Disappointed at fertilisation rate

[hollyhd]

Feeling really disappointed right now. First cycle of IVF - age 35, no known fertility issues (same sex couple), using donor sperm from sperm bank. Everything seemed to be going so well on the monitoring scans, had EC on Fri and was pleased to get 11 eggs. When I came to, they gave me the news that they had discovered a polyp and fresh transfer was out.

We were already disappointed about that, and then when they called us yesterday they said that only 5 have fertilised, which to me seems like a low number? Why would this be? If the sperm is good, is this an egg quality issue?

I'm annoyed with myself for not asking any questions. Due another call tomorrow with a day 3 update, are there any questions I should ask the embryologist?

Feeling a bit upset right now and can't help catastrophising, worried we won't get anything out of this round.

I know for me low fertilisation was a symptom of poor egg quality - I was similar age to you too. Did you do ICSI? I would ask for more details from the embryologist about what your eggs seemed like ie outer shell hard, did they fertilise but abnormally or not fertilise at all?

Hi @hollyhd sorry you’ve not had the results you wanted. I’m also using donor sperm (I’m single) and have had varying results over four rounds. At best all 12 eggs collected fertilised, and 11 normally, at worst on my latest round 10 of 13 eggs collected fertilised but only 3 normally.

Same as the poster above I’d ask about abnormal fertilisation or none at all. You could ask if it was anything to do with egg maturity, too. And if there was a lot of abnormal fertilisation, ask for their thinking as to why. On my latest round, I had a much higher than usual abnormal fertilisation rate caused by too many sperm getting to eggs at once. I was told it’s just bad luck rather than age/quality.

But, to prepare you sometimes they just don’t know why to give you an answer. Even if you’ve paid for an embryoscope, this isn’t used until after fertilisation so they don’t have the time lapse view to go back and watch. Fertilisation still seems fo be an ivf mystery. Hope you have a good blast date, 5 still gives you every chance.

Thanks both. We didn't do ICSI - they advised it wouldn't be needed with donor sperm. I'm with ABC but if egg quality is an issue, perhaps we need to look at clinics with a more tailored approach.

@hollyhd I had my third egg collection Friday with 12 eggs collected, 9 mature & only 5 have fertilised ISCI.
My 1st round was
9 collected, 6 fertilised, 1 to transfer & 0 to freeze IVF.
2nd round 13 collected, 6 fertilised, 1 to transfer & 0 to freeze IVF.
The first cycle the embryologist said you normally lose a certain percentage but I can't remember the amount that was said.
Good luck 🤞

If this was first cycle it's alright actually. There are plenty of things you can do to increase egg quality such as diet and supplements. If you want I can send to you some recipes I've saved and I'm using to increase my egg's quality.

What did the embryologist say?

Why are they doing IVF if you have no known fertility issues?

Have they explained the rationale for this? IVF is extremely invasive and with donor sperm, if you have no issues yourself, surely they should be doing IUI?

Also on your question about numbers - 5 out of 11 is actually quite good, and definitely within normal realms. There is always a drop off rate in fertilisation and to get half fertilise is not bad at all.

BUT, I am very concerned that they are doing IVF with you at all, unless you specifically requested it for some reason. It seems unnecessary if you have no issues.

Hi @want2bemum, it was our choice after being advised that the success rate of IUI was likely to be low based on my age.

Thanks for the reassurance about the fertilisation rate, the embryologist also said it was normal - she said they only expect 50% to fertilise. I expected 75%-80% but that'll teach me for getting my information from obsessive googling!

@hollyhd Of you 11 eggs collected, are you sure all were mature? Only mature eggs will fertilise. Best of luck

@hollyhd p.s. We're a same sex couple, no known fertility issues and did IVF (though ater 4 unsuccessful rounds of IUI).

@hollyhd

Hi *@want2bemum*, it was our choice after being advised that the success rate of IUI was likely to be low based on my age.

I am really surprised they advised that tbh, at 35 you are not that old. My clinic would not advise it (I'm under NHS care)

I'm not an expert though and of course you make your own decisions, I just think it's very odd and wonder if they want you to pay extra for the IVF - ABC is a franchise really! It would make me question the patient care that they didn't encourage you to try IUI first.

Anyway, fingers crossed for you - that is a good fertilisation rate and I hope you get the result you want! x

True @want2bemum, that's always my worry with private, I'm always thinking they're after more money rather than my best interests. Wish we were eligible for NHS treatment.

To be honest though, we know a few couples who ended up doing IVF after multiple unsuccessful IUIs so we thought it would be better to go straight to IVF and increase our chances. We did go to a few different clinic open evenings/webinars targeted specifically at lesbian couples and the consensus from all clinics seemed to be that it was personal choice to go IVF v IUI, no clinical recommendation either way. Well that was the impression I got, all private clinics so it might have been that they all were trying to flog the more expensive packages.

Anyway, great news from the embryologist today, we have 1 day 3 embryo and 2 'good quality' day 5 blastocysts frozen! So a great result in the end, and all that worry for nothing. Thanks for the replies, best of luck to everyone!

@2mumlife I asked the embryologist - 2 eggs were immature, 2 abnormally fertilised and 1 just didn't fertilise.

How did you get on with the IVF?

@Reefy please let me know the outcome of your 3rd round of ICSI.

I have just had a very similar outcome of ICSI:

1st round (Gonal):
12 eggs collected
7 Fertilised
1 early blastocyst transfered day5, nothing for freezer

2nd round (meds changed to Menopur)
13 eggs collected
4 fertilised
1 early blastocyst - again, nothing for the freezer

I am now waiting to go again but worry i will have the same outcome! what can i do?

Have they given you indication if it's the egg or sperm?

We had terrible ICSI fertilization rate but started PICSI and improved a lot but that's because it was a sperm issue.

@Cherry35 thank you for advise - ive never even herd about PICSI, what is the difference between this and IMSI? can I ask which clinic you did it with?

My husband has poor quality sperm and DNA fragmentation (which is originally why we are going through this process). we found out about the fragmentation before our 2nd round of ICSI and changed the ejaculation time to 24hrs before which improved his sperm on the day was good, the doctor said he sperm looked very good this time which is why its so confusing we had such a bad fertilisation rate. The clinic have mentioned that it could be an egg issue now, but not provided anymore advise or suggestions.
I find it hard to understand when the 1st round 7 of my eggs fertilised.

what was the outcome from your PICSI, did you have anything for the freezer? was it successful?

@VictoriaFR we got
12 collected
9 mature
5 fertilised
Day 3 we had 4 going
Day 5 we had 2 left but the lowest quality so did a double transfer but unfortunately another BFN!

@Reefy are you going to go again? What suggestions have they given you to improve your chances for the next round?

Hi there,

My husband has/had poor sperm. Did 3 stim cycles with ICSI only on a bulk bill clinic and in total had 17 eggs but only 2 embies.

Changed to private clinic that discovered his sperm was very bad and did IMSI which is same as PICSI and had 3 embies (5 day) out of 5 eggs. 4 fertilised but 1 didn't make it to 5 day. First time we put 2 in freezer.

I think they should have done IMSI even if his sperm looked good because with IMSI they use a very powerful microscope to choose the sperm and not with normal ICSI. Perhaps the sperm they used was moving but had fragmentation issues. Better push to continue with it even if sperm is good.

Having said that my DH sperm improved a lot with cq10, fish oil, lycopene, menevit, Ashwaghanda, accupuncture and ejaculating every 2-3 days but this was only on the last cycle when I only had 1 egg so still bad results. This cycle I had testogel before as a primer to see if it increases eggs.

@VictoriaFR

Hi there,

My husband has/had poor sperm. Did 3 stim cycles with ICSI only on a bulk bill clinic and in total had 17 eggs but only 2 embies.

Changed to private clinic that discovered his sperm was very bad and did IMSI which is same as PICSI and had 3 embies (5 day) out of 5 eggs. 4 fertilised but 1 didn't make it to 5 day. First time we put 2 in freezer.

I think they should have done IMSI even if his sperm looked good because with IMSI they use a very powerful microscope to choose the sperm and not with normal ICSI. Perhaps the sperm they used was moving but had fragmentation issues. Better push to continue with it even if sperm is good.

Having said that my DH sperm improved a lot with cq10, fish oil, lycopene, menevit, Ashwaghanda, accupuncture and ejaculating every 2-3 days but this was only on the last cycle when I only had 1 egg so still bad results. This cycle I had testogel before as a primer to see if it increases eggs.

@hollyhd So we did 4 medicated rounds of IUI, all BFN. We then moved to IVF. I'm 32 now and have normal everything, but discovered I respond very poorly to stimulation. So first round we only collected 4 eggs. Only 2 eggs were mature. Both fertilised and made high quality blasts. We transferred a 5AA fresh, started bleeding 4dp5dt so no surprise BFN. We did a FET with our 4AA, ended in a chemical pregnancy.

Second round we changed the protocol quite a bit to try to make me respond better. Second time we got 6 eggs, all mature, all fertilised. All progressed to day 5, but only 3 of them were deemed suitable for freezing (we did a freeze-all cycle that round due to protocol) graded 5AA, 3BB and 3BC. We did a FET with the 5AA and assuming all is well I'm 16 weeks pregnant.

Whole thing has taken 2 years and somewhere in the region of £25k (probably a bit more to honest, but I don't dare crunch the numbers)

I've said DP I wont do any more egg collections, so we have been considered options (all being well) that we can have a sibling. DP is 36 but AMH is high for age (its higher than mine) so we're looking at DP doing an egg collection whilst I'm prengant and freezing more embryos (using the same donor as I did) if we can, that I'd then carry in the future (DP isn't interested in being pregnant).

@2mumlife Congrats on your pregnancy!

I have to admit I'm a bit terrified of the £25k figure, being at the start of this journey. We'd like to buy a house but waiting to see how much of our savings needs to go on IVF first. I hate that it's so expensive!

@hollyhd We would have been cheaper just doing 6 IUIs and then joining the NHS waiting list, but I just felt there was no point doing more IUIs after the first 4. Also, at that point covid was still bad and the NHS waiting lists crazy, so we did an Access Fertility package for 2 full rounds of IVF instead. We bought a house just before lockdown, but did set aside funds for fertility treatment. Whilst we didn't expect it to be so expensive, we've been lucky that we've been able to afford it (not doing anything during covid helped!). We would have gone NHS if none of the embryos from our last egg collection took.