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mcc34 - December 6th, 2009 3:46 PM

Hi Dr. Jacobs,

I 37 years old, and just completed my 3rd IVF cycle. I have mild endo, a low FSH, an excellent antral follicle count (28) and no other known infertility issues. Prior to starting getting involved with IVF, I had a spontaneous pregnancy that resulted in an ectopic (my tube didn't rupture...they found a live fetus in the tube upon an 8 week ultrasound). After that, I went straight to IVF. My husband has had several semen analyses...some have shown only slightly low morphology (11%), some have been above average, and some have shown very low morphology (1%). His count and motility are consistently very high. He has gone to a urologist who said his sperm is excellent and we also did the SCSA which showed he had only 5% fragmentation.

IVF #1
Antagonist Protocol
20 eggs retrieved, 12 mature, 12 fertilized.
Day 5 transfer: Only 4 morulas left. Transferred two. The other two not good enough quality to freeze
Note: The embryologist said they had to use sperm that was not within normal limits for ICSI. They basically said out of 500 million sperm, he didn't have one normal looking one.

IVF #2:
Microdose Lupron Protocol
13 eggs retrieved, only 6 mature, 4 fertilized
Day 3 transfer: 1 9-cell grade A, 2 8-cell grade A transferred. Also had a 5-cell that wasn't good enough quality to freeze.
NOTE: Again, the sperm used for ICSI was not WNL.

Switched clinics because we were getting frustrated with whole sperm issue, etc. We also learned that embryo quality can significantly decline after day 3 and since abnormal sperm was used it just didn't make sense to say where we were.

IVF #3:
Long Lupron Protocol
8 eggs retrived, 7 fertilized via ICSI
Day 3: All 7 dividing well and very high quality
Day 5 transfer: 2 blasts transferred- 1 early blast (could not yet be rated) and 1 1BC blast (obviously not great quality). We also had 3 morulas on day 5 that are being monitored to see if they'll be eligible for freezing.

My question is: although I was ecstatic that we actually made it to the blast stage (although slower developing ones), most of our embryos were "slower" or "underdeveloped" for day 5...similar to IVF #1. Our quality has always been great on day 3, but then seems to decline between day 3 and day 5. This lab said my husband's sperm was fine and used normal sperm for ICSI. Along with the SCSA results, I'm not sure if we can attribute the decline in quality to the sperm. Any thoughts on what's going on with us? Also, do you think the blasts that they transferred have a decent shot of producing a pregnancy? I'm feeling awful pessimistic, but trying to stay positive. I would love to hear what you think.

Also, is there any data that embryo quality may be better if we didn't do ICSI? We've never tried conventional IVF b/c of the potential sperm morphology issue.

Thanks for your time.

B. Jacobs, M. D. - December 7th, 2009 6:46 AM

Looking at sperm under the microscope does not tell us anything about the genetics of the sperm. There are commonly problems with both sperm and eggs at the molecular level. Genes from the sperm do not play a role in embryo growth and developement until day 3. There is likel to be a sperm problem that cannot be detected for ICSI selection. Also, remember, your eggs are not those of a 27 year old. It makes a big difference.
Good luck.

mcc34 - December 7th, 2009 11:27 AM

Dr. Jacobs,

Thank you for your quick reply and for your input. And I'm well aware of the effect of age on egg quality, and knew going into this it would be an uphill battle.

With that being said, do you have any suggestions of how to further explore the possible sperm issue? As I posted earlier, my husband already did the SCSA test, which revealed excellent sperm integrity and fertility potential--fragmentation of only 5%. Are there any other tests you would suggest that could help either support or rule out a sperm issue? I just want to make sure I ask our RE the right questions and ask for the right tests before we try another cycle.

Also, in your experience and based on the above information, do you think we'd be better off trying conventional IVF instead of ICSI?

Thank you for your time. I really appreciate it.

B. Jacobs, M. D. - December 7th, 2009 5:23 PM

It is unlikely that ICSI created a problem, if the embryologist who performed it is experienced. There really are no other tests, I know of, to determine the molecular integrity of sperm. Each sperm is different, to a certain extent. So testing a sample give only a statistical result, and not one for specific sperm.
Good luck.

nora - May 21st, 2010 4:45 AM

Hi Doctor,

I'm 33 years old. I have done 1 IVF cycle which resulted in having a marvellous boy in 2008. Now that we have decided to have another baby, I had done my second IVF 2 months ago. The results were satisfying and I thought "that's it"! Twenty two eggs were retrieved - but 14 embryos were there. My first 2 transfers failed, using 2 embryos each time. My third transfer was yesterday and there was the BIG surprise. From the 9 left frozen embryos, only one survived and was transfered. Is there any good explanation of losing 8 embryos (knowing that they have been frozen for 2 months only?!).
If this time pregnancy fails, I need to repeat again from ZERO.
Thanks for your help.

B. Jacobs, M. D. - May 21st, 2010 6:39 AM

Not all embryos survive the freeze-thaw process. We have about a 10% loss rate. Not being the one actually workin in the lab, I am not sure I can give you a complete answer as to why. If yo do not have any embryos left, you will need to make more if you want an IVF pregnancy. Your alternative is to try to find donor embryos.
Good luck.

lulu78 - August 3rd, 2010 12:46 PM

Hi Dr Jacobs,
I am 32 years old and have 3 failed ivf. I have one ovary and we are using donor sperm, MFI. I have had good responses with 150 puregon ~ 11 eggs collected, nine fertilised but only 2 for transfer on day 3. My last ivf similar numbers collected with one blast transfered on day 6. After day 3 embryo growth tend to arrest. My previous 3 IVF were antagonist protocol. My RE is now recommending 450 puregon agonist protocol to see if we can get larger numbers anf find one good egg???? Not sure about this does increasing the quantity have an efect on quality. Also with one ovary does 450 puregon seem excessive considering my previous response?
Your opinion would be greatly appreciated

utb - January 10th, 2012 6:09 AM

Hi

Not sure if this is still active but I would like to ask a question about embyo quality, I have had three cycles of ICSI where I have had HCG readings of 10, 15 and 24 I have had immunes tests done and they have all come back with no signs of any problem, however, my husband has had a sperm DNA test done and per ml he only has 32% that are any good and only 29% of that number are deemed satisfactory, we have been advised to go for sperm retrival rather than a natural sample. My husband had a reversal in February 2009 so we believe that the sperm is being damaged in his ejaculate. My question is would we be likely to say better rates of success with sperm retrival we are fertilising between 8 and 10 eggs but are generally only getting 2 to the blast stage.

Any help or advice you could give woule be appreciated.

Many thanks

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