3rd IVF - Poor Fertilization Eggs or Sperm? or both
7 Replies
Shutterbug - May 13

I just completed my 3 IVF with ending in BFN. I would like to see what protocol you would recommend for another IVF. Summary: I'm 36, DH 38
1st IVF (5 years ago) - Dx Unexplained, 22 eggs w/8 GV so 4 grade 3, 4 grade 2, 1 grade 1 which ended with 2 early blast and 1 morula transferred on day 5, nothing froze - BFN
2nd IVF (5 years ago) - Same Dx noted too many GV so stimmed 2 extra days, 18 follies w/10 GV and 3 grade 4, 1 grade 3, 3 grade 2 and transferred Day 3 - 3 8cell grade 4 and 1 8cell grade 3 - BFP had DD
3rd IVF (just completed) - Dx - MF .4 morph current SA, stimmed 9 days with 225 units Gonal F and 226 Repronex. Had 16 follies, only 6 fertilized with ISCI, 3 arrested after 1 cell, 2 transferred on Day 3 (8 & 10 cell grade A-) and final was "emergency ISCI" on day 2 but by Day 3 transfer had arrested. There were 4 that "lyse" and the other 6 were M2 with a couple having 2PN 2PB.
Are there any testing you would recommend?
Thanks so much for your reply.


Barry Jacobs, M. D. - May 13

Since I have not been involved in your care, I cannot make a valid recommendation. I can tell you that "emmergency ICSI" is associated with a poor pregnancy rate. I suspect you have a male factor problem, as opposed to unexplained infertility.
Good luck.


cde - June 4

I just turned 40 today. This past week I received news of my 3rd failed ICSI treatment. I was told that there may be a female factor problem. We use my husbands frozen sperm - which on post thaw - look great. My first cycle - using 225 bid of Follistim and Ganelrelix - 3 eggs retrieved and 2 transferred (both 8 cells - a gr 1 and 2). Second Cycle - used microdose lupron flair with 300 Follistim in am and 150 Follistim and 150 Menopur q pm. 3 eggs retreived and 2 implanted (an 8 and a 6 grade 1 and 2). Third cycle - use same protocol - 6 eggs retrieved - 4 mature and 2 immature. 1 mature fertilized and 1 immature fertilized the next day. 2 embryos implanted ( a gr 2 8 cell and a gr 2 6 cell)

I am somewhate frustrated as my baseline fsh was 5(10/05) and my ovarian microfollicle reserve was also deemed to be good. But my doctor says I am just not producing enough eggs and the quality this last cycle were not as good. He mentioned trying a cycle with Antagon - how does this work and would there be a benefit to trying? I was also consdering seeing if there is anything from an immunological standpont going on that could be causing me to be resistant to the gonadotrpins and thus not produce enough eggs. - and considered being evaluated by the Beers Center for Reproductive Immunology - What has been your experience with helping women who have a similar probelm to mine?
Thank you,


B. Jacobs, M. D. - June 4

please understand that at the age of 40, your probability of your eggs haveing the correct number of chromosomes is dramatically smaller than when you were 30. Embryo implantation rate in women 40 to 44 is 6.1%. Follicle count does not correlate with the chromosome complement of the eggs. It is up to the sperm to make it into the egg. You would probably be best served by using an egg donor.
Good luck.


Determined Damsel - June 9

I am 37yrs...Anatomically perfect per all tests, but my highest FSH was 20...My husband and I decided to try an IUI cycle anyway. Surprising to my fertility doctor, I produced a number of eggs (8-10)...The cycle failed, so we took our docs advise and tried IVF with donor eggs...This failed as well...

We are now concerned that we may both have a part in our infertility. We have heard of many other tests for men but our fert. clinic has offered none. When questioned they just keep referring back to my high fsh. But what does my fsh have to do with a failed donor egg cycle? The donor cycle was split with another couple and they are now pregnant.

My husband had the basic sperm test re: motility, number, quality, etc. ??? Does my husband need more testing, and if so, what?

Thanks so much....DD


B. Jacobs, M. D. - June 9

Extremely few labs perform a detailed and thorough semen analysis. I do not know what is available in your community, but I ahve semen analyses performed at a specialty (andrology) lab, owned by one of the very few urologist who is sub specialty trained in male infertility. The semen analysis, as they perform it, correlate with the ability to fertilize eggs.
Good luck.


jacki04 - June 12

Dr Jacobs
According to the thread above, is your recommendation that a woman who is between 40 -44 to use an egg donor but her the chances of implantation are still 6.1% after the egg is fertilized?


B. Jacobs, M. D. - June 12

Eggs from egg donors produce implantation rates related to the age of the donor. Eggs from donors between the ages of 20 and 30 will provide implantation reates of 16% to 18%. Eggs from women 40 to 44 years old produce implantation rates of 6.1%



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