# Poor egg quality during IVF - advice needed what to do next



## Nikki3622 (Mar 14, 2015)

Hello,

I was wondering if anybody could give me some advice on my situation. So far, I had 4 failed IUIs (and I believe they failed for various reasons, bad sperm count, bad timing etc.) and 1 failed IVF attempt. During the IVF attempt, 17 eggs were retrieved, but only 3 fertilized and only 1 of those 3 developed normally. I am not sure what to do next. 

It looks like my egg quality was poor and it might be due to my age (I was 36 at the time and now I am 37) or due to the fact that I got (a little) overstimulated or because the eggs were retrieved a little too early. All these things have been suggested by different doctors. It looks like I get a new answer from every new doctor I ask and I am so confused what to do next.

a) Should I try another IVF (possibly with lower doses of hormones)?
b) Should I head straight to ICSI? Some say it only makes sense if the sperm quality is bad, but others say, it is also used if the egg shell is too hard and that might have been the case.
c) Should I head back to IUIs (maybe medicated ones this time)? It would be much more affordable and after all, my egg count was good and maybe it just did not work because I was overstimulated?
d) Should I get any tests done before trying anything? (I pretty much had my hormones tested and US done, but I did not have any other tests to see what is going on in my uterus or ovaries. All I know is that it is highly unlikely that I have PCOS.)

Any suggestions?

Thanks for your help,
Nikki


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## CrazyHorse (May 8, 2014)

Lower stims and ICSI sounds like a reasonable course of action to discuss with your fertility clinic. There are a lot of reasons why fertilisation might be poor, and ICSI would be likely to help (although it does not work with immature eggs). And 17 eggs *is* a lot -- you might get a reasonable number but with better quality on a lower dose of stims.

Have you had an HSG to determine whether your Fallopian tubes are open? If not, I wouldn't do any further IUI until you've had that test done -- if your tubes aren't working properly, IUI is a waste of money.

Do you have significant male factor issues? The clinics I've dealt with generally seem to regard IUI as not much better than timed intercourse (assuming you're in a hetero couple), if count and motility are OK. 

Wishing you lots of luck!


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## Nikki3622 (Mar 14, 2015)

Hello,

Thanks for the response. I am single, so all my attempts were with frozen donor sperm and intercourse is not really an option. One of the doctors I consulted said that some of the frozen sperm loses quality after thawing and just cannot penetrate the eggs anymore. So, he recommended using ICSI right away. Another doctor said that ICSI only makes sense if you have poor sperm quality and if you buy frozen sperm, the good quality is pretty much guaranteed. He thought the egg quality was the problem and ICSI would not help if the eggs are just not good enough. The problem is that my last clinic would not even tell me anything about the egg quality. I asked them if the eggs were immature and they told me: We cannot tell. - Which I think is not true, but maybe they did not want to admit that the retrieval was done too early. I don`t know... ICSI is quite expensive and I am not sure if it is wasted money if my egg quality really is the problem.

Thanks for the advice!

Nikki


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## CrazyHorse (May 8, 2014)

Actually, they probably couldn't tell whether the eggs were immature. When traditional IVF is performed, the cumulus surrounding the eggs is left in place, and the embryologist cannot visualise the internal structures of the egg. When ICSI is performed, the cumulus is stripped away, and then the embryologist can see how the egg itself looks. As you mentioned in your original post, eggs from older women can sometimes be more difficult for sperm to penetrate, and in that scenario ICSI can help even if you are using high-quality sperm.


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## Nikki3622 (Mar 14, 2015)

Oh interesting. I heard from other women who said x number of their retrieved eggs were immature and I was surprised when I was told that my clinic could not tell. 
The next doctor I consulted also asked me if they were mature and when I told her that they could not tell, she said, they should have been able to tell. 
Or is saying that the eggs are immature just a general excuse doctors use if they don`t know what is going on? When I get so many contradicting messages from doctors, I find it hard to know which one to trust.


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## Fraggles (Jul 3, 2009)

Nikki where are you having treatment? If you would consider going overseas I would suggest speaking to Penny at Serum in Athens. Good luck. x


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## Fraggles (Jul 3, 2009)

Penny sometimes does low stim IVF or a natural one which can result in fewer eggs collected but of a higher quality. She also seems to have a good conversion rate from egg collection to transfer.


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## CrazyHorse (May 8, 2014)

Just wanted to add, ICSI is not really a cost factor with a lot of overseas clinics. The clinic I just had a successful cycle with, does ICSI as standard on all their cycles -- I actually had to request traditional-style IVF where sperm meets egg spontaneously in a Petri dish! (Which made sense in my particular case because DH and I have had good fertilisation rates previously.) The cost of a mild IVF cycle with them, including ICSI but not drug costs, is 1070 EUR, and that's after they put the price up recently. PICSI (which I would recommend to anyone going the ICSI route, as it doesn't rely solely on the embryologist's eye to select the best sperm) is an additional 150 EUR. Even when you factor in the cost and hassle of travel, and of scans and blood tests at UK ultrasound clinics and labs, it is SO much cheaper it's astonishing. And I thought the quality of care was just as good, honestly.


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## indekiwi (Dec 23, 2008)

Hi Nikki,


Have you had a hycosy / HSG done to check that your tubes are undamaged / open? In the grand scheme of things you are still a young woman and success rates for IUI should be pretty good.  In your shoes I would be tempted to have another 3 - 4 goes at IUI on low stimms and with regular scans from day 8 / 9.  I am far from an embryologist (!) but it sounds to me (from the response of the clinic where you had the IVF cycle) that egg collection might have been premature.  17 eggs is slightly higher than the 8 - 15 that most clinics would be aiming for their patients to produce, so IMHO it doesn't sound (on the surface at least) to be overstimulation.  And yes, it could be that your egg quality is at issue, but I'd be hesitant to say that if your clinic really couldn't tell whether or not the eggs were mature in the first place - I just don't buy it.  Regarding ICSI, it probably confers upon the embryologists greater control in delivering successfully fertilised eggs, but with the high quality sperm that is available through the donor banks these days, it really shouldn't be needed.  And yes, there are some outstanding clinics outside of the UK with fantastic success rates and at a much lower cost, but equally, there are some very good clinics here too.  For my money, I would revert to IUI as mentioned above, and then if they didn't work, try a low stim IVF cycle with someone like Create or perhaps, as Fraggles suggests, Serem in Greece.  I would definitely consider changing clinics from the one where you had your recent IVF - all sounds a bit too opaque for my liking. 


Good luck!


A-Mx


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## Nikki3622 (Mar 14, 2015)

Hello,

Thanks for all the advice. Let me answer a few points here:

Clinic:
Thank you for the advice about the clinics in Greece - I had not really explored that option before. My problem is that I currently live and work in the US and that I just cannot afford IVF/ICSI treatment here. It is so expensive!!! If I wanted to seek treatment in Europe, I would have to make a lot of time to travel and that is a bit of an issue. Having an irregular period makes planning things like this even more complicated. The prices in Greece sound awesome, though. I am impressed! 

More IUIs:
I had my previous IUIs here in the US, too. And here, it seems to be common that if you have had 4 failed IUIs (either without medication or just with clomid or letrozole /famara), they push you to move on to IUIs with heavier hormone stimulation. One doctor gave me an estimate and a stimulated IUI would have cost me as much as an IVF attempt in Denmark. Since the chances are better with IVF, I decided not to mess with the stimulated IUIs. I am not sure if I will find another doctor here, to try another IUI.

Testing:
I did not get my tubes checked, yet, but I might consider it if I will find a way to try another IUI. I consciously did not get it checked because I did some extensive research on this issue and together with several doctors I consulted, I came to the conclusion that it is highly unlikely that I would have blocked tubes. Since this test would have also cost me $500-800 out of my own pocket, I decided not to get tested. If I try more IUIs, I might reconsider it though.

Egg quality:
I honestly don't know if the egg quality is an issue or not. I am overweight. So, that is definitely an issue. Then, because of I am overweight, I stimulated with 300IE Gonal F for 10 days. I heard this is higher than the normal stimulation and even the clinic I used last time said that they would recommend a lower dose next time. The day before the retrieval, the biggest follicles measured only 18-19mm. with about half of them being less than 17mm. That's why another doctor suggested that they might not have been mature, yet. The fact that only 3 of these eggs were successfully inseminated still shocks me. If they cannot get inseminated in a petri dish, how can they get inseminated in my body? I really don't know what to think... 

I feel a little trapped between a rock and a hard place. I cannot afford ICSI here in the states, but IUIs might just not do it for me and my old eggs (if I am lucky enough to find a new doctor who would try it with me).

Thanks for all your help and suggestions. Keep them coming. It is so nice to have someone who listens and understands.

Nikki


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## GIAToo (Nov 8, 2009)

Hi Nikki
Personally I agree with Indekiwi - I would try more IUIs - but get your tubes checked before you do.  If you want to get an indication of egg quality then I would get your FSH and AMH levels tested.  High FSH and low AMH may indicate a poor ovarian reserve.  But even if that was the case I would still try IUI.  I had premature menopause and I went to see Peny at Serum.  She suggested IUIs and I wish I had taken her advice (although I have a wonderful little boy now through donor embryo treatment   ).

As for clinics not "letting" you do IUI - it's your body, your money and they should go with your wishes! If they don't, go to another clinic.

Good luck - making decisions is always the hardest part I find.   
Take care 
GIA Too xx


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## GIAToo (Nov 8, 2009)

"If they cannot get inseminated in a petri dish, how can they get inseminated in my body? I really don't know what to think... "

Just wanted to add that a lot of fertility specialists believe that IVF drugs can badly affect egg quality.  Perhaps mild IVF might be a good option for you too.

GIA Too xxx


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## indekiwi (Dec 23, 2008)

Sorry Nikki, I'd assumed you were based in the UK as this is a UK site (my fault entirely - there are plenty of women who use FF and are based elsewhere in the world).  

If your lead follicles were measuring 18 - 19 mm, I'm guessing your consultant would have had to carry out retrieval either one or two days later in any case as the last thing they would have wanted was for you to ovulate before they had time to collect your eggs. I never used Gonal F so am not familiar with the dosages.  Maybe someone else can chip in there.  

Here in the UK, couples are generally advised to try naturally for a year before seeking help to conceive.  The closest thing that single women using a clinic and DS can do to emulate this is IUI (stimulated or otherwise).  A couple would have 12 windows of opportunity during the year to conceive.  4 x IUI falls rather short of this.  Moreover, I note what you say concerning your consultations with doctors concerning the likelihood of blocked tubes.  Again, in this country at least, many clinics push strongly for IUI candidates to have a hycosy, and a number of individuals who have posted on the singles threads over the years have found that there was a blockage or other problem on one or both sides.  It really is worth ruling out, despite the additional cost.  Finally, as GIAToo points out, there has been linkages made between IVF stims and egg quality.  This might be something you want to take up with your consultant or at least do some further research into.  It may well be worth staying to mild stim IVF / natural IUI.  I would in any case get a second opinion and consider changing clinics - fertility treatment is big business and I don't really understand why you feel you might not find another doctor (again with apologies - I simply don't know the locale where you live and what is available to you).  

A-Mx


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## Nikki3622 (Mar 14, 2015)

Thanks again for all the advice!  

My FSH and AMH levels have been tested a few times and each time they all still looked very good - my reserve still looks good. 

I think the reason why many doctors only want to do 4 IUIs here and then move on is because there are studies out there that say if you do not get pregnant with clomid on your first four attempts, the chances to get pregnant after taking it more than four times are super small. And I don`t know how the health risks are if you take it over a longer period of time. 
I had one natural IUI, 2 with clomid and one with femara. And I would assume the studies all expected to have 4 perfect attempts, not attempts where it turned out that the clinic had lost 80% of the motility after washing the sperm, or the doctor had insisted on doing the IUI on day 13 even though I never ovulate before day 16 and the ovulation test did in fact not show a positive result until day 16.

I have an appointment with another clinic in 2 weeks and will see what they say. It will not just be a second opinion but actually a 5th opinion and every doctor I saw, said something slightly different... Some of these opinions did not make the slightest sense to me. I consulted a doctor who wanted me to deposit several thousand dollars for a laparoscopy right away and gave me instructions how to cheat my insurance company. He wanted me to do every test under the face of the sun. A few months later, he got arrested for tax fraud. Let`s hope that the next doctor I will see, will be nicer and give me advice that will actually be sound and helpful.

BTW, I posted a link to a survey that I started with a few women from a German and a French forum for single mothers by choice. We already got answers from all over the world, but the UK and Irish section are a little bit underrepresented. So, if anybody has a few free minutes, your participation would be highly appreciated. You can find the link in the research section under "international survey". Thanks!


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## natclare (May 27, 2011)

Dear Nikki and lovely to see you here. You have already had a lot of good advice from my friends indekiwi and Gia. I feel that they are right to plough on with IUI but get your tubes checked first - it may seem expensive but it would be 800 US well spent. I would think if you are getting 17 eggs then you have a really, really good chance with IUI. 
If the IUIs fail and you do end up looking to Serum then there are a few things I can add. You can have a free telephone consultation with Penny at Serum now or at any time you like - she will schedule this and it would probably take 30 minutes (just sign up on their website and fill in the detailed form). I would say why not do this now as it may also aid your decision making whether or not you end up having treatment there. If you do end up having IVF treatment at Serum their one cycle price is 3000 euro and 2 cycles are 4000 plus your medications (1-2000), flights and accommodation which will bump up the price. Technically your DS must be anonymous but there are ways around this. Incredibly DS is free at Serum, obviously costs more to buy and send it from a US bank. ICSI if you need it (with DS I can't imagine this would be very likely) is also not chargeable there. I realise that traveling is difficult, but you would also have a 2 week holiday which is quite a nice bonus (you would only need to be there from day 7 of your cycle and leave after embryo transfer). Wishing you all the very best of luck.


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