failed IVF with ICSI

guest · 08-26-2009, 06:11 PM

Hello ladies,

I have been to this forum many times but never posted. today, after our first failed IVF cycle, I think I have something to add here..

A summary: me 33 with high fsh and hashimotos hypothyroidism, dh 31 with low morphology. dealing with IF for almost 2 years; recently diagnosed with hashimotos hypothyroidism. failed clomid cycle (TSH found to be very high immediately after completing the dose; endocrinologist blamed it on clomid). highest FSH - 14.8 in december. since then, two more tests and each gave an FSH of 10.2. RE feels 10.2 is not bad given that my clinics defines high fsh as over 12. latest blood tests reveal normal values of AMH and inhibin B. my cycles were quite regular at 28 days with ovulation on cd 13-14 before the clomid but since then, they have gone anywhere from 24-27 days with ovulation on cd 10-11.

We just had our first IVF/ICSI cycle. I was on the following dose starting cd 2:

gonal F - 150 morning and 150 evening
repronex - 75 morning and 75 evening
total stimulation for 9 days - hcg trigger day 10.

started ganirelix on day 7 of stims as one follicle took the lead too early (17.5 mm) while others were lagging behind at 10 mm and under.

I had follicle sizes all over the place on the day of trigger. 23, 15, 14, 14, 13, 12, 11, 10; 4 follicles under 10 mm. estradiol on the day of trigger: 2850.

egg retrieval - day 12.

The doc at ER felt that for my estradiol level, the number of follicles was not as high as expected.

expected 8; retrieved 11 eggs.
today we learnt that only 3 were mature (that is almost 25%!!!) and they all failed to fertilize even with ICSI. Although we did not expect all 11 eggs to be mature, we did not expect so many to be immature! needless to say, we never expected zero fertilization although I was mentally prepared for BFN.

Has anyone seen such low numbers of mature eggs even when average number of eggs are retrieved? if yes, what changes were made to the protocol in subsequent cycles. I was quite skeptical when the RE asked me to trigger on day 10, considering that only 4 follicles were above 14 and of course, the 23 mm egg would have been overcooked. so, in hindsight, the number 3 mature eggs looks reasonable. I did bring up this point before the trigger, but the nurse said they will continue to grow for almost 2 days before retrieval...studies suggest follicles should be 14 mm or above at the time of trigger, to have viable eggs. any thoughts? i am wondering why the RE never thought about it...

that said, any insights into the reasons for the failure to fertilize? can it be blamed entirely on the protocol? is it a case of stimming too fast and triggering too early. I did ask my RE for estrogen priming using bc prior to cycle but he felt it was not needed. looks like that contributed to uneven sized follicles, considering that my FSH is high.

I have RE appt on sept 3, to discuss future course of action. according to him, they have learnt many things from this cycle and subsequent cycles will hopefully be better. I wonder if we are just experimental samples on whom they keep learning..i mean, they could have very well kept me on low dose of stims and upped them later in the cycle.

What do you ladies think? do I have any hope in subsequent cycles, given zero fertilization this cycle.

I need your advice on what my future steps should be. I have done wheatgrass in the prior months but did not do it for the IVF cycle.

What questions do I pose to my RE when we meet with him? I am totally new to this IVF game. And I also realized that if we leave ourselves to the RE, somehow they never get it right!! looks like I have to keep asking questions at every step and every ultrasound!

any thoughts/advice would be greatly appreciated. feeling very low ever since the news of zero fertilization came in...

barren-bipolar · 08-28-2009, 09:45 AM

Guest: so sorry about your BFN. I just ended my first IVF and also have a BFN. I also have thyroid issues and I'm 34 so I'm close to you in age. I think everything you're feeling is normal. From all the girls I've corresponded with and went to support groups with, it seems it is quite normal to feel your RE might be doing things wrong. I always remind myself (and my husband) that they really do have our best interests at heart. That said, your case does seem a bit difficult in that no eggs fertilized even with ICSI- what a shocker! We had lower than expected levels of fertilization but I would be quite upset, too, if none fertilized at all. If I were you, I would sit down with my husband and brainstorm every possible question we could think of and write them all down. Maybe you could go to the next consult together. In my experience, my husband is very inquisitive and gets upset that I didn't ask certain questions which he considers the "obvious" questions to ask, but since he never informed me beforehand (and I can't read his mind), his questions never get answered or get answered much later. I'm starting to learn I have to involve him more, but that is my own issue I guess.

Why are you on doses both morning and eve.? I've never heard of that. I only had gonal-f and menopur in the eve. even though I had to take pretty high doses.

guest · 08-28-2009, 10:47 AM

Hi Barren-Bipolar,

Thank you so much for your reply and kind words. So sorry to hear about your BFN. I understand it is quite a heartache.

You have raised a very good question: why was I on the dose twice a day...I was not told the reason for the same. My RE just gave instructions to the nurse after day 2 ULB and she passed them on to me..no reasons given whatsoever. I guess I should have asked but I dint know that is not the norm...I did read somewhere that providing evenly distributed doses twice a day is a better option than a single heavy dose because it allows the medication to be in our body throughout the day...so may be that was his rationale too. I will bring it up in our next meeting with him. Thanks for bringing that up.

did you do ICSI as well? what was your dose? how many days did u stim? hope you got enough mature eggs. Both, me and my husband go for our RE appointment together..but I guess I ask most of the questions. When the RE called to give the news of zero fertilization, I wasnt home..so I couldnt even ask him any questions. so have to wait until the appointment.

Thanks again. hope you have a successful cycle soon. sending you baby dust!

barren-bipolar · 08-28-2009, 11:44 AM

We didn't do ICSI, but we almost did. I think next time we'll have to.

My dose was 4 vials of gonalF and 2 vials of Menopur. I stimmed 11 days. I'm not sure the timing of my embryo retrieval was exactly right, but hopefully better luck next time. That's great that your husband goes along to the RE appt. My husband is tied up with meetings at work. Hope you get to ask lots of questions!

Thanks for the baby dust! I'm sending some back to you!

guest · 08-29-2009, 07:50 AM

Quote:

Originally Posted by barren-bipolar

We didn't do ICSI, but we almost did. I think next time we'll have to.

My dose was 4 vials of gonalF and 2 vials of Menopur. I stimmed 11 days. I'm not sure the timing of my embryo retrieval was exactly right, but hopefully better luck next time. That's great that your husband goes along to the RE appt. My husband is tied up with meetings at work. Hope you get to ask lots of questions!

Thanks for the baby dust! I'm sending some back to you!

Thank you for the baby dust. 11 days of stimming is good...i barely stimmed for 9 days..which means early ovulation and is almost equivalent of high FSH (atleast that is what the REs say: with high FSH, u ovulate early and it is not good...)
Thanks again. all the best

TNBCJB · 08-29-2009, 12:14 PM

Hello guest,

The stim part of your cycle does sound highly unusual. Twice a day plus the early FSH...I have never heard such a thing. Here was my doses...I started on 1 bravelle, 1 menopur. By day 3 they increased to 3 bravelle, 1 menopur. On day 8 they increased to 3 bravelle, 2 menopur and started me on ganerelix to prevent early ovulation. I had to stim for 2 extra days to get the most follicles inside the desired size window for retrieval (stim 12 days total). By the last 4 days of stims, I was going in DAILY for U/S and B/W. They were monitoring very closely.

Based on the U/S's we had 15-17 follicles. We got 14 eggs, and of those, 13 were mature and 12 fertilized through ISCI...my ER was yesterday so I just got that news today. I believe that was the case because of the constant monitoring and changing of doses to get the best maturation. Granted, I don't know how the embryos will progress over the next 4 days before ET...some could stop growing.

Originally they planned for 10 days of stims with me. That seemed unusual because my normal cycle is 30-31 days. I feel that was why we ended up stimming the extra couple days, to more mimick my normal cycle.

I agree with Barren-Bipolar that is great that your husband goes with you to RE appointments. I wish mine had the free time to do that.

Best of luck to you in the future.

tiffsme · 08-29-2009, 01:33 PM

Hi I also have a high FSH highest 17 at 34. I had all 6 and 8s until I did my first round of injectibles and have always wondered if that caused the raise. On my one complete round of IVF (I had 2 cancelled cycles) I did lupron for something like 7 days prior. Then I was on ( can't find my paper work so doing this from memory. But highest dose of Follistim (3hunderedsomething) and then highest dose of Menapur (150 I think). I looked like I had 9 follicles. It looks like I stemmed for 10 days before trigger. At the retrieval I had 6 eggs. They later called and told me only one was mature but it did fertilize. She is 6 months now and asleep in her swing. It does just take one. They probably do just need to tweak things. They wanted to cancel my last round as well but then the doc said lets just give this a try...you may never have a better cycle than this. I have no idea what my fsh was on that round since they didn't test it with doing the lupron supression...it may have been 14 days of that sorry can't remember. Good luck (I found out after the fact that most clinics wouldn't even take me with as high of an FSH as I had. I felt fortunate to have a good doc that said I was young and he thought I had that on my side. I did icsi ...they were going to do hatching but didn't need to.

guest · 08-29-2009, 01:50 PM

Thank you, Tiffsme..your words give me lot of hope. congratulations!!! yes, you are right..it just takes one. In fact, I was expecting 6-7 eggs but when they said 11, I was surprised. my RE planned to assisted hatching but we dint make it so far.

TNBCJB: congratulations!! 12 fertilized is a good number. may you get your BFP soon. baby dust to you...early FSH was just an analogy from my end..they put me on a total 300 units of gonal f and 150 units of repronex. but your cycle sounds very reasonable... 12 days of stimulation seems to do the trick. I will ask my RE to stim me a little longer....

yes, it is very sweet and considerate of my husband to come with me for the appointments..his office is not far from our house, and we try to get either morning (8:30) or later evening (4:30 pm) appointments...so that he can make it too. Our clinic is only 10 mins drive from home, that is another advantage. well, actually I only have had 2 RE appointments till now (in person). apart from that I mostly talk to the nurse who is kind of a link between me and the RE. the ULB happens very early (6:30-7:00 am)..so that is another advantage. but all those advantages are secondary to the main one..that of a BFP.

08-26-2009, 06:11 PM	#1 (permalink)
guest 0-99 post 2 of hearts Join Date: Aug 2009 Posts: 4	failed IVF with ICSI Hello ladies, I have been to this forum many times but never posted. today, after our first failed IVF cycle, I think I have something to add here.. A summary: me 33 with high fsh and hashimotos hypothyroidism, dh 31 with low morphology. dealing with IF for almost 2 years; recently diagnosed with hashimotos hypothyroidism. failed clomid cycle (TSH found to be very high immediately after completing the dose; endocrinologist blamed it on clomid). highest FSH - 14.8 in december. since then, two more tests and each gave an FSH of 10.2. RE feels 10.2 is not bad given that my clinics defines high fsh as over 12. latest blood tests reveal normal values of AMH and inhibin B. my cycles were quite regular at 28 days with ovulation on cd 13-14 before the clomid but since then, they have gone anywhere from 24-27 days with ovulation on cd 10-11. We just had our first IVF/ICSI cycle. I was on the following dose starting cd 2: gonal F - 150 morning and 150 evening repronex - 75 morning and 75 evening total stimulation for 9 days - hcg trigger day 10. started ganirelix on day 7 of stims as one follicle took the lead too early (17.5 mm) while others were lagging behind at 10 mm and under. I had follicle sizes all over the place on the day of trigger. 23, 15, 14, 14, 13, 12, 11, 10; 4 follicles under 10 mm. estradiol on the day of trigger: 2850. egg retrieval - day 12. The doc at ER felt that for my estradiol level, the number of follicles was not as high as expected. expected 8; retrieved 11 eggs. today we learnt that only 3 were mature (that is almost 25%!!!) and they all failed to fertilize even with ICSI. Although we did not expect all 11 eggs to be mature, we did not expect so many to be immature! needless to say, we never expected zero fertilization although I was mentally prepared for BFN. Has anyone seen such low numbers of mature eggs even when average number of eggs are retrieved? if yes, what changes were made to the protocol in subsequent cycles. I was quite skeptical when the RE asked me to trigger on day 10, considering that only 4 follicles were above 14 and of course, the 23 mm egg would have been overcooked. so, in hindsight, the number 3 mature eggs looks reasonable. I did bring up this point before the trigger, but the nurse said they will continue to grow for almost 2 days before retrieval...studies suggest follicles should be 14 mm or above at the time of trigger, to have viable eggs. any thoughts? i am wondering why the RE never thought about it... that said, any insights into the reasons for the failure to fertilize? can it be blamed entirely on the protocol? is it a case of stimming too fast and triggering too early. I did ask my RE for estrogen priming using bc prior to cycle but he felt it was not needed. looks like that contributed to uneven sized follicles, considering that my FSH is high. I have RE appt on sept 3, to discuss future course of action. according to him, they have learnt many things from this cycle and subsequent cycles will hopefully be better. I wonder if we are just experimental samples on whom they keep learning..i mean, they could have very well kept me on low dose of stims and upped them later in the cycle. What do you ladies think? do I have any hope in subsequent cycles, given zero fertilization this cycle. I need your advice on what my future steps should be. I have done wheatgrass in the prior months but did not do it for the IVF cycle. What questions do I pose to my RE when we meet with him? I am totally new to this IVF game. And I also realized that if we leave ourselves to the RE, somehow they never get it right!! looks like I have to keep asking questions at every step and every ultrasound! any thoughts/advice would be greatly appreciated. feeling very low ever since the news of zero fertilization came in...

08-28-2009, 09:45 AM	#2 (permalink)
barren-bipolar 300-399 post 5 of hearts Join Date: Jun 2009 Location: New York City Posts: 351	Guest: so sorry about your BFN. I just ended my first IVF and also have a BFN. I also have thyroid issues and I'm 34 so I'm close to you in age. I think everything you're feeling is normal. From all the girls I've corresponded with and went to support groups with, it seems it is quite normal to feel your RE might be doing things wrong. I always remind myself (and my husband) that they really do have our best interests at heart. That said, your case does seem a bit difficult in that no eggs fertilized even with ICSI- what a shocker! We had lower than expected levels of fertilization but I would be quite upset, too, if none fertilized at all. If I were you, I would sit down with my husband and brainstorm every possible question we could think of and write them all down. Maybe you could go to the next consult together. In my experience, my husband is very inquisitive and gets upset that I didn't ask certain questions which he considers the "obvious" questions to ask, but since he never informed me beforehand (and I can't read his mind), his questions never get answered or get answered much later. I'm starting to learn I have to involve him more, but that is my own issue I guess. Why are you on doses both morning and eve.? I've never heard of that. I only had gonal-f and menopur in the eve. even though I had to take pretty high doses. __________________ me (34) DH (51), TTC #1 low ovarian reserve, hypothyroid, egg quality issues beginning IVF #3- looking for a golden egg http://bravebarrenbipolar.wordpress.com

08-28-2009, 11:44 AM	#4 (permalink)
barren-bipolar 300-399 post 5 of hearts Join Date: Jun 2009 Location: New York City Posts: 351	We didn't do ICSI, but we almost did. I think next time we'll have to. My dose was 4 vials of gonalF and 2 vials of Menopur. I stimmed 11 days. I'm not sure the timing of my embryo retrieval was exactly right, but hopefully better luck next time. That's great that your husband goes along to the RE appt. My husband is tied up with meetings at work. Hope you get to ask lots of questions! Thanks for the baby dust! I'm sending some back to you! __________________ me (34) DH (51), TTC #1 low ovarian reserve, hypothyroid, egg quality issues beginning IVF #3- looking for a golden egg http://bravebarrenbipolar.wordpress.com

08-29-2009, 12:14 PM	#6 (permalink)
TNBCJB 100-199 post 3 of hearts Join Date: Aug 2009 Location: Houston, TX Posts: 136	Hello guest, The stim part of your cycle does sound highly unusual. Twice a day plus the early FSH...I have never heard such a thing. Here was my doses...I started on 1 bravelle, 1 menopur. By day 3 they increased to 3 bravelle, 1 menopur. On day 8 they increased to 3 bravelle, 2 menopur and started me on ganerelix to prevent early ovulation. I had to stim for 2 extra days to get the most follicles inside the desired size window for retrieval (stim 12 days total). By the last 4 days of stims, I was going in DAILY for U/S and B/W. They were monitoring very closely. Based on the U/S's we had 15-17 follicles. We got 14 eggs, and of those, 13 were mature and 12 fertilized through ISCI...my ER was yesterday so I just got that news today. I believe that was the case because of the constant monitoring and changing of doses to get the best maturation. Granted, I don't know how the embryos will progress over the next 4 days before ET...some could stop growing. Originally they planned for 10 days of stims with me. That seemed unusual because my normal cycle is 30-31 days. I feel that was why we ended up stimming the extra couple days, to more mimick my normal cycle. I agree with Barren-Bipolar that is great that your husband goes with you to RE appointments. I wish mine had the free time to do that. Best of luck to you in the future. __________________ Me: 31 DH: 37 TTC since Sept 2006 IVF #1 Aug 09 BFP!!! EDD: 5/21/2010 159 BPM

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08-28-2009, 10:47 AM	#3 (permalink)
guest 0-99 post 2 of hearts Join Date: Aug 2009 Posts: 4	Hi Barren-Bipolar, Thank you so much for your reply and kind words. So sorry to hear about your BFN. I understand it is quite a heartache. You have raised a very good question: why was I on the dose twice a day...I was not told the reason for the same. My RE just gave instructions to the nurse after day 2 ULB and she passed them on to me..no reasons given whatsoever. I guess I should have asked but I dint know that is not the norm...I did read somewhere that providing evenly distributed doses twice a day is a better option than a single heavy dose because it allows the medication to be in our body throughout the day...so may be that was his rationale too. I will bring it up in our next meeting with him. Thanks for bringing that up. did you do ICSI as well? what was your dose? how many days did u stim? hope you got enough mature eggs. Both, me and my husband go for our RE appointment together..but I guess I ask most of the questions. When the RE called to give the news of zero fertilization, I wasnt home..so I couldnt even ask him any questions. so have to wait until the appointment. Thanks again. hope you have a successful cycle soon. sending you baby dust!

08-29-2009, 01:33 PM	#7 (permalink)
tiffsme 300-399 post 5 of hearts Join Date: Jun 2008 Location: new england Posts: 393	Hi I also have a high FSH highest 17 at 34. I had all 6 and 8s until I did my first round of injectibles and have always wondered if that caused the raise. On my one complete round of IVF (I had 2 cancelled cycles) I did lupron for something like 7 days prior. Then I was on ( can't find my paper work so doing this from memory. But highest dose of Follistim (3hunderedsomething) and then highest dose of Menapur (150 I think). I looked like I had 9 follicles. It looks like I stemmed for 10 days before trigger. At the retrieval I had 6 eggs. They later called and told me only one was mature but it did fertilize. She is 6 months now and asleep in her swing. It does just take one. They probably do just need to tweak things. They wanted to cancel my last round as well but then the doc said lets just give this a try...you may never have a better cycle than this. I have no idea what my fsh was on that round since they didn't test it with doing the lupron supression...it may have been 14 days of that sorry can't remember. Good luck (I found out after the fact that most clinics wouldn't even take me with as high of an FSH as I had. I felt fortunate to have a good doc that said I was young and he thought I had that on my side. I did icsi ...they were going to do hatching but didn't need to.

08-29-2009, 01:50 PM	#8 (permalink)
guest 0-99 post 2 of hearts Join Date: Aug 2009 Posts: 4	Thank you, Tiffsme..your words give me lot of hope. congratulations!!! yes, you are right..it just takes one. In fact, I was expecting 6-7 eggs but when they said 11, I was surprised. my RE planned to assisted hatching but we dint make it so far. TNBCJB: congratulations!! 12 fertilized is a good number. may you get your BFP soon. baby dust to you...early FSH was just an analogy from my end..they put me on a total 300 units of gonal f and 150 units of repronex. but your cycle sounds very reasonable... 12 days of stimulation seems to do the trick. I will ask my RE to stim me a little longer.... yes, it is very sweet and considerate of my husband to come with me for the appointments..his office is not far from our house, and we try to get either morning (8:30) or later evening (4:30 pm) appointments...so that he can make it too. Our clinic is only 10 mins drive from home, that is another advantage. well, actually I only have had 2 RE appointments till now (in person). apart from that I mostly talk to the nurse who is kind of a link between me and the RE. the ULB happens very early (6:30-7:00 am)..so that is another advantage. but all those advantages are secondary to the main one..that of a BFP.