ICSI Round 3

[LotStar24]

Hi everyone,
First time posting so here goes...
I'm 31 and my partner is 38. We have been trying to conceive for 3 years.
At the beginning of 2024, we had our initial investigations. They found I have a low AMH (6.7mmols), a low follicle count (5 on the R ovary, 4 on the L ovary) and my right ovary is adherent to the back of my uterus. My partner originally had a 1-2% morphology result on his semen anaylsis test however he's since had 3 further tests which all show a normal morphology!

We made the decision to go ahead with ICSI. In July 2024 we had our first cycle, we had a short protocol and at egg collection only collected 5 eggs. On the day of egg transfer we were told our embryo had started compacting from Day 3 and we were given the option to proceed or not. We went ahead but were not surprised to find out 2 weeks later we weren't pregnant.

Second time round, they increased the dose of stims and I had a dual trigger. We also opted for IVF (as our consultant considered the reason for the result in our first cycle may be due to delicate eggs) and as my other half's sperm parameters were tested and normal on the day of egg collection. I had 11 eggs collected and 6 fertilised. We were devastated to find out on Day 5 none of our eggs made it to blastocyst.

We have met with our consultant since who suggested as the development of the egg stops from Day 3 onwards that its likely to be a sperm factor. We were advised to have a sperm oxidative stress test, which my partner has and results came back normal. They've advised for our third cycle to have ICSI with the same dose of medication as our second cycle and add on artificial oocyte activation (AOA) even though current evidence suggests this only helps with fertilisation, not getting eggs to the blastocyst stage. I also asked our consultant bluntly, if they would tell us when to stop fertility treatment and they told us they would.

I'm not sure what to do next as I'm really struggling and don't feel like I can put myself through IVF many more times as I end up devastated but at the same time I don't want to give up hope either! I feel like I owe it to both myself and my other half to try again before looking into other options (i.e. donor). Nobody has the answers and I suppose that's the frustrating part. Are we facing a future childless?! I've had a counselling session which helped but thought I'd post on here to look for similar stories or experiences and any support that can be offered.

@LotStar24 can I ask why your clinic opted for short protocol? I have an amh of 14.8 and they opted for long protocol (with anything less than this also qualifying for long protocol). It's a much longer process but as its a standard I wonder if that would influence your results? Xx

Hi @Eagerlywaiting1990 my consultant said because I responded well to stimulation and there going for quality over quantity approach. I think my age also plays a factor?! I've read that short protocols are better suited for woman with low ovarian reserve. What's your experience with the long protocol? xx

@LotStar24 I'll be honest when I say I don't know the ins and outs of it but my clinic do long protocol for those with low ovarian reserve and to focus on quality over quantity. I guess I'd just be sure to ask the question. I had a really good egg to blastocyst ratio so i have a lot of faith in jt. Xx

@LotStar24 has your partner had a sperm dna fragmentation test? High fragmentation even if morphology is good can be an issue. Having said that, I think they'd then do ICSI anyway as the solution but there might be other things they'd look into to inrove the situation if there was high frag.

Just to add on protocols, I did 2 x short (private IVF clinic) at 38 with an AMH of 11.8 & around 12 follicles which I think is average or slightly on the lower end of average for my age.

1st round I got 8 eggs, 5 mature, 4 fertilised and 1 blastocyst. 2nd round the upped the stims, I was on them longer and had a different trigger, 9 eggs retrieved, all mature, all fertilised with ICSI and 7 blasts. There's so many ins and outs I can't pretend to know about but a change in meds gave us a much better result, still fewer eggs than they'd expected I'd get bur def quality focused.

Hi @Orangewillow we have considered it but our clinic doesn't currently offer it so we would have to find it elsewhere and the HFEA advises the results of a sperm DNA damage test are unlikely to impact on the management of your treatment so we're also trying to be mindful about where we spend our money now.

Wow 7 blasts thats amazing. Good luck with your transfer and the rest of your journey! It sounds really hopeful.

With my 2nd cycle they increased my Meriofert to 225units and the GonalF was 150units but this was the same dose as my first cycle. I was also taking Ganirelix 0.25mg and had the dual triagger of Zivafert 10,000iu and Decapeptyl 0.2mg. Do you mind me asking what medication you were on? Our consultant was really pleased with the eggs collected and our fertilisation rates so much so she even said she had already discharged us in her head as she was confident it would end up pregnancy! I feel happy with our consultant/clinic but at times I have thought if it's worth getting a second opinion. Just so hard to know where to invest after already spending a huge amount xx

@LotStar24 that makes sense about the dna frag. I'd heard of people with high dna frag being referred to a urologist to get to the bottom of what's causing it (like a varicocele potentially) to improve it, but otherwise i think its ICSI, but I don't know tonnes about it other than what I've picked up on fertility chats! We paid £500 for a frag test so not the cheapest.

Thank you, yes we were v surprised to get the embryos, now having a struggle getting my lining to the right stage for a transfer though! One cancelled cycle down and waiting to see if we go ahead again soon...

I was on 300 ovaleap for 1st round and 450 menopur 2nd, so a fair bit! I'd initially been told to do a dual trigger in the 2nd but in the end only did buserelin, can't remember about the 1st.

@Orangewillow My other half seen a Urologist prior to our treatment and had ultrasounds which came back as normal/no treatment required so was discharged so thats another reason we're reluctant to have the DNA fragmentation test.

What I'm learning is that everyone has hurdles throughout their journey!
Fingers crossed you get to go ahead soon, did you freeze all of your embryos? Are you having treatment to help your lining?

Thanks for you sharing your medication doses xx

@LotStar24 oh i see, sounds like you've crossed that off then! Makes sense to not to the dna frag then and save the cash. Its so hard when you don't know what to do next, I really sympathise!

Yeah we froze all to do pgta testing and embryo bank for the future. I'm on a lot of oestrogen for my lining which hopefully does the trick, I had a surgical TFMR and adhesions as a result which I (thought and hope!) have been treated now but it's been a long old struggle and not there yet...

No worries, hope have been helpful!

Hi @Orangewillow How are things going with your cycle? Could you advise somewhere to have DNA frag test? We are re-considering it before taking our next steps xx

Transfer day tomorrow! So nervous!

My husband did a basic sperm test & DNA frag through Fertility Solutions in London, Claire Mooney is the woman we spoke to and she was really great, I highly recommend them. They are in London and I think Beaconsfield