Anyone else have low fertilization with ICSI?

LMS · 11-13-2009, 11:17 AM

Hello-
Anyone else have low fert rates with ICSI? What's your story? Did protocol changes help? What was the explanation for the low fert rates? How do your embryos do when they don't fertilize well- do the two correlate?

I have a history of low fert rates with ICSI. It is so frustrating! Primary DX is male factor. First 2 IVFs failed. 3rd changed clinics and tweaked protocol (added LH for long lupron protocol-previous cycles had only FSH long lupron) and fert rates improved from 30% to 60% and embryos grew much better..did get a BFP (my son now 2yrs old), had a few frozen and in July 2009 got BFP= miscarriage (46XY).
Now we are trying for a sibling- just had ER on Tues and 17 eggs. But 12 mature and only 5 fertilized- so a worse fert rate than when we conceived my son so I am afraid the embies will not grow well because when they were 30% fert rates, the embies did not grow well.

Ughh. and my RE is going for a 5 day transfer on Sunday. I hope they make it. But I guess if they don't make it to day 3 then they probably won't make it to day 5? Just hoping for 1-2 blasts on day 5!

pepper · 11-13-2009, 11:48 AM

I had a similar problem, lower number of eggs, low % of those mature, and ICSI did not fertilize all mature eggs. They seemed to arrest/fragment before transfer and even when we transferred 4, there was no pregnancy.

ETA: Originally we were dx with male factor/low morphology, but since ICSI takes care of that, in the end it came down to egg quality/slow response. I'm still quite confused and upset by their lack of success with me, even after all these years. I don't feel like I ever got a good explanation - I guess IVF doesn't work for everyone... That hurts.

I have not had in-depth testing of antibodies and have had no Lap to check for endometriosis, no DNA tests for either of us to check for other stuff... I would ask for all of that before going through with another cycle.

Good Luck!

KB75 · 11-13-2009, 04:09 PM

I've only been through one cycle of IVF w/ICSI. I was a high responder to FSH and had really high E2 before trigger. Retrieved 34 eggs, 27 mature, only only 9 or 10 fertilized (got two different answers on that.) Of those fertilized, only ultimately had two to work with (transferred) and none left over to freeze. The cycle was unsuccessful.

DX: Male Factor only

The only change in protocol that's been discussed for our next cycle (January) is lowering my dose of FSH. I have real concerns about what's going on...but don't know what to do to make improvements in our percentage of eggs fertilized. DRs think it's a sperm issue. So...whatever. I'm at their mercy.

BondletMom · 11-13-2009, 11:15 PM

My first cycle we got 18 eggs, 17 mature, only 11 fertilized. I also responded way too fast to FSH protocol - stimmed only 7 days then trigger, egg quality compromised. This time I went a bit slower but my e2 still rose drastically so I'm sure I'll end up with the same if not worse. Another thing is that my P4 rose prematurely so that contributed to low egg quality and low fertilization. I won't know until Monday how many fertilized but am not holding out high hopes at this point. There are so many factors to egg quality/fertilization that it's not easy to pinpoint one thing.

pemmie · 11-14-2009, 08:15 AM

KB75 - i have a very similar story to yours - our Dx is male factor and we did IVF/ICSI. I got stimmed way too fast, ended up w/ 36 eggs retrieved, 28 fertilized and only ended up w/ 4 blasts on Day 5, none of which worked. When they reviewed all that had happened, i was told that it was the egg quality that was the reason it didn't work. Just did my 2nd IVF last week (am in the 2WW), but this time around, my starting dose of gonal-f was half of what it was the first time around, but the menopur was doubled (why, i don't know). anyway, they say i was over stimmed again - i had a ton of small to medium follicles and they retrieved 18 eggs, 13 fertilized and ultimately ended up transferring 1 blast and 1 morula on day 5 (2 blasts were subsequently frozen). I don't know what they're trying to do about the egg quality, but i don't think they did much better the 2nd round... in terms of ICSI and male factor, that did not seem to be the issue at all.

KB75 · 11-14-2009, 10:06 AM

Pemmie - I'm on Follistim only for stims, I don't know about the other protocol. The Dr said he'd probably be cutting back the FSH by 35% for our next cycle...which seems a little too conservative to me. Why not 50%? It seems unlikely that 35% will make enough of a difference. It was basically impossible to slow me down last time, even when they cut me back to practically nothing for the few days before trigger.

Any thoughts?

Oh, also, do you know how they determined it was an egg quality issue for you? My Dr and the embryologist seemed pretty convinced it was probably the sperm...but they didn't really give me any data to back that up.

pemmie · 11-14-2009, 11:12 AM

I ended up moving to another State between my first and 2nd IVF. When i had my records transferred, my new doc showed me this chart that i had never seen - it was a record of EACH egg and embryo, and what happened to each one of them on every time they were observed. They all had grades and comments and he basically could tell by the grades and the rate of fall off at the end why he thought it was the egg. Unfortunately, i didn't get much of the detail he was talking about as it was a bit over my head (my doc is also an embryologist). I suppose the fact such a high percent of my eggs fertilized meant that there was nothing wrong w/ the sperm? It's interesting that you're not on any Menopur while they doubled my dose?

private · 11-16-2009, 08:27 AM

Quote:

Originally Posted by LMS

Hello-
Anyone else have low fert rates with ICSI? What's your story? Did protocol changes help? What was the explanation for the low fert rates? How do your embryos do when they don't fertilize well- do the two correlate?

I had no fertilization with ICSI my first IVF. I have a high FSH (highest 18). I went to another RE. They changed my protocol from a long lupron protocol to a MDL protocol. I had 100% fertilization. I think this was due to my new RE and my new protocol.

nyc76 · 11-16-2009, 01:00 PM

Quote:

Originally Posted by BC-pepper

ETA: Originally we were dx with male factor/low morphology, but since ICSI takes care of that, in the end it came down to egg quality/slow response. I'm still quite confused and upset by their lack of success with me, even after all these years. I don't feel like I ever got a good explanation - I guess IVF doesn't work for everyone... That hurts.

Our issue is low sperm count. There were no issues found with me during the initial infertility testing. Can female infertility issues that weren't found in initial testing arise later on in the IVF cycle? Did you know about your egg quality issue prior to the IVF lack of success?

pemmie · 11-16-2009, 02:18 PM

Quote:

Originally Posted by nyc76

Our issue is low sperm count. There were no issues found with me during the initial infertility testing. Can female infertility issues that weren't found in initial testing arise later on in the IVF cycle? Did you know about your egg quality issue prior to the IVF lack of success?

I was told i had poor egg quality AFTER my first IVF failed. I had switched REs and the new one said that he is lucky to have the results from my first one to then devise a new plan for 2nd round meds. He said that he has info that my previous doc did not have because you learn a lot from each cycle. It kind of sucks because you want each one to be the best it can be, but unfortunately, they start most people w/ out clear infertiility issues on a "basic" protocol and go from there...

11-13-2009, 11:17 AM	#1 (permalink)
LMS 0-99 post 2 of hearts Join Date: May 2006 Location: N cal Posts: 64	Anyone else have low fertilization with ICSI? Hello- Anyone else have low fert rates with ICSI? What's your story? Did protocol changes help? What was the explanation for the low fert rates? How do your embryos do when they don't fertilize well- do the two correlate? I have a history of low fert rates with ICSI. It is so frustrating! Primary DX is male factor. First 2 IVFs failed. 3rd changed clinics and tweaked protocol (added LH for long lupron protocol-previous cycles had only FSH long lupron) and fert rates improved from 30% to 60% and embryos grew much better..did get a BFP (my son now 2yrs old), had a few frozen and in July 2009 got BFP= miscarriage (46XY). Now we are trying for a sibling- just had ER on Tues and 17 eggs. But 12 mature and only 5 fertilized- so a worse fert rate than when we conceived my son so I am afraid the embies will not grow well because when they were 30% fert rates, the embies did not grow well. Ughh. and my RE is going for a 5 day transfer on Sunday. I hope they make it. But I guess if they don't make it to day 3 then they probably won't make it to day 5? Just hoping for 1-2 blasts on day 5!

11-13-2009, 11:48 AM	#2 (permalink)
pepper 5000-9999 post king of hearts Join Date: Mar 2002 Location: GA Posts: 9,348 Blog Entries: 103	I had a similar problem, lower number of eggs, low % of those mature, and ICSI did not fertilize all mature eggs. They seemed to arrest/fragment before transfer and even when we transferred 4, there was no pregnancy. ETA: Originally we were dx with male factor/low morphology, but since ICSI takes care of that, in the end it came down to egg quality/slow response. I'm still quite confused and upset by their lack of success with me, even after all these years. I don't feel like I ever got a good explanation - I guess IVF doesn't work for everyone... That hurts. I have not had in-depth testing of antibodies and have had no Lap to check for endometriosis, no DNA tests for either of us to check for other stuff... I would ask for all of that before going through with another cycle. Good Luck! Last edited by pepper; 11-14-2009 at 08:37 AM.

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11-13-2009, 04:09 PM	#3 (permalink)
KB75 200-299 post 4 of hearts Join Date: Oct 2009 Location: California Posts: 207	I've only been through one cycle of IVF w/ICSI. I was a high responder to FSH and had really high E2 before trigger. Retrieved 34 eggs, 27 mature, only only 9 or 10 fertilized (got two different answers on that.) Of those fertilized, only ultimately had two to work with (transferred) and none left over to freeze. The cycle was unsuccessful. DX: Male Factor only The only change in protocol that's been discussed for our next cycle (January) is lowering my dose of FSH. I have real concerns about what's going on...but don't know what to do to make improvements in our percentage of eggs fertilized. DRs think it's a sperm issue. So...whatever. I'm at their mercy.

11-13-2009, 11:15 PM	#4 (permalink)
BondletMom 300-399 post 5 of hearts Join Date: May 2007 Location: AZ Posts: 338	My first cycle we got 18 eggs, 17 mature, only 11 fertilized. I also responded way too fast to FSH protocol - stimmed only 7 days then trigger, egg quality compromised. This time I went a bit slower but my e2 still rose drastically so I'm sure I'll end up with the same if not worse. Another thing is that my P4 rose prematurely so that contributed to low egg quality and low fertilization. I won't know until Monday how many fertilized but am not holding out high hopes at this point. There are so many factors to egg quality/fertilization that it's not easy to pinpoint one thing.

11-14-2009, 08:15 AM	#5 (permalink)
pemmie 300-399 post 5 of hearts Join Date: May 2009 Location: New Jersey Posts: 345	KB75 - i have a very similar story to yours - our Dx is male factor and we did IVF/ICSI. I got stimmed way too fast, ended up w/ 36 eggs retrieved, 28 fertilized and only ended up w/ 4 blasts on Day 5, none of which worked. When they reviewed all that had happened, i was told that it was the egg quality that was the reason it didn't work. Just did my 2nd IVF last week (am in the 2WW), but this time around, my starting dose of gonal-f was half of what it was the first time around, but the menopur was doubled (why, i don't know). anyway, they say i was over stimmed again - i had a ton of small to medium follicles and they retrieved 18 eggs, 13 fertilized and ultimately ended up transferring 1 blast and 1 morula on day 5 (2 blasts were subsequently frozen). I don't know what they're trying to do about the egg quality, but i don't think they did much better the 2nd round... in terms of ICSI and male factor, that did not seem to be the issue at all.

11-14-2009, 10:06 AM	#6 (permalink)
KB75 200-299 post 4 of hearts Join Date: Oct 2009 Location: California Posts: 207	Pemmie - I'm on Follistim only for stims, I don't know about the other protocol. The Dr said he'd probably be cutting back the FSH by 35% for our next cycle...which seems a little too conservative to me. Why not 50%? It seems unlikely that 35% will make enough of a difference. It was basically impossible to slow me down last time, even when they cut me back to practically nothing for the few days before trigger. Any thoughts? Oh, also, do you know how they determined it was an egg quality issue for you? My Dr and the embryologist seemed pretty convinced it was probably the sperm...but they didn't really give me any data to back that up.

11-14-2009, 11:12 AM	#7 (permalink)
pemmie 300-399 post 5 of hearts Join Date: May 2009 Location: New Jersey Posts: 345	I ended up moving to another State between my first and 2nd IVF. When i had my records transferred, my new doc showed me this chart that i had never seen - it was a record of EACH egg and embryo, and what happened to each one of them on every time they were observed. They all had grades and comments and he basically could tell by the grades and the rate of fall off at the end why he thought it was the egg. Unfortunately, i didn't get much of the detail he was talking about as it was a bit over my head (my doc is also an embryologist). I suppose the fact such a high percent of my eggs fertilized meant that there was nothing wrong w/ the sperm? It's interesting that you're not on any Menopur while they doubled my dose?