Anyone experienced total fertilization failure with ICSI?
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Anonymous
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HI everyone,
I would really appreciate hearing if anyone has experienced total fertilization failure with ICSI. A bit of background: I am 42 years old and have had 6 cycles of IVF over the past two years - 2 in Canada, 1 at Shady Grove and 3 at CCRM NOVA. For the last 3 cycles we have been blastocyst banking without testing. I am a high responder with high AMH and typically retrieve between 15 - 18 eggs. For this past cycle (which was to be our last baking cycle), they retrieved 25 eggs, with 19 mature. However none fertilized with ICSI. We are in absolute shock as we have always had average or above average fertilization rates (average across prior cycles of 76%). We are doing back to back cycles, so no real time has passed since our last cycle in June, where 75% of eggs fertilized. CCRM has indicated they have no idea why this happened as eggs and sperm were both excellent quality. Any insight is much appreciated! |
Anonymous
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My stomach dropped when I read your post. I have an almost identical story. Did 4 cycles at a local clinic, fert rate with ICSI was great.
Cycle 5, I went to CCRM NOVA. Instead of my usual 15 or so eggs, they got 29. Only TWO fertilized with ICSI and both of those failed before Day 5. I know they screwed up my cycle somehow. Over stimmed me, triggered me too late, something. They blamed my egg quality. Said my eggs had clear indicators of being bad. Very suspicious since my eggs never showed such signs before, including during a cycle that was done just 3 months earlier at the other clinic. It was my last shot and they blew it for me. My experience with them was horrible start to finish. |
Anonymous
| Wow, I’m so sorry. I didn’t have this exact experience so I hope people chime in who have, but I’d want a full accounting about everything and everyone that came in contact with my eggs/sperm that day. Is there any way to find out if the person doing the ICSI was experienced or new? Did other people have unexpected failures that day? Is there any way for them to be honest with you - I’m wondering if there’s any way to ask them to do an internal investigation. Maybe they’d offer you a free cycle if they think you’re onto something? If a few people had the same experience here you could all get a lawyer together.... |
Anonymous
| It’s better to have 10-12 high quality eggs than 20 eggs that are over-stimmed. At least that’s impression I get from being on these boards |
Anonymous
| OP I'm assuming the 76% fertilization rate, none developed? I was a poor responder and only had 4 eggs retrieved, ICSI failed with all. I'm sorry OP. |
Anonymous
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OP here: Thank you everyone for your thoughtful replies. They are so helpful at this difficult time!
17:59: I am so sorry to hear this, and was shocked to read we had such a similar experience. They aren't even really giving the egg quality explanation as they said the eggs morphologically appeared excellent. Dr. Payson did say "maybe your eggs aren't tolerating ICSI as well anymore", for which there is literally 0 scientific evidence, and can't really be explained by a 75% fertilization rate of 16 eggs in June. I have looked at dozens of studies. One thing I have found as a potential explanation is a technical error of timing - either starting the process too soon after retrieval once eggs demonstrate MII, which can compromise cytoplasmic maturity (which isn't really observable like nuclear maturity of eggs is). Did they do an investigation or just said poor egg quality and that's it? The embryologist did say to us "we may have missed the fertilization window" when trying to explain what happened. 23:46: There have been many studies that show that the overstimming compromises egg quality argument is completely false. High stimulation can mean that egg quality is low (hence the need for high stimulation), but it does not cause it. I'm actually also on quite a low stim protocol - 200 Gonal F / 150 Menopur - so wouldn't fall into that category of overstimming anyhow. This article shows that the best IVF results across thousands of studies is when 18 - 20 eggs are retrieved. https://www.sciencedaily.com/releases/2018/09/180904103259.htm#:~:text=Summary%3A,at%20in%20today's%20IVF%20treatments. 22:46: Yes, that is a great idea, thanks for that advice. I am going to ask for that. We are also going to ask for them to cover an additional cycle. They said of the other two retrievals that day, fertilization rate was normal, so that it likely isn't lab error. To which DH said 'If I take my car to the mechanic and they damage something, but didn't damage other cars that day, that doesn't mean the mechanic didn't do something wrong with my car".  There is lab error - contaminated culture that would affect all eggs that day - and there is technical / human error that may only occur once. If a lab technician drops a tray of embryos for one couple, that doesn't mean they will drop all embryos for that entire day!
00:43: I am very sorry to hear that. I think it is much more common for ICSI or conventional IVF to fail with a small number of eggs  . Of the 76% fertilization rate, we have good blastocyst conversion rates. Over the last two banking cycles, we have banked 9 blastocysts that are untested and frozen. For prior cycles, we had good blastocysts that were all abnormal, or failed fresh transfers, with one twin miscarriage.
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Anonymous
Hi there- in two cycles we failed to get blasts there. Fert rate was 50-60% but they all failed before day 5. Switched clinics and ended up with 3 blasts. After failure #1 donor was brought up which rubbed us the wrong way after only one failed cycle. |
Anonymous
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17:59 here again. I neglected to mention in my first post that I was 41 when this happened and I also was a patient of Dr. Payson, although he essentially ignored my cycle so I saw all the other doctors and never him. I also was not on high doses of stim meds. I think they pushed me too far and my eggs way overmatured. I told the other docs that I preferred to trigger sooner and get fewer eggs of a better quality but they disagreed and pushed me to do an extra couple days.
I didn’t ask for an investigation or for them to cover another cycle. I should have. I was really at the end of my rope emotionally and I sort of collapsed and gave up on even thinking about it. It was about a year ago and I can now think about it with a clear head but at the time, it was just too much. I’m glad you and your DH are pushing for a resolution. |
Anonymous
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13:47: What clinic did you switch to where you had the better blast rates?
17:59: That definitely sounds possible that your eggs were overmature. I don't see Dr. Payson very often, but I really like Dr. Owen anyhow. Sorry to hear that you had such a difficult time. Did you do donor eggs or throw in the towel after that? |
Anonymous
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Hello
I am 37 and DH is 39 My husband was diagnosed with azoospermia and had to go through TESE to retrieve sperm. We tried 2 IVF cycles; both with ICSI and there was NO fertilization. IVF 1: 7 mature eggs IVF 2: 5 mature eggs They don't know why there was no fertilization. Seems that the eggs were not activated. Morphologically the eggs looked good both times; and the sperm used was thought to be optimal for fertilization. But nothing happened both times. After the first cycle we thought it could have been a lab error that none of the eggs fertilized with ICSI. But it happened a 2nd time
The clinic is recommending using fresh sperm and fresh eggs (DH has to do another TESE and coordinate his surgery the same day as my egg retrieval). They do not know why there wasn't fertilization both times. We were told that sometimes the sperm and egg "looks good" but no fertilization is achieved. Another option they are suggesting is to test some eggs with a donor sperm to see if any will fertilize; this way they can rule out if the issue is with the eggs. |
Anonymous
Was this at CCRM NOVA? I’m so sorry! |
Anonymous
Thank you. No. This was at Cornell NY. |
Anonymous
| My story isn’t quite the same, but I did have experience with drastically different ICSI fertilization rates in back to back cycles. Cycle 1: 10 eggs, 9 fertilized. Cycle 2: 12 eggs, 5 fertilized. They didn’t have a good explanation, but I’m a slow responder to meds—in my first cycle I had to stim for 14 days. In my second cycle, they said I was on the cusp at 12 days and went ahead and retrieved early. I’ve always wondered if my eggs weren’t ready, and been annoyed that they didn’t wait another day, when my results were so good the cycle before. |
Anonymous
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Hi all,
OP here. Just an update that CCRM did do a full investigation, even bringing the head of the lab at Dr. Schoolcraft up from Denver for the investigation. They have no conclusions at all - none technical, biomedical, human error. They are completely baffled, and say they haven't seen something like this before. They are giving us a hefty discount on a repeat cycle, and applying it to our uninsured costs so we aren't out of pocket at all. While we are still upset about the outcome, especially in a cycle with 19 mature eggs retrieved, they have been supportive. Dy. Payson in particular has been extremely empathetic, and advocated for the investigation and financial compensation. |
Anonymous
That’s great news, OP! |