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unexplained IVF failures


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#1 y0rker

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Posted 27 December 2011 - 07:16 PM

We are trying to be the parents and here is our short story.

My wife had tube infection; and consecutively ‘Essure’ procedure was done to block the tubes.

We were recommended to go for the IVF.

We tried with my wife’s own eggs, when she was 37; but all past three IVFs had negative results.

In the 1st IVF, she was over suppressed so we got no good results.

During 2nd IVF [ 5 days transfer] :- 7 eggs were retrieved, 6 matured, 6 fertilized, 3 gone to blast with 1AB, 1BC And 1 CC.

In the 3rd Cycle[ 3 days transfer]:- 6 eggs were retrieved, 4 matured, 3 fertilized, 2 were perfect with 8 cells and almost no fragmentation.

After the embryo transfers during last IVFs, we do not know what happens to the embryos, as there is not even a chemical pregnancy. Wife’s uterine linings are Ok.

Now my wife is 41 and I am 46. I have no other health problem.

A general conventional analysis on my sperms has been done :

Color- pale yellow
Motility- 55%
Volume 3.2
Concentration – 90M/ml
pH- 7.8
Viscosity- normal
Difficulties in Liquidification -none

Progression- 2+
RBC- 0 /hpf
WBC- 2 /hpf
Concentration- 90.0
Agglutination- None

Normal morph- 15
Amorphous -58
Tapering Head-1
Tail defect -17
Macro-head -1
Mid-piece defect-8

The RE thinks my sperms are Ok for and have no issues for the IVF. He does not propose any other analysis on my sperms. Since the sperms got the eggs fertilized and went up to the blasts, so I guess that makes the doctor say that there is No problem with the sperms. I don't know for sure why the RE says there is no issue with the sperms.

This time we tried with Donor eggs. The Donor provided us 12 eggs, out of which 10 matured, 9 fertilized and 7 went for blast. We transferred 2 DE-hatched with grading 5CB and 4AA; and the remaining 5 are frozen with 2 after 5 days with grading 5CC and 5CC. Rest 3 are 4 AA, 3BB, 4BB after 6 days; and are frozen for a while.

The clinic has positive position about the quality of the donor’s eggs. However, for a different recipient, she had No positive result in her previous 1st cycle.

Now there seem to be 2 major factors affecting the IVF result: my sperm or donor eggs as my wife’s linings and other factors are Ok.

I am worried about my sperms quality. What kind of tests should I go for to make sure that my sperms are not the main issue for negative results? I am not sure how the embryologist manages to select a or few good sperm out of millions in our lab.

I come across some options being SCSA test; Karyotype Test, DNA fragmentation Test etc.


Any suggestion/info would be helpful and welcomed.

Thanks

#2 Laura1976

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Posted 29 December 2011 - 02:08 AM

Hi y0rker! Firstly I want to say that I am sorry for your s and your wife's previous IVF failures.

I recently had an IVF failure and our RE said that he doesn't think that egg or sperm quality were an issue because of the quality of the embryos, I would assume this would apply to your embryos as well. I am not extremely familiar with sperm grading so I really can't comment on the information that you provided in that area.

There is testing for recurrent IVF implantation failure. Even after only one failed IVF I pushed to have the preliminary testing done. I think sometimes when RE's find one reason for infertility they run with that one and they don't check further to see if there may be more than that one infertility factor. It may be of use to have your wife do some testing. Here is a link to one of the places that do the testing http://www.repro-med...epro-med-site2/, they are in the US and from what I understand it can be quite expensive. If you are here in Canada you can request that your RE send you for recurrent loss/implantation failure testing (mine was covered under my provincial medical).

The other thing that I would suggest is to get a copy of your medical charts and take them to another RE for a second opinion. It is amazing what fresh eyes can see. From what I gather SIRM offers a FREE consult: http://haveababy.com...consultant.html. There are also options for second opinions in Canada. I just had a telephone consult with Dr. Hudson @ VFC and I was very happy with how detailed they were.

Anyhow there are a few suggestions. I hope that you and your wife reach your goal of being parents soon.

Laura
ME 35 SO 32 TTC #1 since September 2008

See 'About me Page' for more cycle history

November 29/11 - Unexplained IF/Recurrent loss testing

Compliment C3 & C4 below acceptable range
LA Ratio DRVVT above acceptable range
Lupus Inhibitor demonstrated
Antiphospholipid IgG above acceptable range
Antiphospholipid IgM above acceptable range (more than double)


Consultation @ VFC December 10/11

IVF/ICSI #2 (with Intralipid therapy) January/February (Victoria Fertility Clinic)
BCP December 16 -29/11 & January 6 - 28/12
Vitamin D (2000iu daily) and Iron Supplement (Ferrous Gluconate 300mg daily) - Start December 24 until Dr advises otherwise, PregVit 5 (Starting January 12/11), Vitamin E (800iu daily) until Heparin begins (Starting January 14/11) Fish Oil (1200iu daily)
Superfact (0.5mg) - Start January 22/12
Dexamethasone (0.5mg) - Start February 4/12 until beta

After ER - Doxycycline (100mg), Estrance (2mg), Prometrium (200mg 3x day), heparin 5000 units (2x day), calcium (1500mg daily), low dose aspirin (81mg daily)
Intralipids - February 13/12 and day of ET
Neupogen Uterine Flush - Day of ER

February 2/12 - E2 35p/mol
February 4/12 - 300iu Gonal-F & 75iu Repronex
February 9/12 - U/S & E2 - RIGHT- 11, 9, 10, 19, 8, 12, 11, 10, 13, 6 LEFT: 12, 7, 10, 10, 8, 6, 5, 5 E2 2635

February 9/12 Gonal-F lowered to 225iu Repronex remains at 75iu
February 11/12 - U/S & E2 - Right 14, 10, 11, 12, 10, 13, 12, 12, 14, 7 LEFT: 11, 8, 10, 13, 9, 8, 8 E2 5610
February 13/12 - U/S an E2??? & Intralipid Therapy
February 16/12 - E/R 20 eggs, 17 mature and ICSI'ed, 3 left to fertilize by regular IVF
February 17/12 - Fert Report 16 fertilized by ICSI, 1 fertilized by IVF
February 20/12 - Neupogen injection
February 21/12 - Transferred 2 Blastocysts ( 1 x Grade 19 Early Blast, 1 x Grade 19 Expanded Blast) and Intralipid Therapy and Acupuncture

“Here's all you have to know about men and women: women are crazy, men are stupid. And the main reason women are crazy is that men are stupid.” - George Carlin

#3 y0rker

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Posted 29 December 2011 - 05:32 PM

Thanks Laura for replying and for the links.
My RE also thinks that the sperms or Donor Eggs are not the main issue in our case.
The RE is somewhat questioning the " immune issue" at play in this case. It appears as a case of "recurrent IVF implantation failure" as you also have pointed out.
Some people think it may be DNA fragmentation or the chromosome not being normal. Some suggests PGD and SCSA, but I am not sure about these tests.
My sperm are not great, but of average quality as per the RE and Lab analysis.

We have gone for 4 IVFs so far. Last one was with donor eggs [DE] of a 22-yrs old, but with a negative/doubtful outcome on her 1st cycle. The 1st recipient had some ovary- problem, and no issue with the donor’s eggs was reported as per the clinic. However the outcome of DE’s 1st cycle was negative. We did not know the 1st result or it was not disclosed by the clinic in the beginning of the DE selection

Its hard to believe that each time, the retrieved, matured eggs get fertilized with the sperms; and embryos develop well from defined 8 cells[ 3 days transfer] to 5CB & 4AA [5 days ] with self blasts in the lab, but they all fail to implant.
I am not ruling out the role of sperms here. As per my RE the sperms are not the main cause in this case . But I would like to figure out if the sperm is causing these unexplained IVF failures. Meanwhile, I am lining up an appointment to see a Urologist asap.

As I said earlier the donor has no + result in her previous cycle, it makes me to consider that it is either our ‘bad luck’ or the quality of D eggs/embryos.

What info/sheets should i send for free, on-line, second opinion by SIRM doctors?

We don’t know what to do and how to proceed further to pursue the straightforward dream of having a baby.

Thanks and looking forward to hear more

#4 kerrilyn

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Posted 29 December 2011 - 07:18 PM

You can have normal sperm parameters but have high DNA fragmentation, I think its worth while having the sperm DNA fragmentation test done. You can also have fabulous looking embryos with both poor egg quality and poor sperm quality. Remember the report you get is simply what they see in the dish, sometimes poorly graded embryos result in pregnancies and some highly graded embryos don't, the grading of the embryo is not indicative of the quality if the eggs. I'm sorry for your struggles and hope you can find some answers and have success soon. The not knowing can be very frustrating.

  • annagon24 likes this
Me (Kerri-Lyn) 41, DH (Steve) 37, TTC since April 2007Unexplained IF (possibly crappy eggs, AMH 10.4 = poor responder) - HSG, SHGx3, Lap, Cycle Monitoring, Recurrent loss bloods, EMB, Karyotyping, DNA Frag - all normal! 7 IUI's, 2 cancelled IVF's, 3 complete IVF's, 1 FET, 2 clinics, 1 early miscarriage, lots of debt, lots of heartache, lots of tears. We rolled the dice and got lucky on our last ditch "close the door" cycle and have a beautiful little girl. April 2014 - Had the crazy notion to try for another. Shocked with a BFP, miscarried @ 8W6D. See my "about me" page for more cycle details.

#5 y0rker

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Posted 31 December 2011 - 12:21 PM

Suppose the male has high DNA fragmentation, what the RE is going to suggest making it up? I guess they select the best of the best sperms out of millions.Traditionally, a trained embryologist picks the best looking sperm for this procedure.

In our case, the embryos are formed and are developed to hatch blasts with satisfactory grading after 3 days and 5/6 days in the lab. However, they fail to attach to the uterus. After embie transfer, there is no trace of implantation to the uterus, not even a chemical pregnancy.

Is there any way we can trace out the failure after the implantation? Either they fail to get attached to the uterus or after 5-6 days transfer they are almost half-dead/weak to be attached due to the qaulity of the eggs or the sperms. It would be good idea to monitor and trace the embryos from day one just after the transfer. Is there a way to monitor this?

First it was said to be aged-eggs of my wife. We opted for a donor. But even with a 22yrs DE, the embryos are failed again to implant. This is happening since past 4 IVFs.
The RE says there is no problem with the sperms, so what is the reason for the repeated failures??

Thanks....hope I get my answer....

#6 amygirl

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Posted 09 January 2012 - 08:02 PM

Along with the DNA fragmentation test you could explore having our wife take a low does prednisone throughout the next cycle. Mixed literature on this but some believe it helps with immune issues. Worked for me.

#7 Laura1976

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Posted 13 January 2012 - 01:46 PM

y0rker - Sorry for the delayed response. I haven't requested a consult with SIRM, but I would suspect that you would need a copy of your chart (both partners) and cycle history.

Have you had any progress? I hope that you have started to get some answers!

Laura
ME 35 SO 32 TTC #1 since September 2008

See 'About me Page' for more cycle history

November 29/11 - Unexplained IF/Recurrent loss testing

Compliment C3 & C4 below acceptable range
LA Ratio DRVVT above acceptable range
Lupus Inhibitor demonstrated
Antiphospholipid IgG above acceptable range
Antiphospholipid IgM above acceptable range (more than double)


Consultation @ VFC December 10/11

IVF/ICSI #2 (with Intralipid therapy) January/February (Victoria Fertility Clinic)
BCP December 16 -29/11 & January 6 - 28/12
Vitamin D (2000iu daily) and Iron Supplement (Ferrous Gluconate 300mg daily) - Start December 24 until Dr advises otherwise, PregVit 5 (Starting January 12/11), Vitamin E (800iu daily) until Heparin begins (Starting January 14/11) Fish Oil (1200iu daily)
Superfact (0.5mg) - Start January 22/12
Dexamethasone (0.5mg) - Start February 4/12 until beta

After ER - Doxycycline (100mg), Estrance (2mg), Prometrium (200mg 3x day), heparin 5000 units (2x day), calcium (1500mg daily), low dose aspirin (81mg daily)
Intralipids - February 13/12 and day of ET
Neupogen Uterine Flush - Day of ER

February 2/12 - E2 35p/mol
February 4/12 - 300iu Gonal-F & 75iu Repronex
February 9/12 - U/S & E2 - RIGHT- 11, 9, 10, 19, 8, 12, 11, 10, 13, 6 LEFT: 12, 7, 10, 10, 8, 6, 5, 5 E2 2635

February 9/12 Gonal-F lowered to 225iu Repronex remains at 75iu
February 11/12 - U/S & E2 - Right 14, 10, 11, 12, 10, 13, 12, 12, 14, 7 LEFT: 11, 8, 10, 13, 9, 8, 8 E2 5610
February 13/12 - U/S an E2??? & Intralipid Therapy
February 16/12 - E/R 20 eggs, 17 mature and ICSI'ed, 3 left to fertilize by regular IVF
February 17/12 - Fert Report 16 fertilized by ICSI, 1 fertilized by IVF
February 20/12 - Neupogen injection
February 21/12 - Transferred 2 Blastocysts ( 1 x Grade 19 Early Blast, 1 x Grade 19 Expanded Blast) and Intralipid Therapy and Acupuncture

“Here's all you have to know about men and women: women are crazy, men are stupid. And the main reason women are crazy is that men are stupid.” - George Carlin

#8 ddyinwaitng

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Posted 19 January 2012 - 03:52 PM

Hello,

You should try the SCSA just to rule that out. But if the eggs fertilized ok, your sperm sounds like it is fine. The donor eggs im sure were of good fertile quality, and if those did not implant then it sounds like the problem has something to do with the embyo not connecting to the lining. My wife and I have had no luck with IVF and are looking to egg donors now. However, my wife did get pregnant which turned out to be an ectopic. This pregnancy was a result of the Dr telling her after ovulaton to use prometrin and low dose aspirin, the theory was the asprin would help the blood flow better and allow the embyo to "hook up" to her lining. Maybe mention that to your Dr

Good luck!

#9 y0rker

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Posted 19 January 2012 - 08:35 PM

After not getting an answer i decided to see an urologist. The experienced doctor tested my testicles physically and found big bilateral Varicocele on both sides. That finding was a kind of new shock to me as our three REs for earlier IVFs never doubted or suggested Varicocle could be the issue for our 4 failed IVFs. Actually, they never pin pointed any issue with me[male side]. They were happy to go ahead for new IVF with the general Semen Analysis.

Anyway, the urologist suggested 'blood test' and 'ultrasound/sonogram test' on me. Blood test is for hormone level and the ultrasound is to get the exact picture of Varicocle. He said that I have good quantity of sperms but that necessarily is not enough to have a good productivity of quality sperms. He said there is some difficulty with the vein that circulates the blood to and from the testicles. The way he was sure and described some info about Varicocle, we are thinking that that may be holding us away from the successful IVFs… I don’t know why these REs never consider thorough analysis on male side even after 2-3 failed IVFs. I am starting to wonder if our happiness is their first interest OR the money through IVFs- How upsetting !!
I have very little knowledge about Varicocle. But the doctor said that It may take about 3 months to fix it up.

What are the other available options to correct the Varicocele veins???

Thanks

#10 doodle bug

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Posted 19 January 2012 - 09:43 PM

Im so sorry ...you have been through a lot. I just wanted to mention that I have heard of a procedure that helps women with implantaion problems. I'm not sure if there even is an implantation problem in your wife's case- but it cannot hurt to have this procedure done. It's called an endometrial biopsy, and can be done by your RE in his office a few weeks(or a month) before your cycle. Also, I think Dr. Hudson at Victoria Fertility Clinic is a genius, and I know you can get an over the phone consult/2nd opinion with him if you like. Call his office for details. I truly wish you and your wife the best of luck.

TTC since July 2008
July 2008 ectopic/surgery
Dec 2008 miscarriage
then BFN for 9 months....

2009
2 medicated IUI -both BFN
IVF # 1 (flare protocol)
Cancelled (poor response)

2010
IVF # 1 (2nd attempt)-microdose flare/estrogen priming
BFP!
Fraternal girls born Dec 2010

2011
Dec-Natural BFP 
M/C at 8.5 wks

2012
Dec-Natural BFP 

NT- all looks good

Baby girl born Aug 2013

 


#11 Cassandra_Angela

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Posted 19 January 2012 - 09:53 PM

We had multiple IVF failures even though I had perfect lining, my DH gave great samples and our embryos were of fantastic quality. We tried assisted hatching and that didnt help. In the end the RE suggested a surrogate but we wanted to try one more time . I asked about using Heparin to thin my blood and after 10 years we finally had success. We still havent actually found out why there were so many failures but I cant help but think that perhaps it was a clotting problem.
I wish you guys good luck.

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#12 y0rker

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Posted 20 January 2012 - 11:17 AM

doodleBug- Biopsy is an option during next cycle. We are going to discuss that during our next meet-up with the RE

SuperMom- Do you mean to say that you tried blood thinning tabs for 10 yrs?? I am sure my wife took ' baby aspirin' during the last cycle.

Any one here with Varicocle?? I would like to know if Varicocele could effect the outcome significantly of IVF with ICSI. I would like to hear more from the male spouses who are diagnosed for Varicocele and their take on the outcome of the IVF...Hope to hear soon

Thanks