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PESA - no motility after thaw

PESA MF

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#1 schlepp

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Posted 17 June 2016 - 10:57 AM

I'm wondering if anyone has insight or experience with zero motility of frozen PESA sperm.

 

DH had his PESA (due to a vasectomy that is 12 years old) in April. We got 4 vials. During the PESA they said it looked good and when I took it the clinic we were told it looked good. The motility was 44% and morphology 1% (not great but okay).

We just did IVF with ICSI and the fertilization rate was very low. The embryologist said the sperm had zero motility which is likely why. We are shocked. We were not prepared for this and had been really focused on my egg equality which was apparently quite good. 

 

We have asked if another vial should have been thawed once the first one showed no motility. They said normally they would thaw another vial if the first had no motility but usually only if it is from a different sample. They are investigating and will get back to us but we are heartbroken. It feels like someone didn't do all they could. We had 13 mature eggs and only 4 fertilized. We are obviously questioning everything. 

 

Anyone have this happen and receive any answers? The clinic used spindle view (as we had requested). I thought I read that low quality sperm is found just behind the vasectomy block and I am concerned that this is the sperm that they used. They went in more than once to get sperm during the PESA as we wanted to have enough for multiple rounds if necessary. 

 

Any ideas or thoughts for questions to ask or anyone with a similar story would really help. We can't change the outcome but we definitely want answers. 


See my 'about me' page for treatment history.


#2 Hope15

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Posted 17 June 2016 - 11:52 AM

hi!

As you know i don't have any experience with this but i wanted to let you know i'm thinking of you and cheering you on. I will pray for the 4 frosties you have. eusa_pray.gif eusa_pray.gif  th_abighug.gif


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2015 3 IUI = BFN 
Funded cycle IVF March 2016
April 2016 ectopic pregnancy.
June FET BFN. Chemical th_angrywife.gif

August BFP 1 beta 636 2nd beta 1526 fx for being in the right place.

Ultrasound 1 of many Aug.25 (happy birthday to me?)

Ultrasound # 2 Sept. 2


#3 returnable

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Posted 17 June 2016 - 12:06 PM

I second Hope's reply. I have nothing to add, but have been thinking about you since I read what happened. I hope you get some answers. At least you guys are taking a break before FET to recoup and move past what happened.

 

This entire journey is such a test. Every single step. You try to prepare for what is coming next, but the journey is so complex and different for everyone, that you can never be prepared for everything.

 

I hope that at least the embryos that are left do well for you.


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December 2016 IVF - no chromosomally normal embryos to transfer

February 2017 IVF - no chromosomally normal embryos to transfer

 

We are done with my eggs


#4 Cristine

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Posted 17 June 2016 - 02:55 PM

Hi there.  I have some experience with this.  My DH has obstructive azoospermia.  Not a result of a vasectomy but he has a blockage in the epididymis somewhere.  We attempted to have surgey to repair the blockage but unfortunately, it didn't work. 

 

I have used both fresh and frozen epididymal sperm for my cycles.  From my understanding, epididymal (like you guys retrieved during the PESA) and testicular sperm do not thaw out very well after it's frozen.  You lose alot of them after the thaw.  They also do not have the same level of motility as ejaculated sperm.  And you are correct, there are differences in sperm quality depending on where in the epididymis the sperm are retrieved (close to the blockage, etc).  The trouble with PESA is that they go in blind.  All of the sperm we retrieved had poor motility and morphology was bad too.  Most of the sperm were only twitching. 

 

However, even though we had such poor sperm parameters, I always had excellent fertilization rates (close to 100%) for each of my IVF cycles (I've done 6), except for the last one where I got 11 mature eggs but only 6 fertilized.  I was extremely disappointed.  But the embryologist noted that there were visible issues with many of the eggs which is most likely the biggest reason why I had bad fertilization. 

 

I know you mentioned they said you had zero motility but were they at least twitching? 

 

I know that some clinics insist that there isn't a difference between frozen and fresh epididymal sperm but I personally do not agree.  The thawing kills alot of them.  At my clinic the embryologists prefer to use fresh epididymal sperm so that is what we have done for most of my cycles except for the first one and the natural cycle (I didn't want DH to udergo the procedure to retrieve sperm for only 1 egg).  Tough to say about whether or not they should have thawed out another vial.  I do see their point where they figure it was sperm retrieved from the same PESA so what would be the difference.   

 

I'm sorry you are going through this.  I would ask some more specific questions about the sperm quality after thaw.  Were they pliable?  Were they twitching?  I would also ask more details about your egg quality.  Just to see if any abnormalities were noted.  Sometimes they may be subtle but can indicate a problem.

 

How are your 4 embryos doing?  I'm assuming you are still in the middle of your cycle?  Sending you strength and many hugs.  I'm here if you need to chat.  xoxo 


More details on our infertility journey in 'About Me' page

 

Me: 40, DH: 43

TTC for many years - severe male factor - Obstructive Azoospermia

 

DEIVF in Zlin, Czech Republic - March/April 2017

Jan 25 - AF arrives, start BCP

Feb 21 - Lupron Depot shot

Mar 13 - start Estrace (2mg 3x per day)

 

 

 

 

 

 

 

 

 

 


#5 schlepp

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Posted 17 June 2016 - 03:39 PM

Thanks Hope15 and returnable for your thoughts.

 

Cristine - thank you so much for your response. I read your about me page and am in awe at your perseverance. I am feeling defeated in round 1.

 

I'm realising from your questions and story that we got very little information on frozen vs fresh for PESA. We kept asking and they basically said there was no difference. We also found it tough as the RE kind of deferred to the andrologist but the andrologist deferred back to whatever the clinics preference was for fresh vs frozen. DH has two children from a previous marriage so they said they were confident it was all fine. I was told frozen and fresh are no difference. If we had known there was, we would have done the PESA the same day as ER. 

 

I got a call from the embryologist again today and asked even more questions. They confirmed they used spindle view and we discussed motility. They did some investigation and then got back to me that actually, in the system it said zero motility but the embryologists notes actually say that there was 26% motility later in the thawing process. We are confused and unsure what to believe. Their fertilization rate is normally 55-60%, so while this is low, they said it isn't abnormal. I disagree as we got 30%. I asked again about my egg quality and they said it definitely looked like sperm issues. 

 

I am not daring to hope much even though today's report was good and they are all grade 1 or 2 and at the correct stage of development for day 2.

 

I will definitely add your questions to my list of questions for the WTF appointment. We can't change anything but definitely need a better plan if we do this again. 

 

Thank you so much for your response. 


See my 'about me' page for treatment history.


#6 Cristine

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Posted 21 June 2016 - 07:56 AM

Hi there...thought I would check in to see how your embryos are doing?  Did you do your transfer?

 

I'm glad you were able to speak to the lab and ask some more questions.  That is very normal for them to gain motility as the time passes after thawing.  Not sure why but this is typical for epidiymal or testicular sperm.  That is a good sign that they didn't note any visual abnormalities with your eggs.

 

Let me know how you are doing!  xoxo


More details on our infertility journey in 'About Me' page

 

Me: 40, DH: 43

TTC for many years - severe male factor - Obstructive Azoospermia

 

DEIVF in Zlin, Czech Republic - March/April 2017

Jan 25 - AF arrives, start BCP

Feb 21 - Lupron Depot shot

Mar 13 - start Estrace (2mg 3x per day)

 

 

 

 

 

 

 

 

 

 


#7 schlepp

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Posted 21 June 2016 - 02:24 PM

Thanks Cristine. We were doing a freeze all no matter what as I am likely going to be in a Zika region this summer. 

 

We ended up with only 1 day 5 blast. We are devastated. Not sure what we will do next. We will meet with the RE to review the cycle and likely go back to the andrologist as well. We want to ask them to thaw one more vial to see if we should bother keeping them. I've unfortunately already paid the year's storage on them but better to know now that we will need to start over. I'm obviously curious if they are all the same quality post thaw or if it varies. 

 

If we do another cycle we will for sure be going with a fresh sample. Thank you so much for the insight on this and the direction on questions to ask. 


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See my 'about me' page for treatment history.


#8 Abrianna

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Posted 13 July 2016 - 04:41 PM

Schlepp: Did you get any further in figuring out what went wrong with your cycle or next steps. I am in the two week wait from our funded cycle with similar horrible fertilisation rates with ICSI from fresh sample.

My husband was given diagnosis of primary hypogonadism due to decreased testicular testosterone levels causing oligospermia. With our IUI cycle he always had post wash of atleast 1 million 70-80% motile. RE had tought we would have high fertilisation rate of 75-88% with ICSI. In the end we had less then 17% fertilisation rate that basically resulted on only one egg fertilising. We have our WTF appointment Aug 5 but really don't know if it is worth another shot.
Me:33 DH:37Dx MFI

Ottawa Fertility Centre:
IUI#1 Feb 2016: gonal-f/centrotide
1.5mil post wash BFN

IUI#2 April 2016: gonal-f/centrotide
400,000 post wash BFN

IVF#1 July 2016:long agonist protocol (bcp/suprefact, gonal-f 150iu, Ovidrel)
AFC 36, triggered early due to OHSS
12 mature eggs, 1 fertilized with ICSI
2dt BFP ended in CP

IVF #2 Nov 2016:long agonist protocol
(gonal-f 125 iu and luveris 75 added)
AFC 18, 3 eggs retrieved 2 mature, total ICSI failure

Moving on to new clinic and second opinions🤔

#9 hs4816

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Posted 13 July 2016 - 04:53 PM

Abrianna, I've always been told that ICSI failures often have more to do with egg quality than sperm. I'm sure there's cases of both, but make sure to ask about that at your WTF appointment. Different hormonal protocols are known to potentially increase or decrease egg quality based on things like how rapidly you recruit follicles and LH activity/leutinization.


I'm 39 with endo

 

IVF #1: March 2016: Long protocol: Suprefact (200)/Menopur (225)

    9 follicles => 4 eggs => 3 mature => 3 fertilized (ICSI) => 2 blasts (one transferred, one frozen)

    BFN

 

IVF #2: June 2016: Microdose flare: Suprefact (40 BID)/Menopur (150)/ Gonal (300)

     7-10 follicles (?) => 12 mature eggs => only 4 fertilized w/ICSI => transferred 2 @ 3days and 1 blast frozen

     BFP:  day 14 beta = 93, day 18 beta 557 (37h doubling time)

     Ultrasound July 21 = single, live intrauterine pregnancy

     .... so hopeful it sticks!

 

 

 


#10 Abrianna

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Posted 13 July 2016 - 06:43 PM

hs4816: Yeah that is definitely a question we are planning to ask as this cycle was a protocol change from IUI due OHSS risk. When we did the transfer our RE thought looking at preliminary info that it was sperm issue. The one that did fertilize was perfect quality with no fragmentation at all.
Me:33 DH:37Dx MFI

Ottawa Fertility Centre:
IUI#1 Feb 2016: gonal-f/centrotide
1.5mil post wash BFN

IUI#2 April 2016: gonal-f/centrotide
400,000 post wash BFN

IVF#1 July 2016:long agonist protocol (bcp/suprefact, gonal-f 150iu, Ovidrel)
AFC 36, triggered early due to OHSS
12 mature eggs, 1 fertilized with ICSI
2dt BFP ended in CP

IVF #2 Nov 2016:long agonist protocol
(gonal-f 125 iu and luveris 75 added)
AFC 18, 3 eggs retrieved 2 mature, total ICSI failure

Moving on to new clinic and second opinions🤔

#11 schlepp

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Posted 17 July 2016 - 04:41 PM

Abrianna - we have our follow up appointment at the end of the month to get the DNA fragmentation results. The RE and embryologist still think it is a sperm issue causing low fertilization. It is so hard to know. Male infertility seems to just focus on count, motility and morphology. So hard to know what issue is caused by sperm vs egg.

I think there are numerous factors and so little control. ICSI also requires a skilled lab/embryologist.

I want an answer but feel like we won't get it. Just recommendation to try again. Our RE has already said he wouldn't change anything on my protocol and believes we had great results on the egg side.

I'll update if I get more information. I would ideally like to get a second opinion at a clinic that specializes in male factor IF.

See my 'about me' page for treatment history.


#12 schlepp

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Posted 10 August 2016 - 07:42 PM

Finally got the DNA fragmentation back and results were good, 18.4%. They like to see it below 25%. 

 

It was a new RE and he had a very different interpretation of our cycle. He thinks all 13 eggs fertilized but 9 didn't develop whereas the other RE said the 9 didn't even fertilize. We are more confused than ever. One suggestion was that if we did another cycle, we have a few eggs fertilized by donor sperm. If those embryos progress well in comparison to the ones fertilized by my partners sperm, then we know we have a sperm problem. If they don't have a better progression, we know that egg quality is a major factor.

 

We don't know what we will do next but are thinking of doing a FET with our one embryo first and then deciding. 


See my 'about me' page for treatment history.


#13 returnable

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Posted 11 August 2016 - 12:14 PM

Wow and you would think that a fertilization rate different REs could at least agree on? Isn't it clear?


December 2016 IVF - no chromosomally normal embryos to transfer

February 2017 IVF - no chromosomally normal embryos to transfer

 

We are done with my eggs


#14 Abrianna

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Posted 12 August 2016 - 07:21 PM

Schlepp that is so frustrating. I think your plan to go ahead with the FET is a good idea hopefully it will stick!

Our cycle ended in a chemical pregnancy from our one embryo at 5 1/2 weeks. Our RE also didn't really have any answers for us at our follow up last week. Nothing was noted that would indicate egg quality issues as my hormone levels were good and nothing was noted by embryologist. Alot of mid piece defects were noted in sperm sample but otherwise usual count/ motility. Statement was pretty much 90% of the time it is eggs but we don't have an answer as to why fertilization failed. She also recommended repeating same agonist protocol with small luveris dose added to boost egg quality. In her opinion it was a successful protocol as the one embryo implanted eventhough it likely failed due to chromosomal abnormalities. I asked if we could switch to antagonist protocol as I really don't want OHSS again and I don't like the idea of taking the same suppression drugs that potentially impacted egg quality. I don't know which protocol to go with at this point. We have decided to go ahead with one more cycle in Oct/Nov as it is to hard to walk away after getting so close.
Me:33 DH:37Dx MFI

Ottawa Fertility Centre:
IUI#1 Feb 2016: gonal-f/centrotide
1.5mil post wash BFN

IUI#2 April 2016: gonal-f/centrotide
400,000 post wash BFN

IVF#1 July 2016:long agonist protocol (bcp/suprefact, gonal-f 150iu, Ovidrel)
AFC 36, triggered early due to OHSS
12 mature eggs, 1 fertilized with ICSI
2dt BFP ended in CP

IVF #2 Nov 2016:long agonist protocol
(gonal-f 125 iu and luveris 75 added)
AFC 18, 3 eggs retrieved 2 mature, total ICSI failure

Moving on to new clinic and second opinions🤔

#15 schlepp

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Posted 21 August 2016 - 03:52 PM

I've been reading a bit about the type of fertilization, or lack of, that we had. Our RE said it was 0PN. I just saw a study where they kept cultivating 0PNs and ended up with viable blastocysts from them with fairly normal levels of PGS normal embryos resulting. In the study almost 17% developed to blast. I am wondering if I can ask my RE about culturing longer since we had 8 of those type. 

 

Also, I found this article where they state low fertilization from ICSI is considered a sign of the quality and source of the sperm sample. 

 

http://www.brusselsi...roll=true#NavL3


See my 'about me' page for treatment history.


#16 schlepp

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Posted 21 August 2016 - 03:56 PM

This is the other study. Definitely going to discuss with the RE if we do another round of IVF as I want all of my options open to me considering we're looking at such low numbers.

 

http://www.ncbi.nlm....pubmed/26749389


See my 'about me' page for treatment history.