low fertilization with ICSI
10 Replies
lms2006 - October 8

I have had low fert with ICSI 2 times in a row. 5 of 15 mature eggs and 3 of 11 mature eggs. I am 30yrs old diagnosed with male factor only. Same protocol both cycles 225 units FSH only (long lupron protocol). Embryos have been average quality. Both BFNs. I have been getting second opinions and it looks like adding in some LH could help fertilization and embryo growth....My old RE says a change in protocol most likely will not make a difference. Others say it could definitely make a difference as LH can go to zero with lupron. Some of these other Drs agree with immunity testing while my old RE does not. What do you think? Would you recommend immunity testing?
Thank you...


lms2006 - October 10

update: I have all of my immunity testing done...positive for MTHFR(compound hetero for 2 mutations), borderline positive for one APA. Nks at 12.9. Anti-thryoid antibodies elevated. All of the immune issues will be treated. But I am still concerned about our low fertilization. My new RE thinks an addition of a little LH should help! (left my previous RE because he does not believe in immune issues or change in protocol) New RE says the sperm has to be pretty severe to affect the fertilization...what is your opinion?


Dr Smith - October 10

I agree completely with your new doc. It is very likely that the addition of LH will improve the cytoplasmic maturation of the eggs and, in turn, improve fertilization results. For sperm to cause fertilization failure, the sperm have to be really, really bad. For example, we see this when we use grossly immature testicular sperm, but it is extremely rare with ejaculated sperm and in those cases, all the eggs fail to fertilize.


lms2006 - October 10

Thanks for your response!! It is nice to hear something positive...I hope and pray we get better results this time!!! Will let you know how it goes!!


lms2006 - November 28

I wanted to update you on my 3rd IVF cycle, egg retrieval was yesterday...

My new RE added in LH to hopefully help the fert rate with ICSI. I was on 3bravelle/1menopur for the long lupron protocol. 17 eggs retrieved, 14 mature and 8 fertilized (2 more are in between and may fertilize). I was pleased to have improved fert rate compared to our previous 30% on FSH only with long lupron protocol. I am still a little dissapointed with the fertilization rate though at 57%....isn't normal fert rate at least 70%? I am not too hopeful about the other 2 eggs that "may fertilize". Have you seen this happen? When fert rates are below 70% with ICSI do you see less success with the embryo growth?


Dr Smith - November 29

Yes, fetilization rate following ICSI is usually in the 70-80% range. However, you can't make a bad egg good by sticking a sperm inside. As I mentioned before, it is unlikely that the sperm was the cause of the lower fertilization rate. Some eggs are duds and even with ICSI, they fail to initiate development. Is this related to poorer development of the eggs that did fertilize? Yes and No (sorry to be vague). It really depends of the cycle and the indivual. In your case, the addition of LH to the stimulation protocol resulted in improved egg maturity (14/17; 82%) and to some degree improved fertilization/activation of development. However, it may not just be the stimulation on the previous cycles that was a problem. There may also be an egg "problem". We will find out as the embryos develop. Poor development and excessive fragmentation during Day 1 and Day 2 of development indicate a problem with the eggs. If the embryo fails to develop beyond the 6-8 cell stage, this is indicative of a genetic problem with the embryos (usually traced back to a problem with the genetics of the egg). Developmental arrest after the 8-cell stage could be caused by the egg or the sperm or both. We'll just have to play it out and see what happens.


lms2006 - November 29

since we had improved fert rates from 30% from my first two cycles IVF/ICSI improved to 60% with addition of LH during stimms....is this a good sign? It is still not at the expected 70% but I am hoping we get better embryo growth with the improved fert rate since with the 30% rate the embryos were just about average quality....


lms2006 - November 30

today is day 3 and our embryos look excellent. 2 8 cell grade 1. 10 cell grade2, 2- 9 cells grade 2, a 7 cell grade 2 a few others not doing as well.
I was so pleased to have such improved results after a small tweak in protocol (added in LH in long lupron protocol). A change in protocol can really make a difference!!!!


Dr Smith - December 5

The consesus opinion is that LH is necessary for a successful stimulation. There are still some hold outs that continue to use FSH-only protocols. I'm glad that the embryo development was improved. It rules out an "egg problem". Best of luck.


lms2006 - December 14

We transferred 3 embryos on day 3. 2, 8 cell grade 1 and 1, 10 cell grade 2. We got a BFP!!! Beta 118 (14dpo) and 256 (16dpo)
Just wanted to update you and also thank you for your advice as I was looking for answers to our low fert with ICSI. Our RE we had at the time said their was nothing we could do to improve our results. Your advice was very helpful and correct!!!
Thanks again!!!


Dr Smith - December 14

Congratulations.! Glad to have been of some help. Its always nice when someone posts that their cycle was a success. Otherwise, you'd get the impression every cycle's a bust by reading the posts on this board. Again, congratulations and Happy Holidays.



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