ICSI

[talktime]

Hello Doctor,

I have just had a failed ICSI cycle. They retrieved 7 eggs, and 5 fertilised. All went well until after day three when they
deteriorated. Prior to that we had "A" grade embryos, even an early morula . By day five we had no blastocysts. only a ten cell embryo left, which they transferred. Needless to say, it did not work out. My partner has submitted a sample for a sperm fragmentation test.
I really dearly wish to have a family. My issue is - even if we do another cycle, how do we get better results from it ?
Is it possible to get better results next time? How many does one do before success or giving up ? Enduring another failed cycle would just break me.

Thanks for your time.

[LvnEmbryos]

It is really used as a diagnostic test and the embryos if they developed would be discarded -- or I suppose you could pay to have them frozen and then donate them to another couple or to research.  GL!

[talktime]

i really do not want to have a donor baby. What would they do with left over embryos in this case ?

[LvnEmbryos]

That is reasonable...we usually suggest it in patients with fert issues or multiple miscarriages.  You must do what you feel is best though.  Also have you ever thought about doing a donor cross match test?  In this test 1/2 the eggs are fertilized with your partner and half with a donor.  Then  before the transfer if you only have donor embryos you can choose not to have the transfer.  This is one very definitive way to know if it is a sperm issue before doing PGD.  Much cheaper as well.

[talktime]

PGD is very expensive, more expensive than a cycle, and cannot claim any of that back from insurance. My doctor said that she does not routinely advise it and that the technology is such that she would still recommend antenatal screening to confirm the result. She says that it would be worth considering if i had previously had a downs pregnancy for example.

[LvnEmbryos]

Those are the only ones I know of, besides sperm binding assay which is irrelevant with ICSI or anti sperm antibodies, also irrelevant with ICSI.  Have you thought about looking into egg issues?  PGD maybe?

[talktime]

Hi

any other tests you think we should do ?
we started off with male factor, I really don't know if it is an issue with the eggs.
i just would like to know what factors could cause ICSI to fail when all seems ok.
And how we can prevent another failed cycle

[LvnEmbryos]

Well try not to be TOO frustrated, that is good news that there is no sperm problem, but it might be bad news for the eggs.  Have you considered having pre-implantation genetic diagnosis done to see if the embryos are normal (really diagnoses the eggs because 97% of embryo chromosomal abnormalities are due to the egg).

If it is an egg problem unfortunately there are not a lot of options besides donor eggs, which is a difficult decision.  Keep me posted!!

[talktime]

Hello !

We got the DNA fragmentation test back. It was 4.6%- totally normal.
Which makes me wonder why our ICSI cycle failed. Maybe it was the protocol used.
my estrogen was way up at 6000 when I triggered. I am no expert but I have read that high estrogen can cause poor quality eggs.
You mentioned other diagnostic tests- could you tell me what they are ? I really want my next cycle to work. I am considering changing clinics. is there anything else you can reccommend ?
thanks very much for your help

[LvnEmbryos]

I think if ICSI is not working for you a donor might be a good idea.  You could always try with 1/2 donor and 1/2 partner and then it will tell you if the egg or the sperm is the problem.  Then they can keep track and before your transfer you will know if the embryos are donor or your partners and have the decision to choose not to have the transfer.  I would definitely recommend a DNA integrity test too which can tell you more about the overall health of the sperm.  There are still many more diagnosic tests you can have on the sperm to better understand what the issue is.  Good luck to you!

[talktime]

So do you mean be prepared to have a donor baby ?

[Heather5]

Yeah, they don't seem to answer the posts very often over there. Last time one of the doctors answered there was on February 28, which opened it up for new questions again, so I posted a question on the 29th. Still no answer. And the forum got "full" again a day or so after I posted. Not really sure why they're not following up on that forum.

[talktime]

Hi

anyone know how to post on the experts forum where a doctor responds ?
Every day it says tthat it has reached the daily limit. Last post seems to be from
february
thanks

[talktime]

He recommended we do it when i went to see him about what happened in the last cycle.
I have done two IUIs and one IVF last year. None of the eggs fertilised with the ivf because the sperm did not bind to the egg. That is when we were recommended to do ICSI. So it has taken all of those cycles to get to a point where they are doing this test on the sperm. It takes three weeks to get the result. He submitted it last week. His morphology rose after a varicocele operation 3 years ago from 2% to 14%. sadly this still has not been enough to get me pregnant.

[rghkah38]

We are kind of having the same problem as you.  Did your DH have a sperm analysis done?  What were the results?  I asked my Dr. a few months ago about doing a sperm fragmentation test, but she said the results from his sperm analysis was good and they choose the best sperm to put in each egg for ICSI that there was no reason for doing that test.

[IlliniQT]

I would say if you have three failed IVF's then nothing will probably change.  I would suggest trying 1/2 with your partnets sperm and 1/2 with a donor, then you will know if there is a fertilization issue which is causing your embryos not to develop past day 3.  Good luck to you.