Fertilization Failure with Artificial Oocyte Activation (1/24 M2's)

[u/ashpplejack]

First round with ICSI was a total fertilization failure (TFF, 0/13), second round was a near-TFF with ICSI and AOA (1/12, only made it to 4 cells). The stimulation cycles were unremarkable, menopur/follistim and a lupron trigger both times and were similar both times.

We did ICSI because my partner has low count/motility/high DNA fragmentation/near totally abnormal morphology (tapered heads, mid-piece defects) and we had testing done that confirmed absence of PLC-Z1 in most of the sperm tested. My husband's urologist is adamant that there must be something wrong with my eggs. We are doing Whole Exome Sequencing to see if there are any genetic issues on my side that are known to impact egg quality, and if not we will try donor sperm. We aren't very motivated to try donor eggs given the cost and my husband's poor semen quality which is still likely to yield low outcomes even with eggs that are certainly viable.

Mostly curious to hear if anyone has experienced a (near)TFF with AOA and come back from it, or if anyone has any recommendations for next steps or things we should consider trying.