3rd round ICSI - no blasts. Thoughts on what went wrong…

[CurlyJ21]

Hi everyone

I’m looking for some insight into what might have happened on our latest round for ICSI. We opted for ICSI because DH’s morphology was 2% prior to our first round, so wanted to play it safe. After a poor first round (where the trigger seemed to have not worked properly) we had a good second round (15 eggs, 13 mature, all 13 top quality on day 3 and then 5 day 5 blasts). It was a ‘freeze all’ in the end because I was at risk of OHSS. We subsequently transferred one which failed and then found out I have an issue with my uterine microbiome. We decided to do another ICSI round to bank some embryos as we didn’t know how long it would take to rectify the microbiome issue.

We did the same protocol (300iu gonal f) for 7 days. The medication seemed to affect me more this time - I felt pretty dizzy/sick throughout and by day 7 (my first scan), 19 follicles were growing and all much faster than the last time. After that scan they reduced my medication to 150iu as my oestrogen was already at 10,000. It was 13,000 by day 8. I only stimmed for 9 days this time (as opposed to 11 the last) and triggered on day 10. We ended up with 17 eggs, 15 mature, only 5 fertilised, all still going at day 3 but all of have stopped developing.

I won’t have a review for at least a week and I’m beating myself up over what went wrong/what I could have done differently. Does anyone have any insight? I know I’m very lucky to have some blasts frozen but I’m devastated to have put myself through this again for nothing.

So just to clarify, the exact same medications with the exact same doses and both rounds with ICSI?

How old are you and what's your AFC?

When you said the trigger didn't work in the first cycle what do you mean?

I'm so sorry your round ended badly - I would perhaps asks if the estrogen levels were a factor - obviously it's a sign of OHSS and I know lots of women who didn't get any blastocysts because of OHSS despite getting loads and loads of eggs - unfortunately it just spread the quality too thinly over them all

Do you have any more rounds to do? X

@anditgoesonandon, yes, medication levels started exactly the same on rounds 2 and 3. The plan for both was 300iu gonal f for 7 days and then switching to 300iu of menopur. On day 6 of round two, they actually asked me to up my dose from 300iu but I refused as I didn’t think I needed it and continued with 300iu menopur. In the end (I think) I was right as my oestrogen reached over 20,000 on that round and I had fluid in my tummy.

I had my first scan a day later (day 7) on round 3. After that scan, they changed my dose. The original plan was to take 300iu menopur but they reduced it to 150iu. I only did two days of that before my trigger.

I am 34 and my most recent AFC was 23.

I suppose I was reading between the lines that my trigger didn’t work the first time. I found it hard to get an answer why the first cycle didn’t work well and understand the first round is always abit of an experiment but, after it, they upped my dose of stims (round 1 was 215 iu of gonal f) changed my trigger from ovitrelle to gonasi and recommended a higher dose of it. They were tracking 10 follicles that cycle but they only retrieved 5 and after egg collection the consultant who did it said she was disappointed with that and expected more. For round two they recommended 12 days of stims as well. That combination seemed to have worked well but on round three, because the follicles were growing quickly, I only had 9 days of stims.

@bonetiredwithtwins thank you. I was concerned about possible OHSS impact as well which is ironic as, after my first cycle, they said I was very low risk. Round 2 and 3 would suggest otherwise though!

I don’t have any more rounds planned atm (and naively thought that could possibly be my last). I think we’ll move to frozen transfers of the remaining embryos from round 2 after (I hopefully) resolve the microbiome issue.

@anditgoesonandon yes, sorry I forgot to say all rounds have been ICSI

So did you do 7 days of 300 gonal f before you're first scan and blood tests? And then they reduced it?

Id perhaps say that they acted Too late? My clinic would scan every other day from cycle day 4 or 5 (depending on how the weekend fell) which would be perhaps only day 2 of stims so they could catch things early and see what hormones are doing?

If you went again I'd ask for earlier scans and blood tests?

@bonetiredwithtwins yes, 7 days of 300iu gonal f before the first scan/blood test (which was cycle day 10/11). I think you might be right that it was too late.

Do you mind me asking which clinic you are with? I don’t know whether I’m starting to lose faith in the whole process or just my clinic.

Hi was with create x

@CurlyJ21 what was the result of the first round? It sounds like there's definitely scope for an improvement in the protocol.

Gonal-F is artificially made and is only FSH. I had a cycle with menopur (made from the urine of menopausal women and has lh and fsh) and had IVF not icsi. I did really well.

Then I had another cycle mostly artificial FSH, I didn't really respond well until they added in LH and they insisted on icsi for no reason except the clinic does it on everyone. We got quite a poor result.

I would ask what your specialist thinks, maybe ask about starting on a lower dose of just menopur initially and get in for an early scan, day 6 at the latest.

@anditgoesonandon thanks so much for your recommendation. It’s really interesting to hear how differently you reacted to the medication

On round one, we collected 5, (not sure how many were mature) 2 were still progressing at day 3 but they were only 4 and 5 cells and both were fragmented. The clinic gave them a low chance of survival until day 5 so we transferred both on day 3 just to give them a chance. Unsurprisingly, it was a BFN

If I find the energy to do it again, I will definitely insist on early scans/bloods

@CurlyJ21 did you take suppression medication before the cycle by the way?

@anditgoesonandon yes, I’ve always done a long protocol using Nafarelin/Syneral from day 21

You might be interested in this thread - www.mumsnet.com/Talk/infertility/4341015-good-fertilisation-poor-blastulation-any-hope