Advice please, low blastocyst conversion rate - 1 from 8

[TurtlesAndTropicalFish]

Hi all

Feeling really deflated today and looking for advice please from those in a similar situation.

Our second IVF cycle has ended very similarly to our first. In our first we had 1 4AA which resulted in a miscarriage and froze a 6 day 5CC.

This time we had 1 4BB and two that looked capable of reaching blastocyst by Day 6. We got the call this morning that there was only 1 left and it was a 4CC. We are doing genetic testing as can’t go through the pain of miscarriage again. By the time the embryologist was going to biopsy the embryo it had degraded to a DD and was no longer suitable for biopsy or freezing. So we made 1 blastocyst from 8 embryos growing fine on Day 3.

Please can anyone in a similar situation advise what to do next? We are awaiting PGTA results on our 4BB but it seems are chances are 50/50 so we are fully prepared now we might need to do another cycle.

In our first cycle I was on 150 bemfola, this time I was on 300 meriofert. In our first cycle only 2 out of 8 embryos were growing well on Day 3. This time 8 embryos were growing well with 4 8 cell and above on Day 3 so I don’t understand the massive dropoff again. DH does have a sperm DNA fragmentation score of 28%, but could that explain such a poor result?

In both cycles I had to STIM for 15 days as my eggs didn’t grow for the first 4 or 5 days of STIMS. Are my eggs just very poor?

I’m so confused as all our parameters seem normal. Good egg retrieval numbers both times: 14 and 15. DH’s motility, morphology and count are all normal but something is clearly causing such a low blastocyst conversion rate....

Any advice welcome.

Hi @TurtlesAndTropicalFish - I'm sorry you are going through this - I had a similarly poor blastocyst rate in my first cycle and started a thread where lots of people chipped in with useful advice and similar stories - may be of help to you too

www.mumsnet.com/Talk/infertility/4341015-good-fertilisation-poor-blastulation-any-hope

I believe in my case it was down to poor egg quality - I tried some things to improve it and had a much improved blastocyst rate in round 3. I have heard that having good quality embryos on day 3 that subsequently drop off can indicate a sperm issue and I've also seen lots of threads about improving dna fragmentation scores that might be helpful

Wishing you all the best

Hi @TurtlesAndTropicalFish. I second @KatRee on the thread she cites, which speaks to exactly this issue. I had the same problem (and have messaged in that same thread).

I moved to a new clinic after two disappointing cycles, and start my next round at new clinic in two weeks. Am changing protocol (was on 125 Bemfola, and will now be on 225 Menopur). My Dr at new clinic thought the disappointing results could be due to any of the following: Lab issue, sperm issue, egg quality issue. Which clinic are you with?

For egg quality, he recommended 600 mg Ubiquinol and DHEA 75mg per day. I have taken the Ubiquinol but only 25 mg DHEA (too scared to take more - it’s powerful stuff!).

Also, @TurtlesAndTropicalFish, I would consider getting another view from another clinic even if you don’t actually move clinic. I wasn’t getting any answers from my clinic about my poor results so booked an hour consultation with a Dr at my new clinic (who had spoken to previously when I did IUIs). I found that very helpful, as gave me a wider view and some suggestions for how I might improve things. Crossed fingers that I see better results this time

I agree about the egg quality although the drop off after day 3 is also indicative of sperm issues. Is your DH on treatment for the fragmentation?

IMO stimming for 15 days is too long - and sounds like it's just forcing your body to grow eggs that it Would never have chosen itself.

How old are you if you don't mind me asking? I'm surprised the clinic went ahead with PGTA on a single embryo? I PGTA 2 embryos age 36 and neither came back normal

@KatRee Thank you so much for linking your thread. The change in your blastocyst rate was very significant. I will buy the supplements you mentioned and give them a go. Thank you. Have you had had a transfer since your third cycle can I ask?

@Mouseorchestra7 Thank you for your reply. That’s a good idea and I might speak to another clinic about my results. I actually did my first round at ABC IVF and my second round at Lister. But it would be good to get a second opinion from another clinic on what’s going wrong. Good luck with your next round 🤞 When do you start?

@twinsetandpearl Thank you for replying. Yes DH is on Proxeed to help the sperm fragmentation. But I agree there seems to be both an egg quality and sperm quality issue.

I agree with the 15 days of stimming being too long. And I was completely fed up by the end of it which I don’t want to feel again.

I am 37 years old. We said in our consents we didn’t want to transfer any embryos that had not been PGTA tested which is why they tested just the one. Our first cycle nearly broke me. We got a 4AA and I thought this was it. The miracle that is IVF had worked. Then I had a miscarriage and to be honest I don’t think I can mentally or emotionally go through that again. I’m so sorry to hear neither came back normal. Have you tested for similar reasons? Can I ask please what have been your next steps?

@TurtlesAndTropicalFish

I had 5 miscarriages and then 2 ectopics and lost both tubes - all my tests had come back clear so there was no obvious reason for my miscarriages and PGTA just seemed like that last thing we hadn't tried.

I have to say though that after my rubbish PGTA results I joined lots of groups where it's common in other countries to transfer abnormal embryos and women had healthy babies (in the U.K. they have to be destroyed) and did lots of research and the science is very much flawed/in its infancy so I decided not to test again

I said to my doctors if it was between going through another miscarriage or giving an embryo a chance then i wanted to at least try

I changed my protocol to natural modified IVF and concentrated on much fewer eggs (stimming only every other day for only a few days) I had twins on my next transfer with 2 untested embryos

I was with Create - it was a gamble but at that point felt I had nothing to lose x

I hope it helps @TurtlesAndTropicalFish . I also felt like trying to get 60g protein a day might have made a difference for me. I hadn't realised how little I was eating before I started tracking it and there are a couple of small studies I read about that showed an improvement in blastocyst quantity and quality as well as live birth rates for women following a high protein diet. Of course, it could all be a fluke, but whatever happens, I do think cycles can change and I hope you will get better results on your next one
I did a fresh transfer from from third cycle- ET was 5th March and so far it's sticking- I know there is still a long long way to go, but this is the first time I ever had a positive test, so third cycle has been best by lots of measures
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