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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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There are actually several products on the market that contain FSH. I prefer the FSH-only products. For pituitary supression, I use Lupron for either down regulation of the pituitary or for the flare effect in those patients who are poor responders.
Good luck.

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I am a just-turned 37 single woman with good FSH (4.6 this cycle) and a history of responding well to fertility meds. After 6 failed IUIs, I am now doing my first IVF cycle. I had 20 antral follicles on cd2, and responded well to low dose of stims. I had 16 eggs retrieved on Friday, 14 of which were mature. The next day, I found out that only 5 eggs had fertilized. Of those five, four are 4-5 cells on day 3, and only one has made it to 8 cells (and it is "good to fair" quality). I'm waiting to see if it (or any of the 4-5 celled embryos) make it to day 6 for transfer.

My questions have to do with the low fertilization rate and "poor" embryo quality of those that did fertilize...and what this says about my egg quality.

ICSI was not used because the donor sperm I used was reportedly fine. The doctor said that sperm was not binding to my eggs, and that this may be a problem with receptors on my eggs, which can be taken care of by ICSI.

I am terrified that all of this suggests that my eggs are not good. This is confusing to me, since all of my numbers have been fine up until this fertilization report. Any thoughts or help is greatly appreciated.

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I do not know Supercur, or the dose you used. I assume it is similar to Lupron, which can suppress ovarian response. I do not use a product containig LH, as Menopur does. I use products that azre only FSH.
Good luck.

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I am in the same boat. 35 year old - 6 eggs retrieved, only 3 mature, all ICSI'd. None fertilized. Devastated, don't no whether to try again. Will be talking to RE soon about options. Did anyone recommend another protocol? Any advice from people in the same boat?
can't tell whether it is an egg or sperm problem, absolutely no fertilization with ICSI seems so unlikely.

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There are several stimulation protocols and several different producers of the same type drugs. For poor responders, I use a microdose Lupron flare protocl, with an FSHonly product.
Good luck.

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Thank you for your response. I was on 5 days of Gonal-F, followed by 6 days of Menopur and Cetrotide. Why do you prefer products with just FSH, not LH like Menopur? I was under the impression that LH helped mature the eggs, but only three mature eggs were retrieved, with no subsequent ICSI fertilization! My FSH has always been less than 6, and I am only 35. I had 17 follicles at the time of egg retrieval, but only 6 or seven were more than 15 mm in size. My estrogen level was 3500. Do you think my eggs were not mature enough to fertilize? Any advice or suggestion you could give would help, it is my first egg retrieval and I would want to fine tune things next time.

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We find we get better quality eggs and embryos if we do not add any LH to the stimulation. The hCG we use is a surrogate for the LH surge, which matures the eggs after follicle growth.
Good luck.

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Human embryologist error: when no eggs (or only 1 egg) fertilizes with ICSI....


Maybe my experience will give some women out there some useful, important information, so they won’t have to go through what I did.

I am 38 years old. My FSH level was 9. Husband: age 49.

I recently completed my first (failed) IVF cycle with a clinic whose live birth success rates were recently in the highest tier for my age group. My RE removed six eggs from my ovaries, all mature. ICSI was needed for all of them, as my husband had an unsuccessfully reversed vasectomy. We used frozen sperm that had been removed from my husband’s testicle (TESA) by a doctor who is one of the leading experts at these procedures. In all, there were 10 vials of good quality sperm.

Then I learned that only one of my eggs fertilized with ICSI. I was shocked and devastated, as we were told that my husband’s sperm were of very good quality. My one fertilized egg lasted to day 5 and was transplanted into my uterus as a "high-quality" AA-grade blastocyst. My first HCG test was only 17 (a maybe pregnancy), and two days later it was 2--the embryo had obviously died.

Because I’m a journalist by profession, I’m used to researching things and seeking reliable answers. My husband and I went to the embryologist to try to get an explanation for the low fertilization rate. At first, we were given a "poor egg and sperm quality" refrain. We didn't believe it, though. Not with my FSH level and high-quality embryo. Not with the surgical report which had found that my husband's sperm were of very good quality and ready for ICSI.

So what happened?

We soon discovered that the embryologist had committed a couple of serious mistakes which should have never happened. To begin with, she had only thawed one vial of sperm from the ten that were available. I quickly learned that it's standard in the business to thaw more than one TESA vial, as each generally contains very low sperm counts. In addition, it’s well known that TESA samples need to be thawed at least 24-48 hours before an IVF egg retrieval, as it takes the sperm a long time to “wake up” and get active. (See the following article “Optimal use of fresh and frozen-thawed testicular sperm for ICSI” in Vol. 22, Nos. 11/12, December 2005 issue of “Journal of Assisted Reproduction and Genetics”.)

Our embryologist thawed my husband’s vial of TESA sperm only a couple of hours before my egg retrieval. As a result, she reported seeing virtually no moving sperm and chose to fertilize my eggs with sub-standard, slow-moving sperm with poor morphology (none of the good morphology sperm were moving yet). In her opinion, these poor quality sperm were the reason why 5 of my 6 eggs didn’t fertilize.

Here’s the kicker: you’d think embryologists are M.D.s or Ph.D.s of some kind—or at least hold a graduate degree in the subject. But most don’t. Usually, IVF clinic embryologists only have a bachelor of science degree as a “Clinical Laboratory Scientist” (the C.L.S. designation you’ll see after their name). You can even become certified as a C.L.S. in a single year, much as an ultrasound technician can. Considering this, it shouldn’t surprise you if many of these folks don’t know much about the current IVF research, nor have the academic or cognitive skills to understand the language in such articles. Would you trust your eggs or sperm with a young 20-something holding only a B.S.? It kind of gives me the willies. I would have assumed these embryologists are doctors or highly trained specialists of some kind, when most aren’t.

Our embryologist simply didn’t know about standard TESA sperm thawing procedures. Nor did she have the foresight to thaw more than one vial. In short, she seriously dropped the ball. Now my husband and I are out $20,000 and five months of my life. Not to mention the heartache of losing valuable eggs and sperm that could have produced a child.

If you find yourself in a similar situation of poor fertilization with ICSI, I would suggest you make sure there were no lab mistakes before you buy the story that your eggs or sperm are “poor.” Even if your clinic is highly rated—as ours was—this sort of thing can still happen. People aren’t infallible. Don’t be afraid to research the situation and ask questions. You are your own best advocate, and it’s best to stay on top of things.

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Hello i was looking for advice and guidance regarding the following situation.. my partner and me have been trying for children for 3 + years. Naturally we have had some late perods(2 weeks max) and late periods with clotting!! With IUI a 4 week pregnancy and with IVF/ICSI a 8 week pregnancy.. On the latter occasion we used icsi having used imsi procedure. We used IMSI as the male had a sperm DNA fragmentation test, and had a DFI/DNA 6% high of DNA fragmentation; 29% medium of medium fragmentation (is this borderline normal?).. using chosen sperm which was high quality we achieved 7 embryos, of which 5 were grade 1 and 2 were grade 2, we put 3 back in and gained pregnancy.. the 1st scan, at 10 weeks, showed that it had been developing until recently but failed. From the given information is the failure still likely to be the responsibility of sperm, as embryos were achieved ?? What other reasons can you suggest..

Furthermore, my partner has a mild clotting disorder, called Heterozygous Factor V Leiden for which we were prescribed Clexane post transfer. She took it for two weeks but was then advised to stop taking it when she had implantation bleeding. What is your opinion of this..? Most recently, transfer of 4 frozen embryos, where no Clexane was taken, resulting in early bleeding with clotting (blood was mostly dark), which we thought was implantation but produced a negative pregnancy test..

What is your opinion on this? Is there a correlation between pregnancy
(8 wks)when taking clexane and no pregnancy ? Any advice would be welcome..

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After two years of ttc and two miscarriages, my husband and I underwent our first ivf treatment. 14 eggs were retrieved but unfortunately none of them fertilized in the lab. Is there any way to determine why the eggs did not fertilize and is a second ivf treatment with icsi worth considering for us? My husband and I are both 40 years old.

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jenna- im wondering if you ever got an answer...i am in the exact situation and im looking for some answers. ivf attempt #2 with icsi and no fertilization either time. i dont know what to do?

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Sam - I am sorry to hear that your second ivf did not work - I know how it feels. Knowing that women are advised to take a few months break in between their ivf treatements (to let the ovaries relax) - my husband and I are currently meeting with and interviewing a few other doctors who come highly recommended to us by our friends. Thus far, they've sugegsted that (i) the egg stimulation could have been off (I had a large number of 'small' eggs which is why they suspect that they didn't fertilize), (ii) genetic testing - which can be performed on fertilized eggs to help determine which ones have a better chance of leading to a successful pregnancy and (iii) Coenzyme Q10 - which is an over the counter vitamin supplement that 'some' fertility specialists beleive could lead to increased egg quality. I hope this helps.

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