Infertility/Fertility/2 failed ICSI - what's going on
Dear Dr Ramirez,
My husband and I (both 33 years old) have just had our second failed ICSI, following 2 unsuccessful IUI's in the UK.
I have an AMH of 7.5 (measured in 2010) and we have been actively trying to conceive our first child for the last 4 years.
The first ICSI followed a long protocol of Prostap at 21 days and Gonal F. I stimulated 11 eggs of which 7 fertilised. 2 were our NHS clinic quality rating of 7 and 8 (8 being the top grade) and were transferred at 2 days (no eggs to freeze). I was on progesterone pessaries from transfer and suffered a chemical pregnancy with a false positive BETA of 14 at 13dp2dt. My BETA was monitored and built to 143 by 19dp2dt but fell away to zero by 21dp2dt.
Our second ICSI, 6 months later followed an identical protocol resulting in stimulation of 10 eggs with 6 mature enough to fertilise. Of those 6, 2 were graded A and B quality by the clinic (A being the top). The embryos has 8 cells at a 3 day transfer and again I was on progesterone pessaries from the date of transfer. This treatment cycle was negative.
My husband's sperm has great volume but the motility is low, hence ICSI instead of IVF.
We are now saving for a third ICSI cycle but I would be incredibly grateful for any advice you could offer to us for this next attempt.
In addition to low AMH, I have a couple of fibroids, I'm told they do not impinge on the uterus so should not be a problem. I've been having acupuncture regularly for the last 2 years. We both cut out caffeine, sugar, wheat, yeast and made other dietary changes and are fairly active people.
We are so very keen to hear any ideas you may have to improve our chances - is it likely to be implanation that is the issue as it seems that up to the transfer, everything else goes fairly smoothly. Do we just need to keep trying?
Hello Jo from Scotland,
Without a thorough review of your medical records, it is not possible for me to give you advice as to what may have gone wrong and what more can be done. Suffice it to say, that if you had a chemical pregnancy (the first IVF/ICSI cycle where the beta was positive and went up for a short duration), that is a sign that implantation occurred and means that your got pregnant from the IVF even though the pregnancy did not continue. Discontinuation of a pregnancy can be due to multiple factors, but the most common is because the embryo is abnormal and therefore stopped developing. However, other factors could be lack of hormonal support or immunological factors.
I think you need to be reassured that you can achieve pregnancy by IVF/ICSI as the first cycle showed. Continuation of the pregnancy is NOT an IVF/ICSI factor, but returns to natural factors in your body and within the pregnancy itself. I would expect that it will just be a matter of time before you are successful.
Changes to protocol are very clinic and Physician specific. That is what makes each center different and why there are differing pregnancy statistics. You'll have to either be confident that your clinic and doctor are doing a good job, or that maybe there is a clinic that might be better.
Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
Monterey, California, U.S.A.
for additional information check out my blog at http://womenshealthandfertility.blogspot.com
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