# Lots of promising Embryos but nothing to transfer, what else can we do?



## EdnaAverage (Aug 11, 2015)

Hi all,

Newbie here but been lurking for a little while now. Myself and OH are both 41 and after TTC #1 for 2 years, we finally started treatment this year.  The road to ICSI has been tortuous with me needing to get a polyp removed, a cyst drained and a dust up with my GP over an underactive Thyroid which was 3.8 TSH or normal according to him...... 

My AMH is high at almost 50 so OHSS and over response was always going to be a potential issue.  We also have MFI issues, namely morphology so it was always going to be ICSI and likely a FET due to OHSS.  We visited two clinics, GCRM in Belfast and SIMS in Dublin before settling on the latter who we felt were much more progressive and inclusive.  We've been very well looked after through the whole process there and I highly recommend them.  

Stims on short protocol were textbook, I did over respond but not too seriously and they got 13 eggs, 12 of which were mature. 9 fertilized and at least 5 were EEVA high predictors late on day 4.  Well, we just weren't prepared for what happened next at all - basically they all fell over on day 5 with nothing to freeze.  This was the one outcome that we didn't even consider so were devastated, I'd assumed we'd get to transfer and it might fail there.  It's just so surreal and feels like the cycle didn't happen, other than some half used medication in the fridge!

Sims were as surprised as we were and instead of suggesting DE as I thought they might, they want my OH to have FISH and Fragmentation tests as apparently last min failure of the embryos can be due to Sperm issues. We're about to do both tests and I'm terrified that the FISH is going to show a serious abnormality.  Fragmentation can apparently be worked around to some extent with lifestyle changes and SSR but a poor FISH result would bring us to donor sperm which would be devastating for my OH. Given our ages, I'm not in the clear regards egg quality either of course....

We've taken all the vitamins etc religiously for months and eat pretty well.  I exercise well but not too much (OH could do more and is about 1.5st overweight) and overall we're in good health.  Has  anyone else had this happen or can suggest any other things to try?

I was on 112.5 -150 of Gonal F + Luveris and Cetrotide.  I've been taking Levothyroxine for 6mths and am under 2 TSH at last test and am now taking Metformin due to official PCOS diagnosis.  Is there anything at all that we can do?

TLR - Lots of high quality embryos fell over on day 5 before freeze. 

Sorry for war and peace, I'm a bit lost right now!

edna


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## Wishings15 (Mar 27, 2015)

I don't have the answer, but I hope someone else will be able to shed some light it xxx


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## EdnaAverage (Aug 11, 2015)

Thanks wishingonastar, see you've had some disappointments yourself too even with using donor. It must be so hard as you assume that donor's another step closer to resolving any lingering issues so you always think it's more likely to work. How have you found GCRM over your two cycles there?

One thing I didn't mention in my post was that outside of the vitamin regime, I've also had maya massage and accupuncture.  While both have been enjoyable, I'm not 100% sold on the benefit that they bring. It's amazing what you'll try to give this very expensive process the best chance of success.

One thing which I didn't do which I will do next time will be to take protein shakes and milk during stimms, I didn't like the idea of all the other rubbish in the former but maybe more protein would have helped us over the line and made stronger eggs which might have helped. That is assuming we have another cycle ourselves based on the outcome of the two sperm tests, will freely admit I'm bricking the results......

E


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## bundles (Jul 16, 2011)

Hi EA   Tbh your clinic are bang on & the defrag & Fish would be your next step. For me, one of the most important things in this 'game' is to stay as calm as possible. There's no point in worrying about things you can do nothing about   While your waiting for the results, start the sperm improving vits & supps, as it can't hurt. Have you both had Karyotyping ? (More of an exclusion suggestion than an indicated one) Not sure about the massages but I used to listen to Paul McKenna I can Make you Calm every evening in bed. Used to help me sleep and did make me feel very relaxed.
Good luck
xx


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## Wishings15 (Mar 27, 2015)

I haven't found them ok. Sometimes the nurses are lovely, kinda but at other appointments I think - that they should be working somewhere else if they don't have any sensitivity. 
I tried the protein shakes but found it hard to reach the recommended 60g per day.
There are loads of vitamins that you can take for egg equality, I'm taking like 8 vitamins from Holland ans Barrett a day to help with implantation.
I will take a look at the list I have and pop you pm
I'm going through a fet at tmoment, and think it will be one more attempt then DE overseas. I know everyone's opinion differs so might on the donor side but I can honestly say that I wouldn't care either way
This is such a long and stressful journey, i hope you find the answers in your next steps
Sorry for the typos (predictive text) 
How are you finding your clinic x


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## Bluebell82 (Jan 24, 2015)

Hi EA,

Do the DNA fragmentation test, but also be aware that your options after that are limited, especially if your partner has already been living a healthy lifestyle before the test. Sometimes they switch from IVF fertilisation to ICSI with high fragmentation, but since you've already had ICSI, this is not an option for improvement.

If sperm parameters are healthy, then there is a reasonable chance that the low embryo quality is due to the egg. On day 3, the embryo's chromosomes get switched on properly, half of them come from the sperm and half of them from the egg. 

I have started a thread on poor embryo quality after day 3 in the unexplained forum and the other two ladies who have joined me have both polycystic or multicystic ovaries, as you have. I don't know what to do about improving egg quality here. Me and another lady on the thread are cycling with ARGC, as we hope that the tailored stimulation drug regime based on daily bloodtests will improve our egg and embryo quality. 

My feeling currently is that some ladies are more sensitive to the IVF hormones levels than others and it looks like PCOS patients often belong to this group. High cytokine (TFN) levels in the lady's immune system are also associated with lower embryo quality, I was told by the ARGC consultant. So it's good to try ad lower them before and during treatment.

Maybe you can also change protocol. Looking at your drugs, you've not been on the most common long or on the follicular protocol. I don't know which one is most recommended for PCO, maybe you can find out.


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## EdnaAverage (Aug 11, 2015)

Thanks guys, seems we have a little flurry of people on the board with things going pear shaped on the way to day 5!

Bundles - easier said than done on the calm front.....! I'm very into the detail of the whole process so like to do a lot of research so I can understand what is going on at each stage but it's so hard to get good quality information and there's so much information out there.  I also find forums quite stressful so for my sanity, I need to dip in and out and take a break from the whole process now and again.  We haven't had karyotyping, Sims suggested FISH and defrag would yield more info.  Should I be doing karyotyping to find out more about eggs?  Presumably best to wait until we get OH's results regardless. 

Wishingonastar - Oh we're on so many pills, we rattle, all high strength Solgar etc so nearly bankrupt....  Off the top of my head, Both of us: Vit D, Vit C, Vit B complex, Rhodiola, Omega 3 fish oils, folic acid, Co q 10, Probiotic. OH only: Wellman Conception (was on Marilyn Glenville but gave him a very upset stomach). Me only: Levothyroxine, metformin (luckily no trots etc to date!) and Asthma inhaler. I was also on Maryilyn glenvill but taking a break for a little while as they're a bit tough to take first thing. I REALLY REALLY hope your FET goes to plan, will be thinking of you and make sure you keep us posted!

I'm actually in a kind of TWW myself right now. I'm 5 days late but had a negative test 3 days ago. My cycles are 30 days like clockwork but I do ovulate late. We did the deed about day 22 so though it was one for fun but I'm beginning to wonder. I'm sure it's just a weird cycle or maybe the Metformin as its the first true one after the failed cycle but I can't help thinking maybe Levothyroxine has worked and one good sperm has also made it through....  Feels like period coming for last 5 days but hasn't arrived yet (usually get PMT for 12-24hrs max), otherwise no symptoms but I've never been pregnant so  I wouldn't know what to expect anyway.

I'm finding SIMS excellent, definitely the right choice, very caring, very responsive and willing to be collborative on meds etc and not take offence if you suggest something or want to be heavily involved.  I was interested in auto immune impact on fertility and GCRM openly admitted they didn't consider them an impact and had made that decision without actually doing any clinical trials.....  I found them rather closed minded, like so much else in Northern Ireland...!  I didn't consider Origin after the shut down a few years ago and well the Royal's reputation precedes it so GCRM would have been the only NI option. I'm intrigued by ARGC but couldn't afford it and wouldn't be surprised if we ended up abroad in Greece or Prague.  This won't be an open ended process for us for financial and sanity reasons and my husband would get very stressed over foreign logistics - he's a real stress head!

Bluebell = that's what concerns me about these tests, they'll say something but then what are the options.  Hubby could be healthier in the fact he could eat better, lose weight and he does no exercise much to my annoyance!  On the plus side, he drinks very little and has never smoked so agreed, there may not be a huge amount of scope for improvement.  Options suggested for high frag were IMSI + ICSI and surgical sperm retrieval so potentially somewhere to go. I think I can just about get my head around donor eggs but double donor is a step too far for me.  OH not open to donor sperm or eggs right now - would want to go straight to adoption so we have some conversations to have. Other than morphology, Sperm parameters are just a touch below normal for count and motility.  Last sample was about a year ago and Morp was 3% then so again, just below normal. 

Will check out the other thread, how do you lower Cytokines?  I was on prenisolone and clexane in the last cycle, would they have had an impact on them?

Clinic have confirmed that they would do the same protocol again but with a slightly lower dose of Gonal F as they were happy with the response.  I suggested modified Agonist/Antagonist as read somewhere it was best for older eggs but they said it can impact the Buserellin trigger shot adversely. They felt that I responded exactly as predicted and they would lower the dosage just to reduce OHSS so that they could try to do a fresh cycle but of course that wouldn't impact embryo development unless embryos were higher quality on lower dosage.

thanks for your replies and your support guys!

EA


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## Bluebell82 (Jan 24, 2015)

Hi,

Good to see your reply. I forgot about IMSI! The surgical sperm retrieval may motivate your husband to further improve his lifestyle  . Maybe you can talk to him gently and tell him that to get best outcome from IVF he can have an impact. Tell him it's for a limited amount of time (like 3 months before the next IVF cycle) and don't be to extreme in your demands, otherwise he's going to feel too restricted (well that's what I felt I had to do get my hubby on board). If his sperm parameters are slightly on the low side further lifestyle changes may actual result in improvements.

ARGC lowers cytokines with humira (delays treatment by 2-3 months) and intralipids/IVIg drips during treatment. You could try to get a second opinion from them, but get treatment at your current clinic. Your clinic sounds fab otherwise.
Clexane is a blood thinner, prednisolone acts on immune system, but scanning the Internet not on cytokines.

Some people say fish oil can lower cytokines (I don't know if this is scientifically proven), you are already taking that.


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## bundles (Jul 16, 2011)

Karyotyping is more often done after recurrent miscarriage, hence ruling out in your case rather than definitely indicated, however a balanced translocation could cause a problem. The FISH test will look at the sperm chromosomes.  With regards to cycling abroad, I used Ruth Pellow, a fertility nurse who deals with a number of clinics (not sure about Czech Republic ).The clinics pay her a commission, so no cost to you. Despite living in Greece, I found her invaluable on the other end of a UK landline number. Her websites is www.ivftreatmentabroad.com 

/links


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## EdnaAverage (Aug 11, 2015)

Thanks guys, very helpful as ever.  FISH sample is winging it's way to Spain as we speak, results in 2 weeks so a TWW of a different kind. He'll do the defrag test at the end of this week to get it over and done with too. 

My own TWW was a fantasy sadly, I was a week late and SIMS very helpfully gave me a quick scan yesterday while we were there, period came last night...Oh well. 

Wishingonastar - hope FET going to plan for you

EA


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## Wishings15 (Mar 27, 2015)

Oh I'm sorry. I read your earlier post and yesterday day and got rly excited for you xx
Are you planning to stay with Gcrm in Belfast? Have you though about Serum? Xx


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## EdnaAverage (Aug 11, 2015)

Hi there,

I'm with Sims in Dublin not GCRM as the latter weren't very open minded. Scan was because I was a week late and there was a chance we'd managed it naturally. They only scanned me as we were there anyway for my OH's FISH test sample and the scan confirmed simply hormonal collywobbles and period turned up last night

I think I'm a little way off clinics abroad just yet but it's something I'll consider in the future.  OH is magnificent in a crisis but stresses needlessly about day to day eg the logistics of going to Dublin. He'd have a coronary if I suggested abroad so in one respect donor Sperm might actually end up being less stressful for me as a result


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## Wishings15 (Mar 27, 2015)

Lol. Aye, I never thought I would go overseas but I went to a seminar and it was quite interesting. I'm not sure how much you would get to see of wherever you ended up but it's definitely someting were looking into after this x


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## L_ouise (Sep 23, 2010)

Research "reactive oxygen species" xx


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## EdnaAverage (Aug 11, 2015)

Thanks L_ouise, anything in particular I should be looking out? Can you recommend any good sources of info or more importantly, treatment/meds/vitamin options to do something about it on top of high dosage anti oxidants?

Also - likely to impact both or just one of us?

Thanks EA


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## EdnaAverage (Aug 11, 2015)

Well, just wanted to come back an update this thread as we're pretty lost after the results of the DNA Fragmentation and FISH tests.  The Frag test was absolutely fine and OH only has 12% defrag which is excellent considering he is 41, albeit reasonably healthy. The FISH on the other hand was not so good and the results have come back as above normal levels of abnormality.  Apparently normal is 0.25% and he's 0.54% but you can't assume that the result means he's only half as likely to be able to do the job.  The level of abnormality was general and all of the five areas tested showed no significant individual issues as far as I can understand. 

I'm still in shock and really don't know what to do but my poor OH spent several days thinking that he was totally infertile and would never have a child.  I had to explain from my own limited understanding of the call with the clinic (I was very upset) that it was still possible it would happen naturally but it would just be a bit harder.  We seem to have two main options. 1. have another go ourselves and hope we make it to 5 days so that we could do genetic testing on the embryos but none of them made it on our only go to date. Also, As I'm also 41, my own egg quality could be suspect despite the high AMH and 13 eggs collected.  2. Go to donor sperm.  

This is so far outside my comfort zone, I have no idea what the best thing to do is and my OH is equally confused but perhaps more matter of fact about it.  I can't help thinking through all the implications of donor and perhaps double donor if we wanted a second child and didn't have frosties. On the other hand, the stress of this whole process is killing us and if there was a way to introduce more certainty, maybe we're mad not to take it. 

I've asked the clinic for full details of the FISH test and the sperm analysis undertaken at the same time so at least I have the full facts. One option I'm considering is contacting the infamous Dr Ramsey to see if there's anything that he can do to help OH.  Does anyone have any experience in this area

We also haven't shared the test results with anyone as I'm not ready to share the fact we might need donor, my natural instinct would be to keep that info to ourselves and manage as we go, not ready to let that genie out of the bottle.

All thoughts welcome, feels like we're at a very broad cross roads and I can't see a clear path to the other side. 

Edna


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## bundles (Jul 16, 2011)

Hi Edna. Thanks for the update. My initial thought is to do PGD which many clinics will do. There are threads on Dr Ramsey, pop Ramsey in the search function on here & it will pull up threads where he is mentioned. I've also found an old thread with some FISH info 
http://www.fertilityfriends.co.uk/forum/index.php?topic=195237.0
It may also be worth posting on the Male Factors boards :
http://www.fertilityfriends.co.uk/forum/index.php?board=35.0
Good luck 
xx


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## Bluebell82 (Jan 24, 2015)

Hi Edna,

Sorry to hear that the investigations were inconclusive. I would think that another go with your eggs and OH sperm is a good idea. I agree with you that it's early to think about donors - you only had one previous cycle.

Maybe you need to start thinking about egg quality. Although your AMH and egg numbers are good, your age and your PCO diagnosis could mean that the eggs you got during your first IVF cycle weren't as good as you were made to think. As I said in an earlier post, on day 3 both sperm AND egg chromosomes are switched on.


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## EdnaAverage (Aug 11, 2015)

Thanks both, really helpful! My OH confirmed this morning that he's not ready for donor sperm as unlike me carrying donor eggs, none of him would be part of the process. I totally understand his feelings but I can't help feeling that we're narrowing our options. 

I think our initial next step is to contact Melanie Brown and Dr Ramsay with the aim of having another go ourselves but trying to get the highest quality eggs and sperm that we can with their help.  If we can just make it to day 5 we can do PGS but I wonder if I should also be considering mild or natural IVF if it's supposedly better for older eggs and non standard PCOS (I have none of the classic symptoms and have regular periods and ovulation?  We'd have fewer embryos to test of course but maybe they'd be more normal anyway. 

Looking back, the only think I would have done differently would have been to have a lot more protein during stimm, maybe it would have made a difference, maybe not. Why is this whole thing so bloody hard yet totally unsuitable people just pop sprogs without a second thought  Life is feeling a bit unfair this week, thanks for listening! 

EA


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