No fertilization

[glory]

Hi Carole,

I was just wondering if you could give me your opinion on something.

I had egg retrieval on Thursday and found out today that of 9 eggs retrieved none fertilized. Neither my husband or I have fertility issues and they were trying to fertilize via ivf.

What are the chances of this happening again?

What are the common reasons that it happens?

Should they try something different next time?

Thanks so much.

[Carole]

Hi Glory,

I am so sorry to hear about your no fertilization result. I wrote a post about this issue here http://fertilitylabinsider.com/2010/06/ivf-disasters-no-fertilization/. I don't know what the chances of this happening again because it's not clear why it happened. I am assuming that you did not use ICSI. ICSI would definitely be something to try next time because then you can be assured that the eggs are mature (eggs are checked for maturity before ICSI is done) and assured that the sperm entered the egg, making fertilization failure less likely. Common causes for fert failure with regular insemination are(not in any particular order);
1.lab errors: miscalculated sperm concentration (too few or too many sperm added); wrong culture medium used, pH or temp issues, damaged eggs during cumulus cell removal for fert check. If technicians are well trained and if other patients had normal fertilization results in cases done at the same time, these are unlikely causes. Always check out your program's pregnancy rate as reported to either the CDC or SART. The CDC database is more complete but the SART database is easier to use. http://www.sart.org/find_frm.html The newest reports are from 2009- reports are always two years behind. Really good programs achieve a 50+% pregnancy rate in their youngest patients (under 35 years of age).
2. Egg and sperm must interact through molecular receptors. Sometimes these receptors are defective and egg and sperm do not bind. No binding. No fertilization. ICSI bypasses receptor problems because sperm are injected right into the egg.
3. To achieve fertilization, the sperm must not only enter the egg but it must decondense the sperm head nucleus, releasing the sperm DNA so it can interact with the egg DNA. Sometimes egg decondensation does not happen.
4. Inside the egg, the egg nucleus must also decondense and form a pronucleus, just like the sperm head. It must discard extra egg DNA by producing a secondary polar body. If this fails, normal fertilization does not happen because the egg has too much DNA.
5. Sperm and egg pronucleus must find one another inside the egg, chromosomes from each must line up and mingle, combing male and female DNA, creating a new unique human being.
6. The ovarian stimulation protocol was suboptimal and eggs were not fully mature or were post-mature. Adjustments in the stim protocol may help.
7. Even if you became pregnant easily before, secondary infertility is not that uncommon due to changes in sperm quality and advanced maternal age- neither of these may apply to you but these are other reasons for fertility problems.
I am sure your doctor will schedule a follow-up meeting to discuss what went wrong and what can be done differently. If he doesn't do this- go somewhere else.

Best Wishes,
Carole
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[glory]

Hi Carole,

Thank you so much for your prompt reply. It has given me a lot to think about especially if i cycle again with them. While this was all going on my dr was not able to be contacted as he was on his way to a conference, so there was talk of icsi but they needed his permission, by the time they realized that the wasn't to be contacted another dr spoke to me and said not to do rescue icsi, she said I should just cycle again in 2 months, because of the cost if pgd, she believed that there would only be 1percent chance of pregnancy without pgd, with pgd she said my chances are zero.

Needless to say I disagreed and begged for rescue icsi, 4 were fertilized by the next day.

If they are still good tomorrow, they will do the pgd.

Going from what the dr said I would need a miracle for a normal embryo, in your experience with rescue icsi, is this true? I am now worried I did the wrong thing and that if I did become pregnant something would be wrong with the baby.

If a baby is cleared normal with pgd, then does it still matter if it was rescue icsi or not?

I have heard from my dr but he wont be back till Tuesday, he has said that we will schedule meeting and go over everything then.

Thank you so much, I have been reading your blog and it is most useful.

[Carole]

Hi Glory,

I am glad that your are going to have a sit down with your doctor to discuss all these issues. I am not a doctor and I am not licensed to give you medical advice. What I can do legally and ethically is describe my own experiences with IVF protocols like rescue ICSI and encourage you to speak with your doctor regarding treatment advice for your specific situation.

Our lab protocol required that we only did rescue ICSI when there was no evidence of sperm binding so we could be reasonably sure that we weren't adding an additional sperm with ICSI, causing aneuploidy. Aneuploidy is an abnormal number (excess or less than) the normal number of chromosomes. Aneuploidy detection is one kind of preimplantation test that can be done on a cell(s) from the embryo to identify aneuploid embryos. Abnormal (aneuploid) embryos would not be selected for transfer. Aneuploid embryos (especially if they arise from addition of 23 extra chromosomes from an extra sperm) would not be expected to live.

ICSI has been around since 1993 so there is significant pregnancy outcome data regarding long-term outcomes and child health which are generally encouraging. Rescue ICSI is done much much less frequently because total fertilization failure is a relatively infrequent outcome. I can not answer your question about long term outcomes based on accumulated scientific data from rescue ICSI because long term study data specifically for rescue ICSI cases is not available, to my knowledge. In our program, we used rescue ICSI to salvage zero fert cycles and have had healthy pregnancies result (although the preg rate was less then when we used ICSI right away on fresh eggs).

I know this is stressful for you. Your meeting with your doctor will probably clear up the confusion and hopefully reassure you.

Best Wishes,
Carole