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?

@Mouseorchestra7 - stupidly I never got my vit D levels checked. Just assumed I would be a bit deficient initially because most of the population are and I don't spend that much time outdoors getting it from the sun! I followed the advice in ISWTE, starting off on 5000iu for a few weeks and have been in 3000iu for many months now. I thought you had to be on a much higher dose to have any negative effects, so reading about this study has worried be a bit. I should probably test my levels now

Hi @KatRee I wonder if I could ask you how much pqq and TruNiagen you take? I read it starts with the egg but can't find dosages for these, and at 43 I need all the help I can get!

@LouScot of course!
These weren't mentioned in ISWTE - I don't think they have done many studies on them yet in the context of fertility, but they should help in theory, there are promising animal studies and I have seen a few anecdotes where people really think they helped them

Tru Niagen I take 300mg/day - that's the dose recommended by 'the egg whisperer ' and I checked with so who was recommended it my their clinic and they said 300mg too

Pqq I take 20mg/day. I can't remember where I got that dosage info from tbh, but definitely checked it somewhere before I bought it

🤞they help us

@KatRee I haven’t seen that study and will look it up. When will you proceed with your next cycle? Also, do update on what your Dr says when you speak to them this week :)

I wish my next cycle wasn’t so far off. Am just going to become more and more of a bundle
Of nerves as it gets closer to the date.

@KatRee thanks for the info. I seem to be spending a fortune on supplements but want to do all I can! I'll so some googling tonight :-)

@KatRee and @Mouseorchestra7

Thank you for the suggestions.
I am supposed to transfer my last embryo, but it has been put on hold until I get my immunology test results and just as I thought that I might get closer to the transfer, I found out on Monday that a fibroid had started growing feeding off all the estrogen I had taken. So now it has to be monitored and removed if necessary.
I might do another EC in the future, but right now I am not in a good place. I can't cope with the constant pressure anymore, so I am just taking a break and reflecting about what to do next. It has became such a traumatic experience for me that every time I see my consultant, I get very depressed and for two or three days I am not myself anymore. It literally makes me sick. Some days I even try to get used to the thought that I might never be a mother.

Reading all your stories, I simply cannot understand and I am still outraged by the fact that so many of us have to through such tragedies.

@Mouseorchestra7 - all being well will start next cycle mid February. Feeling v apprehensive and wondering if anything I've been trying to improve quality will have had any effect at all.

@LouScot I know- i don't even want to think about how much I've spent on supplements, but want to feel like I've done as much as I can

@Yuliaaa I am sorry you are finding it so difficult. For me it feels like a massive rollercoaster. I feel so low after a disappointing cycle, lose all motivation, get overwhelmed by the fear it will never happen. Then I will have a few weeks of obsessive googling, trying to find things I might try to improve things next time. Sometimes it makes me anxious if I feel there are things that I'd like to try that I realistically can't, like super expensive treatments, but then focusing on the things I do have some control over helps a bit. That's the phase I'm in now and I'm doing small things like taking supplements and trying to consume more protein, but I'll still have a drink or two every now and then and think about other things and I feel it's not entirely ruling my life. But I know that when the cycle starts I'll get anxious and obsessive, and won't be able to concentrate on anything else.

It's a really hard thing to go through and I hate that so many of us have to

@KatRee I am starting my next round in mid Feb too! Possibly on Valentines day

I am throwing the kitchen sink at my eggs for round two after a disappointing first go:
Naturelo prenatals
DHA/omegas
Methyfolate
Ubiquinol 600mg (300 am and pm)
Vit D
B12
NAC
Ashwaganda
Maca
Messima
Vitex
Probiotics
Iodine
Levothyroxine
Evening primrose (follicular phase)

For mitochondrial support
Electrolytes am and pm (esp potassium and magnesium)
Methylated b complex
Extra thiamine b1
Extra riboflavin b2
L carnitine
Creatine
ALA
PQQ
NAD+
NMN
Tru-niagen
D-ribose
Glutathione
Oh and human growth hormone

(Saving DHEA for next round).

I am taking a lot but also have autoimmune issues (CFE/MS), a dodgy thyroid and I’m on the cusp of 40. 😊

Also @Porridgeislife good call as my DP just had his Comet results and his sperm DNA fragmentation is 30% so I hope we could improve that a little. Consultant is suggesting ICSI this time but I am not convinced (yet).

Hi all,

For me fertilisation to blast rate really varied and not due to lifestyle changes as I was doing embryo banking so pretty consistent time period/ supplements/ nutrition and also the same protocol.

1st round: 2 viable eggs, 2 fertilised, 2 blasts - 1 5AA BFN, 1 4AA still frozen.

2nd round: 15 eggs, ended up with 3 blasts - 5AA, 4AA and 3AA.

3rd round: 13 eggs, ended up with 1 blast - 3BB - transferred and 16 weeks pregnant.

So it doesn’t necessarily mean poor quality in my experience. That said I’ve no idea what the others we have left are like quality wise.

Re DHEA it can have a negative impact on egg quality if your testosterone gets above recommended levels of 1.5-2 so please be careful taking it unsupervised.

Hello - how is everyone here getting on?

Like @Phrenologistsfinger I'm pencilled in the start a new cycle tomorrow. Just sitting here waiting for the 🧙‍♀️ - definitely feels like she's on the way. I'm hoping that Valentine's Day is a slightly more suspicious starting date than my last go which began on Hallowe'en!

I'm starting to feel very nervous now, I feel like there is a lot riding on this and though I've made a few changes like eating much more protein and adding in some extra supplements, I'm regretting not doing more. My diet's been sadly lacking in fresh veg these last few months and I've done virtually no exercise.

@AlexissFreeenncch congratulations on your pregnancy. It's reassuring to hear rounds that don't yield much in terms of percentage of embryos making it to blast can still lead to pregnancies

@KatRee Best of luck. I understand your nervousness. I am already feeling sick with worry about my cycle starting in April. Also wishing that I’d used the six month break to eat more healthily - I keep lapsing into bad habits. Every time I have a drink or a portion of fries, I imagine my eggs deteriorating a little bit more :/ wish I had an IVF dr friend who could reassure me that the odd drink or burger doesn’t hurt!

It sounds like your protocol this time is very different, so crossing my fingers that this will be the one for you. By the way, did you think about having any implantation testing? I have had similar results to you (including 2 failed transfers), but probably won’t get any testing until a third failed transfer on Dr’s advice. Part of me thinks I should try getting a few tests done , such as NK cells. Ugh. Suppose I’ll
Just wait to see whether I get any blasts from the next cycle.

Sorry, autocorrect- I meant Valentine's Day might be more auspicious, not SUSpicious!

@Mouseorchestra7 my Ivf doc did tell me that the odd drink won't hurt and recommended red wine as it contains antioxidants! And I've read many times that it's overall habits that make a difference and the odd treat won't harm anything. I just feel like some of my overall habits are not the best!

My protocol this time is 300iu gonal-f. First cycle was 300iu fostimon for the first 8 days, switching to 300iu meriofert for the final few days, second was 300iu meriofert only. My understanding is that fostimon and gonal-f are similar because they only contain FSH, whereas meriofert is a mix of FSH and LH. I've read somewhere that older women already have a higher level of LH and some doctors design protocols that don't include LH til later on with their older patients for this reason. But what I read suggested that LH should be added at the end to help maturation, so of course now I'm worried that the complete lack of LH this time isn't going to help the whole egg quality, but I know reading one opinion on the Internet is not a substitute for my doctor's decades of experience, so I'm just going to trust and go with it.

I asked about whether having a lower dosage of stims could help with the quality too as there seems to be a quite prevalent theory that you can overcook eggs by throwing too many stims at them. Doctor said the maximum dosage they prescribe at the clinic is 300iu as they noticed a few years ago that there seemed to be a decline in egg quality with anything higher. He said I could go down to 225 if I wanted, but wouldn't recommend anything lower as it would probably mean very few eggs to work with. I kind of chickened out of that this time though.

We talked a bit about implantation testing, but I think we both think that the previous implantation failures were probably due to embryo quality (or lack of). They sent me some info on repeat miscarriage tests which I decided against for now. I didn't really have a close look at what it involved but don't think it is anywhere near as comprehensive as some clinics offer. I've been considering asking for a freeze all (assuming we get anything to freeze), doing a fourth round and then getting some test done before I do another transfer, but I feel nervous about that too. I feel like I need to do a lot of research on the whole implantation/endometrium testing thing but I feel like I dont really have the bandwidth for it now as I'm too busy obsessing about embryo quality! It's all so overwhelming!

@KatReeCrossed fingers that Valentine’s Day is indeed auspicious for you!

My overall habits aren’t great either. I’m generally one week on, one week off when it comes to healthy eating. I said from January, I’d start clean eating in prep for my cycle, but have been v inconsistent. That’s good to hear what your doctor says about the odd drinks.

I had lower stims in my cycles and it didn’t make any difference to quality (although I suppose my quality could in theory get worse when I move to higher stims in April :/ ). I’ve read that it’s baseless that it improves quality. And mild IVF generally has lower success rates. Would agree with your doctor that it is best to get more eggs. Also 300IU is not ridiculously high. I’m going to be on 225 Menopur and the max dose of that is 450IU for example. Hopefully, the change in stim will make the difference.

There is so much testing you can have in IVF and it is just so overwhelming. I wish I didn’t have what seem to be a few issues (poor embryo quality and implantation failure), and so just had one thing to worry about :( I am considering doing a freeze all as well. But just scared that I’ll have nothing to freeze.

Did you ask about HGH by the way?

@KatRee we are on the same schedule then as my period started today - booking my baseline scan, eep. I am also finding myself hoping that the valentines day start is auspicious! Blood and love kind of sums up IVF for me (sorry bad joke!).

I wish I had done more too, despite eating really healthily since my last failed round nothing feels enough - but I know that’s anxiety and nerves talking…The good side is that I have been taking mitochondrial boosting supplements which have really boosted my energy, I’ve eaten high(ish) protein wholefood vegan diet (what I eat normally but more protein, fewer carbs and slightly less chocolate!), cut down to only two teas a day (1 green, 1 black - very hard as I am a tea addict). I’ve also been on hgh, so hoping that does something. My thyroid has finally gone optimal (0.97) after being 5 then 3 something for years. DP is on more supplements due to slightly high dna frag. Hoping this stuff helps…

Negatives though are I had a covid-like (neg pcr) virus last month that turned into weeks of nasty cough (caught at booster appt, the only place I’ve been in 2022!) so bit run down. I’ve had work deadline stress on a big project and now I’m worried about Russia. I haven’t been sleeping well as the dog keeps having night terrors and just feel like my adrenals are a bit burnt out. Need to try and do some meditation, baths and relaxing dog walks to calm my system all down a bit. Oh and despite eating well and calorie counting to 1200, I have only lost 1-1.5kg which just gets me back to pre-ttc weight but barely changes my high bmi. So that is frustrating.

I guess what I am saying is I want to be in full perfect physical and mental heath when starting ivf but it’s not realistic is it? Life just gets in the way. But then people conceive with covid, in warzones, despite v unhealthy diet. So maybe I need to chill out and trust the process…

Sorry - brain dump!

I have a new protocol of dexamethosone + gonal f 150 in am then hgh+ pergoveris 150 in pm. I took meriofert 225 in round 1.

So, looks like I won't be starting today after at all my period has decided not to show up ☹️ So blood and love on hold here for now!

@Mouseorchestra7 That's interesting about doses? Do you mind if I ask what your AMH is? My doctor treats me like I have DOR, but last time I had my AMH measured it was 11.5, which when I looked into it a bit, seemed to be about average for my age, so sometimes seems a bit odd that I would be on the same dose as someone with much lower, but again, I trust they know what hey are doing!

In the end I didn't ask about HGH as we are changing a few things this cycle and I would be very surprised if my clinic offers it- they don't do many add-ons. I will definitely ask after this round if results don't improve, but I do think I'd probably need to go to a different clinic to get it.

I did ask about DHEA and he is happy for me to try it if I won't to , so I'll get some tests done and look at introducing that for cycle number 4

@Phrenologistsfinger - it sounds like you are doing loads- I will be following your results with interest and really hoping it pays off for you! I've added in some 'mitochondrial ' supplements since last time - pqq, tru-niagen and higher dose of ubiquinol and noticed they are really helping me focus so I'm hoping that's a sign of increased energy and that some of that is being directed to my eggs!
You are right, there is no point stressing about stress as humanity would be extinct if we couldn't conceive in stressful situations. I'm sorry you managed to get a virus from venturing out once, that sucks! But again, I shouldn't think it will have much impact on your cycle. You're doing well sticking to the healthy eating - I find it really hard to be consistent with that.
Is your baseline booked for tomorrow?

@KatRee I don’t actually know what my AMH is now, but when I got it tested 3 years ago at 33 it was 21. It will likely have dropped now. My AFC is normal. 11.5 sounds good, so I’m surprised they consider you to have to have DOR.

I will also take the same approach with DHEA. Not taking it for this cycle, but will take it for the fourth if results don’t improve.

@KatRee how are you getting on? Hope AF showed up for you.

I had my baseline scan yesterday, went fine. I have started the new protocol - dexamethasone, gonal f and pergoveris plus increased my hgh dosage. I really dislike taking steroids due to the side effects but trusting that it might help. I’m not sleeping too well anyway.

On DHEA, I tested my DHEA-S levels via medichecks and I am at the low end of normal range. Going to ask Dr what they think as it could be counterproductive if I don’t need it - but thinking ahead to our next round as well (even if successful I don’t think this one will lend enough usable euploid embryos).

Willpower not my strong suit but I find filling up on beans or pulses and veg stops me snacking mid meal. Steroids not great for healthy eating as raises hunger but am trying to limit damage by snacking on nuts or fruit. Don’t want to restrict calories as much asI have been during stims as I have read it might be counterproductive.

@Mouseorchestra7 fingers crossed for your next round too! It is such a pain trying to figure it all out I know. Wishing you lots of luck as well

What are you both doing about exercise? It is my total weak point as I had chronic fatigue 4 years ago and had to really rest - am better now energy wise but still need to not overdo it and my cardio fitness is shot. I walk the dog every day but it’s probably not enough. Maybe I should dig out my dusty yoga mat (at least until the ovaries get big/sore)?

Hi @Phrenologistsfinger
AF decided to show up yesterday evening and I've just got back from my baseline scan now- been given the go-ahead to start stims tonight! Just gonal-f for me. It's interesting you are on a few things- I often look on the Reddit ivf thread and there's lots of Americans post on there and seems to me clinics in the US often recommend different combinations of various meds for different things, whereas here they seem to stick to fairly simple protocols more often than not. I always feel like maybe I'm missing out on a magic ingredient! Have they explained the rationale behind what they've put you on? I'm sorry you are having side effects, but I'm sure they've got you on stuff they think will have a positive impact

Exercise is also my weak point besides the not getting enough veg! I've never been very sporty, but I had a really good routine going pre-pandemic with yoga 3x week at the gym and then a bit of running. But in the last 2 years I've really struggled to stick to a routine and that leads to weeks and months doing virtually nothing. I'm going to try to do 10 000 steps/day during this cycle. I might try a bit of yoga at home too- I'll dust off my mat if you dust off yours!

How's it going @Phrenologistsfinger ? CD7 for me and the doctor this morning labelled my response so far as 'moderate', so not as good as cycle 1, but better than cycle 2, which I would label as 'shit'
Just hoping these follicles have some good quality eggs in them this time 🤞
Hope you're doing ok

@KatRee cycle day 9 for me! My scan yesterday showed my right ovary is being lame and prob has only two good follicles - 6 or so are failing to grow and are even regressing. So much for human growth hormone! The left is a bit more promising but I’m not overly hopeful this time around. I’m feeling like the numbers are way down from round 1, which yielded 8 eggs (and only 1 mutant embryo). I’m also having terrible side effects from Dexamethasone (steroids) so I’m asking clinic if I can stop it. Bit glum but I’ll be glad when it’s over, roll on EC day! They say Saturday or Monday for me…

And yes, I think it is all pinned on quality now. I can deal with fewer high quality eggs but it feels like a big ask of my almost 40 year old ovaries. I wish I could be more optimistic! Trying some affirmations, feels a bit woo but maybe it might help?

They didn’t really explain my protocol but I googled it all - I think I’m on poor performer drugs, haha!

I haven’t done any yoga sadly, the steroids are messing with my blood pressure so I’m clocking a lot of sofa time this week. Hope you’ve had a better time of it

Hi @Phrenologistsfinger - sorry it's not going as well as hoped and you're feeling glum. Have the clinic said you can come off the steroids now?
I had a lot of follicles at the baseline scan which just didn't grow, so disappointing. 'Quality over quantity' seems to be the appropriate affirmation in this scenario- let's hope there is some truth in it! Maybe some of those supplements will have had an effect. I've definitely come across a few stories of like 43 year-olds getting 2 eggs and ending up with a BFP, so it can happen
The doctor that did my scan a couple of days ago told me to think positive so in his clinical opinion, there is something in all that!
I've not managed any yoga either - the bloating is making me feel a bit delicate, so all I've managed is some short walks when it's alright outside
Egg collection for me will be Monday provided nothing goes horribly wrong in the next few days
🤞for us both