Total fertilisation failure

[BlueBirdy]

Hello,

My husband and I have just gone through our first IVF (with ICSI - we have male factor issues - bad count and morph, motility is ok). At my final scan I was only showing 8 follicles (was on 150 units gonal f) 6 were a good size but two were smaller ones. I thought this was on the low side but the FC said they were happy with how I responded and pleased with the amount of follicles. Had pregnyl 1000 trigger shot on Saturday and went for egg collection yesterday (Monday). They collected 7 eggs but only 6 were mature. Got a call yesterday eve to say that of the 6 they injected, 2 didn't respond very well, so was usually an indication that those two did not have the best chance of fertilising, but overall there is a generally a 70% rate of fertilisation. Got a call this morning to say that sadly NONE had fertilised. They said this was very rare (I later googled it and apparently there is a 1 - 3% chance of it happening with ICSI) and said they could not tell why it happened (or rather, didn't happen) but could be down to either the sperm or eggs or drug regime I was on. I'm really gutted. This was our one and only NHS funded cycle.

I've got a follow up appointment on Thursday morning, not sure if I'll find out anymore then. Was just wondering if anyone else has experienced this, and if they had any success with further cycles?

[MrsHY1]

Hello
I'm afraid I have no words of advice but I didn't want to read and run. I'm sorry this happened and I hope you get the answers you need. X

[Shellster52]

Hi BlueBirdy. I am at the tail end of another failed IVF cycle. My Dec 13 cycle, I got only 3 mature eggs and only 1 fertilised. I thought the low fertilisation rate was just bad luck since I didn't have many eggs to begin with. This cycle my IVF Dr suggested adding calcium into the egg when they inject the sperm. I have read studies online showing women with previous 0 fertilisation rate having a good portion fertilise using calcium. I got 5 mature eggs but again, had only 1 of 5 fertilise. I know it's not as bad as your 0 of 6 but like you, I am really wanting answers as the one did not make it to day 5 so we have to go again and I need to know what to correct for next time.

Not much online about the topic. One report I read showed pictures of bad eggs causing poor fertilisation, bad sperm (sepcifi8cally, round headed) and bad embryology technique. Like you, we are doing IVF for male factor. I have my follow up appointment on 14th August and will definitely be asking about this. Would also love to hear what information you are told. Did they tell you about your egg quality on the phone or do you have to wait for your appointment? Do you mind if I ask how old you are? I am 37 and am worried I am going to be told at my appointment that my eggs all looked awful as there's nothing I can do to fix that.

[Atavistic]

Hi OP,
This pretty much happened to me on my first IVF about 10 years ago- 12 follicles, 10 mature eggs, ICSI performed, and only 2 fertilized, and only one was good enough to transfer, and they considered that one poor quality (grade 3). The cycle failed. They said that they had found the 'shells' of the eggs difficult to penetrate when performing ICSI. We had funded that cycle ourselves.

I remember being on my knees, in a ball, howling like an animal. I was 32, and being presented with egg issues, on top of my DH's rubbish sperm, was like a kick in the guts. I went back to the consultant, and he was very reassuring, that these things happen randomly, and I had only about a 1 in 200 chance of it happening again. I'm sorry, but Ican't remember how he worked out his stats, but we were v reassured.

Fast forward 4 months to our next retrieval. I was lying in recovery, when they came to ask my husband for another sample, as the container must have been contaminated, as the sample swimmers weren't swimming. I heard all of this through a post drug haze, but I managed to sit up and say " but we're here for ICSI, BECAUSE of poor motility. The embryologist looked at his notes, perplexed. Nobody had written it on my notes in biro across the top - this was their highly scientific system to notify when ICSI was needed!

7 fertilized, 2 transferred, one baby girl 42 weeks later. FET 10 months, 2 embryos transferred. Morning sick for DD first birthday, 2 baby boys born 38 weeks later, both 7 pounders.

Consultant offered to tie my tubes during the CS, but I informed her that there was no need, as we couldn't conceive as DH has motility of

[BlueBirdy]

Thank you for your replies!

Shell the calcium sounds interesting, I'm making notes to take with me tomorrow, and that's going on the list! (He he, sure doctors and the like HATE google!) All I know is that they were mature enough for injecting - but will ask about their quality, too. I'm 31 next month, and none of my tests have ever indicated that there could be anything wrong with me, but guess nothing is certain. Sorry to hear about your story - I'm sure I've read another thread you were on and someone was talking about a high protein/low carb diet for better egg quality, so I'm going to give that a go too. I'll check back in tomorrow with any update from my appointment - I was lucky he could see me so soon, would have normally had to wait a couple of weeks. Hope both of our next rounds are MUCH more of a success!

Atavistic, thank you for your wonderful story! It has made me feel much more positive! Thank goodness you were awake enough to intervene! And your outcome was a lot better, too, with a bfp to boot . I had always wanted 4 children, but have obviously since realised now how unrealistic (and expensive) that could be, but guess nothing is impossible .

MrsH thanks for your kind words, too xx

I don't suppose anyone knows how soon I can start on the next round? I was on short protocol last time, guess I'll find out tomorrow!

[Shellster52]

Atavistic, not sure what brings you to the infertility section of Mumsnet, since you are well past your infertile days! But very glad to hear your story and chat with you. Can I ask (if you remember), did you do the same protocol for both IVFs? I took Puregon for my first two IVFs,, and had 4 of 5 fertilise in total for the two cycles. I then changed to Puregon and Menopur combination and had only 2 of 8 fertilise. Just wondering if that could have been the case for you?

BlueBirdy, the fact that you are a bit younger than me and should have better quality eggs, yet still had the poor (well, utterly crap) fertilization rate, gives me reassurance that it was something other than my 'old eggs' that caused this. Will be very interested to hear all the details of what your Dr suggests as we are both in similar circumstances.

As for how soon you can start on the next round, I was reading yesterday about a clinic in USA that actually offers a program of 4 back to back IVF cycles (unless you fall pregnant during one of them!), as they have found that this increases the number of eggs collected for poor responders. I can't get in to see my consultant until my next cycle, so I now plan to take my left over Puregon during the follicular phase of my next cycle and then start IVF the following cycle! So, my next IVF cycle will be the 3rd cycle in a row where I have taken the stim drugs to hopefully get me more eggs. I actually have a friend who took Clomid the cycle before her 3rd IVF in a last ditch attempt to fall pregnant naturally. The next cycle she got a whopping 25 eggs instead of the usual 8-10 she got the first two cycles. So I have seen that this clinics theory works in real life! Again, will be interested to hear your Dr's thoughts on how soon you can start.

[BlueBirdy]

Hey Shell, that sounds promising, makes sense really! Could they not increase your stim dosage, or were you on a high dose anyway? Saw the main man at the fert clinic earlier - and I get another go at an NHS cycle! In my area you only get one go, but as I didn't get as far as ET it didn't count as a full cycle - so pleased! He said they'd start me on the burserelin earlier and increase my gonal f dosage, and that if there are enough eggs, they may try a few with just standard IVF, as some eggs just don't do well with being injected. Seems a bit risky as DH's sperm has 0-1% morphology . He didn't mention anything about the calcium thing (assisted oocyte activation?) but that seems like a really successful technique - I'll mention it if it goes tits up again. Think it's only been available in the UK for a few years, the clinic may not even offer it, but it is good to know that there is that option as well! Darn, forgot to ask about the egg quality! Oh well, he said he wants to start after my next period, with egg collection likely in Oct, so unfortunately it won't be right away.

[Shellster52]

Will ask about increasing my stim dosage too Blue, but I think the theory behind the clinic that does the 4 back to back cycles for poor responders, is that it's the cycle before IVF which is important as your body prepares your antral follicles for the following cycle. By the time I start stims on day 2 of the IVF cycle, the number of follicles will already be determined and upping the dose will only get those growing but not make more appear.

So the theory of starting the burserelin earlier and increasing the Gonal F dosage is to hopefully get more eggs in the hope that one or two will then fertilise? Or does he think that this specifically will do something more to the eggs and increase the overall fertilization rate?

When I was trying to find reasons for low fert rate, I saw pics of eggs from poor embryologist technique where the sperm wasn't in exactly the right spot, or the egg was slightly damaged with the needle, so perhaps natural IVF would help if that was the issue. But I understand your fear with 0-1% morph as my hubby has the same issue.

I got my period today as a lovely reminder that this IVF didn't work. If my Dr allows it, I plan to have this cycle off and then start IVF the next cycle. Well, when I say this cycle off, I plan to do the Puregon from tomorrow as I mentioned above. Feels good in a way, like there is something pro active I am doing now for my next IVF instead of just waiting.

I will let you know what my Dr thinks about what went wrong. Oh, and so glad for you that the NHS didn't count that cycle!

[BlueBirdy]

Shell I actually have no idea - at the time I didn't think to ask all these questions that are now plaguing my mind!! I'm so cross with myself, have spent ages googling and have come up with nothing, so guess I'll just have to wait and see. I think basically last time I was on short protocol and next I'll be on long. I think he's trying to get more eggs but at the same time try to make sure they will be top quality. I've still no idea about the quality of my eggs, all my good intentions for asking all the important questions went out the window - it wasn't my individual questions I forgot, it was the actual asking of any questions in the first place that I forgot . I'm sort of thinking that this time they'll just be trying something 'different' rather than 'better' and just hoping for the best.

I'm envious of your good plan! All the best for your next cycle, I'll be keeping an eye out for any up-dates!

[Shellster52]

Hope I didn't stress you out with all my questions about your new plan. Sorry! He obviously had your particular case in mind when he made the changes. I am sure your plan will work much better than mine. I have got pretty experienced at trying to be detective and see how I can fix things for next round. But it obviously never works as this will be IVF number 8! So I don't have much faith in my plan to inject myself this cycle in prep for next cycle. But I have to try something new so this is it.

150 Gonal F is a low dose to produce 6 mature eggs. I produced only 4 mature eggs when I was on 450 of the stuff. So you are going to make more eggs for sure next cycle to up your odds, while I will be lucky to get 5 again.

I think it will be nerve wrecking for both of us right the way through the stim phase next cycle as no matter how many follicles the scans show, it won't be reassuring because we will just be worried about how many/little are going to fertilise.

[BlueBirdy]

No don't worry, I stress myself out all the time After looking into it a bit more, I found an article on how protein in the diet can significantly improve egg/embryo quality. Got myself a tub of whey protein milkshake powder, and with being on an increased dose of Gonal F, am hoping for more egg as well as better quality. FX both our plans work!! All the best

[Shellster52]

Well blue. Turns out my nurse led me up the garden path. The day after EC, she said '5 eggs were mature and 1 fertilized'. So I have spent my time trying to come up with solutions to my low fertilization rate. But I had a follow up appt with my IVF Dr yesterday and it turns out this is what happened with my 5 eggs:

1 - Did not fertilize
2 - Fertilized abnormally with 3 polar bodies instead of 2
Have read that our eggs have more chromosomal abnormalities as we age.
Assuming my 37 year old egg was to blame.
3 - Fragmented with the ICSI process
4 - Fragmented with the ICSI process
5 - My lone normally fertilised embryo.

The Dr said that the two eggs that fragmented were probably the two larger ones at my last scan on day 12 which would have been over mature by EC on day 16. She said this happens with over mature eggs. Glad she gave me a reason so I didn't leave the appt stressing my eggs are crap.


She agreed with me that after starting with 19 follicles on day 3, 5 mature eggs was a low result. I was on 300 Puregon and 150 Menopur, so we are upping the Menopur to 300 too next cycle. Hopefully this will also mean I have a few more ready at the same time so I don't have to allow the lead follicles to over mature and not be able to withstand ICSI, while I wait for the smaller ones to catch up.

After 7 failed IVF's I just feel already like it won't work. But just going through the motions. Starting again next cycle so we shall see...

[BlueBirdy]

Shell that doesn't seem so bad now, I'm sure your next attempt is bound to be more successful! As soon as we have more eggs for them to work with our chances are bound to improve significantly.

If you do have one or two over ripe eggs next time, maybe you can suggest having them try conventional IVF with them, rather than having them fragment - as they will be choosing the best swimmers, and there is not that far for them to go, they may have a comparatively better chance.

Pretty sure my AF is due today or tomorrow - a few days earlier than expected, and I'm expecting to start down-regging on cd21 this cycle, so we may be doing this around the same sort of time :) Will have fingers crossed for you!!

[Shellster52]

I've never down the down-regging thing. Do you still get your period as normal while down-regging? About how long after starting those drugs on day 21 do you start the injections?

Would be nice to be IVFing along side you with your fertilization failure and my general failure after 7 attempts. Others seem to get lots of eggs and have lots fertilize where as we would understand each others fears and anxiousness in the lead up.

Yes, it seems next time if I (and you) can get more eggs, then there's more chance of a few fertilizing well. That is a very interesting thought about doing conventional IVF on any over mature eggs. Not sure if they are so careful as to measure the follicles when collecting eggs and keep the eggs from bigger follicles separate to know which to perform IVF upon and which to do ICSI though. I will keep that thought in mind. If they allow a couple of larger ones to continue growing/over mature again while they wait for the smaller ones to catch up, I will ask. But hoping with the higher dose that I will get more follicles growing and it won't be such a poor response that they have to allow a couple to over mature so that a couple can catch up.

My main new idea this time is to relax and let go. I did four IVF's with a cheap crappy clinic last year and the Dr had no idea. So I was trying to play Dr, researching and telling him what protocol I need to be on and organizing my own blood tests during the cycle. Now paying more for a better clinic and trying not to be my control freak self. So I don't want to stress out too much coming up with new ideas. My next IVF plan is set and I have banned myself from Google research. I have even purposely started a course to distract myself!

[BlueBirdy]

Mmmm, I have no idea about long protocol - they will be posting my schedule today, so will have more of an idea about everything hopefuly tomorrow. I'm away last week of Sept, so they have had to work around that - I'm guessing EC will be in w/c 6 Oct - so probably after you have yours.

Oooh - what course have you started? I may have to find something to take my mind off things, as if I'm not googling IVF stuff, I'm researching the best pram/sling/nappies and that is proving pretty pointless at the moment!

[Shellster52]

You're sounding more positive than me Blue by researching the baby items... I get depressed when those catalogues come in the mail and they go straight in the bin!

I have been considering studying nursing for a while. My IVF Dr is fantastic, but her nurse is horrible, which made me look at courses, thinking I would love to become an IVF nurse as I have been on this side of infertility and know how women need to be treated - unlike my nurse. But I have to do a bridging course before the university will consider me for their nursing degree as I haven't studied in a while... so that's what I'm doing now. It's all online (as I can't afford to work less while I'm paying through the nose for IVF!) so it's really has kept me away from researching about my IVF disasters.

[BlueBirdy]

To be honest I don't know why I do it, whether it is to make myself feel worse, or better!

I'm half way through a degree with the OU, but haven't done a course in ages! Maybe that's what I need to do with myself! Good luck with it all, it sounds like a great idea.

Just spoke to the clinic and my EC week is scheduled for w/c 13 Oct - ages away!!

[Shellster52]

Yep, I can imagine that 13th Oct feels like ages away. Day 14 of my IVF cycle will be about 18th Sep and that is already long away enough. Been feeling quite crappy about the whole IVF failure thing. I haven't had alcohol in ages but started having a bourbon at night while I cooked dinner. Helped to take the edge off, so then Tuesday night, I went all out and stayed up on my own while hubby was sleeping, drinking at the computer while chatting online and listening to infertility songs. Maybe it was good for me emotionally but now if my embryos are poor quality next cycle, I wonder if I will be forever regretful of my night of self pity and alcohol. Also haven't been as fantastic with the diet as I have been in the past. Keep telling myself tomorrow I'll eat healthy high protein low carb, but keep finding junk at night to eat. Frustrating myself!

[TooFly]

This happened in our 2nd round of ICSI two years ago. We have male factor infertility too.

The first round we had 16 eggs and 7 fertilised. We had 2 good quality embryos put back but I didn't get pregnant.

2nd time we had 7 eggs, but none fertilised. Awful.

We had our 3rd round last spring. We had IMSI this time, and I had a higher dose of stims. they only got 5 eggs, but 4 fertilised and there were 2 good quality embryos which we had put back. I got pregnant with DS, he's now nearly 7 months old.

The clinic couldn't explain why our 2nd ICSI attempt was such a failure, they basically said it was just one of those things, although they did recommended IMSI for the next attempt because they suspected DHs sperm issues to be the problem.

[Shellster52]

Thanks for your input TooFly.

Can I ask what day your 2 were put back with your first IVF?
I was at cheaper clinic last year that only did day 2 transfer, and thought that if embryo was put back at day 5 when the embryo has made it much further, surely the odds are higher.

Were you on the same protocol for your second IVF or a different protocol as you also produced less than half the eggs of your first round? And then your third round you had a higher dose of stims, yet got less eggs again? Do you know what caused this? I am a poor responder and am trying to up my egg count to up my chances.

Just did a quick Goggle as I haven't heard of IMSI.
So they basically use a stronger microscope to see the sperm morphology more clearly and can pick better sperm?
Seems bizarre. I always thought they would just use the best microscope and technology available to select the best sperm.
So if I don't pay for the extra service, they use a less powerful microscope when they have a better one sitting right there in the lab?
Am I understanding IMSI right?

Sorry for all the questions. Next cycle will be my 8th IVF and I'm getting pretty tired of it so wanting to get it right.

[BlueBirdy]

Shell this is only my 2nd attempt and I've already given up on my original healthy eating plan - I haven't touched an avo or pineapple since we got the results back! I'm still trying to be healthy but can't quite give up on the sugary snacks. For the past 2 years my husband has cut down hugely on the amount of alcohol he has, has quit smoking, been taking well man tablets and been eating really healthy - but his SA from 2 years ago and the one from 2 weeks ago showed hardly any difference! So I'm not much persuaded by healthy eating any more. I'm just trying to live life as normally as possible!

Hi Toofly, thanks for posting your story :) I'm definitely going to see if my clinic offers IMSI! I suppose even though you had fewer eggs third time round, 90% of them fertilised, compared with less than half on your first attempt. And hooray for your little boy! :) Am seriously hoping our zero fertilisation was also 'just one of those things', though the clinic did say that they would suspect it to be an egg issue rather that a sperm issue (which kind of shocked me).

Shell with the whole transfer day thing, I was under the impression that the embryos that don't make it to blast stage may have made it that far (and further) if they were in the right (comfy womb) environment, so they only try to take them to blast stage if they have quite a few to 'play' with.

[TooFly]

My embryos were put back on day 3 both times shellster. My clinic only go to day 5 if you have several embryos, and both times I only had 2 good quality embryos.

I was on the same protocol for the 1st two attempts. I don't know why I got fewer eggs the 2nd time, I was a year older though, and a year older again when I did it the 3rd time. I'm in my late 39 so obviously getting to the age where my fertility is dropping off quite quickly :(

Yes IMSI is using a super strong microscope to pick the best sperm. Not many clinics had the equipment when I did it last year, I think it's fairly new, and according to my clinic it's very expensive to buy and run.

[Shellster52]

TooFly, that's amazing to be on the same protocol and have such a reduced follicle response with a year difference. My clinic does the same as yours - day 5 if 4 good embryos but day 3 if less than that. However, last IVF I pushed for day 5 even with one embryo alive at day 3. I have read studies proving that embryos don't like progesterone in uterus at day 3 (they would naturally be in fallopian tube). My embryo died before day 5 transfer and on the one hand I think better to see that happen in the petri dish than it be back inside me at day 3 and I get my hopes up before my period comes and I have no idea what went wrong. On the other hand as you say BlueBirdy, I am left wondering if my embryo would have survived better in utero and I would now be pregnant.

[BlueBirdy]

Oh no, Shell, don't think like that! I'm like you, I'd rather it fail at that stage and more or less know why, rather than some time during the 2ww where you don't have a clue and just symptom spot and get your hopes up. I think it is better, at least emotionally speaking, and as it is such a long process (esp for you) you really should have emotional well-being as a top priority.

Just got my schedule through! I am going to be on Buserelin for a month before I start with the stims - 300iu Gonal f (so double that of last time) and then I have the Ovitrelle trigger. Last time I had pregnal, which I know is made from urine, but this ovitrelle is made using Chinese Hamster Ovaries - and I'm not that thrilled about it :(

[StephanieLaws84]

Hi everyone
i just had my first IVF cycle and had a positiv pregnancy test a few weeks ago.
but..... although i had 17 mature follicles after the egg collection, only 4 where fertilised.
At Day 3 they froze one as it was so good and they tried to keep the rest going until day 5-6. Sadly non of the remaining 3 survived, and obviously we where really upset to 'only' end up with one day-3 embryo and no back up plan. But the doctor keep telling us not to give up hope and that we only need one good egg for a pregnancy... and that is what i am trying to say.. all these numbers do not mean anything as you only need one good embryo or blastocyst.
All these numbers about follicles, Embryos and Blastocysts really got my down while i was having all the hormones and the treatment. It is not anything we can control or are in charge of, and that is the most frustrating part about it.
just do not give up hope ladys :D

[Shellster52]

I am the opposite Blue. My old clinic used Ovidrelle but my new Dr used Pregnyl for my last IVF. So do you know when you start the Buserelin? I amm starting the estrogen at CD20 in two days time. Then just wait for my period and here I go again. I am very paranoid as my day 2 follicle count varies so much. Was only 5 in March cycle so I cancelled IVF. But last IVF cycle it was 19. So I just want to get that first scan over with to see that I have enough follicles and will actually be going ahead.

As much as Stephanie says numbers don't matter when you have only had only one IVF and got success, it is a different feeling from our situation and me having had 7 IVF cycles to produce the number of eggs that most produce with IVF cycle. In my situation and at my age with little time left, numbers count!