Good fertilisation, poor blastulation- any hope?

[KatRee]

I'm currently 6dp5dt on first ivf cycle. I'm 37 with an AMH of 11.5 and before beginning the cycle we were advised that they were expecting 7-8 eggs from me. In the event, they managed to collect 12 mature eggs of which 10 fertilised, which both we and the clinic were delighted with. However, after that good start, we ended up with just 1 blast on day 5, graded 4BB, which was transferred fresh. A second embryo made grade 4BC blast the following day and has been frozen. I understand that usually 30-50% day 3 embryos make it to blastocysts, but in my case it was only 20% and I was lucky to get that after having been warned on day 3 that it was possible none would make it (at that point I had 4 grade B, 4 grade C and 2 grade D.
I'm worried that this doesn't bode well either for this cycle or future cycles. I've come across lots of stories of people having success after having a very small number of fertilised eggs, but nothing about success after such a big drop off once the eggs have successfully fertilised. I wondered if anyone had any experience of this that you could share?

Hello.

Did you have ICSI or ivf? I'm in a similar situation to you. Had a fresh transfer today with 1 good quality embryo but we had 8 on day 3 and only 1 today on day 5. Such a huge drop off. We are "unexplained" but the only thing that came back was my husbands low morphology on a few tests, nhs insisted we didn't need ICSI on the day and did ivf. I'm now convinced some of the not normal looking sperm fertilised some of the eggs causing the huge drop off.

It's really disheartening when you start with higher numbers so I know how you feel. Fingers crossed our transfers stick. It's so hard to stay positive.

Hi, I've had similar discussions with my consultant about how the numbers play out. I'm pretty sure that in your case my consultant would say you might just have been a bit unlucky - if you'd had one more blast then you'd have hit the 30%. It's not really possible to say after one round whether there is an issue, as there's a good likelihood you're just slightly on the wrong side of statistics.

If you do find you need further retrievals, I'd recommend speaking to your clinic about whether adding in human growth hormone injections might help. I'd also look into DHEA, plus supplements including ubiquinol.

I know it feels deflating (I've been there) but remember a lot of women don't get anything to freeze, so you've done well by many measures. Fingers crossed for you that this first transfer is successful.

@KatRee

To be honest I had a similar drop off from 14 mature eggs - low fertilisation, crap grade on day 3 and then 2 average blastocysts. And actually most people I know/have spoken too no matter what number of eggs they started with generally only got 1-2 blastocysts at the end (unless they were in their 20s or something)

I don't think clinics talk about it much but actually they usually only expect to get you one to transfer and a spare to freeze if you are lucky

My doctor told me most womens bodies are only capable of making 2 blastocysts per cycle which is why we changed protocol to get those 2 the best quality they Could be x

Thanks so much for your replies

@Ashleighz88 - it's such a rollercoaster isn't it and so deflating when things suddenly take a turn for the worse. Before we began I'd been worried about being a poor responder and not getting many eggs, or having them all not mature or not fertilise, and once we'd passed those hurdles I'd been feeling much more positive. But since day 3 update 've been struggling.
We had ivf rather than icsi. They did give us the option of ICSI on the day, which I was a bit surprised by, but again they advised it probably wouldn't be necessary as OH's SA is within all the 'normal ' parameters and they also said as it was our first time... which does make me wonder if they sometimes try it later if there have been issues with the embryos even if the SA appears normal?
Really hope that this is the one for you, despite the rocky road to get this far!

@msgloria Thank you for your support and suggestions. You are right about the stats, it could just be bad luck I suppose. And I know I am lucky to get any blasts at all really, let alone one to freeze.
I read 'it starts with the egg' and have been taking 400mg ubiquinol off the back of that for three months (some days I forget to take the full amount though!) I also thought I might ask about DHEA for next time - I noticed DHEA blood test on my clinics price list, so presumably it's something they are open to. I'm not sure if they would add in the human growth hormone though, as they don't seem to offer a lot of extras. I think I might have to consider another clinic depending on what the current one suggest and how much they will offer to try and improve results.
Have you managed to get better results from changing things up in subsequent cycles?

@twinningatlife You might be right about the 1-2 blastocyst thing. I have read lots of stories where people only got one, but often that was from a much smaller number of eggs and day 3 embryos, so I guess I was thinking their blastulation rate was much higher as a percentage and there must be something wrong for mine to be so low. That's very interesting that your doctor thinks that- can I ask what changes you made to your protocol and was it successful?

X

@KatRee I did 2 cycles of short protocol with the same rubbish results and 3 transfers and then changed to natural modified IVF- much fewer eggs (2 then 7) but did back to back cycles to bank what we could and froze 4 top quality blastocysts from those 9 eggs - 2 are my 7 month old twins and I have 2 more frozen x

Thanks @twinningatlife and congratulations on your twins- how wonderful!
When you say they were top quality, was that in terms of the grades the embryologist gave them, or did you have them PGS tested? Did you stay with the same clinic throughout all 4 cycles or switch to a clinic that specialises in mild/natural ivf?

Hi that was all embryology grading in terms of quality

I stayed with the same clinic - I actually did 5 rounds but on the final one I had to revert to my original protocol and didn't get any blastocysts so only my natural modified IVF with ICSI yielded good results

My twins werent PGS tested and neither are the 2 I have frozen

I actually did PGS test 2 from the short protocol rounds (round 2) - neither came back normal - one complex abnormal which had to be destroyed and one low level mosaic which the clinic did agree to transfer but was a BFN

@twinningatlife - that's amazing. I will definitely look into the natural modified route based on your story- thanks so much for sharing x

@KatRee
No answers from me I'm afraid but I read your post with interest as we are in a similar situation. We have had two fresh IVF cycles - 11 eggs collected both times with 100% fertilization. On the first cycle we had a huge drop in numbers by day 3 with one blasto on day 5 (fresh trf BFN) and 2 made blasto on day 6 (1x BFN and 1 x MMC). In the second cycle one made it to blasto on day 5 and another MMC.
We've started another fresh cycle and had my day 9 scan yesterday - we're going to try ICSI this time in the hope we see better results from day 1 - 5. Seems a little odd to me as we're getting such high fertilization rates.....we'll see I guess 🤷🏻‍♀️

Hi @IVFhope
I'm so sorry to hear you've been through so many transfers without success yet. My first transfer that I had a few weeks ago failed and I just feel gutted.
We have our follow up appointment booked in for next week and I'm keen/terrified to hear what they say about what might have gone wrong. Have your clinic been able to give you any indication on why you also have such a drop off despite such a good number of fertilised eggs? Or how common it is?
Sending you lots of good wishes for your next cycle

How are people getting on here? I have a similar high fertilisation but then a drop off. 29 AFC /24 follicles/ 8 eggs/ 6 fert / 1 pgs abnormal 5 day blast. Rest just arrested days 2/3-6. Just starting a month of HGH priming before my second stims in feb.

Hi @Phrenologistsfinger I’m really keen to use HGH. I actually didn’t realise they prescribed it in IVF cycles here in the UK. I thought it was just the US. It seems to produce some really good results. I also had a poor fertilisation to blast rate in my previous IVF Cycles.

It may not be your eggs that’s the problem. You don’t say when they stopped developing but drop off between days 3-5 usually indicates a male, not female problem. It may be worth getting your partner to see a urologist & potentially getting DNA fragmentation tests.

Did you have timelapse/embryoscope imaging taken? Talk to the embryologists and find out when exactly the embryos stopped developing.

Normal (not modified) IVF/ICSI works well in the majority of cases and so I’d be reluctant to completely change tack after one round when there are more obvious things to investigate.

@Mouseorchestra7 I got mine prescribed in UK by a UK clinic (private). I’m having it for a month prior, will let you know if it improves things.

@Porridgeislife thanks, we are on it. I spoke to the embryologist at the time and they started slowing on day 2. My initial thought was that it’s my eggs running out of steam because I have CFS/ME. BUT after researching I am now taking a lot of mitochondria boosting supplements which have massively improved my health and cured the brain fog/fatigue/aches hugely so hoping that will inpact. Eggs have the most mitochondria of all cells in the body (and they also reduce as we age). I think a significant improvement in general health must have an impact.

The hgh is I think because all my right side follicles were empty so we collected only half of the amount of eggs predicted.

But we are also getting DP (who has good SA results) a comet DNA frag test on Friday to check him too. Definitely not assuming it’s me (odds are it’s both of us)!

@Phrenologistsfinger it sounds like you’re doing the right things. Our issue was predominantly egg quality and our clinic had me on Tru Niagen, ubiquinol, melatonin, NAC, resveratrol and L-Carnitine amongst others.

I also prepped on 8 weeks of human growth hormone and took micronised DHEA following tests for the latter. I also had much more success on a drug called Pergoveris over Menopur/Meriofort.

Good luck with your next round, it is tough but hopefully they can solve the conundrum.

To give you an idea of just how poor my eggs were, they were either immature or broke during ICSI over two consecutive rounds. Once we fixed the prep and stimulation protocol I got good fertilisation and the standard 40% blastocyst rate.

This is a really interesting thread.
For me:
First try

• 5 follicles
• 5 eggs
• 1 blastocyst - no implantation

Second try
-14 follicles (I think)

• 11 eggs
• 2 blastocysts

Fresh transfer - implanted but no heartbeat at 7 weeks Awaiting FET.

@Porridgeislife I suspect I have egg quality issues, but we haven't had any advice about supplements for me or DH. When did your clinic have this conversation with you?
I take Zita West ubiquinol and her vitafem and vitafem boost, plus a 4000 iu vitamin D spray. I'm nervous to try DHEA as I've read it should be taken under guidance.

Hi all, I'm sorry there are quite a few of us who have had this issue, but it's good we can compare notes and think about what might help

Since my last post I did another fresh cycle of ivf, which ironically had a worse outcome on every parameter, except blastulation rate. I got one blastocyst out of two fertilised eggs, so it went from 20% in the first round to 50% in the second. The one blastocyst was graded 3CC and resulted in BFN

I'm pretty sure I have egg quality issues, although the clinic say they can't really tell, might be bad luck

I've started taking more supplements just off the back of things I've read online, which might not be the best idea, but I want to feel like I'm doing something. One of the things I've started taking is Tru Niagen, so it's good to hear your clinic actually recommended that @Porridgeislife. Also trying to eat high protein/low carb diet, which I don't find easy!

Does anyone know of any London clinics that prescribe HGH? I've seen a few people in the US saying they got more blasts on that

Hi @KatRee

I’m sorry the results from your second round were disappointing. I had a similar experience to you with a poor blastulation rate and

Thanks @Mouseorchestra7, I am sorry you are going through this too.

I have read something online where an embryologist mentioned that sometimes people see a big improvement by changing lab. It doesn't necessarily mean that the first lab is doing anything 'wrong', but sometimes some peoples embryos apparently prefer one lab environment over another. I wish I could try a different clinic, but my original clinic were actually quite optimistic after my first round and I ended up signing up to a 3 cycle package with them as it seemed to make sense at the time.

My clinic said they can't really draw any conclusions from our results. The embryologist said that even if you get lots of eggs and then some embryos don't develop well early on, it could just be because those eggs weren't the best, but doesn't mean you have an issue or no good eggs. Because the protocol causes eggs to grow that normally wouldn't. He said they wouldn't expect me to have a huge egg quality issue at 37, as whilst there is some decline you'd expect to be able to find some good eggs then.

I had a follow consultation with the doctor over the phone last week, but stupidly got the time mixed up, so I wasn't expecting his call and didn't have all the questions I wanted to ask ready. I'll have another one next week, so will ask more then. He is going to try different meds. First cycle I was 300 iu fostimon for 8 days then 300iu meriofert for the next 3 or 4. Second cycle 300iu meriofert every day. He says we can try gonal f next time. Their philosophy seems to be it's just trial and error and you might find someone responds better to a particular protocol, but you can't predict beforehand if they will.

Did they test your testosterone level before recommending DHEA? I understand monitoring that is the key to knowing whether it might help or not

Hi @KatRee. That’s really interesting about what the embryologist said. I actually posted separately on this forum about the meaning of ‘lab issue’ and that answers the question.

I had my consultation with the new clinic over three months ago now and have been obsessing over the consultant’s words (and the outcome from my two disappointing cycles ever since). Now I’ve got this new and more aggressive cycle coming up (I did mild IVF before), I’m starting to get really anxious that I will have the same outcome (or worse). Planning to go again in April.

Quite a few women seem to get good results from a protocol change (having trawled various message boards and articles, etc.) so you might find you get better results with your third round. Have you discussed upping your doses with them as well?

I like what your doctor said about egg quality. I do think it is worth asking about HGH, as, anecdotally, I’ve heard that it can improve the quality and number of blasts. Do report back if you raise it with your dr! I will raise it with my dr as well.

It’s frustrating because I didn’t know much about ‘egg quality’ before I started IVF. I just knew that I had a normal reserve for my age and thought that was it and that I would be OK. It’s just in my head now that I have poor quality eggs and I don’t even really know what it means (not sure anyone does really!) or if it’s possible for me to ultimately change it, although I’m trying. It’s become a stick to beat myself with.

Interestingly, in my first round my embryos were mostly good on day 3, but then there was a drop off on day 5. The second round my embryos were mostly poor on day 3 and there was actually less of a drop off to day 5. So it shows you how variable each round can be.

My Dr just said to take DHEA without testing. 75mg. I haven’t started taking it yet, but have ordered some and will probably take 25mg per day initially. I don’t know why some Drs only advise on DHEA with testing and others don’t. I’m quite nervous about taking it, as I self tested and my DHEA S levels are normal. I’ll see how I get on with the 25mg. Might be another think to raise with your doctor. Or you could just do a medichecks test, as I did.

Hi @Mouseorchestra7 I also follow an IG account called nurture.hf which I think is run my embryologists and they did a post a little while ago which mentioned lab issues could be the air in the lab not being as pure as possible. Apparently that means things like a no perfume, no nail varnish rule for anyone entering the lab area and they should have good air purifying systems if near a busy road. But yeah, apparently some embryos seem to do better in certain culture mediums according to this other thing I read.

So far we haven't discussed upping doses. As I actually responded well in therms of mature eggs retrieved in round one, I am clinging to hope that round 2 was just a blip. You're right, the different results you've had with the embryo development do show how different each round can be

I agree- I had no clue egg quality was a thing before I started ttc seriously. I thought it was just numbers of eggs you needed to be concerned about. I would definitely have started trying earlier if I'd know age-related decline in fertility is mainly down to quality. At 35 I was told i had a good number of eggs and remember feeling so light as I left the hospital, like I had no reason to worry- if only I'd known

I will ask about DHEA, but don't think I'll take it if they don't suggest doing bloods first

The unknowns are so difficult. Here we are trying to understand and control our outcomes as much as we can, but so much is beyond our knowledge or control. It's really hard

Hi there.
I am in the same boat.
First IVF (age 37):
AFC 10, 8 retrieved, 6 fertilized only ONE made to day 5 (4BB). I had it transferred next cycle, unfortunately it was a chemical.

Second IVF (age 38):
AFC 15, during stims some more showed up, 7 retrieved, 5 fertilised (1 good quality day 3 still frozen and 1 4AA transferred next cycle and ended as a BFN). I was absolutely devastated by the news.
The first round was a disaster and I think the second wasn't better since not so many eggs were retrieved.
I was on vitamins and ubiquinol. No Dhea since the results are within normal range.
My consultant who is also an embryologist thinks that it is an egg quality mixed with bad luck.
I eat quite healthy, don't drink alcohol, don't smoke. I drink coffee and from time to time I have a sweet tooth. Also, I suffer from depression, but it is being treated.
My DH has no issues.
I honestly don't/can't understand what is happening and I can't find any reasonable explanation rather than age. As a PP have said, I have become so obsessed with the age thing that it's taken over my life.

Hi @Yuliaaa
I'm sorry you are in the same boat. Are you planning another cycle soon?
I spoke with someone on another thread who had seemed to have an egg quality issue, but eventually got pregnant with twins after her sixth retrieval, and that gave me hope that perhaps we all do have some good eggs lurking somewhere

I've been researching supplements and have started taking pqq, tru niagen and açai berry since my last cycle on top of all the ones in it starts with the egg (other than DHEA, myo-inositol and melatonin as not sure they are right for me). I'm a bit worried I might be doing more harm than good though as there is not much solid evidence that they help.
This morning I came across a study that showed that high levels of vit D in the follicular fluid has a negative effect on embryo quality and now I'm worried I've been taking too much vit D!

Hi @KatRee. Very interesting about the importance of the lab. It just goes to show how incredibly delicate and fragile the process is (and these embryos are).

If anything, and not going to pretend to be an expert (because I’m not), would perhaps take that fact that the new round went so differently as some sort of consolation. It does suggest a blip, especially if it followed quite shortly after another. That’s how I’m trying to think about my second round. The next round could randomly go in a completely different and better direction.

On the Vit D, have you had your levels tested? I’m taking 3800IU a day. Have previously been tested and shown to have a deficiency. I’ve read that lack of vitamin D can lead to poor egg quality and am kicking myself for not taking a higher dose before my first two rounds (just relied on the vitamin D in my prenatal). It feels like such a minefield. The other day I had a few too many ciders and still worrying that that might have impacted my egg quality (I’m not having IVF again until April, but feel like I should be living like a monk until then in order to give myself the best chance).

@Yuliaaa, am so sorry that you are going through this as well. I wish the term ‘egg quality’ didn’t exist. I feel like I have a big neon sign in my head blinking ‘bad eggs’. Just makes this process so much more difficult. Again, don’t want to sound like I’m meddling or pretending to be an expert, but have you considered having a consultation with another clinic? They might have a different take on your results and what you could do to improve outcomes.