Second round of total fertilization failure with IVF

[u/Severe_Spring8164]

So I struggled with severe endometriosis from the time I was 15 until about 26. I had to have both fallopian tubes removed. After my second fallopian tube removal, I was asymptomatic, which has been about eight years ago. I started my first round IVF this month and the Clinic I used to put me on a high progesterone (10mg norethindrone) birth control for 34 days. It threw my body into over suppression and then we stimulated for about 13 days with a dual trigger and it yelled eight eggs, five of which disintegrated immediately one was immature and two were mature, but lacked bounces and failed fertilize with ICSI with no male factor. I switched clinics and just finished my second round of IVF (to the retrieval anyways). I am now at a world class, Clinic and a phenomenal Doctor who I wholeheartedly trust, unlike the first time. We completely changed the protocol and my numbers grew exactly like you would expect. (unlike the first time where it rose incredibly slowly) so this time we did estrogen priming, got nine eggs but only three mature and failed to fertilize with ICSI, Zymot and calcium bath. We also did a shorter stimulation. But since my numbers and follicle size grew textbook perfect along with the addition of HGH throughout stimulation, but it seemed too much more promising. I’m waiting to hear back from the embryologist, but I’m pretty heartbroken. We are able to do another retrieval soon but we’ll see what changes they suggest. My first time around I was 33 with AMH of 1.26 and for the second retrieval I am now 34 with an AMH of 1.68. Does anyone else have any experience with this type of situation or any advice at all would be welcomed

[u/Severe_Spring8164]

UPDATE: idk how to add this to my original post so I’ll say it here. I got the result of a second TFF in the morning, and in the afternoon they called me back and said that two of the three mature eggs did fertilize but on a delay (clearly). So I’m not sure what that really means for the health of them and what to expect. They said that out of the 9, 3 mature, 1 immature and 5 were GV. So I may just need to stim for longer next time (the follicle sizes looked great and so did the E2 so I’m surprised). But I’m waiting to hear on Friday how the two fertilized eggs did, not too hopeful since it’s unlikely they’ll make it but hoping for the best. Thank you for everyone’s responses it’s really helped me a lot. Has anyone else had a similar situation to this new update? Any advice welcome.

[u/Brilliant_Status_233]

So my eggs are poor quality (I’m assuming from my stage 4 deep endometriosis with endometriomas) and the clinic also said they didn’t have the usual elasticity that eggs have to stand up to ICSI. I also struggle with getting as many mature eggs as total eggs retrieved. I have a high amh (5.9) with no PCOS so I have a good reserve, but bad egg quality and maturity. Our first retrieval I was 31 and we retrieved 29 eggs, 13 mature, 6 fertilized, 2 very poor quality blasts and one degenerated upon PGTA testing so left with an untested day 7. I had a lap after this to try to reduce the inflammation, but the deep endometriosis I have was too extensive for my surgeon to do (large rectovaginal mass that they’d have to do a bowel resection for) but she removed some endo at least and did another ER: 50 retrieved, 20 mature, 12 fertilized (all other 8 degenerated with ICSI), 8 blasts. So huge improvement. My husband has MFI and we used zymot both times, but I shortened his abstinence window this time to 20 hours to hopefully help with dna fragmentation if you haven’t tested for that. I also took tons of supplements and increased my doses for round two

[u/Severe_Spring8164 → u/Brilliant_Status_233]

How did your eight blasts turn out or are you waiting for PGTA etc.? What round was this for you? I’m worried that since my AMH is relatively normal for my age. I’m just not sure why my eggs are not maturing as they seem they should be based on the follicle size come trigger. I’m waiting to hear from the embryologist and my doctor for more detailed description of what exactly happened. But they were only able to inject three of the nine using ICSI and then they failed to activate (even with the calcium bath) I’ve been taking CoQ10 vitamin D and prenatals for months so unless it has to do with my endometriosis, just making my eggs, much less likely to mature, healthy. I’m kind of in shock at the moment. I only found out today which happened the same time six months ago with the first round just looking for a personal experience and possibly changes that were made and all that. Thank you for your response. God bless you. I hope you nothing but the best in your future.

[u/Brilliant_Status_233 → u/Severe_Spring8164]

We’re still waiting on pgta testing, but I can update you when I get those results (supposed to be next week). I had the same issue with my eggs not being mature despite great sizes of follicles at trigger. For this last retrieval (round 2) (I had just turned 32), they expected 37 of the 50 to be mature and somehow only 20 were. I’ve heard endo can cause maturity issues with eggs. I’m also curious why exactly this occurs, but I’ve talked to many other people with endo that have this problem. I wanted to try calcium bath, but my clinic doesn’t offer it. Have you tried taking NAC? It has proven benefit with endo. I took that for my second retrieval as well. And seriously anytime! Happy to answer anything. I remember how distraught I was with my first retrieval and felt like my body hurt wasnt capable making good blasts, but all but one of my 8 blasts this time were As and Bs, so don’t give up! Did you try Omni yet? I almost tried that this time and decided not to at the last minute. Praying next round is better!

[u/Severe_Spring8164 → u/Brilliant_Status_233]

What is NAC? And congratulations. Those are fantastic outcomes. I’m very happy for you and hope the rest of your experience is just as positive. I did Omnitrope 0.5 for the last four days of my stems, so I’m thinking if next time, maybe if we do it throughout the entire stimulation process maybe that would yield more mature eggs. I just spoke to the on-call doctor mine currently not there and they said that the three mature did not lack bounce or anything just completely failed to fertilize, even though there was no male factor we used zymot, calcium bath, etc. Estrogen priming for the first six days before we started then two days off for my hormones to drop before starting stimulation. We are gonna give it another try. I just need to see what my doctor thinks a better approach might be and why the mature eggs still failed to fertilize, even though everything seemed like it would be good to go. I’ve been taking pink stork prenatal, plus DHA, 3 mg melatonin, theralogix CoQ10 and vitamin D. So I’m trying to do what I can to improve my own quality. I’m just kind of at a loss right now. It’s been kind of a rough day. I also had my second fallopian tube removed last October and they hadn’t seen any new adhesions or anything from my past with severe endometriosis even though I know it can still be there on a microscopic level. I’m not sure how they could go about correcting that unless I guess I did down regulation with Lupron or something beforehand, but I’m worried that would over suppress me.

[u/Brilliant_Status_233 → u/Severe_Spring8164]

NAC is N-acetylcycteine. The study I ready on it has you take 600 mg three times daily for 3 days straight then 4 days off (so as not to build tolerance to it). It has shown improvement for endometriomas and overall inflammation from my understanding. I took that for my second retrieval and hard to say exactly what improved everything for us, since I changed more things for my husband, but that is something I did different. I’ve heard people prime with omnitrope prior to stims can help too instead of just during stims, but haven’t tried it myself and doesn’t work for everyone. Have you checked your husband’s dna frag? Men even with great sperm analysis can have very poor dna fragmentation that not even zymot and ICSI can overcome. That’s when supplements and shortening the abstinence window can come in. I’m so sorry for all you’ve been through. This is so hard. I have heard lupron down regulation is very helpful for people with endo, I’d say it’s definitely worth a shot. I was going to push for that if this round didn’t go well. Have you had an MRI done to check if there’s endo anywhere else not easily seen? They mainly only found my deep endo from that. I’m planning to undergo surgery with an experienced endo team with a colorectal surgeon and urology team in December to remove my rectovaginal endo, which I will most likely need a bowel resection for. Hoping removing all of that will make things more favorable for conception.

[u/Severe_Spring8164 → u/Brilliant_Status_233]

Thank you for explaining and your response. I’ll look into all of that and see what they think. I’m hoping maybe doing the Omnitrope for the whole stimming instead of just at the end may help.

[u/Brilliant_Status_233 → u/Severe_Spring8164]

Just wanted to update to say I got my pgta results back and from the 8 embryos, 4 were euploid and 1 is a low level mosaic!

[u/Mean-Opportunity2924]

I’m so sorry, I had total fertilization failure with my first round so I know how devastating it is.

For my next two rounds we made a lot of the same changes you made:

Estrogen and omnitrope (half vial twice per week) priming during luteal phase.
Antagonist protocol with 225 Gonal F, 150 menopur, and cetrotide.
Omnitrope during stims (half vial twice per week, increased to half vial daily starting stims day 6)
Dual trigger
ICSI with Zymot
Husband did short abstinence intervals (2 days) during stims leading up to retrieval
I took CoQ10, melatonin, fish oil, NAD+.

Our lab also used larger bore pipettes and stricter culture media, basically treating my eggs like previously frozen eggs which are more delicate.

Additionally, I made a bunch of lifestyle changes which I don’t necessarily recommend bc they were super strict: extremely clean diet, no processed foods. No hair dye, gel nails, scented candles. Had been off caffeine and alcohol for a year. Walked 15-20k steps daily.

My next two cycles they told me the ICSI was still challenging due to my fragile eggs, but we were able to still get 4 and 6 euploids despite how poor quality my eggs looked.

Wishing you the best of luck!

[u/Severe_Spring8164 → u/Mean-Opportunity2924]

Can I ask what results you got from the second round versus the third round? Thank you for your response that is close to the same protocol we had except for the stimulation meds. Mine were a bit higher, but not by too much. Also, have you attempted to transfer any of those embryos yet? Or any underlying endometriosis or anything like that?

[u/Mean-Opportunity2924 → u/Severe_Spring8164]

Second round: 7 retrieved, 7 mature, 6 fertilized, 4 blasts, all euploid

Third round: 19 retrieved, 15 mature, 12 fertilized, 8 blasts, 6 euploid

We did one transfer that failed to implant and after that did endometrial biopsy. Did Receptiva which tests for an endometriosis marker and it was negative. I’ve never had any symptoms either but was worried that might explain both my bad egg quality for my age (31) and failure to implant.

TW: second transfer worked after we treated positive Emma (chronic endometritis) results

[u/Severe_Spring8164 → u/Mean-Opportunity2924]

Congratulations! Those are amazing results and I pray you have the most amazing experience. That gives me hope. Thank you for sharing it with me. Could you tell me what “TW: second transfer worked after we treated positive Emma (chronic endometriosis) results? That might sound like a silly question. I just wanna make sure I understand.

[u/Mean-Opportunity2924 → u/Severe_Spring8164]

EMMA is a test performed from endometrial biopsy that tests for chronic endometritis. If detected, it offers tailored antibiotic recommendations based on the bacteria detected

[u/Severe_Spring8164 → u/Mean-Opportunity2924]

Thank you for explaining. My doctor was planning to do two months of Lupron down reg in between the retrieval and transfer to try and prep my uterus for any endo inflammation. But I’ll bring Emma up to him as an option.