Ghost-- question about fertilization

[Brooklyngirl]

Ghost,
I am wondering if you have any thoughts about this situation:

I had my first IVF, produced 7 eggs and 2 average embryos that didn't stick (with ICSI).

I just had my second IVF cancelled. The RE increased my meds, so I had 11 eggs, 9 mature ones, but only 2 fertilized with ICSI. Neither of the embryos developed properly. In fact, I had to wait for day 6 and got the call that the embryos were a crazy mass of cells (my words, I can't remember what the doctor said). Of course, the RE wouldn't implant embryos that were so bad.

So here is my question: the RE said the low fertilization rate with ICSI was unusual. What would cause that? Is there anything to help with this problem? Would coculture help?

Thanks for any thoughts?

[Ghost]

Ghost,
I am wondering if you have any thoughts about this situation:

I had my first IVF, produced 7 eggs and 2 average embryos that didn't stick (with ICSI).

I just had my second IVF cancelled. The RE increased my meds, so I had 11 eggs, 9 mature ones, but only 2 fertilized with ICSI. Neither of the embryos developed properly. In fact, I had to wait for day 6 and got the call that the embryos were a crazy mass of cells (my words, I can't remember what the doctor said). Of course, the RE wouldn't implant embryos that were so bad.

So here is my question: the RE said the low fertilization rate with ICSI was unusual. What would cause that? Is there anything to help with this problem? Would coculture help?

Thanks for any thoughts?

That is a low fertilization, but that happens sometimes. We usually don't know why.

We used to do co-culture, but we don't bother with it anymore because, for us, it did not seem to make a difference.

If you had to wait to day 6 to find out they were a crazy mix of cells, it sounds like the issues occurred after day 3. After day 3, the embryonic DNA controls development, so your embryos were probably not genetically normal. Has your clinic expressed concern about sperm quality being the cause? I see your signature indicates your partner has sperm issues.

If it is a chromosomal issue, such as aneuploidy (a very common problem), then co-culture has no possibility of addressing it.

Aneuploidy occurs when the embryo has the wrong number of chromosomes, with an extra one, a missing one, or both. Sometimes they are missing more than one. The embryos that fail to develop properly are often non-viable.

[Brooklyngirl]

My dh has low motility, low morphology, and a low count. Is there any way to tell if the issue is a sperm one or an egg one?

If it is a sperm issue, would it be possible to use donor sperm on some of the eggs and dh's sperm on the others in the next cycle? I have only one more shot at ivf, so I want to maximize my chances.

Thanks!

[Ghost]

My dh has low motility, low morphology, and a low count. Is there any way to tell if the issue is a sperm one or an egg one?

If it is a sperm issue, would it be possible to use donor sperm on some of the eggs and dh's sperm on the others in the next cycle? I have only one more shot at ivf, so I want to maximize my chances.

Thanks!

That makes a lot of sense. My clinic does cycles like that sometimes.

Of course, we don't really know if the problem was caused by the sperm, and there can be more than one problem sometimes.

[Brooklyngirl]

Thanks for the advice.

A few more questions, if you don't mind:
1. The nurse mentioned the possibility of a Lupron flare. Would that make a huge difference (I produced 11 eggs with 9 mature on 450 gonal-f, 150 menopur and clomid)?

2. Is there a test for chromosomal abnormalities in sperm or eggs that we could do ahead of time?

Thanks!

[Ghost]

My dh has low motility, low morphology, and a low count. Is there any way to tell if the issue is a sperm one or an egg one?

If it is a sperm issue, would it be possible to use donor sperm on some of the eggs and dh's sperm on the others in the next cycle? I have only one more shot at ivf, so I want to maximize my chances.

Thanks!

There are genetic tests for sperm quality. Ask your clinic what they recommend.

My clinic does cycles using both partner and donor sperm. Not often, but sometimes. They are really best for the high responder female with a partner with poor sperm quality. If the patient has, say, 20 eggs, we can inseminate 10 with partner sperm and 10 with donor. If the partner-inseminated embryos make good blasts, we can transfer them, otherwise we use the donor-inseminated embryos.

With 7 eggs, that may not be as practical. You should ask your RE what he/she recommends.

[Brooklyngirl]

Thanks for all of the advice Ghost. You are very helpful.

So one last question. Would a lupron flare increase the number of eggs, given the 11 that developed on the high doses of gonal-f and menopur (as well as clomind)?

Would a lupron flare include those high doses as well?

Again, thanks a ton!!

[Ghost]

Thanks for all of the advice Ghost. You are very helpful.

So one last question. Would a lupron flare increase the number of eggs, given the 11 that developed on the high doses of gonal-f and menopur (as well as clomind)?

Would a lupron flare include those high doses as well?

Again, thanks a ton!!

The literature I have seen suggests the Lupron flare is little or no better than conventional stimulation. We have tried some flares in patients who did poorly before, and sometimes they had amazing improvement. But we have no idea if the flare made the difference. Sometimes there was no improvement at all.

It can save a little money, initially using the FSH already stored in your pituitary instead of from an expensive injection.

Clomid makes no sense in a flare cycle.

You see, clomid interferes with the estradiol receptors in the hypothalamus, tricking it to release GnRH to stimulate the pituitary (with less estradiol sensed, it acts as if there are fewer follicles, and ups the FSH in response). But if you use Lupron to flare, you've already released the FSH, and after the Lupron, the pituitary cannot release FSH again for awhile because it's desensitized. That's why Lupron is usually used to suppress the pituitary. Initial exposure releases an FSH and LH surge, but after that, it cannot surge again for awhile because it cannot respond to GnRH or Lupron.

Clomid may get the hypothalamus to release GnRH, but that GnRH will not be able to stimulate the pituitary to release FSH. Clomid is cheap, so it's not a lot of money wasted, but it won't do anything for the follicles after Lupron exposure.

[Brooklyngirl]

Many thanks for your explanations, Ghost. I really appreciate it.

At this point, I have to wait until I see the RE. That will take a while, probably at least three weeks, considering his schedule. I am very curious to hear what he has to say.

Happy Holidays!

[baylorbear33]

Hi Brooklyn, just wanted to pass along that I was the candidate that Ghost described. I was a high responder and my DH had poor sperm quality, count, motility, etc. We made the decision to use his sperm if possible, but we had donor sperm shipped in for back-up. I had 41 eggs retrieved, 33 mature. They did ICSI with my DH's sperm on about half of my eggs and used the donor sperm for the other half. Fortunately I have a DH that was understanding of the situation and was more concerned with simply having a baby as opposed to having "his" baby. When it came right down to it, we only had 5 embryos make it to blast. For our fresh cycle, we transferred one embryo from my DH's sperm and one from the donor since my DH's embryo was of lower quality. We lost that pregnancy at 19 weeks, but tried our first FET several months later. We used our last embryo from my DH's sperm, got pregnant, but mis-carried very early at 5 1/2 weeks. We then used our last two embryos, both from donor sperm, back in June of this year, and I can happily report that I am almost 30 weeks pregnant with a baby boy. My DH is thrilled that he is going to be a dad regardless of the measures we had to take to make it happen. I just wanted to pass this along as it worked for us. Best of luck to you.

[Brooklyngirl]

Thanks for the story. I will definitely ask my RE about this, if he thinks the sperm quality is an issue. This is my last IVF (insurance) so I want to do everything to increase the chances of success.

Best,
BG