Why did my IVF Cycle fail 2023?

[Ecas88]

Hoping someone might have more of a clue than I do right now, feeling very lost atm.

After having ectopic pregnancies in both tubes, resulting in a salpingectomy and a salpingostomy, we decided to try IVF.

This is my first Cycle (naively thought it would be my only one) I have a DS who is 3 years old.

I went with Create and found out I have PCO (no syndrome) but everythign else looked great, also the sperm analysis via NHS showed everything in normal range.

Opted for mild IVF Cycle, no issues whatsoever with the drugs, had my egg collection on Wednesday (6/12/23)
EC - 28 eggs were collected. 20 fertilised

Day 2 - 2no. embryos with 5-6 cells, 13no embryos with 3-4 cells, 2no embryos at 2 cells and 1no embryo that didn't look good.

Day 3- 1no embryo was textbook, 7no embryos were developing well, 8no still viable but not developing as well. They froze the textbook embryo.

Day 5- 1no poor quality blastocyst which they will leave until Day 6, but they didnt sound like it was going to make it. The rest failed

How did it go so wrong? Everywhere talks about a 30%-50% drop off, I had so much hope of having at least a couple of blastocysts to freeze.

Would you say this is an normal thing to happen? Anyone have any similar experience or know why it was a huge fail :( and whether it's even worth trying again?

X

Absolutely not a doctor and can only speak to you from my experience. I think 30-50 percent drop off is very much on the positive side. I was told far higher drop off percentage.

My friend had the same issue, many eggs but sadly a large drop off rate.

One of the main reasons that eggs retrieved might not make it past the fertilization stage is that they are not mature enough at retrieval time. When a patient is going through Conventional IVF, they are most likely taking higher doses of fertility medications and have higher hormone levels. This causes their ovaries to overproduce eggs that will grow at different rates. Once a certain number of eggs look mature, the patient will need to trigger ovulation for retrieval. The doctor will then perform the retrieval and collect all eggs that are within a certain size range. Since the eggs grow at different rates, not all of the eggs retrieved will truly be mature enough to make it through the fertilization stage. Since conventional IVF focuses on quantity over quality this can make the percentage of viable embryos feel smaller

This is what she sent me x

Ps - sorry I pressed "post" too soon. I'm so sorry you're going through this. It took me several rounds of ivf but I am currently almost 36 weeks pregnant. I know what a rollercoaster this journey is x

It's such a personal journey there will be a multitude of factors at play.....age being the biggest factor

(FWIW I used Create - 5 rounds after multiple ectopics and miscarriages)

I think the biggest miss-selling of IVF treatment - not by Create specifically but every clinic is the success rates just aren't publicised enough - or not hammered home enough.

The reality is under age 35 each cycle "only" has a 30% chance of working. That's why even the NHS guidelines recommends 3 cycles of IVF. Over 35 then success rates fall...and fall...and fall. Over 43 it's something like 3%

Also I think it's not talked about enough that actually clinics don't really expect you to have loads of embryos frozen on each cycle - that was the biggest shock I had after my first round - 2 average to poor embryos. For some reason in my head I thought I'd get like 6 or something! Most clinics are actually only aiming to get you one to transfer with anything more just being a bonus really - unless you are in your 20s

The first cycle is a massive learning exercise for the clinic (and the patients) it's just no clinic wants to say drop £10k on this tester round whilst we work out what we'd do differently for the next round!

I did change protocol after round 2 of similarly poor results. Swapped on to natural modified and did a 3 cycle package and had twins eventually

Echoing this. You've put it perfectly. I've known a dozen or so ladies (including myself) go through IVF and only one lady had a successful first transfer x

@CR7 thakks for alsing your friend for me, i really appreciate it. Xx

20 of the eggs fertilised though, does that still not indicate they were mature enough then? I have so much to learn still 😩

I also thought i was going with a clinic who ethos is quality over quantity, so starting to wonder if that's actually true now.

I'm so happy to hear it worked out well for you in the end and that you are sooo close now, that's super exciting! it makes you really appreciate everything so much more, your baby will have the most loving mama.xx

@Ecas88 such lovely words xx

It's hard; a really tough journey. We did a lot of research into all sorts of extra investigations; every time something went wrong we asked WHY. We made them change things after every cycle. We researched. Went through genetic testing (which was right for us). Sending you lots of baby dust 🩷🩵

@thelonemommabear I've just turned 35 and guess I was thinking it would all work well for my situation. At every stage I was told things looked great, things are working well....and then today I'm told basically none have made it.

I think I've been super naive about this whole process, but the reality is starting to hit me and I'm starting to see what you are saying, it's a trial and error thing 🤦‍♀️ The Dr did mention about only 1 or 2 eggs being good per cycle, as I was worried about having too many blastocysts before! Guess I got what I wished for 😅

I'm glad you had a positive ending though and twins!!! 🙌 it gives me some hope for the future xx

@Ecas88 I feel for you. I’ve also just turned 35 and also had a failed ivf cycle a few weeks ago and also didn’t expect it to be so trial and error but that does seem to be the case.

We started with much lower numbers to you - 6 where 4 fertilised and had 1 blastocyst. I was so gutted we had none to freeze and then when the transfer didn’t work. We are planning to try again in Jan.

@thelonemommabear Great to hear things worked out. I think healthy twins are the dream at this stage 🤍

@Blossomofhope it's such a crappy feeling 😞 sorry you are going through it too. If you dont mind me asking, what was their explanation to why it didn't work for you? Was the blastocyst you transferred good quality? Are they going to do things differently next time?
I'm still clinging to a tiny bit of hope that they froze the best one at day 3 and that one might be good enough once transfered but I know if it fails, it's going to be super hard 😔

@Ecas88 That’s great that you at least have a frozen embryo. They didn’t really give us much of an explanation. The embryo was grade 3bb but from what I’ve read grading is very subjective. But ultimately whether it was a sperm, egg or implantation problem - they don’t really know. Next round we are not doing down reg and trying different medication. So im hoping we’ll end up with better quantity and quality. Im pouring all my hope into this next round - I don’t know what I’ll do if it fails again. This whole experience is so insanely all consuming. Did you get an explanation?

@Blossomofhope that's frustrating :( I haven't seen the clinic yet, I have a scan tomorrow so I'll ask for an explanation then, I'll let you know what they say. I think we are also going to test for sperm dna fragmentation as well, apparently it can be a factor if the eggs are making it to day 3 but not to day 5, so it would be good to rule that out as a possible cause.

@Ecas88 ya it’s probably worth doing. We did that before our first cycle and was all fine. But my partner has low morphology so we did ICSI. Best of luck tomorrow.

Hi @Ecas88 I'm so sorry you're going through this - the disappointment can be crushing when you think things are progressing so well.

I was in a similar situation in our first round of ICSI - 35 as well, and unexplained. Much lower number of eggs than you (9) but 7 doing well on Day 3, and then just an early blast to transfer on Day 5 (BFN) and none to freeze. It was such a shock!

The clinic didn't give us any explanation but I also read that it can be a sperm issue that casuses such a drop off after Day 3 so, although my partner didn't have a DNA fragmentation test, we went into our second round assuming he had an issue there. So additional supplements and quite a few lifestyle changes for him, including diet, for 3 months. Oh, and very frequent ejaculation 😅I don't know if it's just coincidence, but our second round went a lot better... we had a fresh transfer that resulted in our son, and have another 2 4BB embryos frozen.

I wish you the best of luck and reiterate what PPs have said that it hardly ever works first time round... so I hope the next cycle is the one! xxx

@beachbum85 I guess because the only issue was to do with my tubes not working, I was under the impression things would go very smoothly for me....how wrong I was. It's like the one issue i thought i had, is now a multitude of other issues, it just seems one bad luck after another :(

Thanks for the positive story, and i wish you all the best with the remaining 2 frosties. it's always good to hear a happy ending :) xx

From my experience Create don't really support lots of additional testing - I asked about sperm fragmentation tests but because my (ex)husband had been taking Proceive max for years by that point he said the treatment for fragmentation wasn't much different so would be a waste of money

I had 6 miscarriages and 2 ruptured ectopics and I was just so desperate to know why - I'd go into Create with a long list of tests I'd read about and they talked me out of most of them

If it helps here are my stats

cycle 1 - mild ivf. 14 eggs. Less than 30% fertilised. Grade 2 on day 3 and 2 average blastocysts- both 3BB. First transfer was a BFN, second transfer was a 2nd ruptured ectopic

cycle 2 - mild ivf. 14 eggs. Again rubbish fertilisation. Grade 2 on day 3. 2 average blastocysts - both 5BB. Decided to PGTA test - one mosaic and the other a complex abnormal. Was allowed to transfer the mosaic but it was a BFN

cycle 3 - natural modified. 2 eggs. Both fertilised both grade 1 on day 3. One frozen at day 3 (became one of my twins) the other was cultured to day 5 and became a 4aa and is still frozen

cycle 4 - natural modified. 7 eggs. 100% fertilised. 2 grade 1 on day 3. One 5aa still frozen and a day 6 4bb became my other twin

cycle 5 - natural modified. 2 eggs. Both fertilised but awful quality. Whole cycle felt wrong from the beginning - I was one of the first patients as soon as clinics allowed to reopen during covid. No blastocysts from this round: to be honest it felt like my body was tired by that point and was telling me it had had enough - cycles 3-5 were done almost back to back and all 5 cycles were done in 18 months with a natural conceived miscarriage and the ectopic in that time too.

So I chose to transfer the day 3 (which was cultured to day 5) and the day 6 (against create wishes - they wanted to transfer a better quality one)

After cycle 2 I just knew I couldn't continue with mild ivf - I had a "feeling" about natural modified and pushed for it - again create didn't suggest it - so my advice is always push back, ask questions, challenge them

@Blossomofhope thought I'd update you. They basically suggested that maybe they didn't give the eggs long enough to mature and that next time they would do similar amount of stims but extend the time for egg collection by a couple of days (My EC was day 12). Talked about there not being any issues that stand out to them and that it doesn't always work first time and 3 rounds is what is suggest by nice. I asked about natural modified and my nurse wasn't keen on it as I've got PCO but I have an end of treatment consultation with the Dr and she said see what he suggests. She made me feel better about things so I'm feeling more positive about doing another round, but I think I'm going to try the FET day 3 embryo first.

@thelonemommabear thank you for sharing, makes me understand how things can go with ivf. I asked them About the dna fragmentation test and they said we can but didn't seem to concerned about it due to us having a baby already, I might look into the supplements you suggested and get my partner to take them anyway. I asked about natural mod but they suggested mild again as I seemed to respond well. I'll speak to the Dr about it though as I like the sound of it less eggs but better quality.

Is good to hear they still went with your wishes and took your choices. I've been with Bristol create via abc Oxford and everyone had been so great so far.

@Ecas88 ah that’s great that the feedback was somewhat helpful. Hopefully next time will be lucky!

@thelonemommabear

Sorry forgot to ask about the ectopic :( having been through 2 already with emergency removals due to horrible pain(no rupture on the first, slight rupture with second) I'm doing IVF to try avoid having another...I know the risks are generally higher for most ppl but I was told I've got a 1in3 chance if I try naturally, so ivf would still be a much lower chance of having one....

Could you tell me more about what happened? You only had one tube when you started ivf but still got another one in the remaining tube even though you'd had multiple pregnancies go down it? How did it rupture if they were monitoring you? I'm so scared of this happening to me.

@Ecas88

IVF can actually increase the chance of an ectopic happening - especially if you have tubes which may not work/been operated on before...my clinic didn't give me that snippet of info until after my second ruptured ectopic (I was also doing IVF for a sibling)

Something to do with negative pressure - since the embryo is being sent into the uterus from the wrong end if you like - it can get sucked back into the tubes and if they don't work fully then they can't move the embryo back down to where it needs to be

The only monitoring clinics do as such is the pregnancy test on Test Day and then the viability scan around week 7 - most clinics don't do multiple blood draws and lots of ectopics can have "normal" Hcg increases anyway - mine did (I found a place which did private blood tests)

I felt fine up until 6wks - then one morning I picked my eldest up for a cuddle - and something just didn't feel right. Intuition maybe. I know the difference between miscarriage pain and ectopic pain and I just knew. I rang my hospital who'd seen me for previous miscarriage clinics and the first ruptured ectopic. They weren't really interested and fobbed me off. I rang Create and to be honest they were brilliant - I had a really good rapport with the nurses and doctors there - and they got me straight in for a scan - saw the ectopic - both of mine were live - so had full heartbeats hence why hcg levels were always normal. They called an ambulance and i ruptured not long after arriving in a&e. I can't fault Create for their reaction
*
I asked about natural mod but they suggested mild again as I seemed to respond well. *

Go with your gut instinct. I responded well in terms of follicle numbers and my doctor would have gone for a 3rd mild round had I not said no I want to do something different and really pushed. It may be different if you are using ABC though - not sure how much you can influence the protocol with it being nurse led? My Create was very much like well give you our opinion and try and persuade you but at the end of the day it's your money 🤣

Are you on a package? or paying by the cycle? I might be inclined to try another cycle on mild and extend EC - day 12 is very early and then if you are wanting to keep going then try something different

It's so hard and IVF is just mind baffling. I had PCOS and didn't have periods so couldn't really try for a baby so actually had my first round of IVF when I was 25. It was successful right away and I now have a 2 year old. But like you , I was also shocked with the massive drop off.
I was happy to begin with at 17 eggs being collected. We had icsi so they injected 15 eggs (2 were immature). Only 7 fertilised to begin with and then loads dropped off and basically there was 1 good quality embryo and one rubbish quality.
They transferred the good one and that is my son but honestly I was expecting about 10 in the freezer!
The clinic seemed very positive that one had made it and was good quality and told me there was a good chance of pregnancy. At the time I was a bit gutted because I didn't think it would work the first time. But I don't think the necessarily expect you to have any frozen. The aim is one good quality one per cycle and to achieve a pregnancy.
Especially because I was young so obviously eggs are younger but it's not always the case.
Also read that the more eggs you produce doesn't necessarily mean they will produce more embryos because a lot end up being poor quality.
Do you take any supplements?

@thelonemommabear I knew there was an increase from 1% to 3% for ppl with no tubal damage. But I was hoping my chance of ectopic would be still be less than 30-40% as the tubes might not be used with ivf but 100% will if I go natural. I dunno though a nurse said it won't make a difference but then 2 Dr's said it would... feeling nervous about it 😞

That must have been really hard to go through and I'm so glad create were there for you and had such good patient responsibility and care. It was similar with me, very very painful periods both times, they didn't find either of them until around 9 weeks, both mine died in the tube and my static hcg levels was the main indication it was ectopic. The clinic said they will scan me at 5 weeks to make sure it's in the right location, so I feel much safer knowing i can get help as early as possible, I can then use the NHS to check for viability at the 8 Week mark, if needed.

They are happy for me to try whatever I want, but like you say have their own views on what they think is best. The nurse who is advising has 25years experience and is so so lovely. She's said she's seen it all and that in the past they used to only try for a couple of eggs but results weren't great especially for pco so the more eggs the better in her opinion. I am thinking maybe mild one more time, I think they were quite cautious with me this cycle as I was very anxious about getting ohss and even though she said I met criteria for EC, I think they rushed it because of me being so nervous. I feel a lot more confident about going into it a second time now, so think I can handle a few more days.

We bought 1 cycle...thinking that was all we needed 😅 I'm going to transfer the frozen day 3 as soon as i can, so I still have a very small amount of hope it could still work out this cycle.

@Swirls346 Ah that's so great you were able to try IVF at a good age and that it worked first time!! I always wanted children so much earlier but just wasn't in the right relationship until I was 29! Were your embryos day 3 or day 5? Did you do a frozen or fresh transfer? If fresh, did they not have any concerns regard ohss? My clinic has a policy that over 12 eggs collected means freeze all, so I'll never be able to do a fresh one.

I get you, i was told lots of eggs dont equal quality eggs, but everything suggested even though I did have lots, they were good quality so it was such a shock as my drop off was very extreme at 20 fertilised, 8 growing really well day 3 then nothing on day 5 😳 from everyone else's drop off and everything I read online about drop off, it was looking likely I was going to have more than 1. Even the Dr came to me afterwards (because he knew i was concerned about having too many embryos) and said we have 28 eggs that are suitable for fertilising, do you want us to fertilise less of them 😂 glad I said fertilise them all as I would thought it was all my fault I got 0!

My transfer was a day 5 one with a very good quality embryo.
By day 5 I'd already started to get OHSS but they still wanted to go ahead with my transfer.
The OHSs settled down a couple of days after but got a hell of a lot worse around the time of test day. Like extremely worse. This is how I knew I was pregnant. Basically the HCG exasperated the OHSS.
I was in and out of hospital having bloods and had fluids all around my organs. I was honestly in agony and wished just to be better. I even said I don't care if I'm pregnant! They were going to put a drain in but didn't in the end. Luckily the ohss resolved completely by 7 weeks pregnant and I had a very smooth pregnancy.
No sickness really at all. Xxx

Was meant to add my AMH was 72 so a high risk of OHSS anyway.

With your case it's so hard to predict why it didn't work. And frustrating.
We did have ICSI where they choose the sperm and inject it. I think that's meant to increase your odds but I'm not so sure it does.