I finally got that much awaited phone call from my RE to discuss what went wrong with our cycle. He started off the conversation by telling me that there was nothing more we could have done to make the cycle a success, we did everything right. The simple fact of the matter was that the embryos we produced were not sufficient to continue growing. He suspects that there were chromosomal/genetic abnormalities. The surprising part, however, was that he doesn’t think it was purely on the sperm side of the equation.

Given the semen analysis results, we suspected that some of the sperm would have some fragmentation issues, but a wash and ICSI should have been able to produce a viable embryo or two. I asked him if it was possible to do a DNA fragmentation test to see what we are up against before doing another round of IVF and he told me that 4-5 years ago that was a standard protocol test for MFI, but studies have shown that knowing the fragmentation of a batch of sperm does not accurately predict success rates. Basically, a highly fragmented batch of sperm could still look great and a non fragmented batch could look crappy. Also, there is no way to individually test the sperm before putting it in the egg. So, the best selection process to follow is a wash and to choose the best looking sperm and to hope for the best. So basically, a DNA fragmentation test isn’t used anymore because it really doesn’t help the outcome of IVF…..well poopie.

Then I asked him what he meant by not thinking the sperm was the sole problem with the cycle. He was almost positive that given my age and reproductive health determined by the hormone levels and ultra sounds, that my egg quality would be good and my uterus great for an implanting embryo. Well, maybe the egg quality isn’t so good. The first red flag for him was the slow stimming. He figured that it was just due to me being slightly overweight and the low dose protocol he chose for me. However, he wasn’t too concerned because I still had 16 follicles growing at a steady pace, even if slow. The biggest red flag was during the retrieval. Of the 16 properly sized follicles, only 8 held an egg…….like any egg at all. The 8 that were retrieved were mature enough, but apparently not the best looking. But his biggest concern was the fact that 1/2 of the follicles were EMPTY. Apparently, it’s not a good indicator of quality when half of your follicles don’t even hold an egg at all. It can also be related to PCOS, the cysts could just be follicles that were empty not rupturing to release an egg, well because there isn’t one. Seeing that my FSH levels and such are normal, he figures this is a more likely reason than older ovaries.

So, here is the overall gist of the situation. Our genetics and quality of reproductive cells just couldn’t produce a good enough quality embryo to sustain this time around. He recommends another attempt at IVF, with some modifications. This time around he suggests that we increase the intensity of my stimming. He thinks that we should use a different protocol, increase the dosages, and extend the stimming time in order to produce as many mature eggs as possible. He hopes to get at least 20 next time to increase the chances that a good egg exists and that they can combine that egg with a good sperm. We may have great yields, but the ultimate goal is to at least get 1 or 2 GREAT quality embryos out of the mix. Unfortunately, he said that if we still can’t get even a single GREAT quality embryo out of that cycle that we should probably start considering non biological alternatives. Well shit 😦

I told him that our insurance coverage was maxed out and that we would need some time to save up for another cycle. He said that is understandable and he wished insurance companies didn’t think it was in their right to dictate what each person needed. I think that a little time off from the whole TTC thing will bring us closer together as a couple. We have just been so focused on TTC for the past 5/6 years that we have barely had enough time to enjoy each other. So, while we save up for another round that is what we will do.

This has been one hell of a ride and we are really sad about the outcome, but it’s good to at least know what is going on and our true chances of conceiving.

Three glasses of wine later……..I think we will get through this!