# Poor Blastocyst Quality



## Cloclo15

Hi everyone,

I wonder if you can offer some advice.

We have undergone two ICSI cycles due to DH having very low count and poor motility/morphology.

Our first ICSI cycle resulted in my DS, but was not especially successful in terms of blast formation.

We got 31 eggs, 25 ok to inject and 18 fertilised (about 72% fertilisation rate)

On day 3, we had one grade 1, most were grade 2, some grade 3 and 4 were poor quality.

As expected, on day 4 we had 14 morulas, with 10 looking pretty good.

When we went for blast transfer we only had one 3bb blast to transfer (no more had made it yet, but it was early on day 5). By day 6, only one more had made it to blast and wasn't deemed good enough to freeze.

The 3bb blast however stuck and we had our DS.

In the meantime, my DH was advised to take Proxeed. On his pre treatment SA his count had reduced to 2mill and his morphology had reduced from 4 to 2%, however his motility had shot up from 15 to 74%! No longer classed as motility issue.

We have just done our 2nd cycle. We were advised to do short protocol this time as I had massively overstimmed on first cycle and was left feeling very ill. There was also some thought that the amount of eggs may have affected the quality.

I still responded quickly to stimms on low dose and had more than 15 follicles after only 9 days stimming. I stimmed for 11 days and 13 eggs were collected, 11 mature to be injected.

This time we only got 6 fertilise (55% fertilisation rate). All 6 developed normally, on day 3 we had 4 grade 2 and 2 grade 3. We were advised to go to blastocyst.

On day 5 we had one bb blast and an 'early blast' transferred. We were told that of the others, one had arrested, two were at the 'cavitating morula' stage and one was behind.

I started bleeding on OTD and unsurprisingly a BFN. We have been told we have no frosties, but I'm not sure if no others made to to blast or they just weren't good enough quality to be frozen. However, either way it is not a good blast formation rate.

We were told today it was really all about luck and ensuring that the right egg meets the right sperm. We certainly weren't discouraged from trying again.

What I wonder if anyone can advise is:

What would cause the big drop in fertilisation rate? Is this likely to be an egg or sperm quality issue? (I have been found to have optimal AMH levels, but could over stimming be affecting them).

Would the drop in sperm morphology have affected matters? Is there anything else DH can take/do to change this?

Why do we get such poor blastocyst rate? Is this egg or sperm?

What would cause the two blasts transferred to fail to implant this time? Is this likely to be an implantation issue or just down to blast quality? I thought once they made blastocyst they had got over a big hurdle developmentally? Is it possible to develop an implantation issue after having a c section?

Sorry for the barrage of questions. It is likely that we will have to wait a couple of months to get an appointment to discuss our failed cycle and I just want to get my head around it now. I realise that there may be no answers to this, but I'm hoping someone may have had a similar experience and improved matters somehow!

Thanks!


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## -Susan-

Hi, 
Sorry for your failed cycle. I don't have answers for all your questions, but some. They say ICSI overcomes male-factor problems like morphology, motility etc. The exception is DNA frag which might be an issue but you've had a child already so it's probably not a big issue. 

Your second cycle didn't get that bad a response in regards to getting to day 5, you do have to expect a drop-off in a typical cycle. The rate expected would be a bit lower with day 3 embryos that are at grade 2 and 3 too. The whole point of taking to blast is that they can choose the strongest when the embryos are about the same quality at day 3, they know there will be a drop off so going to day 5 means they can see which will manage the process of developing further. Blasts have a better success rate but it's still not certain at all they will implant, it's not necessarily an implantation issue particularly since you've already had a child. The fact you've had a successful cycle before does suggest it's partly down to bad luck. I would certainly be trying again in your situation.


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## Cloclo15

Thanks so much for your reply, it is going to drive me a little crazy to wait so long to debrief after this cycle as i keep googling all sorts and getting depressed. I am just desperate for advice before we head into another cycle in August.

I have read about DNA fragmentation - we were told we could go and get the test done before this cycle but I have to admit i am a little bit scared to in case the results are bad as there isn't anything that can be done about it is there? Because it has worked once i think we will have at least one more go and i don't want to go into the cycle without any hope. But perhaps I am kidding myself?

We clearly don't make great blasts but I'm hoping that the embryologists will be able to find at least one more decent sperm and one more decent blast will grow. Its just awful that we had two on board and neither stuck.


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## -Susan-

I know, I can imagine how difficult it must be getting a BFN with 2 blasts. You'd hope at least one was 'sticky'.

It depends what causes the DNA fragmentation really, sometimes it can be a hidden infection which can be cleared up with antibiotics, or it could be due to a fixable varicocele. It could be that DNA fragmentation is an issue and you were simply lucky first time round, even with high DNA fragmentation a healthy pregnancy is still possible. I looked into testing after my first cycle failed, it's not cheap in the UK (I think I saw the test advertised for £500) but in some foreign countries is much cheaper.

I wonder if IMSI would help in your case - it's good for poorer morphology, as they magnify the sperm even more than straightforward ICSI to choose the very best looking sperm, with the idea being the ones with the best morphology are probably the most likely to be healthy inside (i.e. the DNA is likely to be less damaged). Not everywhere does it mind, and it does come at an extra cost. It depends if you want to throw everything at your next cycle, or whether you think it was bad luck and are willing to try the same as your previous cycles again. x


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## Cloclo15

I don't think my clinic does IMSI so I would have to look elsewhere for that. I'm not totally averse to changing apart from the issue of having a toddler and trying to get to appointments a long way away.

Can I ask what if anything you did differently between the first and second cycles? You say on your first cycle you had poor/slow development but on your second you even managed to get a frostie (which we never did!).

I am wondering whether changing from long to short protocol had a negative effect, but I suppose only the clinic can tell me that. It just seems strange that we would go from 72% to 55% fertilisation rate. Isn't that supposed to be to do with egg quality or could that be sperm too?


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## -Susan-

Well he took supplements like high vit C and E, vit D, zinc, etc for our second cycle, but actually his sperm quality was worse for our second cycle than our first! Poorer morphology, count, motility etc. It's different for us because we had PGD (genetic testing, as my husband has a serious genetic condition) and it's always a lottery with that anyway. For our first cycle it was simply the case that only the poorest embryos at day 3 were the ones free of my DH's condition, whereas this time the best quality one was free of it and has resulted in a pregnancy. The embryos affected by his condition are destroyed before day 5, so it's difficult to tell what our blast rate would have been without testing. His sperm sample was worse than your DH's though, think our morphology was 2%, but motility was practically 0 (the embryologist said only some were 'twitching'), so it can happen with poor samples 

We were told our considerably-lower fertilisation rate this time was probably due to poorer sperm quality, so I guess in your case it could be egg or sperm. Protocol can make a big difference, it might simply be short protocol isn't right for you. I'm sure if you raised it with your clinic they'd have an opinion on it.


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## Cloclo15

Thanks again for your help, I appreciate you taking the time to give me advice. I suppose the poor fertilisation rate could be down to a bad batch of sperm in our case too then. I have my fingers crossed we can sort it out. DH is taking Proxeed, I might try to get him to take Vit C and Vit E too. Are they safe to take for prolonged periods?

I am also wondering whether we should ask about them using the frozen sperm that they have from before we did our first cycle in case that is any better? I don't know if the success rates with frozen sperm are worse though.

I don't know if the clinic would let me go on long protocol again as I massively overstimmed last time and I think that compromised egg quality to an extent. However, I'm prepared to do anything to up our chances. I'm wondering now whether to pay for another consultation rather than wait for the follow up appt just so I can ease my mind about the cycle and any changes we can make.


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## simone546

Hi,

Sorry about your bfn. Our first cycle produced poor quality embies... All grade 3 on day 3    

However, for us switching to the antagonist short protocol and lots of coenzyme q10 worked much better for us.. Still waiting for that sticky bfp though. I think the main issue with us is egg quality - day 3 poor quality is mainly down to egg. Ours always perk up when the sperm kicks in and our day 3 make it to blast but not great ones.



Good luck

Xxx


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## Cloclo15

Thanks for the reply. I'm not sure whether it is sperm or egg or both for us. I know that we have bad sperm as everything always takes a nose dive after day 4. However, what we get fertilised usually survives up to day 4 and some a bit longer. 

But we never have top grade embies on day 3 either, I think we have only ever had one grade one on day 3. And I'm not sure if that is down to egg or sperm quality. I know I have quite high AMH (in the optimum range) but this doesn't seem to be translating into quality embryos. I'm not sure if the sperm is so bad it is causing this, or if over stimming is compromising quality too.

I wish you every success for a BFP - it is worth all the heartache.


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## Bubbles12

Hey,

I have never had 'great' blasto quality.. Mine tend to become slow growers after day 4... Ive had an early blasto transferred on one cycle and a day 6 blasto transferred on my 2nd..

The clinics have always told me that so long as the sperm fertilises the egg, then the issue is not with the sperm....

Confused!

X


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