First IVF/ICSI - Is it all about the Egg?

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momtobe
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First IVF/ICSI - Is it all about the Egg?

Post by momtobe » Mon Mar 14, 2016 9:37 am

Hi Doctor,

Background - me 30, husband 33. Trying for 2 years with one natural CP. Did 3 IUIs, all unsuccessful. All my testing came back normal (very high amh over 8, fsh 3.6, all other hormones normal, no tubal issues, normal saline sono, normal immune testing and blood clotting). Our diagnosis was male factor infertility (highly variable SA results - best was 20 mil count, 40% motility and 5% strict morphology. Worst was 5 mil count, 17% motility and 1% strict morphology)

For our first ivf cycle I was on Long Lupron protocol and very low dose of follistim (75iu) and 1 vial of menopur daily. Stimmed for 10 days. Estrogen at trigger (10,000 hcg) was around 6,000. Retrieved 23 eggs, 20 were mature and 18 fertilized (no ohss:-). . Majority were going strong on day 3, but on day 5 we were left with only 4 morulas that made it to "good quality blasts" on day 6. Transferred one which resulted in a chemical pregnancy (we already had one prior CP a year ago naturally).

In your opinion, what could be the reasons for low % of blastocyst formation?
Is it the egg or the sperm issue or both? Is there a way to figure that out so we know what there is to "fix" and what our best options are (trying with our own genetic material or explore donor options. If donor - on which side, as we would not want to spend a lot of money on donor eggs to than find out it was the sperm for example.)

Given that I had tons of tests ran already, and we were doing icsi for male factor, would it be helpful to do sperm dna fragmentation test? Are there any other tests available for the male side of things (seems that majority of testing is done on the woman and eggs are often blamed on failures. Does sperm play a role as well or is it all about the egg?)

My husband already has been taking antioxidants for about a year while we were doing IUIs and ivf. He does not smoke, drinks in moderation, works out, eats healthy, in shape. I don't know what else we could do to improve things.

Thank you so much for providing couples with such a great forum and taking your time to give valuable advice.

Telf
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Joined: Sun Mar 17, 2013 11:59 pm

Давно я здесь не бывал

Post by Telf » Fri Mar 25, 2016 12:05 pm

Давно я здесь не бывал

Dr. Amin
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Re: First IVF/ICSI - Is it all about the Egg?

Post by Dr. Amin » Tue Apr 12, 2016 4:59 pm

Based on what you've told me, it's difficult for me to know why there was a low percentage of blastocyst formation. I recommend that you speak with your reproductive endocrinologist about this.

Unfortunately, there are not many tests available to evaluate sperm in further detail. In regards to sperm DNA fragmentation testing, I would again recommend that you speak with your physician to see if this is indicated in your particular case.

Marli Amin, MD
Reproductive Partners Medical Group
Marli Amin, MD
Reproductive Partners Medical Group
Orange County, CA

momtobe
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Re: First IVF/ICSI - Is it all about the Egg?

Post by momtobe » Thu Apr 21, 2016 7:58 am

Thank you. We had a consult with our RE and were told that about 25% of blast formation, while on a low side, is in the realm of "normal". Our Re also does not believe in the sperm DNA issues, attributing it to junk science and unproven theories. Her opinion is that there is no real threshold of what results mean to the prognosis and that results can change very rapidly, not offering much value in diagnostic and treatment. She said that low blast formation is more than likely due to the egg, and given that my E2 was very high before the retrieval, it might of compromised the quality.

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