Failed IVF cycle follow up consultation/2nd cycle?

[Becky348]

Hi everyone,
We have our follow up soon and just wondered if anyone had any advice on things to ask please? I've checked out some of the other threads, so have a good list but wondered if anyone had any advice specific to our situation?

I've just turned 40 with low amh (0.6 pmol/l), I had 6 eggs collected, only 2 mature, 1 fertilised with a Day 3 transfer. On the day of EC we discovered my husband had low volume and antisperm antibodies, so did ICSI. I usually have very low progesterone but my levels were good on the day of ET (100), but dropped very low by 10dp3dt when I started spotting on 8dpt. Embryo looked quite fragmented to me - the clinic said it was developing nicely (6 cells at transfer, I know 8-10 is better).

Does anyone have any info on whether my low progesterone would have ruined any chances, or do you think that the embryo likely failed and therefore didn't produce enough, which is what a nurse suggested to me? If we had another cycle I'd add Lubion in addition to Cyclogest.

We started TTC in early 2023, had a MMC and MVA at 9 weeks after getting pregnant unassisted on the 3rd cycle of trying. Nothing since then but I had a few months of irregular bleeding and have had intermittent pain during my cycle ever since the MVA.

I didn't start stims until day 3 or 4, due to timing of my period and a possible cyst. So stimmed for 9 days. Do you think this would've made a difference to egg maturity? I realise at 40 egg quality is likely an issue. We're not sure whether to try a 2nd cycle with OE, or to potentially explore using donor eggs.

Is there anything we can do for DH's ASA? He's taking Impryl and all other results looked ok on NHS sperm analysis. I'm taking CoQ10, DHEA, prenatal, etc.

Thanks so much for reading and for any advice x

My clinic changed my protocol and I got 21 eggs on 2nd cycle compared to 8 at first cycle- 18 fertilised and 3 got to day 5. We transferred one and I have a toddler sleeping next to me.

Other half stopped drinking and taking hot baths/ using the hot tub.

We booked some things to look forward too during the wait for round 2 and then in the 2 ww it took the pressure off and I was less stressed.

Good luck

Hmmm it’s a tough one! You got 6 eggs which is pretty good but the fact none were really mature suggests maybe you should have been on stims for longer. Have you considered PGTA testing? It does sound like quality is also at play maybe - your supplements look good but make sure you’re eating a high protein healthy diet as is partner (I also cut caffeine and alcohol completely, and my partner cut alcohol and reduced caffeine to one coffee a day). Not too sure on the progesterone - I think it’s more likely the embryo was no good, but progesterone probably (not in all cases) should have stopped you bleeding.
40 isn’t really old in IVF terms though so I do think you have a chance with your own eggs but totally depends on your finance situation. I’d probably be tempted to have another go before moving to donor eggs.
Good luck with your next cycle whatever you choose! (Low AMH here too and I didn’t think it would work at all as we only had 2 eggs collected but one of them did work so keep the faith if you can ☺️)

Hi @PMAmostofthetime, thanks for your reply, that’s great that you had a happy outcome when your protocol changed. Can I ask what protocol worked for you please? I had a short antagonist cycle of Ovaleap and Meriofert combined with Letrozole. I think that 6 eggs is probably the maximum I’d ever get with my low amh though!

Wise words about relaxing and booking in nice things for the 2ww ☺️

Thank you @HopefulllHolly, so happy to hear that one of your 2 eggs worked wonders for you!

I think we’d consider PGTA testing if we ended up with more than one embryo. We eat fairly healthily (though could definitely cut down on sweet things!), and I ate loads of protein during the cycle. No caffeine or alcohol for me anyway and my partner cut down on both. The sperm antibodies were definitely a surprise to us.

If our clinic agrees, I’d be inclined to try with my eggs one more time but it feels like such a roll of the dice, financially. Thanks for your kind words!

@Becky348 I guess it’s whether you’d wonder if you didn’t try what if, as you’re still young in my opinion! Donors eggs will always be there and younger so it’s definitely more the financial side of things that I’d think about. What dose of stims were you on? Given you won’t get many eggs because of AMH I wonder if it’s worth asking your clinic to be on a lower dose and be on the stims for longer to allow them to mature a bit? I don’t know if that is how it works but you weren’t on stims for a huge amount of time and didn’t get many mature eggs so maybe it would help? I think I was on stims for 12 days and it was only the last few days 2 of the eggs grew 😅 Im not clued up on the sperm antibodies - did they suggest anything for that other than ICSI?
Really hope it works for you! Whatever route you go down x

First cycle was short protocol with Meriofert 2nd cycle was long protocol 17 days down regging on Burserelin and then stims Meriofert highest dose and Burselin for 12 days.

Good luck the switch up really worked for us x

@Becky348 my Amh was really low too and we had male factor issues. It can happen x

Thanks @HopefulllHolly, exactly, it’s definitely about not wanting to have any regrets over at least trying with my own eggs first. I think I just find the low stats for success over 40 (especially with low amh) quite disheartening.

Just had our follow up and our consultant was pretty happy with my response to the 300 of ovaleap and I think the same for the meriorfert. They’ve suggested a double trigger shot next time and leaving longer between trigger and EC to help with egg maturity. You’re right, I think my two lead follicles grew too quickly for the others to catch up, so I didn’t stim for long enough. They didn’t seem too concerned about the sperm antibodies, so I think it would just be ICSI again. Thanks again x 😊

Thank you @PMAmostofthetime, that’s interesting that you were on the long protocol with more success. Thanks again for the kind words x