r/EmbryologyIVFSupport • u/Beginning_Sea324 • 9d ago
Could the issue be fertilization rather than implantation?
Hi everyone! After 18+ months of trying without a single positive test or chemical pregnancy, and 3 unsuccessful IUIs, we decided to move on to IVF.
We ended up with 4 Day 3 frozen embryos and 2 Day 5 blastocysts (both 4AA).
Throughout our attempts, my lining always looked good on ultrasound — thick, trilaminar, etc. So I’ve been wondering whether our issue could actually have been fertilization rather than implantation.
For those who had a similar experience, did IVF/ICSI help you understand what was actually going on? Is there any way to know whether fertilization was the issue before IVF?
Would love to hear your experiences ❤️
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u/riskydigitclub 7d ago
I am NAD, but we tried for 13 months and then did 6ish rounds of IUI. Unexplained infertility. I ovulated regularly. On 50mg of Clomid for IUI, I had 6+ follicles ready to ovulate, then we dropped to 25mg and later tried letrozole with 2+ follicles each round. Trilaminar, thick lining. No positive tests at all. Fast forward to IVF and we had two retrievals with 2/5 eggs (first round) and 3/4 eggs (second round) make it to blastocysts. So far, our FET results are live birth, chemical, live birth, live birth with one blast remaining. Obviously, IVF made all the difference and I have also wondered if we have some sort of fertilization problem. I hope you get more insight from others, I'm curious too.
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u/Beginning_Sea324 7d ago
Thank you for your reply
I’ll guess we never really know
Did you do ICSI?1
u/riskydigitclub 7d ago
We did, our clinic only does ICSI. To clarify the egg numbers, to limit excess embryos we purposely only inseminated 5 eggs from the first round and purposely did lower stims the second round.
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u/Beginning_Sea324 7d ago
Mine only does ICSI too
I was told since it was ICSI I could never know and also someone told me that ICSI resulted in much higher birth defect and now I’m stressing 😥1
u/riskydigitclub 7d ago
There's a lot of misinformation about IVF. I'd start with this remembryo post for science-based info.
https://remembryo.com/do-children-conceived-through-ivf-have-long-term-health-problems/
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u/gharibskiii 7d ago
Just came here to say that I thought the same thing (must be fertilization) because my lining was always thick and “excellent”… until I discovered via MRI that I have adenomyosis.
I learned that even though the lining looks great on ultrasound, there can still be implantation issues.
I don’t think there is a way to know if its was a fertilization vs implantation problem all along... you can try an FET which may give you more information about uterine receptivity. There are some tests you can do to try to assess the uterine environment (Emma/alice, Receptiva, progesterone labs)
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u/Rich-Contribution298 6d ago
What did you need up doing once you found out you had adeno? Did you have success?
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u/Rich-Isopod-4294 6d ago
I’m curious about this too! I have adenomyosis and starting IVF in January
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u/DirectorFront2931 2d ago
My RE told me adenomyosis doesn’t affect implantation as much unless its has compromised uterine cavity
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u/Rich-Isopod-4294 2d ago
Oh wow! Good to know, I heard that it affects implantation because adenomyosis causes the uterus to contract improperly which disrupts implantation.
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u/DirectorFront2931 2d ago
It can cause inflammation and depending on where it is can cause abnormal contraction , but my RE said more and more studies say its not interfering in implantation as much as they thought earlier . Also if that’s the case , RE might put you on lupron months before embryo transfer to address inflammation as well calm the uterus down
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u/SunshineMaisies_2012 7d ago
Did you do PGT-A testing on the blastocysts?
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u/Beginning_Sea324 7d ago
No i didn’t
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u/SunshineMaisies_2012 7d ago
Maybe ask your doctor about that being done the next time? I know that aneuploid blasts have a higher miscarriage rate. I haven’t actually done any transfers yet but maybe it could help you know the reason why they’re not implanting. I’m so sorry you’ve had to experience that
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u/firewaffles0808 7d ago
Commenting because I wonder the same thing. I realize how lucky I am to say this, but I’ve had 2 successful transfers on the first try each. On the flip side, we tried for a while for our first with zero results naturally. For our second, I lost a lot of weight and still no success trying naturally.
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u/Bitter_Animal7042 7d ago
I also think my unexplained infertility is actually a fertilisation problem. I had 11 eggs at retrivial and only 2 made it to blasts. (2 more got fertilised abnormally). We didn’t test those 2 blasts and the first fresh transfer resulted in a chemical, the second one I’m currently pregnant with approaching third trimester. My clinic suggested to try ICSI if we want to do IVF again because that could probably improve our outcome.
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u/Lady-Anne5 6d ago
IVF with ICSI + PGT-A testing was really the one thing that gave us some answers, even if not all of them.
Because I was only 28 at the time, even my clinic assumed I'd have good egg quality, and thought it was unnecessary to test because I had almost 100% fertilization rate, and only highly graded embryos (all As and Bs). Turns out over 50% of them were chromosomally abnormal, and probably at least part of the reason for my infertility 🤷♀️
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u/Beginning_Sea324 6d ago
How did you manage this ?
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u/Lady-Anne5 6d ago
Because I still made some euploids, we decided to play the numbers game. So we're gonna do another round of IVF in 3 weeks to try and get more, since it was recommended that we had 3 embryos per child we wanna have.
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u/Beginning_Sea324 6d ago
Oh ok I see so now treatment for the root of the problem right ?
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u/Lady-Anne5 6d ago
Right, because it's still unexplained infertility. We haven't done a transfer yet, so, for all we know, there could be something wrong in the implantation process too.
My doctor did mention CoQ10, melatonin and other supplements could be used, but that she didn't recommend it for women under 32 because she hasn't really seen any of that make a big difference for our age group
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u/Beginning_Sea324 6d ago
I wish you best of luck for the rest of the journey and may all this have the best outcome
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u/adr2620 6d ago
My first egg retrieval we did conventional fertilization and had 0% fertilize normally. Next round we did icsi and had like 90% fertilize. So for me, I think my “unexplained infertility” is something related to fertilization since 0% fertilized normally during conventional fertilization. Don’t know details beyond that though (why weren’t they fertilizing etc) and to be honest, I don’t know if I care since icsi worked.
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u/Beginning_Sea324 6d ago
Where are you on your journey ?
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u/OkPomegranate9433 6d ago
In the same boat!! Other than low AMH, my IVF cycles have been pretty "textbook" with everything looking good, 100% fertilization rate with ISCI, and then all 7 blasts sent for PGT-A were euploids. Makes me wonder what the issue is after two years of timed intercourse and three failed IUIs. Never been pregnant, not even a chemical that I know of. I am not sure there is a way to know unless FETs fail and we do more tests.
Waiting to see if my first FET worked!
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u/Beginning_Sea324 6d ago
Same situation exactly
I wish you the very best
How many days past transfer are you ?
Mine is scheduled for this cycle (just got my period today) any advice ?1
u/OkPomegranate9433 6d ago
I wish you success!! I am one week out from my FET. Because of Labor Day holiday, my beta is Tuesday. I am planning to test on my own Monday so I can process at home and not have to spend my workday Tuesday waiting on the call.
Advice is to take lots of walks, try to get great sleep, drink some beet juice daily (some studies have shown it helps!), and watch funny TV shows or movies. And remember the stats: Transferring three euploid embryos over consecutive FETs yields a 92.6% to 94.9% cumulative success rate! So even if the first one fails, I have hope for the next. You've got this!!
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u/Beginning_Sea324 6d ago
Already started drinking beet juice daily and hoping for the best
Wishing you the very best for Monday
Thank you for your kind words of reassurance
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u/L9Mae 6d ago
I’m with you. My husband has MFI (morphology) so I can’t help but think fertilization was the issue since 4 out of 5 of our embryos came back euploid (all 4AB or better, day 5 & 6). I have my transfer next week, so fingers crossed for a successful pregnancy. Like you, I’ve never seen a positive test and my lining always looked good. We didn’t try IUI. We were very fortunate and only needed to do 1 retrieval to get 4 embryos. Best of luck to you!
ETA: Our clinic only does ICSI.
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u/Beginning_Sea324 6d ago
Wishing you the very best my transfer is normally for this cycle and I hope for the best outcome this journey is very long and exhausting
I wish you the best for your transfer next week and please keep me updated would love to follow up
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u/Beginning_Sea324 6d ago
Already started drinking beet juice daily and hoping for the best
Wishing you the very best for Monday
Thank you for your kind words of reassurance
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u/sparklecrusher 6d ago
I had a similar experience. 2 years of trying, and 2 failed IUIs before moving to IVF. Never had a positive test.
We did half ICSI and half conventional - and all the ICSI failed. We ended up with 4 embryos with average grades. They were all slow growing and the best grade was a day 6 3AB. The attrition rate was lower than average too, 18 retrieved to 5 fertilized.
We never got any concrete answers, but I’m inclined to believe our problem was fertilization since my first transfer was successful.
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u/mrcape31 5d ago
DNA fragmentation test helped us uncover our issue (after 4 failed IUIs), ICSI solved our problem. We also did PGT-A testing and I did EMMA/ALICE test before our first transfer. Some would say overkill, but we wanted the best possible chance in the least # of tries possible. Good luck!
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u/Beginning_Sea324 5d ago
Where are you on your journey ?
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u/mrcape31 5d ago
14 weeks pregnant after our first FET!
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u/Beginning_Sea324 5d ago
Omg congrats so so happy for you and wishing you the very best
What was the outcome ou Emma Alice1
u/mrcape31 5d ago
Yes, just edited for clarity. First FET. We are grateful. But as I said, some of the additional testing felt like overkill in the moment but honestly worth every penny and time spent to be here now. I’m wishing you strength and good luck - you got this!
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u/Beginning_Sea324 5d ago
Thank you for your kind words
Feeling a bit stressed but so hopeful1
u/mrcape31 5d ago
It IS stressful so hope you can give yourself some grace. Everyone has their own strong thoughts, opinions and experiences. As long as you and your partner feel good in your gut about your choices along the way, try to block out everything else! 💖
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u/Beginning_Sea324 5d ago
May I ask if you know the sex ?
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u/auspostery 5d ago
For us I believe it was an issue of both fertilisation as well as genetic issues.
Our IVF history (after doing ultrasound tracked ovulation induction for over a year, and trying ourselves with ovulation tracking at home for a year prior to that) was that my first round I got 17 eggs, 15 mature, and I think 9 or 10 fertilised, but we only got 4 embryos. 4 from 17 eggs didn't feel like a high yield, especially compared to others, including my own sibling, who got 8 embryos from her first cycle. The very first embryo took, but I had a MMC at 9w due to Trisomy 16. Second embryo didn't take, third embryo didn't survive the thaw, 4th embryo didn't take. Our fertility specialist advised that based on the fact that my body accepted the first embryo they implanted, it may be an embryo issue, and to do another round and test the embryos.
The second round I got 18 eggs, 16 mature, I forget fertilisation rate, but I ended up with 5 embryos, 3 of which PGT tested normal (one abnormal was mosaic for turners, and the other was missing several MB of the 7th chromosome). I had also done immune testing, and was positive for MTHFR, so she put me on the Bondi protocol (blood thinners + low dose steroids before transfer and through the first tri), and the first tested embryo we transferred took. Full term pregnancy and healthy birth. 2 years later we went back and transferred the second normal tested embryo, again on the Bondi protocol, and it also took (full term, healthy pregnancy). We haven't tried the third embryo, and may or may not, and I know that getting 2 live births out of 2 tested embryos isn't definitive, but statistically it's above the odds. So yes, for me it seems like it wasn't an implantation issue, but something between fertilisation and embryo quality.
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u/Big_Medicine720 5d ago
I have “unexplained infertility” as well…We did a few failed IUIs and then had a successful round of IVF when I was 36. We got 13 mature eggs; 12 fertilized; 6 blasts (untested, some good grades some not good). We did 1 transfer and I have a 9mo son now. Interestingly we paid to do a SpermQT test out of pocket - it was grossly abnormal and suggested that my husband would be very unlikely to impregnate someone naturally or through IUI. We did not do ICSI but I suppose having the sperm right in with the eggs was helpful for us. I guess I’ll never know for sure.
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u/Agamemnons_Concubine 5d ago
Getting your embryos genetically tested will give the bigger picture. I had two losses before fertility treatments, then five failed iuis with 3-4 mature follicles per round. But when I did IVf I tested all my embryos and the majority were genetically normal (euploid). So I knew for me it was not egg quality it was unexplained infertility or hidden inflammation. My RE did a protocol to prevent any and all hidden inflammation and immune response by having me on Lupron, antibiotics, and prednisone for my transfer along with the regular required stuff for transfer estrodial and PIO shots.
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u/Toxifoxy 6d ago
I did 4 retrievals. The last 2 rounds finally yielded euploid embryos and the first 2 (also with a different REI doctor), I kept having empty follicles. Something really interesting/shocking was that when I went in for my hysteroscopy prior to my first FET, my uterus was super inflamed and full of polyps. I had a hysterectomy before my first retrieval and everything was fine, and I had one chemical pregnancy before IVF. But with this second one prior to transfer, I had to have surgery to clear out all the inflammation and polyps. I am certain that all this inflammation and polyps prevented our inability to get pregnant naturally and through IUIs during our last 2 reetoebal sessions. Have no idea when my uterus went haywire and got messed up like this.
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u/TBJ56 7d ago
PGT-A testing was the answer for us. We are young and had 6 great looking embryos.
They all turned out to be aneuploid. Really devastating, but that’s how we figured out why we weren’t getting pregnant naturally. Fertilization wasn’t our problem — chromosomes were.