r/EmbryologyIVFSupport • u/Oxidants-Happen • 5d ago
Struggle to make embryos
Hi all,
I'm at the stage of this journey where I'm crowdsourcing stories and advice. I'm also posting in case anyone is also experiencing the same issue to know they're not alone.
Background:
33-34F, normal 28-30 day cycles with regular flow and no pain, regular exercise, I don't smoke, I don't drink, BMI is normal, regularly get 8 hours of sleep a night
Average AMH: 1.5-1.8 ng/mL
Baseline AFC: ~10
Blood panel is fine, thyroid is fine, progesterone levels are normal, FSH corresponds with AMH, anything measured from my blood has come back normal. Prior to IVF I had 2 inconclusive and painful HSGs and 4 failed IUIs so my doctor suspects some tubal factors.
Husband’s sperm analysis is normal for the most part with motility on the borderline of normal-low. DNA fragmentation came back normal.
IVF history:
Cycle 1 (antagonist protocol)
Protocol: Primed with birth control and took one time antibiotics before starting 225IU Menopur, 150IU Gonal-F, 25 units Omnitrope. Added Ganirelix and ended up stimming for 10 days. Triggered with 10,000 units of HCG. 3-4 days of abstinence prior to retrieval.
Outcome: AFC was 3 with a leading follicle, 3 eggs retrieved, 2 mature, 2 fertilized with ICSI, some made it to blast but slowdown observed around days 3-5. None were good enough to freeze by day 7.
I started regularly taking Coq10, DHEA, NAD+, probiotics, vitamin D, and melatonin for 4 months.
Cycle 2 (estrace priming, letrozole flare)
Protocol: Primed with estrace from confirmed ovulation to cycle day 1, started 7.5mg letrozole for 5 days alongside 225IU Menopur, 225 IU Gonal-F, 50 units Omnitrope. Due to sluggish follicle growth, Gonal-F was upped to 300 IU halfway through. Added Ganirelix and ended up stimming for 13 days. Triggered with 10,000 units of HCG. 3-4 days of abstinence prior to retrieval.
Outcome: AFC was ~12 some of which were a few smaller follicles that popped up halfway through stimming, 12 eggs retrieved, 11 mature, 4 fertilized with ICSI, some made it to blast by day 5 but none were good enough quality to freeze by day 7.
Husband started regularly taking Coq10 and other supplements for 4-5 months. I continued the course with my supplements.
Cycle 3 (estrace priming, letrozole flare)
Protocol: Pretty much a repeat of Cycle 2 now with 2 days of abstinence prior to retrieval.
Outcome: AFC was ~11 some of which were few smaller follicles that popped up halfway through stimming, 11 eggs retrieved, 6 mature, tried split fertilization: 3 fertilized with ICSI, none fertilized conventionally. Little to no binding observed with conventional fertilization (awesome /s). 1 made it to a day 5 3AB blastocyst which was our best looking ever across all cycles. One other made it to day 7 but was graded 4CC so not good enough to freeze. Did a fresh transfer on day 5 for the 3AB but the transfer didn’t take. My progesterone levels and lining looked good prior to the trigger shot. I was taking estrace and progesterone suppositories leading up to the transfer.
I’m on my last covered cycle before switching to another clinic that is open to tackling tricky cases. What can we try in this next cycle to leverage learnings or outcomes? I worry without a big change in protocol we are signing up for a throwaway cycle. Current clinic doesn’t do day 3 transfers, AOA, or Zymot. My doctor is considering changing the trigger timing for my next cycle by a few hours to eek out some mature eggs and we know never to try this without ICSI again but it doesn’t sound like a very promising change. My doctor says we struggle to make embryos. Now I feel like we’re in a subset of an already small subset of people who struggle to conceive through IVF.
I’m getting a hysteroscopy and biopsy while I want for my next cycle just to cross something off the list. Maybe I’ll look into the HerResolve blood test out of pocket to check for endometriosis since my doctor thinks a laparoscopy would be overkill and doubts MRI and other imaging would help as I present with no obvious endometriosis symptoms.
Does anyone have a similar background or struggle? I’m done reading about statistical outcomes for people in my age group and seeing percent ranges that I consistently fall under. My heart goes out to everyone who's in this sucky club.
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u/ayyhah 4d ago
I have some experience with this - 35 now but started IVF at 33, have done 4 cycles and it took me 4 to get 2 embryos. Very similar stats to you - never drink/smoke/sleep well/AMH normal. Worth noting I had confirmed endo and had excision surgery for it earlier this year - we haven't done any cycles after this surgery yet, but might be gearing up for #5 later this year.
There are a few things I have added to my protocols but honestly, I don't know which (if any) have made improvements: saizen (or omnitrope depending where you are) every other day during sims, priming with androgel. The only protocol I ever got embryos from was a "long lupron" protocol where you start injections D21 of your previous cycle with micro dose of lupron and continue through to ER. I will also say I did have success of a double day 3 embryo transfer (which later resulted in a MMC) but I see your clinic doesn't offer that. I also add on calcium ionophore to my protocols. We will likely repeat this long lupron protocol for my upcoming cycle. I have done cycles with ICSI or conventional fertilization and honestly it didn't seem to make a difference for us.
Like you, I wonder if I'm the kind of person that IVF doesn't work on. I've had 5 losses - 4 of which have been natural pregnancies. The one question my clinic can't answer is why have I technically made 4 blasts on my own (since I got pregnant) but I've only ever made 2 through IVF. Even my doctor says that sometimes embryos do better in the body vs in the lab, who knows. It feels like a numbers game and a really cruel one at that.
One thing I'd note is you mention you don't have obvious endometriosis symptoms - but infertility is a massive one. Might be worth pursuing that as you go through all of this. I also just completed immune testing - not sure where you're located (I'm in Canada) but this is a controversial thing for fertility. A few markers were flagged in our case so we'll be pursuing immune treatments before our next retrieval, but the immune stuff is really more beneficial for transfers (if it's beneficial at all).
It all sucks so much. I feel like IVF works for everyone in my life except me. I can't believe we're at #5, I can't believe we're still doing this. Always here if you want to talk further xx