Not making blastocyst causes?

[VenusStarr]

I'm at a loss. We've previously had a 5AA (early loss), 3AA (MMC), and another 3AA that deteriorated after the thaw, transferred but bfn. But now we're not making any blastocysts.

In my last 3 cycles (4 in total), with 9 fertilised eggs, we have only had a morula (transferred, bfn) and an early blast on day 5, arrested on day 6. The rest stalled at the cell stage.

We don't get lots of eggs, but 3 fertilise normally each time. Day 3 updates have been 1 ok, the others highly fragmented. By day 5, the 2 are still cell stage and one morula one early blast. We froze a day 3. 7cell, grade 2 last time. But my 8cell, grade 2 this cycle didn't make it, so that is unlikely to either.

Is this a sperm issue, egg issue or both?

I'm 40, partner 41, dna frag 14%, motility / morphology fluctuates, but samples on day always meet ivf criteria (we had 90% motility onetimee, once prepped) and fertilisation is generally 75%. Amh 9.8, afc between 9 and 17.

Previously been pregnant without assistance 4 times but no living children. 6 losses in total, known immune issues. 2 of those babies were cytogenetic tested and were healthy.

Feel numb, the embryologist today when she heard our history just kept saying 'oh god bless you, I'm so sorry' 😪 and 'I'll pray for you' 😖

We're on a tonne of supplements but results aren't improving. One cycle left but feel like it's pointless. Got a review with my Dr tomorrow.

We've got 1 cycle left. I doubt we'll ever get a big yield of eggs, 7 is my top but only 3 fertilised (that was my first and only nhs cycle). I then got 3, 4 and 5 but still only 3 fertilised and not blasts. Always done mild ivf (am with Create) and I'm not moving clinics now.

If you have any advice or things I can put to my Dr in my review tomorrow, please let me know x

Hi @VenusStarr so sorry to hear everything you’ve been through, you’ve been through so much and I’m thinking of you. I don’t have loads of advice but I would ask the Dr what they think and if there is anything to they would really recommend for your third cycle package. Do you have any frozen from the cycle package? I think it can often be a combination of things which make this process so hard and challenging and unpredictable. The embryologist shouldn’t have said things like that, it’s not professional or helpful either, I’m sorry they did.
You AMH and AFC seems good though which is super encouraging. Thinking of you and hope you feel better after speaking to your consultant tomorrow xx

Hi @LAURAPAX thank you so much for replying. I spoke with my doctor for ages yesterday. He's disappointed in how things are working out for us but he does think its age related egg quality, because its so drastically different to our first cycle. We've changed my protocol to menopur instead of bemfola and I'll start on a lower dose.
Next cycle is my last one, so I'm doing a cycle day 3 transfer. We do have a 7cell, grade 2 frozen but the thinks we'll get some fresh day 3s suitable.

I feel I need to draw a line though, so won't freeze anything else at day 3 and just see what happens to everything else. In my heart I think I'm done with ivf / trying to have a baby.

@VenusStarr So sorry to read this.. I make blasts (just) but it sounds my case/advice provided by Create was quite similar to yours.

I am 42 this year, 40-41 when I was with Create. All bloods came back normal apart from NK cells and sticky blood. My husband has morphology issues, motility fluctuates. At our second cycle with Create, we made 1 day-3 and the doctor blamed it on the sperm’s motility. We did ICSI.

I was annoyed that he said he’s done everything possible then go on to recommend a hysterosocpy (I mean, he suggested it’s a sperm issue but I was to do more tests after he said he’s checked everything?!). I put my husband and I both on TCM before round 3, we didn’t rush into it and manage to produce 1x4AA and 1x5AB that round; both frozen at the moment.

I know you said you are not changing clinics but I feel it’s worth seeking a second opinion.

I have had my hysteroscopy since (1/3 the price abroad), awaiting results. We managed to get 4 good-excellent blasts from a DuoStim cycle.

Wishing you the best for your 3rd cycle 🍀

Thank you @blahblahetc I'm pleased you have good blasts now.

I know create aren't sperm specialists but I do wonder about the sperm quality - my dh was incredibly ill this time last year and his liver function and bilirubin levels were through the roof, so wonder about long term damage. But as we are getting fertilisation (quite good for my egg numbers) we're told its not an issue. I'm tempted to do PICSI for our last try - my Dr said there isn't a clinical need to but if we want it we can, but my eggs might be more fragile and not like it. So I don't know.

What's TCM? Just feel a bit like I'm not sure what else we can do really. And I'm tired of doing it, spending all our money, feeling anxious all the time for nothing 😢

@VenusStarr Traditional Chinese Meds. It's just herbs really, for the woman it's (1) egg quality and then (2) after collection, to prepare the womb to recieve and hold the embryo. They mix the concoction accordingly... For the men, it's to do with sperm quality, but they also said because there's so many sperm it's not really necessary. I made him take it anyway even for just peace of mind! ie., that way, I know I have done everything possible!

Ask if they do MACS (instead of PICSI), my clinic abroad does that and it's cheaper than PICSI - I'm not 100% of the difference tbh, I think both aims to get the best sperm.

I know that feeling, I think it's important you acknowledge you have tried your best. I'm hopeful with my frozen embryos (preparing for April FET) but I (think I have!) have come to terms that if these frozen ones don't work then it's not meant to be for me. Take time to care for yourself 🤗

@VenusStarr I'm really sorry to read how your last cycle went. Have you spoken to the Dr re max dose of stims rather than mild IVF?

I was going to say the same as previous poster. I was 40 and on my first round they didn't give me a high dose of the drug. It wasn't meant to be mild Ivf but I responded really bad (180 rekovelle) and only got 3 eggs - 1 poor blast on day 5.

Second round used menopur and they upped to 300, still wasn't responding well so increased to 450 and I got the 10 eggs they thought I would have got on the first round, 4 frozen blasts. Pregnant with my 5AB, 2 good quality ones still frozen. I think there are mixed opinions on stims at older age but if you have had that many rounds on mild IVF I would be tempted to go for the stronger dose.

Hi @Zest11 nice to hear from you. I was on 225iu last time after estrogen priming and had 13 follicles but they only got 5 eggs. I had follicle flare even with priming, so with a higher dose its likely my top ones would just run away again which is what happened in the first go. I think I'm just a bad responder.

Thanks @LittleDoveLove congratulations. I'm with Create, so don't think they would go much higher than 225iu anyway.

To be honest, I don't have the energy to fight this. I don't think it's going to work whatever I do. There's too many things stacked against me, it's not even getting pregnant, I have to stay pregnant and I've not managed that in the 6 times previously. If I hadn't already paid for the 3rd go, I wouldn't do it.

@VenusStarr so sorry to hear that. I had 3 miscarriages and then 2 failed transfers before this pregnancy so I understand. I will cross everything for you. Have you read it starts with the egg? I think that really helped me. Particularly taking the COQ10 Super Ubiquinol and I also did fertility accupucture the 12 weeks leading up to ivf and and then the 12 after this time. X

@VenusStarr I think you have done so much. I'm afraid I don't know the answers to your questions. I was recommended high dose drugs because I had some small follicles left on one round so the higher dose boosted them rather than some shooting ahead of others. There might be different advice for follicle flare but I don't know it. Give yourself some time for now, hormones are very hard after IVF (I have always found the withdrawal/aftermath of IVF/fet more difficult than the actual stim/prep). You've got a good quality frozen and one cycle left if you want either.

Thank you @LittleDoveLove I've been on ubiquinol since after my first miscarriage in 2019, I got iswte after that. For my first and second cycle I was on 400mg, these recent 2, 600mg, plus NAC, high strength omega, vitamin E. I do see a fertility acupuncturist too. I've also been under a private recurrent miscarriage specialist for the last 3 years, so I think I'm a bit of a hopeless case.

Thanks @Zest11 started my post cycle bleed today. We've had a chat and we're delaying the final round. I've emailed my clinic to see if I can speak to the Dr again about the dose. I just need some breathing space.
How are you doing? X

@VenusStarr I'm very sorry to hear about your experience. I had ovarian PRP and primed on growth hormone and also took growth hormone during the ovarian stimulation, then we were able to make blastocysts. I also know someone else who was 42, had PRP and then made blastocysts in the fourth cycle. I'm not saying you should definitely do it but these are some encouraging anecdotes. I've been getting treatment at Evewell Hammersmith and they do PRP and growth hormone priming.

Hi @Ikigai22 thank you for replying.
I actually stopped ivf and ttc not long after this due to my mental health crashing badly. I started antidepressants and we parked ivf. We decided to go back to it as we'd paid for 3 cycles and had the day 3 frostie, otherwise we couldn't.
I changed meds to menopur and dud estrogen priming the month before. I had egg collection last week and we got 7 eggs and miraculously 6 fertilised (we only ever got 3 per cycle before). By day 3, we had 5 all 7cell+ grade 2 and 1 x 7cell grade 3. I decided to put the best 2 back, which were a 9 and 10 cell by the time of transfer. We thawed the frostie too. By Friday, we had 3 blasts to freeze as well (5BB x 2 - one was the day 3 from January and 4BB). We also had a 3DD and an early blast but they discarded those yesterday.

So I'm hopeful that the 2 we put back had a good chance of making blastocyst too.

The only thing I can think is my stress levels were much lower bring on antidepressants and taking a break. Plus I've been walking 8000 every day for 6 months.

I'm glad you were able to make blastocysts with your protocol. How are things going? Xx