Reason for low fertilization - when are follicles too large

[Anonymous]

Looking for opinions.

Just had a very disappointing egg retrieval - out of the 13 measurable follicles, they only retrieved 7 - the rest were empty which was a first (empty follicles). Today they call and tell me that only two fertilized??
The day that I triggered, a lot of them were measuring around 21 - and was told that they continue to grow after trigger.

Is it possible that they were too mature and could be reason they didnt fertilize or suspect a larger issue at play? DH has 3% morphology and we did conventional insemination.

TIA.

[Anonymous]

Sounds like DOR. With two fertilized, you should end up with one embryo. Rule of thumb is that half the eggs are mature and fertilize, half make it to day 5, and half of day 5 embryos are a pregnancy. So even with only the two you are still looking at 50/50 chance of pregnancy.

[Anonymous]

I should have added that - I definitely have DOR. But of the 7 retrieved, all were mature. So I am still trying to understand why 5 didnt respond at all?

[Anonymous]

I had DOR and DH had low morph. We always did pICSI. I would see if you can ask the lab what they think, but I think even odds that the conventional insemination could have been the problem.

[Anonymous]

Could be sperm or egg quality issue. But my eggs were same size when I triggered but I had a lot that weren’t mature because of uneven growth and birth control could have helped me - but not someone with DOR because it can suppress production. Some women have success getting stimmed less and producing less eggs but better quality. Other times, same protocol have different results. Such a crapshoot. Did you do ICSI? You should if you didn’t. Also recommend taking supplements like CoQ10 (Ubiquinal) 400g, vitamin D and DHA. I also took NAC and my RE prescribed HCH for egg quality in my protocol.

[Anonymous]

Anonymous wrote: I should have added that - I definitely have DOR. But of the 7 retrieved, all were mature. So I am still trying to understand why 5 didnt respond at all?

From what I've heard, fertilization rate is egg quality, the drop off from day 3 to day 5 is the sperm quality. Day 3 is when the embryonic genes are turning on and dad's DNA needs to kick in. Sometimes it is just dumb luck and being on the wrong side of it.

[Anonymous]

Anonymous wrote:Could be sperm or egg quality issue. But my eggs were same size when I triggered but I had a lot that weren’t mature because of uneven growth and birth control could have helped me - but not someone with DOR because it can suppress production. Some women have success getting stimmed less and producing less eggs but better quality. Other times, same protocol have different results. Such a crapshoot. Did you do ICSI? You should if you didn’t. Also recommend taking supplements like CoQ10 (Ubiquinal) 400g, vitamin D and DHA. I also took NAC and my RE prescribed HCH for egg quality in my protocol.

Unfortunately often the first cycle is a test run.

[Anonymous]

It took me so many years to understand how important the lab is to success. You should be doing picsi or conventional icsi w DOR to maximize success.

[Anonymous]

Anonymous wrote:It took me so many years to understand how important the lab is to success. You should be doing picsi or conventional icsi w DOR to maximize success.

I think a good lab was a factor in our success. We had testicular sperm and required ICSI and had 100% fertilization, which is amazing. The top urologist in our city recommended a particular high volume clinic and was associated with his urology program. If your case is even slightly complicated you should consider a bigger clinic with more experience.

[Anonymous]

Anonymous wrote:

Anonymous wrote: I should have added that - I definitely have DOR. But of the 7 retrieved, all were mature. So I am still trying to understand why 5 didnt respond at all?

From what I've heard, fertilization rate is egg quality, the drop off from day 3 to day 5 is the sperm quality. Day 3 is when the embryonic genes are turning on and dad's DNA needs to kick in. Sometimes it is just dumb luck and being on the wrong side of it.

My knowledge isn't as detailed as above poster as I was just IUI on low dose clomid, but my memory is kinda consistent with above poster as to Sperm quality/ viable number of sperm in sample after thawing being key to success.

Here is what I remember: the team doing my US just before my IUI would start got excited at something they were looking at ( visible to me from my feet in the stirrups ) . So, I said , " what is it ??? " And they flipped the screen for me: it was a huge egg about to release and you could almost watch it live.... it was like a full blue moon or something .. the Dr then said to the Nurse, " go get me the vial with the highest sperm count " , he looked at me and said, " we will start in about 30 minutes "

My baby was born 9 months later

[Anonymous]

Are you DOR? Stims usually don’t work well with DOR

[Anonymous]

Anonymous wrote:It took me so many years to understand how important the lab is to success. You should be doing picsi or conventional icsi w DOR to maximize success.

100% agree

[Anonymous]

I don’t have DOR but has uneven growth so of 17, 9 were mature and 5 fertilized with ICSI and 4 made it to blast but only 1 of those implanted. I’ve known a lot of women with fewer blasts have success. BTW ICSI can be key for a lot of women so recommend that next round. Also ensure you are taking supplements for egg quality. I would also ask about adding HCH to your protocol for egg quality issues.

[Anonymous]

Anonymous wrote:I don’t have DOR but has uneven growth so of 17, 9 were mature and 5 fertilized with ICSI and 4 made it to blast but only 1 of those implanted. I’ve known a lot of women with fewer blasts have success. BTW ICSI can be key for a lot of women so recommend that next round. Also ensure you are taking supplements for egg quality. I would also ask about adding HCH to your protocol for egg quality issues.

Do you mean HGH (human growth hormone)?

[Anonymous]

Anonymous wrote:

Anonymous wrote:It took me so many years to understand how important the lab is to success. You should be doing picsi or conventional icsi w DOR to maximize success.

I think a good lab was a factor in our success. We had testicular sperm and required ICSI and had 100% fertilization, which is amazing. The top urologist in our city recommended a particular high volume clinic and was associated with his urology program. If your case is even slightly complicated you should consider a bigger clinic with more experience.

Do you mind sharing the name of the clinic with the good lab?