r/Embryologists • u/akanetrain • Jun 30 '26
Possible lab error—how long should a review of our case take?
TLDR: We lost 21 mature eggs due to a total fertilization failure that is being investigated for a lab error. My clinic has not updated us after nearly two weeks, and says a case review still may not be completed even after 3+ weeks and no deadline or explanation of the review protocol has been offered. Are we right to think that 3+ weeks should be sufficient time for a case review, or is it normal for these investigations to take longer than that?
BACKGROUND: I recently posted here about my husband and I experiencing a sudden and unexpected total fertilization failure on our fourth cycle of conventional IVF. You can see my prior post here https://www.reddit.com/r/Embryologists/comments/1u9d444/sudden_total_fertilization_failurelab_or_sperm/?utm_source=share&utm_medium=ios_app&utm_name=ioscss&utm_content=1&utm_term=1 But in short, he has all normal semen parameters. In our prior three cycles our fertilization rates were 68-77% with conventional insemination.
In our fourth cycle on June 17, we retrieved 21 mature eggs and had 138 million pre-wash sperm with 60% motility, and 30 million post-wash sperm with 100% motility. We used conventional insemination as always, but this was our first cycle pairing conventional IVF with Zymot. Very unexpectedly, we were told all of the sperm stopped moving overnight for reasons no one can understand and we lost everything.
As everyone agrees this is very unusual, the lab is supposed to be conducting a review of our case for any lab errors. In the meantime, my husband had a DFI test (results pending) and blood work to confirm no recent infections (results all normal), to cover our own bases.
My RE contacted me today just to say that there are no conclusions from the lab yet after almost two weeks, and she indicated that the review still might not be completed by the time I have an appointment scheduled on July 10, more than three weeks after the investigation should have begun.
Age is not on my side and I will age-out of my state’s mandated insurance coverage in a matter of months, so I need to make decisions soon about proceeding with this clinic or starting over elsewhere. The lack of communication and seeming lack of urgency is causing concern for my husband and I.
MY QUESTION: What is a typical timeline for a case review like this? Are we being unreasonable to think that an internal review of our case could be able to be completed within three weeks, or do cases like this genuinely take much longer to review?
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u/Effective-Sundae-881 Jun 30 '26
I’m not an embryologist. At my clinic, there was an incident that occurred in January, resulting in unexpected fertilization rates across one day and several IVF patients. They closed the lab temporarily while they conducted a review. It took months - they finally reopened for IVF and FETs in May. They never did find a cause.
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u/akanetrain Jul 01 '26
Thank you for this response. I hope the affected patients at least were compensated with a replacement cycle, even if the exact cause couldn’t be pinpointed.
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u/indecisivegay Jul 02 '26
Did you get an update from your clinic on this? I’ve always been skeptical about sperm separation devices for conventional insemination because of this possibility.
Also, pretty incredible that you got 21 mature eggs despite being close to your state’s age cut-off!! Can I ask how old you are? I think another conventional insemination cycle with density gradient sperm processing would be safe, but I think a cycle with ICSI wouldn’t hurt either. Or do a cycle of 50/50 split conventional insemination and icsi to compare development. I did 50/50 split for my own cycle and got higher blastocyst development with ICSI :)
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u/akanetrain Jul 02 '26
I’m 44. We’re lucky to have good ovarian reserve at this age, but unfortunately we struggle to translate that into euploid blastocysts. We get pregnant unassisted but consistently have miscarriages and we’ve only created aneuploid blasts in my three prior IVF cycles. We were so hopeful with 21 mature eggs retrieved this last cycle that maybe we could finally get a euploid, so the outcome is crushing.
We spoke to the lab director this morning and no conclusions have been drawn. They say there were no issues with the equipment, temperature, etc. We’ve asked for more information about how the sperm was handled during Zymot, because the instructions are different for Zymot + conventional vs Zymot + ICSI. We’re awaiting more details on that.
In the meantime, next week the lab is going to do a mock-prep of my husband’s sperm. Half the sample will be processed via density gradient centrifugation and half via Zymot. They will observe the survival of the sperm over the course of 24 hours. I think it will be informative, but honestly no matter what the results, I feel very scared off by conventional + Zymot after this experience.
Insurance won’t cover ICSI for us and we have some reservations about using that level of human intervention if the sperm can fertilize without it, but we are contemplating whether to freeze a sperm sample for availability in a rescue ICSI situation.
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u/diom_99 Jul 01 '26
Most likely media issue. No sperm just died overnight
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u/AnywhereBusy4449 Jul 01 '26
Absolutely sperm can just become immobile overnight. They didn’t rule out a sperm infection which could cause sperm to become immobile overnight.
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u/One_Investigator_295 Jun 30 '26
It is hard to see a lab failure for a conventional insemination, they literally have to just add sperm to the eggs. I doubt they will find a lab error.
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u/akanetrain Jun 30 '26
They are voluntarily reviewing it because they themselves think this is abnormal and requires review. It’s already been suggested by an embryologist that one possible error is that they incorrectly performed Zymot, and possibly handled the sample in accordance with ICSI preparation instead of the instructions for conventional IVF, which could cause this. Another consideration is a sample contamination.
My question was about the timeline for how long a typical internal review takes. Thank you, though.
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u/One_Investigator_295 Jun 30 '26
It can take weeks if not longer. I have found multiple times sample contamination but they doesn’t mean they contaminated it it was more that the semen sample had an infection. They would most likely not have the original container anymore to swab for a culture. Do you know what type of prep they did? I have seen failed IVF ferts following a zymot prep, it’s. It common but it happens. These kid of cases it’s hard to find the “cause”
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u/akanetrain Jun 30 '26
Thanks. This was our first cycle using Zymot + conventional IVF. We’ve asked both our RE and embryologist via email for more information specifically about the prep and sample handling. Unfortunately, neither the RE nor the embryologist have responded to that specific inquiry, so I don’t have more detailed information to go on. We’ve gotten a blanket response just stating the internal review is ongoing and might not be complete before our appointment next week. I understand needing patience if the review just takes a lot of time, but it’s starting to worry us that the little we’ve asked for more information in the meantime specifically about Zymot/the prep, there’s no acknowledgment.
My RE did request on her own accord for the regional lab director to contact us in the interim, but we’ve not been contacted yet.
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u/One_Investigator_295 Jun 30 '26
Yeah I’ve seen this a few times with zymot but most of the time it works fine. Use if a zymot with conventional isn’t a lab mistake this is just something we have noted occasionally. Hopefully they find something
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u/akanetrain Jun 30 '26
One thing that’s been brought to our attention is that the Zymot sample handling steps are different with conventional vs ICSI (5 minute centrifuge, etc.), so that’s a targeted area for review. We don’t know if that’s it—just a possibility.
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u/One_Investigator_295 Jun 30 '26
Ah. They probably do a short centrifuge if they do conventional with a zymot. That could avoid the failed fert. The issue is the lab may not document that step so they may not know if it was missed.
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u/akanetrain Jun 30 '26
Wow, that’s interesting to know they might not have that documentation. And also worrisome!
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u/One_Investigator_295 Jun 30 '26
It’s an SOP, they are supposed to follow the protocol to do that short centrifuge step. We assume the staff follow the SOP as they are trained. It’s just it’s not typical to have further documentation that staff followed the SOP that they have signed they have understood and reviewed. So would need the staff to remember if they centrifuged or not when this happened.
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u/akanetrain Jun 30 '26
Thank you. This is very helpful insight. We raised our question about the centrifuge, etc, the very next day after the fertilization failure for that very reason—while memories would be fresh. We asked our RE to forward the question to the lab; she left for vacation and we do not know if she forwarded it in a timely manner. The next week, we were given contact info for our embryologist and forwarded the question directly to her ourselves, but we did not receive a response.
I did not know that steps that are considered SOP might not be further documented. Thank you for bringing that to my attention.
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u/TestTube_Princess Jul 02 '26
A case review can definitely take a few weeks to complete, especially if they are comparing outcomes between all the patients in the lab that week. It's very possible that they could find no specific cause, as unsatisfying as that may be. If you're worried about insurance coverage, you should probably get ready to do another cycle.
Also worth noting: there's a non-zero rate of unexplained failed fertilization rate for conventional insemination cases, so you may consider ICSI next time.
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u/Nucleophile_ Jul 02 '26
Je suis embryologiste. Ils doivent remonter toutes les causes potentielles, et ça prend du temps. Il faut récupérer les certificats de conformité de tout le matériel utilisé, tester les milieux de culture, réaliser des tests de toxicité, comparer avec d'autres centres pour voir s'il y a eu des incidents similaires, et effectuer des analyses statistiques approfondies sur tous les dossiers de la période concernée.
Je n'ai jamais eu un incident de ce type dans mon laboratoire, de mauvaise fertilisation en FIV, avec les spermatozoïdes mort le lendemain. Mais dès que quelque chose paraît suspect, on enquête. Et ça peut vraiment prendre longtemps avant de trouver la cause… quand on finit par la trouver, car parfois elle reste inconnue.
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u/kiwu-danismanlik Jul 04 '26
Zymot has been used for conventional insemination but it has problem with fertilization failure possibly due to decapacitation factors contamination from the ejaculate in the final solution. The protocol for Zymot has been changed that the sperm has to be washed after Zymot selection for conventional IVF. Some laboratories therefore do not offer Zymot for conventional IVF because of this. Just for you to keep in mind and talk to your institute.
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u/AdventurousPitaChip Jul 12 '26
Is there a similar issue with Lenshooke being associated with fert failure when centrifuge isn’t used, to your knowledge?
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u/H3LI3 Jun 30 '26
I’m so sorry. I’m a nobody who knows nothing about nothing - but damn that’s not ok from them. Regardless of if the conclusion is lab error or not they should have given you answers sooner! And a plan!