no good blastocysts on day 5

[Ikigai22]

hi,

this was our First IVF cycle (mild IVF with ICSI). 5 eggs were retrieved, 4 fertilised and were doing great until day 3 but on transfer day 5, they were all at compacting morula stage. the next day embryologist called and said none of the them made it to good blastocysts. Two of them made it to poor blastocysts unfit for freezing. The doctor transferred day 5 morula although I feel pessimistic about it, based on whatever I've read. I'm 37, normal bmi, eat very healthy, been taking all kinds of supplements since six months, AMH is 10.6 and AFC 11, lower than average for my age but doctors have said it's not too low. I had one chemical pregnancy in second month of trying but nothing since then, it's been a year since we started trying. I'm devastated by this result and just wondering what can I hope for future. My partner's SA results are all fine. motility - 68%, morphology -4%. I'd appreciate any insights. Thanks a lot!

I'm really sorry, it's such a tough experience. From 5 eggs having no blastocyst isn't that unusual unfortunately. You do see a big drop off as the process goes along. The number of eggs does seem a bit low for your AFC and AMH. Your first cycle is also a bit of a trial as they can't predict exactly how you will respond. Hopefully you will have some follow up with your clinic and they can make recommendations for a future cycle if needed. I did have succes with a day 5 morula age 32. Whilst you're a bit older id say age is still on your side so wishing you luck with this transfer. They wouldn't have transferred it if they thought there was no chance 🤞

hi thanks a lot for your message. We both feel like we're grieving, bursting in tears every now and then. You said it's not that unusual, could you please elaborate what you think is more usual? It'd really help. And why did they transfer morula in your case? The embryologist said it was the best embryo so far morphologically so that's why they transferred it. Doctor said it's common and they have pregnancies from Day 2 and 3 transfers as well. My partner has a colleague who's 40-41, pregnant from Day 3 transfer, she had 3 follicles, two retrieved and fertilised, the one that was not transferred didn't make it to blastocyst. So that's what encouraged us to try this.

It was our only one viable for transfer from 6 eggs (5 fertilised). We are currently undergoing IVF again to try and conceive a second, same numbers and this time did get one to transfer and one for freezer but they were surprised by that. You can expect as little as 50% to fertilise and as little as 50% of those to reach blastocyst, so if you start with 5 that can = 0, if that makes sense?

I don't personally think grading is the be all and end all. If they felt it was good enough to transfer, that's great. They grew our last embryo this round to day 7 and it reached 4BB. Very unusual but essentially the point they freeze/transfer is arbitrary, if you looked a few hours later it might be a different grade. It's just that statistically if they know it has reached a certain stage by transfer/freeze they can be more confident re potential for success. Does that make any sense?!

Clinics prefer day 5 transfers as it is clearer which embryos are more viable by then. The biggest drop off is between days 3-5. At your age I would think they would always go for that unless you had very small numbers. As you get older they sometimes opt for earlier transfers, but again that tends to be because numbers are lower.

Hi @Ikigai22 similar story but im 39. I had 5 eggs retrieved my amh and afc is 7. I have never tried to concieve naturally. 4 eggs of 5 fertilised all doing well on day 3. They all made it to blast but the clinic said 3 didnt look suitable for freezing and just froze 1 embroyo at 5AB grade which they said they were very happy with. Not sure when I will transfer. Best of luck with your tww.

Sorry to hear you’re disappointed OP. I totally get it. I’d query why you’re doing mild IVF with your AMH and AFC. The aim is to generally maximise number of eggs retrieved. I know there are exceptions with PCOS and very high AMH/AFC and that OHSS needs to be avoided but in general the more you retrieve (up to a point), the higher the success rates.

That was our story as well. We had 13 eggs, and only one made it to day 5 and it wasn't a proper blastocyst. We transferred and it didn't stick. Hoping for better results next time... The doctor said it's most likely that the egg quality is poor.

Things will get better next week. We were devastated the week we started getting bad news, but then you breathe, move on and hope for better results next time. Every day you learn to cope.

@Bubblesdublin that's great, wish I had the same result. Did you have standard IVF?

@CailinInUK thanks. You're right I'm thinking the same that I should've had standard IVF. Why only 5 of 11 eggs were retrieved when around 8 were growing. That could've given me a better chance. Thanks for suggesting my AMH and AFC is not too bad. I don't know why we haven't been able to conceive naturally, we tried for around 10 months and than panicked. As I wrote in my original message, we mild IVF as my partner's colleague did natural modified and is currently pregnant with first transfer. Also we live right next to the clinic. Probably not the greatest reasons in hindsight and should've done more research. I've a consultation booked with ARGC next week if this transfer doesn't work out.

@contentsmayb so sorry about that, good luck with next time.

@Ikigai22 yes I used standard IVF, hard to decide been the two really but it was cheaper so went standard.

Thanks for your messages. I felt a bit better yesterday but feel so defeated again today. I've so many doubts about my body and fertility, that my eggs are older than other women my age or even older women, although I've taken care of myself all these years and eat healthier than anyone I know. It feels so unfair that others eat junk and sweets and are overweight but seem to get pregnant easily. I'm losing hope if we'll have a baby. Feel a bit traumatized by the whole IVF process and stress of waiting for calls, not being prepared for day 3 to say 5 drop off.

@Ikigai22 are you nhs or private as it appears they all have different criteria for what they keep. Such as my nhs don't keep any that don't reach blasts whereas private clinics will transfer ones that aren't blasts. I also read that if you get a good number fertilised then there isn't compatibility issues. If they grow for a couple of days then egg quality is good but if they don't do well day 4-5 onwards then it's sperm issues. Have you looked into sperm dna fragmentation?

@Ikigai22 I know it's easy to say don't lose hope just yet. I'm 42 and had to wait a whole year for my husbands procedure first (sperm retrieval) which absolutely killed me knowing i had absolutely no time to waste and I only have an AMH of 2.9!!! I've had to undertake 6 cycles back to back in order to get the 6 blasts that we had originally planned for. It's absolutely crucified me physically, emotionally and financially. All I can say is never give up hope.
Some cycles I only had 2 folicals growing and only one egg retrieved. Some cycles nothing made it past day 3..... but I've kept on going and am now in my prep month for transfer xx

Hi OP
I had a similar experience on my first round. I'm 40 and my AMH was 13.4 and I have 20 follicles. My first round I was on I think a relatively conservative dose of Rekovelle. I only grew 5 follicles and only got 3 eggs. Only one poor quality 3BC made it. I was in complete shock as was told to expect about 10!
They thought I might be a poor responder so I did the blood test to check - That came back fine. I just needed a higher dose so I changed drugs and did 300 menopur which was upped to 450 at Day 5. I did also do a few other things such as up a few vitamins I was taking from it starts with the egg book, did accupuncture weekly, no drink for a month (also husband no drink either even though no problem) and during Stims I followed some advice from ARGC (they have a leaflet online)

This round I collected 10 eggs, 9 fertilised, on Day 5 I had 4 and I froze a 5AB, 4AB and a 4BB.

I feel it's good to read up yourself on stuff too, for example I wouldn't transfer a top quality embryo this time as my lining was 7.1mm - That's acceptable and clinic happy but I wasn't as I had read over 8mm had a much better chance so I transferred my other slower developing blast which was at 3BC at transfer a few days ago.

I was devastated after the first cycle but things can change drastically from cycle to cycle. I did want to swap clinics after as I feel everything was very basic and I had to sept up myself to get the correct monitoring but i was keen to get moving again due to my age. However I wish it had happened elsewhere as now they have my embryos I'm pretty stuck with them unless I want to risk moving them so definitely read up on where you want to move to :)

I think there is a clinic called Create that does mild ivf for older people as they think it yields better quality eggs over quantity: if you where at a create clinic that might be why. X

Hey lovely, I have very similar stats to you in terms of AFC/AMH/age. My first round I only got 5 eggs, none fertilised, so you’re doing well by those standards.
I needed more meds to get going. Changed to 300iu daily Pergoveris (had been on Gonal F) and had trigger of 250iu Ovitrelle + .5 Buserelin (previous trigger just ovitrelle). Got way more eggs.
If you need another round, I’d recommend LWC Harley st and asking doc for different/more meds. Xx

I am in the exact same position as you OP - same age and similar AMH & AFC. About to go into my egg collection in August and crapping myself. I feel so worried about everything. I've also had two miscarriages in the first 12 months of trying and have suspected endo so feel like i have so many things against me. Hoping you are feeling a little better now. xx

actually my AMH is only 6.1 so much lower than users. My AFC last time checked was 11 (it was 16 in Oct 2022) xx

Thanks for all the encouraging and supportive comments. I really appreciate it. I've been suffering from new anxiety and intermittent insomnia due to failed IVF cycle so now trying to resolve that. Started new meds/supplements as well, dhea 25 mg and nmn. Hopefully something works!

Good luck with your egg retrieval. I hope it works but if it doesn't try to be objective and look at it as a diagnostic exercise and what can be improved. I wish I knew this. It'd have saved me a lot of heartache. I went into IVF with very unrealistic expectations but the truth is it doesn't work first time for most people. Now I'm working on building resilience so I can be unaffected by future outcomes.

Hi @Ikigai22 I'm so sorry about your failed cycle. Our first cycle was similar in that we had no good blasts on Day 5 - we had 7 doing well on Day 3, I had really high expectations and was not at all prepared for the dropoff. We had transferred an early blast but it was unsuccessful and the anxiety of the calls and the waiting really threw me too.

Our second cycle was completely different: only 6 eggs retrieved, all fertilised, 5 doing well on Day 3, 3 good blasts on Day 5. 1 transferred and is now my son, 2 frozen.

All this to say, every cycle is different. We made some lifestyle changes but we'll never know if that made any difference or it was just chance. I was a lot calmer the second time round, used an app called Mindful IVF, did some yoga every day, and tried to do lots of things I enjoy during the TWW, but most of all I went into it a lot more prepared. It's all a numbers game and most is out of our control, so the anxiety is very much justified... take the time to process this cycle and hopefully you will feel a little less defeated and ready to try again. Wishing you all the best xxx

@beachbum85 thanks a lot, your message really helped. I can understand how you must've felt as it's an even bigger dropoff than mine. I also discovered after the failed cycle that my vitamin D is on the lower side. I wish I'd looked into all of this beforehand as I'm sure it makes a difference. The sad thing is doctors I saw never did any such investigations so it's really up to us to check all this. Also, I was taking prenatal with Myo inositol which women who don't have pcos shouldn't be taking as it can lower testosterone and affect egg quality. Again, pregnacare is so common that nobody seems to question this.

Now I'm just hoping to resolve my insomnia as it's one thing that's really throwing me off day to day.

Hi @Ikigai22 I don't know if it helps but I had two completely different cycles. My first cycle was short protocol, 9 eggs collected, 7 fertilised, none made it to blast. I had 2 poor quality embryos transferred but both failed.

Second cycle & different clinic, long protocol, 17 eggs collected, I had 12 embryos on day 2 by day 5/6 I had one top quality one transferred and 6 other top quality blasts frozen.

What I'm trying to say is don't loose hope after a failed cycle (like we did too!). After the first cycle, we were in absolute bits and couldn't imagine things improving if we did another round but here we are!

Good luck 🤞🏻

@wtawtaw thanks a lot, by the way, may I ask if you have any recommendations for a clinic in London? I went to Create Wimbledon for the first cycle and didn't have a great experience. Of course I had a failed cycle but I think my bad experience extends beyond the negative result. I'm looking for somewhere that would address the issue I have which is I have a dominant follicle very early on in the cycle, even in Day 2. I did discuss this with ARGC and they were very non-committal on how they'd address this. I think I want to try long protocol next as well.