No blasts- any tips on how to recover from this?

[LimeBird]

Hi all,
Just looking for advice on how to pick myself up from this outcome. For context, I’ve just turned 41, no children, this is my third round of ICSI (but 2nd round of 3 cycle egg collection with PGTA testing package). I have one more round left and struggling to see any light at end of the tunnel.
First NHS round I did short protocol 300iu Ovaleap. I got 8 eggs, 7 mature, 5 fertilised but only 1blast (3AB), transferred but BFN.
Second round I did long protocol with Meriofert. got 7 eggs, 6 mature, 3 fertilised normally and only 1 blast (5BB) which has been biopsied and frozen.
This round I did short protocol again and was on highest dose stims (450 Ovaleap) and triggered earlier than previous rounds as follicles grew fast. Only 5 eggs, 4 mature, 2 fertilised (one a day late) and no blasts.

Any tips particularly from 40+ ladies very welcome. I’ve though about a break from treatment may be an idea but worried about my clearly decreasing odds over time!

I've had a round with no blasts and it's gutting - I didn't even know it was a possibility when it happened. The update calls are true horror.

Good news in your history - you are producing good grade blasts, even though they're in low numbers. The attached is a position I think it's useful to bear in mind - it's pointless to think of each round individually. Essentially you will need to produce 4 or 5 blastocysts to have a decent chance of a euploid. This could mean having to do more rounds than 3 if it's affordable.

Thanks so much @sirensong - sorry to hear you have experienced this too 🫂
I think that’s actually a really helpful way to look at it, and so different to the way they talk about it currently isn’t it?
If I did more rounds after this third one it would be autumn/winter, and I’d be getting closer to 42. I’m not sure if they advise carrying on this late? I may have it in me, but would have to dig deep. We also get financial help with the ICSI from a generous family member and I can’t help feeling guilty they’re spending so much money on this to no effect 😢

@LimeBird can you remember your follicle sizes at trigger each round? Wondering if you could in theory benefit from an extra day of stimulation in light of your late fertilising egg this last round.

Hi @LimeBird Sorry you had a horrible IVF round. It is truly rubbish. (also apols in advance for this long ramble).

Over the years of TTC for me, I had 5 rounds of IVF (i think at least 2 were ICSI, but I can't remember). Of the 5 rounds, i got 2 blasts on the first go (one fresh transfer, one fet), and got a CP. Round 2, they transferred on day 3 (BFN, clearly wasn't gonna make it to blast!). Round 3, we got no blasts. Don't think they even made it to day 3. I remember that call so well - gutted! Miracle natural pregancny that ended in MMC. Round 4, got 1 blast, CP. Round 5 we got 3 5day blasts. The first of those (4aa) is my now 3.5yr daughter. The 2nd we just had transferred as an FET (but think it's a CP), and we still have one on ice.

I don't have any tips particularly - just to sympathise with how tough the whole thing is - and to say, go easy on yourself. My OH and I always planned something nice for after each failed transfer / IVF round. It helped to clear our heads and pick ourselves up a bit.

We did try different things each round. My clinic was good on suggesting slight changes to drug protocol - and i think maybe in the end for us it was just these minor tweaks, and a bit of a numbers game and getting very lucky. I asked about all the extra stuff you hear about (endometrial scratches etc), and they said tbh there wasn't much evidence for those things. It was kind of reassuring that they weren't just out to take my money! I tried (and hated) accupuncture, and had given this up for the succesful round. I decided I would have been better off spending the money on a weekly relaxing massage! I was slightly younger than you, but am now starting again age 41 for no. 2. But, i think the fact you've had some decent blasts in the past is a really good sign. You are capable of getting there, and I do genuinely believe in the numbers game, and just all of those tiny little pieces slotting into place. Like a really difficult jigsaw puzzle!

(Incidentally, we had an enforced break between rounds 3 & 4, because of COVID, but then only 2 cycle gap between round 4 and round 5, which was the winner - so who knows!).

Wishing you all the best, and please do treat yourselves to something nice this weekend - doesn't have to cost money, maybe just a walk with a nice view. The best thing you can do is be kind to yourselves.

❤

p.s. In my NCT group of 7, 3 of the mums were 40+, the oldest being 46. There is hope!

Hi @LimeBird, it's disheartening to get a bad round, I'm sorry you're going through it.

It's a numbers game at the end of the day and by doing multiple rounds you're giving yourself the best shot possible. Stay strong!

I also did 3 rounds of egg collection with PGT-A testing at the end. I was 39, a bit younger than you, but my numbers were similar:

1. Round 1: 6 eggs, 3 fertilized, 2 blasts, 1 euploid (BC quality)
2. Round 2: 5 eggs, 3 fertilized, 0 blasts
3. Round 3: 9 eggs, 5 fertilized, 4 blasts, 1 euploid (AB quality)

Everyone was surprised by the results of the last round after the dismal round 2. There was no change in protocol, it was just luck. The only difference I can think of was that I took a month break between rounds 1 and 2, while rounds 2 and 3 were back to back.

I was on human growth hormone for all three rounds, my consultant said it might help with egg quality in older women. I have no idea if it helped but maybe worth asking your clinic about it? I was also recommended Coq10, DHEA and vitamin D.

I didn't do accupuncture because I couldn't imagine how it could possibly relax me in any way.

I wish you all the best!❤

@GreenLemonade That's funny - my successful round, no. 5, was back to back to with round 4, and also no accupuncture (which i always just found slightly painful!). Also similar nos previously!

@sirensong I can’t remember sadly, and I’m not usually one for keeping note of the sizes- maybe I’ll ask at our follow up. It’s funny you should say that as my phone call re: the trigger, they said they’d discussed whether to do it Weds or Thurs and had settled on Weds in end. So who knows if Thurs would have been better 🤷🏼‍♀️

thanks for such a lovely message @Evi83 - so sorry you had such a tough journey too and so pleased you have your daughter. That’s funny as I also tried and hated acupuncture! I literally felt no different apart from dreading every appt 😂 as I hate needles. (Not sure how I’m doing stims!)

Aw thank you @GreenLemonade - we do have quite similar numbers don’t we! That gives me a bit of hope for next round (although daren’t hope in case I jinx myself at this stage!) I am on Coq10 and Vitamin D, I took DHEA for a year but stopped last year as one of the docs advised me to as levels would be high. I will ask about the growth hormone.

This forum helps me so much in the midst of it all so thank you ☺️ and best of luck 🤞🏼

Thanks for sharing your stories @GreenLemonade @GreenLemonade

I'm trying for baby number 2 after my first being an IVF baby. I was never told by my dr I had low reserves but I never had many eggs collected (6 to 8) previously and none left over good enough for freezing.

My first cycle trying for baby 2 and only had 3 eggs collected and 2 mature enough for fertilisation. Pretty devastating to be honest but have to wait to see what happens. Your stories gives me hope that it this can improve next time if I decide to go again.

We had several months off between our 2nd and 3rd cycles and went on a long holiday. Our third cycle was successful. I was a little bit younger than you as my daughter was born a few months before my 42nd birthday. I am having one more go for a sibling but with donor eggs as I think my odds of success will have dropped too much over the last 2 years.

Hi ladies, I hope you are all well?
I just thought I’d update this thread as you all were so kind to offer insights earlier this year. I’ve just finished my fourth (and final) round and went with 375iu of Ovaleap, also did Testogel priming in the lead up.
I got 9 eggs, 6 mature, 4 fertilised so it looked more promising initially, but sadly none have made it to a blastocyst (I have one hanging on to Day 7 which is tomorrow, but not holding out much hope although you never know!)
So will likely be sending my lonely one 5BB off for PGTA testing by itself in next few weeks! Clinic said around 25% chance of it being euploid (although it’s from when I was 40 not 41- can I claim a slightly higher odds?) 😂
Wish me luck for a miracle euploid! X

@LimeBird all the luck! And yes, if was from when you were 40 the average odds are more like 40%. If it was just before 41 maybe go with 30%.

That’s what I was thinking @sirensong - got to claim those slightly higher odds while we can! 😝

@LimeBird has your dr given you the option to do fresh day 3 embryos transfer or is there a reason why you can't do that? My clinic encourages the use of day 3 embryos especially in cases where you don't have a lot of eggs. My dr believes from her experience that using day 3 embryos will get higher chances because you have more embryos to use for transfer and that the embryo have a better chance to survive inside you rather than outside. My pregnancies were from day 3 embryos so I have no idea if mine would have ever made it to say 5 and I didn't have much options as each cycle I only had 1 embryo left at day 3.

Each person is different so maybe your circumstances are different to mine. Hope it all works out for you.

Hi @WhiteJasmin ! How are you getting on? To be honest they have never even mentioned that possibility?! At my clinic they call on day 2 to confirm embryo and fertilisation numbers, then again on day 5 to confirm blasts. So day 3 has always been just a ‘waiting’ day? I will ask them at my follow up. I’m in the south west. Is this a standard option at yours? Or did you request it? X

@LimeBirdi think some clinics are better with patients in our age range than others. You have had good blasts and not every round is equal x

@LimeBird I'm not based in the UK but you can do some google research on day 3 vs day 5 transfers. From my understanding, a lot of drs nowadays opt to wait till day 5 as standard practice because those making it to say 5 have higher chance of pregnancy and also at the blast stage you can do genetic testing.

From what my dr said, she prefers in situations like mine where I don't generally produce a lot of eggs each cycle, to do day 3 fresh transfers. She believes based on her experience (and she's been in the industry for a while) that day 3 fresh transfers are the best option because it gives the embryo a chance in the mother's natural environment that's the best chance it could get to make it. Also, at every stage of freezing, unfreezing and genetic testing you risk damaging the limited number of embryos you have. She said if we had lots of embryo then yes, waiting for day 5 etc. will help us narrow down which embryo will have the most chance. In my case each cycle I only had one viable embryo so she didn't want to chance it.

However, fresh transfer might not be suitable for everyone as I understand it depends on each person if they are ready that month for transfer. Some people might need to wait for all the stimulation drugs to wear off in the next cycle to transfer so it might not be the best option for you if that's the case.

But yes I am currently pregnant with my second IVF baby from the single embryo that made it to day 3. Good luck! I hope this helps you on your journey.

Thank you @WhiteJasmin thats really interesting. And congratulations on your second pregnancy ❤️ amazing that it has worked twice!
I will mention what you said at our follow up. I’m pretty sure I’m not going to have any more rounds using my own eggs at this stage though- I think the results of last two are telling me it’s not going to happen! We’ll just get the one embryo we have frozen tested just in case euploid and then decide what to do from there (possibly egg donor or leave it) x

@LimeBird you have way more embryos than me! I hope it works out for you. The most eggs I ever retrieved was 6 (first cycle failed).

The other thing you can try to ask is if you can use Saizen. My 2 cycles resulting in pregnancy my dr gave me this. It's a human growth hormone. She said my egg quality was so-so and that adding Saizen to the treatment can help me improve egg quality. The drug is expensive but I mean it's cheaper than doing multiple rounds.