Terrible fertilisation with ICSI - advice?

[Eggling]

Hi everyone

Posting for advice and to see if anyone has any ideas why this has happened? We have just had round 3 of icsi, got 12 eggs, only 7 mature, only 1 fertilised.

Background info: I am nearly 33 and have pcos. DH is just 32 and previously had poor morphology, although they said morphology was fine on his sample this time but motility low. We started icsi in 2020 following 6 failed clomid rounds (I ovulated but no pregnancy). First round gave us 21 eggs, 14 mature, 12 fertilised, 8 day 3, 4 day 5. All blasts were 4bb and above so good quality. Freeze all cycle as risk of OHSS. Blast number 1 became DD who is now 2, born by EMCS in May 21.

Returned to clinic last year. One embryo didn't survive the freeze, then we had 2 fail to implant. A further round in November 22 on a low dose (to try for a fresh transfer) resulted in only 2 eggs, only 1 fertilised. It ended up being a frozen transfer anyway due to fluid in my uterus. I did fall pregnant but miscarried at 7-10 weeks (it was really protracted and frankly traumatising).

Then had an abandoned cycle in May as we had some issues with leaking injections and I wasn't responding properly. This round looked much more positive, I had loads of follicles at my scan on Wednesday so even 12 eggs seems low, leaving aside the terrible fertilisation rate. I stimmed on 187.5 bemfola with cetrotide and ovitrelle trigger.

We've had full recurrent implantation failure / miscarriage blood panels and all is fine. DNA kareotyping on both sides is fine.

For the past few months I have been taking coq10, metformin, inositol, omega 3, vit d, folic acid, and liquid iron. DH has been in proxeed and zinc. We've also both had acupuncture, I've been going weekly for months. Neither of us have had any alcohol or caffeine for almost a year. Diet is fairly good, very minimal processed food. I avoid plastics, have switched out all my cleaning and beauty products to non toxic. Consultant was really pleased with getting 12 eggs and said it was the sweet spot for decent quality. The embryologist who rang today seemed baffled as to what has happened.

Does anyone have any tips? We have a follow up booked with consultant on the 17th.

Sorry that was long, just trying to get all the relevant info in! If so so love to hear from anyone who has any idea why this could have happened - is it my eggs? I think (unless by some miracle the one fertilised makes it, which seems vanishingly unlikely) it's perhaps time we switched clinic?

I would write down any questions you want to ask them well ahead of time. No question is daft and you do not want to leave there thinking oh I should have asked about. …He should also attend this appointment with you as he can ask questions too and give you moral support.

Who suggested ICSI originally, was it the clinic and if so why this particular treatment option this time around?.

Have they tried to address PCOS at all via other treatment methods like injectable drugs or ovarian diathermy surgery?. The cystic follicles associated with PCOS do not all contain an egg. Some are dormant whilst others release hormones that can interfere with ovulation.

Thank you so much for responding. Yes definitely a good idea to write questions down in advance.

ICSI was originally suggested by our nhs consultant on the basis of DH's morphology results, we've carried this over with out private clinic (where we've done every cycle - nhs didn't work out due to Covid) . As sperm always seemed a bit iffy it seemed like our best bet and as fertilisation rate was decent first round o guess it made sense to continue.

I've not had any other treatment for pcos - would that happen as part of the ivf cycle or separately? I'll ask them about that for sure. They've honestly seems to expect things to work for us every time so it's frustrating that we've had so many setbacks, and this one has come as a definite shock.

My clinic does mild ivf so I'm wondering if another clinic on higher dose would be better, but then with pcos surely mild stims is better as its quality over quantity? Feel like we're firing in the dark at the moment to be honest 🤷🏻‍♀️

Other treatment options for PCOS are available but they would be done separately so not as part of any IVF cycle. I would ask them about this at your next appointment.

I did not have IVF as part of my fertility treatment, it was ovarian diathermy surgery that worked re me becoming a parent at all. I would have responded very poorly to IVF and ran a very high risk of OHSS particularly if the ovaries were quickly stimulated. I was also advised such should only be tried when all other treatment options have not worked.

Thank you, I'll definitely ask. With the ovarian drilling do you then try naturally? I guess I'm worried that wouldn't work for us as clomid made me ovulate but no pregnancy and DH's sperm might not be top quality.

Sorry this has happened to you. I’ve had a number of rounds with failed / poor fertilisation so know how devastating it is. We used Artificial Oocyte Activation in our last round and our fertilisation rate was much better so that could be something to explore next time - if there is a next time, hopefully the one you’ve got is all you need!

Thank you @Sunshinebytheseaside - is AOA offered by most clinics or will we need to go somewhere special? I don't think I've seen it mentioned by ours (create). I've read about this today though so will definitely ask!

It’s not offered by Create (or wasn’t when we were there at the end of last year) but I think most other clinics do it. Good luck!