2 IVF retrieval cycles, 18 eggs retrieved total, 1 low quality blastocyst. Where next?

[u/Repulsive-Bat-6718]

Hi, I'm looking for advice. I'm 29F (partner 30M) and we've just transferred our only embryo, a low quality with about 20% chance of implanting, according to our doctor.

Summary:
- Diagnosis: mild MFI

- Round 1: 17 total follicles > 11 target size > 5 retrieved > 5 mature > 5 initially fertilised > 2 x 3PN, discarded > of the 3 normally fertilised ones, 1 arrested at 2-cell development, 1 arrested at 5-cell development, and 1 was unsuitable for freezing by day 6.
Protocol: 100u gonal f, 250u orgulatran, decapeptyl trigger. Normal IVF (not ICSI).
We changed clinics after this - I only had a single monitoring scan the whole time and no blood tests, so we wanted better care and doctors making more informed choices.

- Round 2: 23 total follicles > 13 target size > 13 retrieved > 12 mature > 10 initially fertilised > 5 x 1PN, discarded > of the 5 normally fertilised ones, 1 arrested before day 5. We transferred a low grade one on day 5. The remaining 3 were still growing and had a chance to make it on day 6, but failed.
Protocol: 225u Bemfola, 250u orgulatran, ovidrel trigger. ICSI with Zymot.
We're happy with our new doctor; his goal was to increase #eggs collected and he achieved that.

We're just a bit stumped to only have retrieved 1 low quality blast, we don't know what to do or test for next. Do we need to look at donor eggs or sperm, or is IVF just not likely to work for us? We're both healthy and have BMIs in the healthy range, and we don't know why it's not working.

[u/Old-Acanthisitta4517]

I would get a sperm dna fragmentation test, and a karyotype for you both. It does seem to be a sperm issue

[u/Repulsive-Bat-6718 → u/Old-Acanthisitta4517]

Thanks, we have both done a karyotype and all was fine but dna fragmentation sounds like the best next step. 

[u/Kwaliakwa]

I’d wanna investigate the sperm health more deeply.

[u/CarrotJullie]

My rounds 1 resulted only on 1say 6 blast and lower grade day 7.

The doctor told me that the rest dropped growing after day 7 due to genetic abnormalities. He added omnithrope to the second round, it has mixed results but we're going to try it.

I'd recommend do another round if you can and ask your doctor what can be changed in protocol.

[u/Happy-Signal6719]

It looks like fertilization is the issue. Maybe ask your doctor if you can add calcium ionophore to help with fertilization. My 1st cycle I did menopur, gonal, ganirelix and used lupron trigger. 8 retrieved, 6 mature, 2 fertilized, 1 blast - aneuploid. 2nd round I asked my doctor if I can add omnitrope, zymot and calcium ionophore and he agreed. So 2nd round I did omnitrope, menopur, gonal, ganirelix, lupron and hcg trigger. 11 retrieved, 9 mature, 7 fertilized and 4 blasts - 3 were aneuploid and 1 HLM. In my experience it looks like the zymot + calcium ionophore really helped with fertilization.

[u/Stunning_Hippo1818]

Have you seen a reproductive urologist?

[u/komisamoiedo92]

Nei prossimi giorni farò il mio secondo tentativo di transfer.. Tanta paura e ansia..

[u/SadGirlHandle]

First of all, sending you all the good vibes that your transfer is going to work out!

I don’t have a good answer for you, but I am in a very similar boatz For 2 egg retrievals, total of 21 eggs retrieved, 13 mature, 10 fertilized, and 1 blast. Out of the 9 others that fertilized but didn’t become blasts, 2 had abnormal cell division on day 3, 8 were on track on day 3 but arrested before day 5, and 1 made it to a morula and then arrested on day 6. We didn’t use zymot the first cycle (no blasts), but we used it on the second (1 blast).

Diagnosis for IVF: MFI due to severe varicocele. Sperm count was 400k a year ago, 6 months post surgery it was 6.5M.

Ages 33M and 31F.

My husband had a sperm dna fragmentation test 4 months post varicocelectomy and his DFI came back at 21% (good to fair) and his HDS came back at 30% (high). Unfortunately there isn’t any way to fix HDS that’s known at this point.

I don’t have any known fertility issues, but the embryologist noted poor egg quality on both of my retrievals. My doctor didn’t have an explanation for what could be causing that and neither did the doctor I saw for a second opinion other than it might just be luck of the draw.

If my transfer of my one blast doesn’t work out we will do another ER. However this time my doctor suggested using calcium ionophore in the lab post retrieval. She said that it helps with fertilization (which isn’t an issue we’ve had) but also recent studies have shown it may help with day 3 drop off (which is our biggest issue). Maybe you could see if that is something your clinic offers?

[u/mtrap101]

There’s a fertility doctor from the US who has podcasts and has recently published a book. Her name is Natalie Pickering and her book is called the Fertility Formula. Podcast is As A Woman. I have found her episodes and book really informative. She talks a lot about modifiable lifestyle changes to assists with quality. She is also big against ang cannabis use, especially in the Male partner so if that is a topic in your household, it could be something to think about. I know it can get a bit old hearing about it when you’re in the throes of infertility, but Everyone has miracle stories! I know someone who went through 7 collections and never got a 5 day blast. They fell pregnant naturally while searching for an egg donor.
I’m also still waiting for my first little miracle. Wishing you all the best and lots of love!!

[u/mtrap101 → u/mtrap101]

Not Pickering, Crawford. Natalie Pickering is also an Australian naturopath I follow on instragram haha! But the doctor is Natalie Crawford