# 3rd failed ICSI - where do we go from here? Very poor morphology



## whigers

Hello,

We found out on Friday that our 3rd ICSI has not worked.  We are absolutely gutted.  I'm also terrified that having our own baby is slowly slipping away from us.

A bit about us.  I am 36 (well 37 in November) and my DP is 35.  I am fine but he has a very low sperm count & 2% morphology.

In 3 years we have tried everything, supplements, healthy eating, no alcohol, no coffee, acupuncture, Chinese herbs.......the list is endless.

Each cycle we have got a great number of eggs with above average fertilisation.  Our embryos never seem to get past day 3 though.  We just don't know if the embryos are arresting inside me or not implanting.

Does anyone know if the poor morphology is affecting the embryo development?  Are there any success stories out there with very poop morphology resulting in a pregnancy....?

I also just don't know what to do now.  We have been at the same clinic for all 3 cycles & although they have been good, they are pretty stuck in their ways & do not offer anything a bit different like assisted hatching, immune tests etc.  

We are going to look into the immune testing but we live in Edinburgh so are limited with clinic choice.  Has anyone else from Scotland gone down the immune testing route & if so where?  I know GCRM offer drugs to treat the immune issues but not the tests.

Also, with the hidden C test, does this have to be sent abroad? Can it be done in the UK?

It feels like we are making all these medical decisions without the knowledge so any advice from my trusty FertilityFriends would be so gratefully received.

Thanks.

Whigers xxx


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## BettyMax

I can't offer much advise but have the same problem with morphology only. MY husbands count and motility and fine, but the morphology is 1%. 

We got pregnant with our first ICSI but found out yesterday that it is either ectopic or missed miscarriage. Obviously we are devastated but the embryo did get beyond day 3 and hatched and implanted. I asked if it was linked to morphology and they said absolutely not because the sperm selected was totally normal. 

We can't work out what has happened to the morphology though and seems that you are equally baffled. I know this doesn't help, but thought I would share my story.


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## whigers

Hello Betty,

Thanks so much for your repsonse. I am so so sorry to hear about your ectopic/miscarriage. I can't imagine how it must feel to get a bfp only for it not to work out. You must be gutted.

I, like you, am confused about the whole morphology. I did post a question on the Agate board on FF http://www.fertilityfriends.co.uk/forum/index.php?topic=283000.0 and she replied which was really useful. As we have now had a 3rd failed cycle, my partner is going to have sperm dna fragmentation testing. We are both going to get tested for infections too. Apparently there can be hidden infections which can affect morphology of which a high dose of antibiotics can help.

Its reasurring to hear that you did get pregnant though so perhaps they work round the morphology.

The hardest part of this journey is not being able to get any direct answers. Its SO frustrating. I think once we have had all the infection/dna fragmentation tests we will move clinics & try a new drug protocol.

Have your clinic given you any indication as to why your husbands morphology is so low?

Thanks again & take care.

Whigers x


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## BettyMax

thanks Whigers, what we are going through is absolute torture as I still don't know if it's an ectopic or not. But I am holding onto a thread of positivity that we did get pregnant. 

The mystery is that my husband has his sperm tested last year and it was totally normal. Only going through ICSI have we found this new problem. The clinic can't explain it and don't know how to improve it! Like you say, very frustrating.


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## Nahla

hallo bettymax and whigers,

I have a similar problem: 

my partner has only 1% of normal formed sperm...and a low count and morphology as well.

we have had 2 failed cycles of ICSI and now we are about to start number 3.

I am a bit confused about the immune aspects...I have read Agathes threads you mentioned above this morning...and I am more confused as before. There are obviously so many things You can test my doc has never mentioned so far... and I am not sure, which ones are suitable for us.

We have had 2 fresh and 3 cryotransfers, we had always good embryos, some transfered at day 3 others at day 5. Up to the transfer everything went perfect...but I just once had a biochemical pregnancy, the others were just BFN...

I really am confused at the moment....

I wish the best for the 2 of You....


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## L_ouise

Hello, 

Sorry about your failed cycle  

My husband has very poor morphology, ranging from <1-3%.

It is just a percentage though and unless is 0% then it should be overcome with IMSI. ICSI is ok, but not the best available technique for identifying abnormal sperm.

We did have IMSI at one point and they did find some perfect sperm to use, so they are there.

If I was in your position, I'd go for IMSI + embryoscope and push for blasties. If they all arrest, they'll be able to see it and diagnose it better. I'd do that before trying for immunes anyway.


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## whigers

Hello Nahla & Louise,

I am also a bit confused about the immune tests.  I have mentioned it to my doctor previously and he pretty much said it was nonsense.  As far as I can see, its mainly the London clinics (well in the UK) that offer the immune tests.  I live in Edinburgh so would need to think about it & research it further before we go down that route.  I have just ordered a book called 'Is your body baby friendly' by Dr Beer.  Apparently this is a great book to explain all about the immune tests.  

I'd also never heard of IMSI + embryoscope.  I just googled them & I'm surprised we have not been offered these.  We are going to move clinic for our 4th cycle.  I think that may help as the one we are at currently at is a bit stuck in its way, offers one size fits all treatment.  Is PGS (Pre-implantation Genetic Screening of eggs) the same as embryscope?  The clinic we are moving to offer this.  Its £2,300 on top of the ICSI costs though which is scary!

I am going to ask for a hysteroscopy at our follow up appointment and have the hidden-C test.  My partner is getting screened for various infections and we are going to look at the dna fragmentation tests for him.  We want to get these all done before our 4th cycle.  

This is one frustrating journey!

Whigers x


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## Nahla

Hi Whigers,
Yes, its completely frustrating, as everybody tells you different things...
I am thinking about the fragmentation test as well.
PGS is when You take one cell of the embryo and look at the DNA, I think embryoscope is when they watch your embryos while growing...

Louise: as we had twice very good blasts at day five, the other times we transferred at day 3, I think, watching the embryos makes no sense for us. Apparently there can be genetic defaults that you cant see...


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## Helen78

Hi ladies,

Firstly,   whigers, I'm sorry about the bfn.

Thought I'd throw my experience in too....

DH's sperm is, to use a clinical term, bloody awful    His count has varied between 5 and 16 million, can't remember the motility % but its bad and morphology has varied between 1 and 4%.

Our DS was born as a result of 1st ICSI (NHS) last year. 9 eggs fertilised but 7 had high levels of fragmentation so 2 good ones returned and the rest were abandoned. I'm still a bit confused about the high level of fragmentation though, I presumed it was the sperm but I've recently been to a new clinic (private) and the consultant suggested the protocol (long) may have been the cause so he's recommended the short protocol for next try....

Sorry, that hasn't answered any questions other than that you can get  a healthy p/g with poor morphology whigers

Baby dust to all  

xxx


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## whigers

Hi Helen,

Thanks so much for your response.  Its really reasurring to hear about your situation & that you can still get pregnant with poor morphology, what a relief!  I was starting to worry that our chances were very slim.  

I have had the long protocol twice & the short once.  Wierdly the long seemed to work better with us.  When we had the short protocol, apart from getting less eggs, they only got to 5 cell and 6 cell by day 3.  With the long protocol, our embryos have been 8 & 9 cell.  We are planning to move clinic aswell and they suggested the agonist flare protocol.  I am a bit confused about this protocol so need to ask more questions.  Have you heard of it before?  Do you mind me asking what your AMH is?

Anyway,  good luck with your next cycle.

Whigers x


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## Mopsy

Hi Ladies

I wanted to give you all a bit of hope about morphology though. My husbands count is so low that the tests always say they can not advise on morphology. On every ICSI cycle it says mostly abnormal and they find 1-3 sperm per slide that look normalish (that means hardly any!). I managed to get pregnant and give birth to a beautiful, healthy baby in January 2011 despite this. The consultant is not that worried about my husband's sperm - they just need one that moves in the right direction and it looks like all you girls have one of those  . 

There are cases where the sperm is the problem of course and sometimes the sperm can even look normal but not be genetically able to produce a viable pregnancy, it's worth doing a DNA Fragmentation test - my husband did one and it was pretty average although it took three attempts to be able to give any information at all as he had so few sperm. If you are worried about sperm then Mr Ramsey on Harley Street is great. Although we went to have ICSI because of my husband's sperm my failed attempts look like its the eggs and my ovarian reserve is going down dramatically. Eggs are much more complicated than sperm apparently. Don't give up hope but have a few more tests would be my advice. Mopsy.


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## Helen78

Hi Whigers,

I've heard of the antagonist flare protocol but I'm afraid I don't really know much about it  

I don't know the actual figure for my AMH but both consultants said that they have no concerns about it as although its a little bit high its well within the range they would expect for someone with PCOS. 

Also just wanted to say as you mentioned you had 8 and 9 cells embies on LP, that we only had 6 and 7 cell embies but one of them did the job so try not to get too upset about results chick, you never know.

Thankyou for the good luck wishes, I've everything crossed for you that the next cycle is the one that achieves the dream  

H xxx


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## whigers

Thanks Mopsy.  Its fab to hear you had a gorgeous baby, congratulations.  It also gives me hope as count & morphology are our problem.  We are definitely going to have the dna fragmentation test & I am also going to have a hysterscopy.  We plan to start our 4th cycle in December/January so praying this next one works.

Helen - you do just never know.  I had a friend who had 2 top grade blastocycts put back and that didn't work.  It does almost seem like its luck & we just need to keep on trying.  I just hope it works for us next time as I am not sure how much longer we can go through this.  Fingers & toes crossed!

Take care.

Whigers x


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## Nahla

Hi everybody,

today I started stim...the 3rd time for us...I am pretty nervous.

whigers: we are also going to do the DNA fragmentation test although my doctor said it doesnt say anything important...but I want to know more about the sperm now.

mopsy and Helen: thanks for Your story...it really helps and gives hope to know that morphology isnt everything....my doctor told me last week in her opinion I am a very fertile woman...I wish it would work! Or, at least, I wish I knew definitely the reason and would be able to treat it.


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