Disappointed with day 5 IVF update and worried about next cycle

[Magix86]

We've just had our day 5 update for our second egg collection and can't help but feel disappointed. Wondering if anyone has any advice or can share their stories to give me some hope! I'd just like to understand a bit more really. We're doing a back to back cycle to bank embryos and I'm worried about getting the same or worse results on our next cycle in a few weeks time. I want to do everything I can to get a better outcome next time or I'm afraid we might need to add a third egg collection 😒

We've used donor sperm due to MFI. I'm 39. Have been taking proceive max supplements and omega 3. No alcohol. No caffeine.
Both rounds have been short protocol, first round was ovaleap 150 and an ovitrelle trigger (NHS). Second round was 175 gonal-f and buserelin trigger (private). Same clinic. We're not doing PGT-A

On day 2/3 of both our rounds we had top quality embryos of all that fertilised and I've read the drop off after day 3 is usually due to the sperm rather than egg quality?
I've also wondered whether the buserelin trigger may have caused a lower fertilisation rate and possibly poorer outcome? I'm really not sure.

Round 1 in 2024:
16 eggs. 13 mature. 11 fertilised with ICSI.
2 x 5 day blastocysts - 1 x 4AA, fresh transfer and baby boy. 1 x 3AB frozen.

Second round just now:
16 eggs. 12 mature. 8 fertilised with ICSI. 1 x day 5 blastocyst 4BB

I'd be really grateful for any insight, anecdotes, advice for how we can prepare for the next round and anything we can maybe consider changing with our protocol or what we can aim to discuss with our clinic.

Hi @Magix86 - not sure if you remember me from the MFI thread... but definitely finding it harder the second time round. We had our son from our NHS IVF round, 4 eggs, 3 perfect embryos at day 3, we got 2 embryos a 5AA (our son) and a 4AA (no implantation).
Our next round at King's we only got 1 mature egg and that abnormally fertilised.
We moved clinic! Next round we got 4AB and early blastocyst both transferred- no implantation (had 3 excellent embryos at day 3)
Last cycle we got 6 mature eggs but only 3 fertilised (3 were soft and 1 fertilised abnormally!), we got three emrbyos 5AA, 4AB and another good grade. But we did PGT-A and no euploid.
So now I am doing duostim in July with the hopes of a euploid!
I know sperm donors have a lot of testing so not sure if it could be DNA frag from day 3?
For this latest round I used human growth hormone which can help with blastocyst development and to get 3/3 fertilised eggs to embryos felt pretty epic. I am on another thread where a poster also found it useful so although expensive (just over £1k for stims timing), could be worth a try.

Hey @TheFanciestPants I do remember you! Thank you so much for replying. And congratulations on your son 🩵
I'm so sorry you're also finding it hard the second time round. It's just awful isn't it!
Interesting you're doing duostim next - will you be starting stims again just a few days after your egg collection? I'm currently doing what my clinic call a duostim cycle although I'll be starting norethisterone on day 21 after my withdrawal bleed, so a bigger gap.

We have a follow up consultation in a couple of weeks and I do plan to ask what tests the donor sperm has, as I would assume they'd have to test it quite thoroughly. I'm also reluctant to change our donor because I'd like for my son to have a full sibling if possible. Is DNA frag just from the sperm side of things?

I'm willing to try anything at this point to get us a better outcome. I've just booked in for some acupuncture as I had this last time and thought I'd give it a miss this time but now wondering if it could help! I'm probably just trying to add something in to feel like I'm doing more. We've spent a lot of money on this for our 2 collections as need to include the cost of the sperm and the ICSI etc too! With the human growth hormone, how long would you take this for and how do you take it alongside your stims? I have heard about it but I don't know too much about it. Would it need a prescription or can you just buy it? I'd obviously need to discuss with our clinic too.

It would be lovely if you'd keep in touch with progress on your duostim round

@Magix86 aww thank you, can't believe he is nearly 2! And congratulations to you guys too. Definitely happy to keep in touch, I am finding it much easier doing IVF having a child already but still very tough!
My friend had a baby with donor sperm (as a solo mum) and she said it is an extremely rigorous process with less than 5% of potential sperm donors being accepted, so fingers crossed it was a just a bad cycle.
For duostim, I will have 3 days off then start again. I wonder as you have a lot of follicles it may not be appropriate clinically to do what I am doing ao maybe the back to back is the answer? There was a lady who had a lot of follicles precludes her from duo stim who did a luteal phase start, but not too sure on that one.
The HGH I understand means your embryos can be more likely to make blasts so if it is more of an egg issue this could help. The evidence is patchy as it doesn't work for everyone but I have had a very positive experience with it. I think the other appealing this is that it doesn't have any negative effects so it's either positive or you are just wasting money...
The doctors at my new clinic said duo stim can give better results so I am keeping my fingers firmly crossed.
Yes, for HGH you need a prescription. It is around £100 a vial and you take it each day of stims, stopping at trigger. If you are in London, Madesil in Marylebone stock it.
Sorry forgot to say on trigger, new clinic I have done dual trigger, buserelin and zivafert in differing amounts.
Wishing you all the best xxx

Thank you! I completely agree, although I am still anxious about the results I do find myself calmer this time, knowing I have my son and kind of knowing what to expect at each stage etc.
Oh really interesting to know that about sperm donors, thank you for sharing. That kind of puts my mind at ease a little. Hopefully our next round might just be the magic one 🤞🏻
Yeah it's a good point about the number of follicles maybe being a reason. Although I did just have a quick Google of HGH and I read it can work by also recruiting a larger amount of follicles so I'd possibly be a bit wary. I'm convinced the buserelin trigger didn't suit me this time and may have impacted things but we'll never know! My clinic insisted on it as I had 20 follicles on my day 11 scan and their policy is that 20 or more you have to have buserelin. I'm still feeling a little bit mad that we're paying all this money and get told we can't have a say on the medication due to their policies.
I'm going to ask if we can possibly lower my dose of stims to get a smaller amount, in the hope that we can do a hcg trigger and a fresh transfer, and also to see if slightly fewer eggs might mean better quality? Probably clutching at straws!
Did your new clinic explain much about the trigger to you and why they added in a dual trigger? I'm really hoping a duostim is the answer for you!! Keeping everything crossed for you 🤞🏻

@TheFanciestPants I forgot to tag you in my last message! I hope you're doing OK.
We got updates from our clinic today and they've agreed to freeze a 4CC and a 3BC on day 6. So at least we have another 2 although I do understand they are lower quality so not sure what the chance of success would be. I've also realised that my proceive supplements only contain 70mg of coq10! I've ordered some ubiquinol to try for our next round although it's probably a bit late to really make much of a difference now 😅

It's great you got another one to freeze @Magix86! I think the big thing is if it's euploid. Even my perfect 5AA was aneuploid last cycle so you never know either way. Fingers crossed!
I am day 8 of stims and looking at 3-5 eggs for collection so pretty standard for me really. My genetic results came back all normal so fingers crossed for a euploid this time. Seems it was just bad luck last cycle.
I have seen quite a few people on here with lots of follicles also used HGH during stims so I would say worth asking just in case. Another recommendation is melatonin, I have found it a game changer for getting more sleep and apparently it's also good for eggs.

@TheFanciestPants we aren't testing so that's another worry about whether they are euploid or not! I was speaking with my OH today about the possibility of doing a third collection this year just to bank some more given our pretty poor outcome, but it's all going to be so dependent on how the next one goes. I've heard good things about melatonin! I'll definitely ask my clinic about both melatonin and HGH and see what they say. By the time we meet with them it will only be about 4 weeks until our next collection.
Ooh day 8 of stims! How are you feeling? Great news about the genetic results, that must be reassuring. Will you be having these embryos tested?

Yeah, agreed, it's so hard to know whether to test or not. We had 2 embryos transferred from our first round this year and no implantation so we decided to check the next batch.
So that is 5 embryos this year so far that haven't amounted to anything... and our frostie from the NHS round so I completely get it. But you might be luckier than me as my clinic is 42% live birth rate per cycle, so I am definitely an outlier here and not in a good way.
I feel pretty rubbish to be honest and really worn out but I think that is because I am on 2 cetrotide each morning to stop the LH surge. Excited to get to EC!

Ohh @TheFanciestPants I'm sorry you're feeling rubbish. But egg collection will be here so soon! How many days stims are you having? Really hoping this is the round for you 🙏 it must feel a bit strange knowing you'll be back on the stims after only a few days too

Thanks so much @Magix86 - have EC tomorrow. Eek! Had 10 days of stims this time, had 11 the previous two times so fairly consistent.
My trigger was quite stressful as the zivafert went all bubbly(!!) so I left it for a bit and was going to inject but it looked really odd so I ended up using the spare one, meant it took a couple of minutes to do the injections which stressed me out but the nurse said was fine.
Yes it is weird to crack on so quickly but to be honest, I really just want to crack on and have another baby so feels a bit better emotionally to do duo stim.
Feel pretty shattered and grumpy today so will try and keep myself in check 😆

Oh @TheFanciestPants that does sound stressful with the trigger! I guess you were lucky you had a spare one, I wouldn't have known what to do! Sending you so much luck for tomorrow, I hope it goes well! Also hope you feel OK afterwards and manage to get some rest.
I'm so with you with wanting to crack on! I'm on day 5 of spotting now waiting for my withdrawal bleed and I'm not sure what's going on. I might message my clinic tomorrow if it still doesn't appear to have arrived.

@Magix86 I saw this on the tube in for EC. I know you had some questions about donor sperm so I thought you might find it reassuring!
Had my scan and everything looks ok so will be waiting around for a bit then head down.

@Magix86 thanks so much for your support.
My breakthrough bleeds have always come ok, but the actual period after the Feb cycle was day 46 (after spotting on and off for 16 days!)... but this time was day 26... It's really frustrating but super common so try not to worry, the hormones are pretty brutal on our bodies!

@TheFanciestPants ohh thank you for sharing! That does help ☺️
Good to know about the withdrawal bleed! Still spotting but can't tell if this is just my actual bleed or if it's still to come. I'll see what my clinic say this afternoon if it's still like this.
Oh I've never had a scan before egg collection! I've just gone straight in. What are they checking for? Excited to hear how it's gone for you

@Magix86 I hope your withdrawal bleed arrived ok. Are you starting again in August?
They scan to make sure you aren't about to ovulate as they can change the patient order for EC if needed. The first cycle at this clinic I was about to ovulate so it was great they checked!
I had my scan for duo stim and it was like a follicle graveyard but bloods looked fine so am on day 2 today.
We got 5 eggs, all fertilised. One was a 2.1pn so slightly less chance. All looking at the right stage on day 3, but one had some fragmentation so think it's unlikely to make it. Keeping my fingers crossed for the others and hoping to have some stuff to send for biopsy.
One thing the doctor said in my scan yesterday was they are thinking about adding HGH to their protocol as they have seen great results so definitely worth asking xxx

@TheFanciestPants oh that's great news about all having fertilised! Fingers crossed now for day 5 🤞🏻 I don't know anything about 2.1pn - I've actually never heard of that grading before. I have my consultation on Monday and adding HGH to my list of many questions 😅

I've started taking 400mg ubiquinol - I know you're meant to take it for at least 3 months to see the effects but I figured there might be at least a little bit of benefit taking it for 6 weeks. We'll see!

So interesting about your clinic checking ovulation before collections, that's really helpful to be able to shift things around as needed. My clinic don't do that so you just have your slot and that's that.
My schedule is all sorted so yeah going again in August...next egg collection currently falls on my son's 1st birthday lol

So day 2 of stims for you now? How are you feeling? I imagine it must be good to kind of get it all done without having a long wait

Awww, that is quite the diary clash! Hopefully it will end up a different day, does he still have 2 naps a day as maybe you could be back by the end of first nap and enjoy second nap together?!

2.1pn is when there is an additional micro nucleus. Embryoscope time lapse has made it much more obvious then before they were using it so there's fairly limited research. They are very rare but it's looking like I have a tendency to it... or maybe just bad luck?
They are a bit less likely to get to blastocyst and they recommend PGT-A testing as there are concerns they may be more likely to be aneuploid. But when the embryologist contacted the genetics lab they used, they said they find they are broadly the same, but as they nornally occur in 40+ women the general euploid rate is low.

It's upsetting as I am 38, but that is the rollercoaster of fertility. I would have done things very differently if we knew about the MFI, but I expect a lot of people feel that way.
Anyway, starting again is better than waiting around, but I am so hot and tired and so is my son so definitely not a free lunch situation...

As well as ubiquinol you could try melatonin. That is another one my clinic recommend. I also took DHA (omega 3), DHEA (every other day - but you would need a blood test for that one as my testosterone is pretty low naturally), NMN and Acai berry supplement. Not sure they make any difference except depleting my bank balance but just thought you might like to know xxx

@TheFanciestPants he's still on at least 2 naps a day yep. That sounds a lovely idea! His transfer was actually on my birthday lol so I'm hoping it's just another lucky day for us!
Really interesting about the 2.1pn info. I guess if they're broadly the same but you're under 40 then hopefully that means you have a higher chance of it being euploid?!
I completely understand what you mean, I don't know what we would have done differently but we certainly would have gotten started sooner and worked to bank some earlier embryos.
You're definitely doing your all with the supplements! I'm impressed! I was actually looking at melatonin earlier today haha it's so hard to know if all these things are the right thing to take or just costing more money but I agree it helps to feel like you're doing something

@TheFanciestPants how are you doing? Did you get your embryos to day 5 for testing?
I had my follow up today. The doctor doesn't recommend HGH or any extra supplements. We're going again with the same dose of stims and just hoping we can get 1 or 2 less follicles growing so we can use the HCG trigger and go for a fresh transfer with hopefully another couple to freeze. She did say we could try a slightly smaller dose but she liked the way my follicles were growing with the last round so wants to keep it the same. She did say that having 2 rounds with all embryos being top quality on day 3 does possibly indicate the sperm quality being the issue but essentially there's not much we can do about it if we want to keep the same donor.
So really no changes being made and just have to hope we get better quality embryos this time round!

@Magix86 it's feeling a bit tough. I am pretty deflated after getting all 3 aneuploid last cycle (including the golden 5AA) so even though I have 4 for testing I am pretty nervous especially as they are all slightly worse grades this time.
For me, it's more about finding the euploid one so I will keep my fingers crossed you find the golden egg and transfer it fresh!
I think the duo stim hormones are tough, i had a litttle cry when the music class sang happy birthday to my son... He's getting so big now.
Could they try zymot or similar for the sperm just to give you the best chance? It would feel a bit ridiculous to use ICSI with donor sperm I feel!

@TheFanciestPants oh I'm sorry it's feeling tough ☹️ it's a difficult thing to go through but then you're also having all the hormones straight away so it's probably hitting you harder! I'm sorry I can't remember if you said but how old is your son now?
To have 4 sent off for testing out of 5 collected is a really great result though! I'm sending all the luck that you get euploids in there. How long does it take to find out?

We didn't discuss ICSI or Zymot. I don't know much about this. Would you mind explaining a bit more about why you think ICSI would be ridiculous? And also what zymot would do? I did ask for our first round and the embryologist said they prefer to use ICSI for donor sperm as she said the sperm can be a bit "lazy" after they've been frozen!

Aww thanks @Magix86 ! He's nearly 2, getting so grown up, definitely not a baby anymore.
Yes probably. I know, it's a great conversion indeed (so it feels a bit ridiculous to feel down about it). The hormones are 100% getting to me so I will try and stay positive! It takes up to 2 weeks to find out, the embryos were sent today and last time it was 10 days, so keeping my fingers crossed!

Urgh, lazy sperm doesn't fill you with confidence, does it?! Sorry definitely not an embryologist, but a solo mum friend had some abnormal fertilisation with a donor and it made her quite annoyed as they suggested ICSI. Given how expensive the sperm is she felt it was a bit bizarre she should pay more for male factor support as it was supposed to be top quality sperm. Zymot can help reduce fragmentation, it's basically a way of getting the fittest sperm (someone described it as a sperm sorter race!). My clinic do it as standard, but the evidence is mixed.

I think a lot of European clinics do ICSI as default but most UK clinics prefer IVF. The big advantage with ICSI I think is you do learn more about the eggs and that can be diagnostic to change things next cycle. For me, 3/6eggs last cycle disintegrated on injection so they changed my protocol and this time none were 'soft'. If it had been IVF I am not sure whether this would have been picked up. So could be worth asking? Although your fertilisation rates look good!

@TheFanciestPants aww that's such a great age! So you must have also started quite early on for a sibling too then.
I get it's hard to stay positive when you just want it to work and when you've also had disappointment in previous rounds. But there is nothing to say this isn't the round for you! And hopefully pretty soon you'll have another few embryos to send off 🤞🏻
Could you have something nice planned for when you finish this next egg collection? Might be helpful to have something to look forward to!
Haha yeah the lazy sperm doesn't sound great does it 😅
Despite the cost I'm happy with the ICSI, our first round got us 11 fertilised out of 13 mature eggs. Second round 8 out of 12. I might still ask about the zymot tho so thanks for the suggestion!

@Magix86 yes indeed, we went back to our clinic when he was about 13 months. Our FET (4AA from first round) sadly failed in October and then our December cycle was a disaster with only 1 egg retrieved which fertilised with 4pn (so no hope unfortunately).
We then switched clinic and did a round in Feb/March 4 eggs where we transferred a 4A B/C and an early embryo (grade 1) fresh.
The May round we got 6 eggs, 3 fertilised and 3 good embryos but all aneploid.
July rounds - 5 eggs and 4 good embryos so far and tbc.
The better embryo conversion and mature eggs I put to HGH (started in May) so hopefully it will continue to help. I just feel at my age and how tricky it has been so far that I need to keep on going as if I stop I might miss my opportunity. So it is all feeling quite relentless.

Oh, interesting about ICSI, I had wrongly assumed donor sperm was always IVF (my friend probably biased my view!) and I now see you have actually written it in the thread, multiple times... sorry about getting muddled. I hope the zymot helps, there can also be quite a lot of embryologist skill so sometimes clinics have labs which get better results. You can also ask if there are any procedural changes in the lab that they would make next time which will ensure any notable features (if there are any!) are carefully reviewed and addressed. I only find things out by asking lots of questions and I probably sound really demanding now, so just a suggestion.

We actually went to a concert last night (I think only 4th evening out since my son was born?!) so that was good for a break.
Will try and plan something fun, just need to find the energy.

@TheFanciestPants it does seem to be a better round for you so looks like the HGH might be helping! How long until your next collection?
I feel like I'm just going to see what the next round brings for us. We've had such similar numbers the last 2 rounds we've done so I think the third will be largely similar. Would be good if we can just improve slightly on the number fertilised and then hope to get 3 or 4 good grade embryos.
We do have the option of freezing it all this round and going again for a third round but I feel like I'd just like to start a transfer now and see what happens. It's weighing up trying to bank everything now while I'm slightly younger or taking a risk and trying again later on! Who knows how long it will take but then you see success stories of people having a baby with only getting 1 or 2 eggs collected so that does give me hope of trying a bit later on too.