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Nette - May 9th, 2005 11:48 PM

I'm 36 and my husband is 38. We naturally conceived our only child together in our 20's. About 6 years ago my husband was diagnosed with an unexplained reduction in his sperm count and quality. His sperm count is < 1mil. We started IVF w/ICSI in Feb 05. Two(9 cl & 10 cl) were put back but didn't take. We had 4 frozen @ 5 cl, 7 cl, and two @ 8 cl. All four survived the thawing process, but two of them were fragmented. My Dr decided to put all 4 back, but none of them took either. We can't figure out why neither attempt worked. Were they all abnormal? Did the thawing process reduce the quality of the four that were frozen? Is it worth it to try again? In light of the poor sperm quality, should we have put all 6 back at once on the first try?


Dr Smith - May 10th, 2005 9:19 AM

First of all, IVF doesn't work every time. At best, it works half the time. Accordingly, you need to lower your expectations to be in agreement with the biological reality. The assisted reproductive technologies can not make the reproductive process 100% successful. You could spend a great deal of unproductive time wondering why the IVF cycle didn't work and, in the end, you will never know because the embryos were transferred on Day 3 when the developmental potential of the embryos was unknown.

The percentage of embryos that are developmentally compentent enough to reach the blastocyst stage of development (the stage at which the embryo initiates the implantation process) is significantly reduced when ICSI is performed for severe sperm problems (i.e. a sperm count of < 1M/ml). My advise to you is to repeat IVF/ICSI and extend the culture of the embryos to the blastocyst stage. Then, transfer only 2-3 blastocyst stage embryos. Transferring 6 embryos on Day 3 is dangerous. Culturing the embryos to the blastocyst stage will also reduce damage to any cryopreserved embryos, as freezing at the blastocyst stage has a higher survival rate than Day 3 cryopreservation.

Nette - May 10th, 2005 10:05 AM

Ouch!!!! Thanks for the information but it would have been nice to have gotten it without a verbal chastiing. Obvisously you're very knowledgeable and experienced but this is my first experience and I'm still trying to sort through it all. Part of becoming realistic is getting more information. I just got negative results yesterday and have been crying all night. I just wanted insight and clarification. Not a verbal chastising!!!!!!!!!!!!!!


Dr Smith - May 10th, 2005 10:52 AM

Sorry for your bad news. I'm sure your nerves are raw and you are very sensitive right now. Sorry if my words cut a little too deep, but the information I provided was important for you to move forward in this.

It is important for patients to have realistic expectations and realize the limitations of medical treatments they receive. Becoming overly optimistic during a cycle can lead to extreme sadness, a great sense of loss and beating yourself up when it doesn't work. You didn't do anything "wrong". It didn't work, thats all. It is unfortunate that your doctor did not properly prepare you emotionaly for the possibility that the cycle may not be successful. Proper preparation would have softened the blow a little when the test was negative.

If you feel you you would benefit from emotional support at this time, I would suggest posting on The Sounding Board (http://www.sharedjourney.co
m/yabbse/index.php?board=12)
.

Nette - May 10th, 2005 4:56 PM

Thanks! I will review the blastocyst option with my RE when he calls back today.


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