[vicsg]

Not sure if this is the right place to ask this question but I hope someone sees this and knows the answer

We have had 2 failed IVF cycles and had our follow-up today and they told us both times that at day 3 all of the embies were in the best possible condition but by day 5 the quality had gone down and most had arrested (1st cycle we transfered 1 grade 2BB blast and the 2nd cycle we had 1 grade 3AB and 1 grade 2AB blasts transfered - none of the others made it at all)

Now my question is does anyone know what this could indicate - is it a sperm or egg problem?

As far as the clinic is concerned they are having us pay for a AMH test and we're seeing a different consultant after xmas

 

[agate]

most docs would say its more likely to be an egg problem - good eggs can often compensate for rubbish sperm - but a poor stimulation (suboptimal dose/drugs/duration - e.g., you might do better with, say, a short protocol instead of a long protocol and a different FSH:LH stimms meds ratio - or if you have PCOS (don't know if you have) you might do better with pre-treatment with metformin - or if you have a poor response to stimms (I am assuming you don't) some docs would try pre-treatment with either DHEA or estrogen priming) and/or a poor embryology department (e.g., contaminated equipment, poor management of the change of medium (most labs change the growing medium at the end of day 3 so this could introduce a contaminant if their procedures aren't up to snuff) could contribute to reducing egg/embryo quality.

some docs would say that testing AMH won't add any more info - as AMH really only confirms what sort of antral follicle count you normally have - and that should be obvious from your baseline scan(s) from your IVFs. 

if you have had 2 failures and your clinic aren't proposing trying another tack, you probably want to look at trying a different protocol and/or different clinic?

maybe have a look at the FAQ on this board under W for 'why' in case there is any testing avenue that you think should be looked at too?

hope this helps

 

[vicsg]

Should have told you more sorry.

My FSH is 12.9 - I'm 33. I don't have PCOS either

The AMH test is to see if I have POF 

As for my response - 1st cycle (4 amps menopur) I had 12 follies, 7 eggs of which 5 fertilised and only 1 made it to transfer and the 2nd cycle (6 amps apparently they wouldn't normally go so high with someone of my age!!!!) I had 8 follies, 6 eggs, 4 fertilised and 2 made it to transfer - so is that good or bad given the amount of drugs I was on?

 

[agate]

well, FSH of >12 at 33 is not good
7 eggs on 300iu menopur is pretty ok though, even 6 eggs on 450 iu isn't terrible - although some docs would say that at higher doses like this, quality goes down and would advocate going back down to a lower dose and stimming for longer/aiming for fewer but better eggs, possibly on a short antagonist protocol.  a few docs would say that if you have poor egg quality on menopur, continuing to use it again may be sub-optimal because it has a lot of LH in it and some docs say that damages egg quality for some ladies.

a lot of clinics would classify poor response/POF as being less than 4 eggs recovered.

most docs would say that AMH really only tells you about egg quantity rather than quality - and you have a fair idea about egg quantity because you are getting reasonable numbers of eggs on your IVFs

you might want to have a consult with one of the clinics who specialise in 'difficult cases' like maybe Lister, Serum (athens), ARGC etc? 

My hunch would be that there isn't a lot of point continuing with your own clinic - unless they are going to come up with something new?  If you want to aggressively pursue OE IVF you'd maybe want to turn to a specialist clinic now?  and if you end up accepting a diagnosis of POF, you;d maybe end up thinking of going abroad for DE rather than in the UK because of the waiting lists?

 

[ANGELA29A]

We had 1 failed ivf, just had an amh test done, as my fsh levels were so different each month, told today amh is low, but not that low if that makes sense, and they are going for full dose meds for next cycle, don't know if that helps.x

 

[CAWA8]

It is rare for doctors to point to anything other than old eggs, but in the US it is becoming more widely accepted that embryo demise between day three and five indicates a sperm issue.  I had a similar situation and as soon as we switched to donor sperm we got pregnant.  Same with another gal I know.  You may have to seek out this opinion from doctors, but it is something to consider.
Lesa

 

[Gribbie]

I had a similar issue (www.fertilityfriends.co.uk/forum/index.php?topic=243441.0) and had steriods and growth hormone jabs this time round.  Best of luck.