3 ICSI rounds and 0 blasts

[Idk12345]

Hi everyone,

im just looking for any advice or thought really.
backstory: we have MFI with morphology less than 2% and Low motility. DNA Frag was 48% and were given antibiotics by JRamsey. We are 32, not yet conceived naturally. We have had 3 rounds of ICSI.
1st round (uk) 7 fertilised embryos which dropped of by day 5 - 1 very low grade blast was transferred in day 5 but was told that this would more than likely not implant - cycle failed.
2nd round (turkey) 13 fertilised embryos which dropped off by day 5. 1 almost hatching blast transferred and one morula on day 5. Failed cycle.
3 cycle and current (turkey) 8 embryos fertilised. 0 blasts day 5. Consultant decided not to transfer as embryos had not made it to blasts on day 5 but still looked like morulas (of a day 3 standard rather than 5).
Consultant has advised us to consider next steps. He believes donor sperm may be the only option but this is not an option for us personally as a couple. He has stated this because he states, though we have good fertilisation rates, we do not get a good rate of blasts in our cycles and more times than not, not blasts at all. I guess I’m looking for advice or something. Should we continue trying ICSI? Should we abandon ship? I guess is there any hope? Or should I be realistic?

Hi, I don't have much advice for you really but just a similar experience/ been in a similar boat so I understand.

We have what would be classed as severe male factor infertility. DNA fragmentation was much lower than yours at 24%. But morphology around the same as you, and very low motility. Basically, the chances of natural conception are slim to none.

We have tried ICSI and have now made the difficult decision to use a donor and go for IUI.

Partly due to age (he's in his 40's and doesn't want to be much older as a dad), partly due to me responding badly to the IVF drugs (I had OHSS both times despite having normal fertility and being generally healthy myself).

Anyway, moving to a donor is a horrible decision to have to make, and I totally understand the initial ick about it (we've been through it). But, how much have you really discussed/ looked into it as a possibility? Is it really a 'no go' or is it just a difficult thing to get your heads around... because we have been through that journey and come out the other side, and now we both feel completely happy with the decision.

I'm not saying you shoudn't try again with the ICSI (no one can really make that decision for you!) but just saying that using a donor might not be as awful a thing as you think.

I wish you all the best, whatever you decide.

Thanks for responding @TunicFox.
i guess more than anything it is that it would be too uncomfortable for my dh. And I’m not quite sure about myself really. I think with me it’s almost as though I have to accept that I wouldn’t bare his child, if that makes sense, which makes it a very emotional thought.
I’m not sure if I should accept defeat or continue. My consultant was of the mindset to go another round but to expect it not work which was really difficult to digest.

@Idk12345 It's a difficult process to go through and yes very emotional. We had the same emotions and fears as you. I can't advise about whether to carry on with the ICSI, that is your decision, but I would say that these fears you have about using a donor might be possible to overcome if you are both just willing to have a go.

You don't even have to decide to do it to start with, you just both have to decide to talk about it, and go from there. If you never discuss it and explore your feelings together, you will never know.

We are doing it now and it has become an exciting and positive thing because we have been through the emotions. My DH has had to go through a process of grieving for his genetic child (which we cannot have) in order to open himself up to love the child which we, hopefully, can have. It is possible x

Hi @Idk12345 sorry to hear of your situation. We’re in a similar boat in that we’ve had 6 rounds, no blastocysts but we have really poor fertilisation rates. The decision about whether you should continue with ICSI is such a personal one but essentially if you stopped now, would you look back with any regrets and feel like you hadn’t done everything you could? For us, our consultant suggested a few tweaks to our protocol so we thought it was worth another shot, to make sure we’d exhausted all options. We’re fortunate that we can afford it though as obviously it’s unfortunately a financial decision as well.

Also, we briefly considered donor sperm a while ago and we used some of the Donor Conception Network resources to help us discuss it and work out how we both felt about it. It might help you to have a look at their website and possibly sign up to some of their webinars. I’ve since realised that at that point I was comparing having a donor conceived child to having a child that was genetically ours, rather than comparing a donor conceived child to no child at all. If our next round fails, I think we’ll probably accept that they are our only options and maybe revisit the conversation.

@GreyZebra but essentially if you stopped now, would you look back with any regrets and feel like you hadn’t done everything you could?

Thats a good question to ask myself. There’s parts of me that wants to try again and see. Yes financial does play a part. We are ivfing abroad to keep costs down but even then things add up.
I think it’s what’s the consultant informed me (that’s the odds would be similar to previous rounds) that’s sort of thrown me massively.

He was more of the mindset that other tweaks may not work and he didn’t think they would make massive amounts of difference :(

Hi, I’m sorry to hear your journey has been difficult so far. I wondered if you and your partner take any supplements? We were told we needed ICSI due to my partner having very low sperm count (less than 3 million) and were advised to take Impryl. He had had two previous sperm analyses come back less than 3 million, but after taking impryl for 6 months on day of egg collection his count was normal (21 million). He hadn’t made any other diet or lifestyle changes and the consultant put it down to taking impryl. You may already be taking it, or feel it’s not for you, but I just wanted to suggest in case it’s worth giving it a go - it’s supposed to help sperm and egg quality so should improve chances of getting a good blast. Good luck with everything, fingers crossed for you

Hi, I'm sorry you're here. We also have high DNA frag and saw Mr. Ramsey.

This is what worked for us:

• High antioxidant diet + supplement plan for both of us for 4 months. We saw a nutritionist who was recommended by Mr. Ramsay - this helped bring down the DNA frag by a few percentage points
• Zymot and PICSI in addition to ICSI - ICSI alone wasn't enough, these 2 technologies helped the embryologist select the healthiest sperm
• IVF protocol change - helped maximise egg numbers and maturity

With all this we had 11 eggs retrieved, 8 mature, 8 fertilised, 6 blastocysts, 3 euplod.

Has your husband been checked for varicocele?

With MFI being your main issue I would try and get another appointment with Mr. Ramsey and trust his advice more than your consultant's (who I assume is a gynaecologist). Also, look for clinics that use Zymot and offer either PICSI or IMSI as sperm selection techniques.

@Immysmumma he has been on many supplements for several years. Prunelpin, coq10 etc. I’ve not heard of Imrpryl but will look into this xx. Hubby and I do not have the best diets tbh.

@giraffesauce thanks for all that information. I agree I do want to make sure I’ve tried everything we can. We’ve come this far. May I ask what Zymot, PICSI and IMSI are?
We made an appointment with Dr Ramsay some years ago after our first round failed. At the time he stated he believed my husband had antibodies and gave 1 month course of antibiotics. The last conversation we had with him, he was very hopeful and believed we could conceive. It’s just so difficult that two cycles on we are being told something else. But it is as you say, this is a gynaecologist and Mr Ramsey is a sperm specialist.

@Idk12345 I completely understand your frustration after repeated failures. It's a tough spot to be in. You've been through a lot.

I do think that you have lots of other things to explore before resorting to donor sperm - if you feel inclined to continue with treatment.

Zymot is a device that has been shown to "filter out" sperm with high DNA frag, more and more clinics use it nowadays as a way to "prep" the sperm before fertilisation.

ICSI by itself will help bypass low motility, but it will not get around the DNA frag issue, because it simply means the embryologist picks any sperm and injects it into the egg. What you want is for them to select the good looking sperm first based on certain parameters that indicate healthy DNA, and inject those into the eggs. PICSI and IMSI are two different techniques for achieving that, the studies I've read show they have similar efficacy.

Definitely get your husband checked for varicocele as well. If I remember correctly varicocele is the root cause of about 40-50% of high DNA frag cases (it wasn't for us). If your husband has it and gets it surgically removed there's a very high chance his DNA frag will plummet and you might not even need IVF at that point.

I think you have a lot to gain by seeing Mr. Ramsay/a fertility urologist again, and finding a clinic that sees high DNA frag cases day in and day out.

Thanks @giraffesauce
You’ve definitely given me a lot to think about and to research.
Can I ask what clinic you are with?
I will be speaking to my clinic in Turkey about these options and if he doesn’t agree I will be looking elsewhere.

@Idk12345 I'm with Aria Fertility in London. Feel free to DM me if you want to chat some more.

@Idk12345 Hi there, how are you getting on?
we are in the same boat. My DH has 48% frag, low motility and morphology. We get extremely low fertilisation rates with picsi+imsi+double calcium ionophore… our track record is:
1st cycle - 20 mature eggs, 2 fertilised and 2 made to blastocysts. Both transfers failed.
2nd cycle - 24 mature eggs, 4 fertilised, two blastocysts, one euploid which we kept on ice and decided to try again to bank some more..
3rd cycle - 23 mature eggs. 4 fertilised, 1 made it to blastocyst, two dropped off and waiting for the progress update on the final one.

For the third cycle, I’ve been doing a lot of research and apparently frequent ejaculation helps to decrease the dna fragmentation but did not help our 3rd cycle…

@Pineapple89
thanks for responding. My sympathies for all you’ve been through. It’s a tough journey.
Currently I’ve no idea what steps to take next. I have also come across the frequent ejaculation to reduce sperm frag. I’m not sure what steps we can take as sorry for the tmi but we tend to BD every day. I have never had a natural conception so don’t know how big of a difference this could make.

How are you feeling? Are you currently in the midst of your 3rd cycle?

@Idk12345 thank you for responding X
yes, not too bad. Just finished the third cycle and waiting for the final update today. We’ll then do the pgt-a again and not discounting the possibility that we may end up with none… like you said it is a tough journey and similar to you, donor sperm isn’t an option for us. We’ve looked at TESE as well but our consultant is not keen on it, may revert to that as a last resort later. If you have fertilisation and had formation of blastocysts, there is hope!

let’s keep in touch and wishing you all the best for the next steps!

@Idk12345 are you currently going through round 4?

@Pineapple89 hey, how did it go?
I’ve not started round 4 yet (finances :/). What is PGT- a?
I have also discussed TESE with my consultant, he is also not too keen though I’m not quite sure why. Did you consultant mention why?

@Idk12345 i feel you… we opted for insurance, have you considered it?

PGT-A is genetic testing. After two failed cycles our consultant suggested to do it to see if we can produce chromosomally normal blastocysts… we got 1 out of the previous cycle. We’ve sent off 2 today from the third cycle (keeping fingers crossed for at least one more). Typically it is not offered to those below 35 or who have a small number of blastocysts but we thought we’d try…

Tese - he said that it’s quite invasive (don’t think it is more invasive than the egg collection though!) and that frequent ejaculation and short period of abstinence ahead of the egg collection is (whilst not the same) similar to the sperm you’d obtain from tese…

I had a chat with the embryologist as well. They are equally perplexed with the results as short abstinence and double calcium ionophore did no improvement to our results..

@Pineapple89 unfortunately I hadn’t considered insurance. Looking back I think I was somewhat naive at the time :/
I had been cycling abroad (Turkey) so was nervous at the time.

Thank you for clarifying the PGTA testing. I wasn’t aware of this and am curious why it was not offered to me.

Yes I agree with the TESE argument. I don’t see how it can be anymore invasive than what women have to go through during the entire process! :p
At the time, when I suggested this to my consultant, he had said a similar argument that regular ejaculation counteracts DNA frag.
I just feel as though I should give it a try at least…