Unsuccessful IVF - Lab issue?

[Mouseorchestra7]

I’m moving to a new clinic to do IVF (did two rounds of mild IVF with ABC/Create that failed, due to fewer than expected and poor-ish quality embryos). Am moving to LWC.

My new consultant mentioned that he thought my poorer than expected results could be down to a ‘lab issue’. Just wondered if anyone had come across this before as a possible explanation for poorer than expected results? Do you think it has any substance to it?

Hi Mouseorchestra7,

I have similar experience with ABC London. I had a failed 1st cycle with them last year and just had my 2nd cycle, I haven't transferred the embryo from the new cycle yet but I am not convinced it will work.

First cycle, 19 eggs collected, 15 mature, 14 fertilized with ICSI, 13 day 3 embryos (11 were grade 1 8 cells) and none made it through to blast on day 5. ABC claimed we have server male factor and recommended donor sperm.

So we just finished my 2nd cycle with donor sperm, this time I had 14 eggs collected, only 6 fertilized which they claimed it's normal, despite there is absolutely no male factor this time and all my day 3 embryos were grade 1, I only had one made it through to day 5 and it's poorest quality of 4CC.

I am 34, PCO but no PCOS, AFC 31 and no other health issues. They never bothered testing my AMH and just assumed it's high.

Honestly a bit shocked with the result, not sure if my expectation was too high in the first place but I do wonder if there are lab issues. Do you mind I ask what was your experience with ABC like and what does your new clinic say? I am not even sure if I want to waste more time transferring the 4CC and thinking about moving to CRGH. I emailed ABC and asked for a review on my case.

Sorry ladies would you be able to keep me updated on the outcome of your reviews? I've had a similar issue with low quality embryos we have known male factor and I've been told it's because of our egg and sperm quality we had these results. However my AFC and AMH are fine for my age and I've had a normal scan and hysteroscopy.
I never thought it could be an issue with the lab!

Hi @Piaopiao. My new Dr mentioned that he thought it could be a lab issue. Stupidly, at the time, I didn’t ask him more questions about this, but I believe it’s to do with things like the embryo culture, the cleanliness of the air in the lab. Sometimes one woman’s embryos just don’t do as well in a particular lab as another’s. Another poster mentioned that her Dr had discussed it with her on another post I’ve been messaging in (the ‘Good fertilisation, poor blastulation’ one), so would also take a look at what she said - v informative. Of course a clinic would never admit to having a lab issue.

I’m moving to another clinic and will have a complete change of protocol. No idea what to expect. I was disappointed I couldn’t get more answers from ABC. They just said to me that they aim to get one blast from a cycle and so considered it to be a good result. My Dr at the new clinic didn’t think it was! I would consider paying for a consultation with a new clinic. That’s what I did. I got ABC to give me all my Test and scan results and then provided those to the new clinic (so I didn’t have to go through them again).

@Roo45 I am normal AFC, etc. too, and I used a sperm donor, so shouldn’t be an issue with the sperm. Have your clinic suggested anything to improve egg quality? Are they considering a protocol change?

@Roo45,
Hey,

Unfortunately I guess we will never know if it's lab issues or not for sure. I just spoke to the lab this morning for day 6 update, embryologist says no obvious issues she can think about from lab point of view. But I heard other people posting here, once they move clinic it seems to work (but that could be down to the change of medication, treatment protocols, when they trigger you, etc.) I also have the same concerns as Mouseorchestra7, we both had mild IVF treatment, not sure what's like if we change to conventional IVF.

I was told by Create up to day 3 is more egg issue and between day 4 and 5 is more sperm issue but our results from two cycles are not much different and still no good quality blastocyst even with perfect donor sperm.

It says on Create's lab report below 35 years old, it's 40-60% blast rate and we are like 0-20%. Two cycles, in total 33 eggs and out of 18 grade 1 day 3 embryos, only 1 4CC blastocyst! Do you mind I ask what's the drop off rate with your day 3 and day 5 embryos?

@Mouseorchestra7

Hey

Thanks for mentioning the post, I will check that one. What I don't understand is almost all my day 3 embryos were grade 1, if there is obvious egg issue, usually cells stop dividing soon after fertilization (so will see 3-4 cells day 3 embryo for example) or high fragmentation or grade 2/grade 3 embryos on day 3. I would like to think grade 1 day 3 embryos have the highest potential to make it to day 5 and I used donor sperm this time which should be perfect quality.

I am not sure if I have seen anyone else has higher drop off rate than me here. My rate is like 1 blast out of 18 grade 1 day 3 embryos. DH still said it could be just bad luck this round.....:(

My gut feeling is that I don't want to transfer that 4CC embryo and I have to move clinic for a new cycle but I am a bit worried about moving to CRGH with conventional IVF, we will have a lot more injections, medications and 2 triggers, assuming we are at higher risk of over stimulation?

@Piaopiao it might be worth at least having the consultation with CRGH to see what their view is. You could keep the 4CC at Create and perhaps get it transferred at a later stage, and then start a new cycle with CRGH or another clinic. That’s what I am doing. The new Dr may help you to understand what the issue is and if they could do things differently.

As for overstimulation, I’m not sure how much I believe in Create’s ‘less eggs, better quality’ approach. I think it might be a marketing tactic! I question whether over stimulation is even a thing (in terms of egg quality, I mean). It certainly didn’t result in good quality for me, but, who knows, I might get worse results from conventional IVF There is a reason conventional IVF is more popular - it might be harder on the body and pricier, but It does seem to get better results.

@Piaopiao a lot of ladies have had successful outcomes with poorer graded embryos so please don't feel too discouraged. Check out Instagram page of paige the embryologist really helpful. A poster on here recommended.
I was with create, my last round, aged 36 I produced 6 eggs, 5 matured, 5 fertilised all went to blastocyst stage. Transfered 4bb embryo which is now my DS. I have 3 frozen, 1 was not suitable to be frozen. My blastocyst rate was good. My remaining embryos are b and c grades, I intend to transfer at a later date. I suppose everyone responds differently. I also did acupuncture
I was due to do a FET transfer which didn't go ahead because my embryo didn't survive the thaw process. I felt that may have been a lab issue but can't actually prove it.
Are you taking high dose coq10, helped my egg quality. Someone else on here posted a good thread on improving sperms quality. I dont know maybe useful.
I wish all you ladies the best of luck with your next rounds x

@Mouseorchestra7

Hey,

Yeah, totally agree. I actually had a consultation with CRGH after our first failed cycle but we decided to give ABC another go as we thought it would be straight forward with donor sperm for the 2nd cycle. I went for ABC mainly for the mild treatment and not many injections. I have booked a consultation with CRGH for the 8th of March.

Their policy of fewer eggs for better quality clearly didn't work for me during these two cycles. Do you by any chance remember your E2 level on the trigger shot day with your cycles? I was told by ABC that E2 level above 6000 is already at risk of OHSS and they won't go ahead with fresh transfer in this case while CRGH doctor told me they can do fresh transfer with E2 level of 16,000! My E2 level was 9000 for the 1st cycle and was only just over 7000 for the 2nd cycle, so does make sense I had better egg quality during the first cycle. ABC nurse said I will feel so ill if they do fresh transfer for me but how comes other clinic is OK with much much higher E2 level....

I think we will have A LOT more injections with conventional IVF, not just for stimulation, we will have to take injections before fresh transfer and FET or even after transfer up to 12 weeks. Also Create seems to be the only clinic don't have down regulation process.

I am going to start a new cycle in April as well, we can be treatment buddy. :)

@SantoPalo

Hey,

Thanks so much for sharing your experience and congrats on your DS! You have great blast rate!!

Unfortunately my embryo grade is a lot worse than the one you transferred, if it was a B grade, I would be more than happy to transfer it. Day 5 4CC is not the worst quality but it's poor with very few cells. There are successful stories with this kind of embryo for sure but I feel it's basically a gamble that more likely to lose (if a 4CC embryo is still developing, it might well turn into a higher grade embryo next day and implant but it can also go the other way with 20% chance not even surviving thaw or likely to stop growing). TBH I am more worried if it implants and then early miscarriage or no heart beat than just a BFN. I also have a grade 1 10 cells day 3 embryo in the freezer, so if both FET fail which very likely to happen, I will lose another 6 months.

I have been taking wellwomen conception and seems to be mixed vitamins, I am going to speak with CRGH about the supplements but heard COQ10 is a big help too. I think it's very likely that my eggs collected are not mature enough with mild stimulation as I have PCO and high AFC.

@Piaopiao I totally understand your worries about the potential risks of transferring lower grade embryos. Hopefully you will have better quality embryos next cycle, I really hope it goes well for you if you choose to proceed with CRGH with a new protocol xx

Hi @Mouseorchestra7 @Piaopiao

sorry I know this is such an old thread! Just wondering if you did switch to crgh how did you find them? I’ve just had my first failed round at abc and have similar concerns. Thinking of switching to crgh for my next round.

Thanks!