u/VastPuzzleheaded2596

Hi everyone,

Reposting now that I have complete information from all three retrievals. We're still waiting for our clinic's multidisciplinary review.

I know Reddit can't replace medical advice, but I'd love to understand how you would interpret this pattern and what you'd discuss if this were your patient.

I'm 29 and my husband is 30. We're doing IVF for genetic testing rather than known infertility. With autosomal dominant genetic issue (50% chance of passing it on).

Cycle 1

Protocol

Gonal-F 225→237.5 IU

Orgalutran

Ovidrel trigger

Results

26 eggs

25 mature

21 fertilised (ICSI)

Embryos

Day 5: 4 × Grade 1, 1 × Grade 2, 1 degenerated

Day 6/7: 4CC, 3CC, 4AB → downgraded to 4CC, 5CC

Outcome

4 blastocysts

0 suitable for biopsy

Clinic impression: Egg quality. Developed OHSS.

Cycle 2

Protocol

Gonal-F 62.5 IU (later increased)

Pergoveris 150 IU

Orgalutran

Ovidrel trigger

Results

17 eggs

15 mature

10 fertilised

Embryos

3 failed to survive ICSI

2 failed fertilisation

5 arrested at single-cell stage

1 arrested during compaction

1 poor-quality cavitating embryo

2 degenerated by Day 5

1 reached biopsy (4AB)

Outcome

1 euploid, genetically unaffected embryo (currently frozen)

Clinic impression: Egg quality still discussed. Possible sperm contribution also raised.

Cycle 3

Protocol

Pergoveris 225→250 IU

Orgalutran

Ovidrel trigger

Changes

NAC

Myo-inositol

IMSI

Zymot

Results

12 eggs

12 mature

8 fertilised

2 poor-quality blastocysts

0 suitable for biopsy

Additional information

Female testing:

AMH 16

Two laparoscopies - endosalpingiosis found and removed, two big cysts removed no endometriosis found. Suspected adenomyosis.

All other tests fine but slimes raised ana levels but further testing didn't uncover anything.

Male testing:

DFI 18% (normal)

HDS 26% (high)

Current clinic opinion:

Likely a combination of egg and sperm factors rather than one isolated issue. Leaning towards a genetic level issue that can't be explained (we love kicking rare and unusual goals).

Overall:

55 eggs retrieved

52 mature

39 fertilised

7 blastocysts

1 embryo suitable for biopsy

1 euploid/unaffected embryo

Questions:

Looking at the three cycles together, where do you think the biggest attrition is occurring?

Does this pattern make you think primarily egg factor, sperm factor, both, lab variation, or something else?

Does having one euploid 4AB embryo make you think this is largely a numbers game, or does the overall pattern still suggest something unusual?

Have we already implemented most evidence-based interventions (IMSI, Zymot, supplements etc.), or are there other changes or investigations you would discuss?

If this were your patient or a member of your own family, would you transfer the existing embryo, do another retrieval first, pursue further investigations, or something else?

Thank you so much for reading. I'd really appreciate your thoughts.

Hi everyone,

Reposting now that I have complete information from all three retrievals. We're still waiting for our clinic's multidisciplinary review.

I know Reddit can't replace medical advice, but I'd love to understand how you would interpret this pattern and what you'd discuss if this were your patient.

I'm 29 and my husband is 30. We're doing IVF for genetic testing rather than known infertility. With autosomal dominant genetic issue (50% chance of passing it on).

Cycle 1

Protocol

Gonal-F 225→237.5 IU

Orgalutran

Ovidrel trigger

Results

26 eggs

25 mature

21 fertilised (ICSI)

Embryos

Day 5: 4 × Grade 1, 1 × Grade 2, 1 degenerated

Day 6/7: 4CC, 3CC, 4AB → downgraded to 4CC, 5CC

Outcome

4 blastocysts

0 suitable for biopsy

Clinic impression: Egg quality. Developed OHSS.

Cycle 2

Protocol

Gonal-F 62.5 IU (later increased)

Pergoveris 150 IU

Orgalutran

Ovidrel trigger

Results

17 eggs

15 mature

10 fertilised

Embryos

3 failed to survive ICSI

2 failed fertilisation

5 arrested at single-cell stage

1 arrested during compaction

1 poor-quality cavitating embryo

2 degenerated by Day 5

1 reached biopsy (4AB)

Outcome

1 euploid, genetically unaffected embryo (currently frozen)

Clinic impression: Egg quality still discussed. Possible sperm contribution also raised.

Cycle 3

Protocol

Pergoveris 225→250 IU

Orgalutran

Ovidrel trigger

Changes

NAC

Myo-inositol

IMSI

Zymot

Results

12 eggs

12 mature

8 fertilised

2 poor-quality blastocysts

0 suitable for biopsy

Additional information

Female testing:

AMH 16

Two laparoscopies - endosalpingiosis found and removed, two big cysts removed no endometriosis found. Suspected adenomyosis.

All other tests fine but slimes raised ana levels but further testing didn't uncover anything.

Male testing:

DFI 18% (normal)

HDS 26% (high)

Current clinic opinion:

Likely a combination of egg and sperm factors rather than one isolated issue. Leaning towards a genetic level issue that can't be explained (we love kicking rare and unusual goals).

Overall:

55 eggs retrieved

52 mature

39 fertilised

7 blastocysts

1 embryo suitable for biopsy

1 euploid/unaffected embryo

Questions:

Looking at the three cycles together, where do you think the biggest attrition is occurring?

Does this pattern make you think primarily egg factor, sperm factor, both, lab variation, or something else?

Does having one euploid 4AB embryo make you think this is largely a numbers game, or does the overall pattern still suggest something unusual?

Have we already implemented most evidence-based interventions (IMSI, Zymot, supplements etc.), or are there other changes or investigations you would discuss?

If this were your patient or a member of your own family, would you transfer the existing embryo, do another retrieval first, pursue further investigations, or something else?

Thank you so much for reading. I'd really appreciate your thoughts.

Looking for thoughts from anyone who has experienced severe blastocyst attrition despite being relatively young.

​

Background:

​

- Me: 29F

- Husband: 30M

- IVF for genetic reasons rather than infertility

- Normal karyotypes

- DFI 18%

- HDS 26%

- IMSI and Zymot used in our most recent cycle

​

Cycle 1

​

- Gonal-F 225–237.5 IU + Orgalutran

- 26 eggs collected

- 25 mature

- 21 fertilised

- 4 blastocysts formed (4CC, 4CC, 3CC, 5CC)

- 0 suitable for biopsy/freezing

​

Cycle 2

​

- Gonal-F + Pergoveris + Orgalutran

- 17 eggs collected

- 15 mature

- 10 fertilised

- Significant early embryo arrest

- 1 blastocyst reached biopsy (4AB)

- PGT-A normal

- Genetic testing normal/unaffected

- 1 frozen embryo

​

Cycle 3

​

- Pergoveris + Orgalutran

- 12 eggs collected

- 12 mature

- 12 injected

- 8 normal fertilisation

- 3 degenerated after ICSI

- 1 abnormal fertilisation

- IMSI + Zymot used

- 2 poor-quality blastocysts

- 0 suitable for biopsy/freezing

​

Overall

​

- 55 eggs collected

- 52 mature

- 39 fertilised normally

- 7 blastocysts formed

- 1 embryo suitable for biopsy

- 1 frozen embryo

​

Our specialist believes there are likely both egg and sperm factors involved, but we're struggling to understand why the drop-off between fertilisation and usable blastocyst is so severe.

​

Has anyone had a similar pattern, particularly at a younger age?

​

If so:

​

- Did you ever get a clear explanation?

- Was it ultimately thought to be egg quality, sperm quality, embryo genetics, lab factors, or a combination?

- Did changing protocols, clinics, IMSI, Zymot, supplements, etc. make any difference?

​

Not looking for false hope, just interested in hearing from others who had similar blast conversion rates and whether they ever got answers ❤️

Poor blastocyst conversion across two cycles — egg issue, sperm issue, or both?

​

29F & 30M doing IVF with PGT-M. All my testing normal karyotype, endometrial biopsy, immune testing, NK cells. One ovarian surgery 2017. AMH 15.

​

Cycle 1

​

26 collected, 25 mature, 21 normally fertilised via ICSI

​

Gonal F only

​

OHSS occurred

​

Day 5: 3 reached blastocyst, all poor quality (4CC, 3CC, 5CC)

​

Zero frozen

​

Cycle 2

​

17 collected, 15 mature, 10 fertilised

​

Gonal F + Pergoveris

​

No OHSS

​

3 degenerated during ICSI, 5 arrested day 2/3, 4 degenerated or poor

​

2 reached day 5 poor quality

​

1 x 4AB frozen — awaiting PGT results

​

Male partner:

​

DFI 18%, HDS 26% — tested during recovery from serious illness

​

Both cycles sperm produced during periods of significant illness

​

On long term medication with documented class effects on spermatogenesis — cannot be stopped

​

Standard ICSI both cycles

​

Cycle 3 planned:

​

Pergoveris again

​

Zymót and IMSI added

​

More controlled stimulation

​

Clinic view: Primarily egg competence issue. Changes being made to protocol and adding sperm selection.

​

My questions:

​

Does this attrition pattern look more like egg, sperm, or both to you?

​

Anything in this data worth investigating before cycle 3?

Today is cycle day 1 of our third egg retrieval. We do IVF with PGT-M for a serious genetic condition.

Our previous cycles have had really devastating results — very few embryos making it, and the ones that did were mostly unusable. It's been a long and brutal road.

But beyond the cycle results, what I'm struggling with today is the fear of what happens outside of IVF while we're in the middle of it. The last two cycles were followed by significant loss and crisis in our lives that had nothing to do with the cycles themselves, but the timing has left me dreading what comes next. ( Death & a serious long term hospitalisation)

I know rationally these things aren't connected. But my nervous system doesn't know that. Starting stims soon and already bracing.

Has anyone else experienced this kind of dread going into a cycle not just about the results but about life falling apart around you while you're already so vulnerable? How do you get through it?