Unsuccessful Cycle - no blastocyst - what's next?

[EstelaAntonio]

Hi all,

my husband and I went through our first ICSI cycle in November in London and unfortunately the results were not great, from 5 eggs retrieved, we had only 3 embryos on day 3 and no blastocyst on day 5.

Our clinic highlighted two issues: the low follicular response rate (potentially low egg quality) and sperm DNA fragmentation. My husband did a varicocele embolization 6 months ago but strangely his DNA frag got worst rather than same or better.

I am wondering if anyone in this community have a similar case and/or if there are any recommendations around:

• Given we must go through ICSI, is there any clinic comparison on which ones are recognised for the best embryologist and equipment too?
• I am on my 40's any recommendation on specialist that could help me around egg quality?
• other suggestions from anyone that went through similar situation

thanks again for your support

We were similar in the sense that we had Icsi and had 5 eggs retrieved. By day 3 we only had 1 fertilised and they decided to transfer that back on day 3 rather than wait for day 5. It was successful and I’m currently pregnant. Did they discuss reasons for not transferring on day 3? I have read on here people who didn’t respond well first time and they changed doses of things for second go and things were much better. Stay positive.

Hi @EstelaAntonio I'm sorry to hear about your disappointing round.
If DNA fragmentation is an issue, I'd recommend a clinic that does IMSI or Zymot sperm chip as they are more advanced and effective means of sperm selection than ICSI that can better get around that particular issue.

In terms of improving egg quality, I've not yet bee successful myself, but having started the endeavor to trying for a baby at 40, I've come across a lot of information on supplements etc...

For egg quality:

• Ubiquinol 200mg 3 times a day (with meals)
• High dose vitamin D (also get out in the sun as much as possible as that's the best form of vitamin d)
• Omega 3 (preferably from fish oil if you're not vegetarian)
• Methyl Folate at least 800mg per day
• Alphalipoic acid
• Vitamin B complex
• Cut back carbs and sugar
• East lots of protein
• Try reducing inflammation and stress where possible

For sperm quality:

• Combined Selenium+ Zinc
• Lycopene
• Multi vitamins for men like Wellman Conception
• Impryl (this one is expensive and should not be taken alongside teh others)
• Avoid hot baths
• Avoid cycling
• Cut back caffeine
• Cut bac sugar

There's quite a good Channel 4 documentary on sperm quality called 'save our sperm' which I recommend

As the previous poster said, if you only had one round, it would be normal for the clinic to adjust your protocol to see if you get a better response, there's a lot of trial and error in this as everybody is different, there may be room for heavier stims or lower them either as whilst possibly reducing the number, may actually improve quality and it's definitely quality over quantity in this game!

Thank you so much for your kind words and sharing your experiences 💛

For reference, it was our 1st cycle and our clinic used the zymot protocol.

I am taking coq-10 supplements, is ubiquinol better? Sorry still a bit of newbie :)

I’ll be honest I don’t really know what I took. It was our first go as well. We were nhs and I did ten days of daily injections but I was prob abit easy going as I didn’t really ask too many questions about what the specific meds were and doses. Someone else may be better placed to know the difference between the two. It’s all so overwhelming looking back I think I Jess just abit of a passenger and didn’t really take too much in.

We're currently seeking treatment in Prague and were made aware of MACS ICSI which is an advanced method of sperm selection (choosing the ones without DNA fragmentation. Definitely check that the clinic does that in your next cycle.

I have done 4 cycles in the UK, and decided to go abroad this time. I noticed they up all vitamins dosage so I'm currently on:

• folic acid 800ug
• vitamin D 5000IU
• omega 3 (Coq10) 1000mg

Husband is also advised to take same dose of vit D and Coq10.

Diet wise - no processed food (except a bit of chocolates!) and mostly mediterranean diet, we also only drink decaf now.

Best of luck!

Totally ask away @EstelaAntonio , I’m glad to be of help 😊

The way I understand it Ubiquinol
is the most absorbable form of COQ10 and therefore the most effective. The problem with a lot of these supplements is that although good in theory, our bodies don’t really absorb them so best to use the more absorbable form when possible.x

Sorry your round didn't go as you hoped. I didn't have the exact same experience but we did have ICSI due to a very severe varicocele that made my husbands parameters so so low. Embolization failed as the surgeon couldn't get the vein it was so pronounced and tangled!

So we went into our round terrified of DNA fragmentation from reading the many threads on here about it. To try and counteract it my husband ejaculated every other day in the three months running up to our round, and took the usual proxeed vits recommended. Didn't have baths, didn't drink caffeine or alcohol.

We got 7 eggs all fertilised and all made it to day 5, one slowed so wasn't frozen so had 6 blasts. We called the fminic every day for an update and were sure wed llse lpts after day 3 when male genetics take over but were surprised. Its not a proper scientific answer as we don't have the data of a dna fragmentation test or a round with a different prep leading up but his varicocele is so so severe so dna fragmentation would be an issue most likely.

Have the clinic suggested surgical removal of sperm at all?

Thank you for sharing your story! Yes that’s one of the options being mentioned.