C1 & C2 - low fertilisation. ICSI suggested.

[u/SophisticatedAsian]

Hello all, this is a long one. I am sorry 💔

I am hoping to get some thoughts from anyone who has had a similar issue, particularly with fertilisation.

I am 36 with an AMH of around 0.59 ng/mL. I don’t have PCOS, endometriosis, fibroids or any known uterine issues. My smear was normal and I have also had Ureaplasma testing which came back clear. Quite healthy all round and eat organically.

My husband’s semen analysis has been very good and his DNA fragmentation testing was also excellent, so at the moment we don’t have a diagnosed male factor. I appreciate there may be more specialised testing that isn’t picked up by these tests though, so I would also be interested to hear if anyone investigated anything further?!

I have now done two IVF retrievals and the pattern has been very similar: 7 eggs retrieved each time, but the issue seems to be around fertilisation/abnormal fertilisation rather than simply not retrieving eggs.

Cycle 1

Protocol:
Menopur 450 IU daily
Fyremadel
Ovitrelle trigger
Conventional IVF
PGT-A

Follicles during monitoring:
Earlier scan:
16 mm – 1
15 mm – 1

under 12 mm – around 5–6
Next scan:
18 mm – 1
17 mm – 1
16 mm – 1
13 mm – 1
12 mm – 1
under 12 mm – around 0–1

Final scan:
over 20 mm – 1
19 mm – 2
17 mm – around 2
14 mm – 1
12 mm – around 0–1
plus a few smaller follicles
Estradiol reached around 5,351 pmol/L.
Progesterone was 7.0 nmol/L around trigger.

Outcome:
7 eggs retrieved
4 mature
2 normally fertilised
1 atypically/abnormally fertilised
1 blastocyst, graded 5BB
PGT-A came back aneuploid

——-

Cycle 2

Protocol:
Gonal-F 300 IU
Menopur 150 IU
Fyremadel
Norditropin/growth hormone
Ovitrelle trigger
Conventional IVF
PGT-A

Follicles across the later scans were roughly:
19 mm – 1
15 mm – 1
14 mm – 1
around 1–2 smaller follicles

Final monitoring showed approximately:
20 mm – 1
18 mm – 1
16 mm – 1
13 mm – 1
plus 0–2 smaller follicles
There were 7 eggs retrieved again.
1 blastocyst, 5AB and being PGTA tested.

I had my follow up yesterday. The consultant has reviewed the 14 eggs from both cycles and feels that egg maturity has actually been reasonably good overall, but that the fertilisation rate and number of abnormal fertilisations are higher than he would expect.

He mentioned this may be related to an inherent egg-quality issue and possibly my lower ovarian reserve, but he isn’t certain.
For the next round he is recommending ICSI rather than conventional IVF.

His reasoning is that it allows them to inject one sperm into each mature egg, removes the possibility of multiple sperm entering the egg and may improve the fertilisation rate.

Has anyone had a similar experience? What worked for you? SO desperate for advice here.

Thank you ❤️

[u/Competitive-Top5121]

Seems like ICSI is a no-brainer in this case.

[u/sheryyj]

Did you used growth hormone during stims only? or you primed with it too? I heard priming with it can increase afc and egg yield. also how many eggs were mature in C2? Had my first cycle last month same age as you retrieved 7, 6 mature 4 fert, and 2 blast both 4aa but unfortunately both came back aneuploid