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8 Replies
cassidy - March 3

Dr Smith,

I am 32 and have a known immune condition (Ankolosing Spondylitis). My husband is 41 and has a very low sperm count with morphology and motility problems. We have had 2 ICSI cycles, 1st 7 eggs, 3 fertilised, 2 4 cell embyos transferred but -ve. 2nd 19 eggs, 6 fertilised, 2 5 cells transferred (2 frozen). This time we had a bio-chem pg which ended v early at day 14. On the 2nd cycle I was treated with steroids for the immune condition and am currently pursuing further blood tests but my other concern is whether to continue with husbands sperm - are we fighting a loosing battle? I wonder also whether we should pursue extracting the sperm via surgery? - do you think the quality would be any better? or should we seriously consider donor sperm?

Thanks for your help
Cass

 

Dr Smith - March 4

The low fertilization rate in both of your cycles was not necessarily due to the sperm. It is more likely that there was also a problem with the eggs. When eggs do not show signs of fertilization after ICSI, it is usually a problem with the egg, not the sperm. Egg problems such as this are sometimes a result of problems with the ovarian stimulation or you may just have higher than expected (for your age) number of poor quality eggs. Without having actually seem your stimulation record, your eggs or embryo growth, it difficult for me to nail it down.

Sperm extraction from testicular or the epididymus will not improve your chances. The best (most mature) sperm are always obtained from the ejaculate and yield the best fertilization results. Donor sperm is an option, as this would allow you to do IUI rather than IVF.

 

cassidy - March 5

Thanks so much for your reply Dr Smith

In order for you to try to 'nail our problem down' what further info do you need? I don't have a copy of my notes but can request the info from my Dr.

Also, are their particular tests I can have done to determine the quality/problem of my eggs?

Thanks again

 

cassidy - March 5

Also, would you recommend that we ask for a SCSA test in the meatime?

Thanks

 

Dr Smith - March 10

I would recommend that you seek a second opinion on your ovariant stimulation protocols. Although a sufficient number of eggs were retrieved each time, the reduced fertilization rate with ICSI suggests a change in stimulation protocol may be necessary to achieve better quality eggs (i.e. better cyotplasmic maturation).

The SCSA will provide some additional information regarding the quality of the sperm, but even an abnormal SCSA result will not completely explained the low fertilization rate.

 

cassidy - March 11

Thanks again for your reply Dr Smith.

I've managed to obtain the embryologist reports from our 2 cycles and would appreciate your opinion on them.

Cycle 1

Stimmed for 5 days on 225 Menopur, scan showed 7 follices (1 x 16ml, 1 x 12, 5 between 10-12). Followed by another 4 days stim at 300 menopur, scan showed 8 (1 x 20, 1 x 16, 1 x 14 and 5 between 12-16). Final day stim on 225 menopur. 7 eggs retrieved, all ICSI, 3 fert.
3 zero pro-nuclei, 1 with 3 pn & 1polar body, of the 3 that fertilised ok ..

First was a two cell by day two (grade3), same on day3 and 4 - deamed not suitable so discarded.
Second was a 2 cell on day 1 pm, 4 cells day 2 (grade3), 6 cells grade 3 by pm and ET.
Third was a 2 cell by day 1 am (grade1), 2 cell grade 1 by day 1 pm and 2 cell grade 1 by day 2 am, 4 cells grade 1 by pm of day 2 - ET

Cycle failed

Cycle 2

Stimmed on 300 menopur for 6 days - scan showed 6 follies on right between 6-8 and 6 on left between 11-16. Stim another 3 days 300 menopur 2nd scan showed 8 on right between 12-17 and 7 on left between 14-20. 19 egss retrieved, 17 suitable for ICSI. 6 fertilised. 2 zero pn with 2 pb, 4 zero pn, 1 pb, 3 zero pn, frag pb (2 noted v.dark), 1 with 4 pn and 1 pb, 1 with 1 pn and frag pb. Of the 6 fert ..

2 with 2 pn, 2 pb frozen
1 with 2 pn, frag pb, 2 cell by pm of day 1, 4 cells grade 2 by day 2 am, 5 cells grade 2 by pm of day 2 - ET
1 with 2 pn, frag pb, 2 cells by pm of day1, 2 cells by am of day 2, 5 cells (grade 2) by pm of day 3 - ET
1 with 2pn, 2 pb, 2 cells by am of day 2, 3 cells by pm, 4 cells by day 3, comp mor by day 4, cavitating mor by day 6 but discarded.
Last was a 5 cells by day 4, Irreg comp morula by day 6 again disgarded.

Result - Bio-chemical pregnancy

What do you think? The sperm analsys from the 2nd cycle says 3 x motile and 5 x twitching sperm seen on wet prep. This doesn't sound great to me! Do you think I need to be concerned about the quality of my eggs too? Also, should embryos have an odd number of cells (1 had 2 5 cell embryos transferred)? What do you think the chances are of our 2 frozen ones surviving the thaw?

Many thanks for your advice - sorry for the essay ::)
Cass

 

Dr Smith - March 13

Yes, I think you have to be somewhat concerned about the quality of your eggs. Egg quality deteriorates as you get older. Some women's eggs deteriorate faster that expected from their age alone. The stimulations sound O.K., so it doesn't look like that's the cause of the fertilization failure.

From the information you provided in your most recent post, the sperm problem appears worse than I thought, so I am now reconsidering my position on using donor sperm. When there are very, very few sperm to use for ICSI, the embryologist can't pick and choose the "best" sperm. The embryologist has to inject whatever they find that is viable, so in many cases, the morphology of the injected sperm is abnormal. This can also lead to fertilization failure or decreased fertilization rates as was observed in your case. Considering the new information about the severity of the sperm problem and the resulting embryo growth rates and the biochemical pregnancy, I would now recommend using donor sperm. If you opt for donor sperm, you may be able to achieve pregnancy through IUI rather than IVF.

 

cassidy - March 13

Thanks so much for taking the time to give me advice and answer my questions - as you can imagine DH and I have some tough decisions to make.

I appreciate your advice regarding donor sperm - We thought we would end up there somehow. What are your opinions on doing ICSI with a a 50/50 split between DH sperm and donor? Is it worth it? This is something that I have also been thinking about but am not sure if we're totally wasting our time using DH sperm and our hard earned cash is better spent throwing everything at donor? I assume this will also rule out any possible egg issues? It it worth trying IUI if there are egg issues?

Again ... Thankyou
Cass

 

Dr Smith - March 14

You can split the eggs 50/50 with husband/donor sperm. However, things get a little complicated when it come time to chose embryos for transfer. A variety of senarios can evolve and you'd have to think through what your choices would be (in advance) if you decide to go down that route.

I don't think your egg problems are severe, so IUI with donor sperm is a low cost solution if you opt for using donor sperm. In the case of IUI, you don't want all the eggs to fertilize and all the embryos to develop and implant. That would be overdoing it somewhat (yikes!). So I think you'd be O.K. even if there are egg problems.

There's also a matter of sequential pregnancies. Maybe it would be prudent to try to achieve a pregnancy using donor sperm now and then a subsequent pregnancy (if you want more than one child) with your husband's sperm or a 50/50 split. Just a thought.

 

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