ICSI - no egg fertilized
28 Replies
JJ08 - January 20

I and my husband are having IVF/ICSI-treatments at a local clinic. We are the kind of unexplainable infertility case. I am 37 and my husband is 55. He also has diabetes.
Our first treatment went well though I didn't get pregnant. They took out 12 mature eggs and the sperm quality was good, they said. They divided the eggs and did ICSI with 7 of them. The standard IVF didn't result in any fertilization of any of the eggs, but all the 7 eggs treated with ICSI got fertilized. On day 3 we got two nice 8-cell embryo, the rest didn't divid normally. So I got one embryo back and they froze the other one. I didn't get pregnant so we went back for another treatment after I got my normal period.
It went well this time as well in the beginning with the hormon-treatment and all. They got out 16 eggs, fine quality and the sperm looked fine. But when we called back to hear about how many eggs were fertilized, they told us that none of them got fertilized. They said that the guy who did the ICSI was the most experienced one at the clinic, they simply didn't know what happened. They said they were shocked and you can imagine how shocked we were after hearing this. We really wonder how this could happen? We are devastated. What went on in that clinic? Is such a thing possible?
In the end they offered to try with the frozen embryo this time. It was frozen on day 5. But we don't know if it will survive the thawing tomorrow. How big is the chance? Does it matter that it got frozen on day 5?
Thank you very much in advance if we could get some answers. This is a very very difficult time for us.


B. Jacobs, M. D. - January 20

As far as preganncy rate with frozen embryo transfer, that is clinic specific. It is possible that there is a sperm problem as a reason for no fertiliization. If the lab did not do a careful assessment of morphology, using Kruger's stricit criteria, it is easy to miss. Also, ICSI does rarely result in failed fertilization. In the single case in my practice, after the husband had his varicoceles repaired, we were able to achieve an ICSI pregnancy.
Good luck.


JJ08 - January 21

Thank you so much for the answer Dr Jacobs.
My husband has varied sperm counts and the activity is only ok, not very good. We asked them if there seemed to be a problem with the sperm, they said no. We did get 7 fertilized eggs through icsi last time, so our suspicion is that somebody did something wrong this time. But of course if they don't say anything, we would never know. We were the so called "hopeful" case in their words. I was pregnant through the natural way two years ago but had a misscarriage. We will keep on trying with icsi, hoping that such a thing would not happen again.
Thank you very much again!


B. Jacobs, M. D. - January 23

Please understand that just because you did not get fertilization does not mean someone did something wrong.
Good luck.


dees - January 27

Hello doctor,

I am going to do ICSI because none of my eggs fertilized with ivf due to the sperm not binding to the egg. I am concerned about potential abnormalities in offspring . I was wondering if you recommend any screening/tests for ICSI candidates to do in order to find out if the sperm has abnormalities that could be passed on to child. Also wondering if you recommend testing the embryo. I have heard of pre-implantation genetic screening. Can this be harmful to the embryo ?, and is it usefull ?
thank you.


B. Jacobs, M. D. - January 27

There is a small risk to the embryo, when it is biopsied to do the testing. Unless there is a specific problem you are trying to find, it is not a very useful exercise. All embryos have some bad cells, even if they eventually produce good pregnancies. You will discars good embryos that way.

In all probability, if sperm did not bind to the egg, the acrosomal cap was not adequate. ICSI will overcome that problem. The chromosomes and genes of the sperm can still be normal, even though the outside of the sperm may not be.
Good luck.


dees - January 29

Thanks for your response.
I have a book that recommends two to three days of rest in bed or on the lounge after embryo transfer.
Staying horizontal , says the author is important for the embryo to implant and not be lost. I would like to know your thoughts on this.
Thank you


B. Jacobs, M. D. - January 29

There may be no need for bed rest, at all. I am still having my patients remain at bed rest for 30 minutes after embryo transfer, and, last year, we had a roughly 50% pregnancy rate. More recent data imply that even 30 minutes mat not be necessary.


B. Jacobs, M. D. - February 5

There are number of potential reason for failed fertilization with ICSI. The greatest is a sperm problem, but technique of injection could play a role. As far as your eggs are concerned, 39 year old eggsa are not the same as22 year old eggs. There is a significantly greater probability that they will not have the correct number of chromosomes. That will probably not impair fertilization, but does decrease your potential for a healthy pregancy.
Good luck.


B. Jacobs, M. D. - February 7

Sperm coount and motility are only half of the information I need from a semen analysis. A properly performed assessment of sperm morphology provides good information about whether or not sperm can enter eggs. Even with ICSI there are rae circumstances that the sperm pro nucleus does not decondence, so that it can merge egg pro nucleus. That merging of the 2 pronucleii is the actual fertilization. If the sperm are motile, they are not dead, but there may be a molecular problem interferring withthe decondesaton process.
Good luck.


sublue - April 17

I am 36 with FSH 5.6. Partner has low sperm count between 1 and 40 million with low mortility between 1 and 6%. We have just had a cycle of icsi with no fertilization. I only produced 5 eggs, 4 of which were mature.
This our second attempt - the first one was cancelled due to poor response.
Should we give up?


B. Jacobs, M. D. - April 17

I would expect someone as youg as you are, with a low FSH to respond better. Perhaps an alternative stimulation protocol would be of benefit.
Good luck.


sublue - April 17

Many thanks. The first protocol was the long protocol with suprecur and menopur (150). The second one was a short protocol with the same drugs but menopur at 225.
Do you mean that there are other protocols? Or other drugs? Or a higher dosage still?


B. Jacobs, M. D. - April 17

There are several variants of several protocols. There are several different products available which contain the FSH need to grow follicles. I do not know the product, Suprecur by that name. I assume you are not in the United States. It is probably 1 of several which prevents the release of FSH and LH from the pituitaty.
Good luck.


sublue - April 17

Thank you. Suprecur is the down regulator.You are right I am from UK. Many thanks for your reponse. Is there any particular protocol/drugs you recommend? My clinic suggest i go for egg donation but i dont think i am ready for that. I have asked for all my notes so i can get a second opinion but havent got them yet.


B. Jacobs, M. D. - April 17

It would not be appropriate for me to make medical recommendation to someone who is not my patient. I do not knowthe clinic you are using. The only one I know, first hand, in the UK is the Borne Hall Clinic, and its medical director Mr. Peter Brinsen. If you would like a second opinion, you might see him.
Good luck.


TheMuzys - April 25

Dear Doctor,
I am 32 and my husband is 37 and we have just had our 1st cycle of ICSI. I responded well to the drugs and produced 12 eggs of which 9 were mature enough, 3 were said to be immature and by English law could not be injected. Of the 9 mature ones, 3 fertilised abnormally and 6 did not fertilise at all. Obviously we are both devastated. We cannot understand how this could have happened. I have blocked fallopian tubes but are otherwise fine and my husband has 98% abnormal forms (morphology). His count this time was about average and he has a 6 year old daughter from a previous relationship. I have conceived twice before at a very young age (16 years ago). We dont know what to think, we trust our clinic and what they have said but we cannot help but think that human error could have played a part in this. The clinic had a power cut before we arrived and was running from generated power. Saying that we have been told ICSI was performed on other couples the same day and was successful. We have decided that we will have another attempt but we wondered what tests could be done on my husbands sperm? The consultant said that it could the eggs or it could be the sperm. Is there some sort of DNA test he could have before we set ourselves up for more heartache? They also mentioned something about the sperm breaking down??
Is this what you refer to as decondensaton?
Any advice would be greatly appreciated.
Many thanks,
Steve and Melanie



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