to normal-looking sperm, but with some DNA fragmentation. Sperm selection for IVF and even ICSI is purely based on sperm motility and morphology, so it is quite possible that the ones selected for standard IVF were quite fragmented? Many recommended a shorter abstinence, 2 days maximum. Sperm numbers were quite similar this time around regardless of the shorter abstinence period, but possibly the quality was better.

All three embryos developed well to day 3, and two got to blastocyst stage in day 5 - both top quality, so ICSI definitely helps! I went to the clinic on Sunday for my transfer and am now in the first week of my first ever 2ww through ICSI! We can't believe we actually have another blastocyst in the freezer waiting for us - I thought this was going to be another fertilisation nightmare but we were wrong and good things can happen, as I'm absolutely sure it will happen to you, too.

Continue to look after yourself and take this time to digest everything that happened - and it's a lot! IVF is a tough journey but we will go through it with hope. I wish you all the best and am sure that you'll be coming back here in a couple of months with good news!

@TheSnufflet I'm glad you have some answers, hopefully it will help with processing things.

Have you clinic garaunteed they'll use ICSI for you next time around?

Take some time between cycles. I'm trying to do positive things for egg quality whilst we're waiting to go again (diet, going to try accupuncture), so you could see if there are things you might want to try too to take back control :)

@Fabsco I am feeling a bit better, although I'm probably just hormonally crashing (letdown bleed started today). I've got to go through two normal cycles before starting back up again, so with any luck it will probably be in September/October. They do offer a counselling service but I don't know if I'm quite yet in the place to accept it. I haven't thought about acupuncture - I know a lot of people swear by it, but I think I'd only be comfortable with it once I'm double-vaxxed. I think I'd prefer reflexology though, I'm very fond of having my feet played with

It sounds as if you had a slightly different issue if the sperm were still trying to fertilise after 18 hours, my husband's sperm didn't even attempt to . My clinic also said they don't do rescue ICSI but I understand this is because success rates are pretty poor from it, so there would probably be no point if you wouldn't get any viable embryos from it statistically.

I think my husband did about 3 days abstinence before ER (day before trigger shot), but then the clinic's advice was for 2-7 days. It's definitely something to bear in mind for next time.

I'm so glad it's good news for you and all the best in the 2WW!

@2mumlife yes, they're definitely doing ICSI next time (having had a previous standard IVF with total fertilisation failure is one of the criteria for prescribing it).

I think I'm just going to carry on with the Mediterranean diet and supplements and try and have other things to look forward to this summer do you know when you're going to have another go yet?

@TheSnufflet Thank you so much for your kind wishes! I also wish you the best in your next cycle and I'm sure you'll be successful with ICSI.

Gosh you must be absolutely fuming.

We are due to have ICSI in a few months time (male factor, 1% morphology), I haven't been through the process yet but have already spent a lot of time mentally preparing myself.

I can only imagine the heartbreak if you go through all of that to find out that the clinic haven't done what they said they will.

I am so nervous about something like this happening as we've already had so many admin cock-ups from our clinic, I don't have much faith in them. Thank you for posting because I will add this to the list of things to be on watch for and to mention when I have my egg collection.

I really think they should offer you an extra cycle (if you need it - hopefully next one will be successful and all will be good!) Good luck

@TheSnufflet Hopefully there will be a much better outcome for you next time . We've got our review consultation this week, so hoping we can get the go-ahead to try EC with a new protocol next month, but will see what they say

Hi, can I ask the original poster what happened in the end. The same thing just happened to me, i got the phonecall an hour ago that none of my 16 eggs fertilised throuh ivf, i was so confused as we knew all along we'd be using ICSI. We're livid as we paid for ICSI. Now my consultant is away and I'm looking to see if we can sue for their negligence. It's still very fresh and I'm reeling with all emotions. Time us not on our side as I'm 39 next month.