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The live birth rate for IVF using testicular sperm is lower than that for using ejaculated sperm. In your age group, you could expect the chances of taking home a baby from IVF of about 20-30% per attempt. The more eggs you produce on the stimulated cycle, the better your chances. I would suggest that you try to culture the embryos to the blastocyst stage prior to transfer because, when testicular sperm are used, embryos may arrest development after the sperm DNA kicks in on Day 3. By waiting until Day 5-6, you can be sure that the embryos transferred are of good developmental potential.

Best of luck.

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Dr. Smith,
I was under the assumption that b/c my dh produces mature sperm that by using Mesa that was what would be extracted? Am I wrong on that? Thanks for your insight.


Sylvia

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It depends on the presference of the urologist and whether or not mature sperm can be obtained from the epididymus. The use of epididymal sperm is preferable, but the success rate is still lower than fresh, ejaculated sperm.

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I am 39 and have failed one icsi trial. We had to do icsi because my husband's sperm do not swim well - he is post chemo. All of my pre icsi trial tests were normal. 1 grade a embryo and one grade b embryo were transferred on Day 3. I am confused as to why it did not implant - as I thought our prognosis was pretty good. What questions should I ask my physicians when we meet with him next week?

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There may have been an effect of the chemotherapy on the gentic material of the sperm. When there is a problem with the gentics of the sperm, it shows up after Day 3, not before. So one possible explanation for the failure is due to the sperm genetics.

What appened to the remaining embryos? Did they grow them to the blastocyst stage for freezing? Were they frozen on Day 3? Were there no embryos of adequate quality for freezing? The ansers to these question would be helpful in assessing a heretoforth unknown "egg problem". Remember, all the tests performed prior to the egg retrieval tell us nothing about egg quality. That we discover only be retrieving the eggs and fertilizing them in the lab.

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Dr. Smith
Thank you for your reply and let me give you more info. I was not very clear in my original message. I am a 39 y.o. physician. My pre-cycle eval was normal - fsh-5.3, estradiol-53, lh-2.2. I had 13 follicles on d3 of my cycle . HSG and sonohystogram - normal. My husband froze sperm in 5/04, prior to his chemo - which finished in 10/04. We tried to conceived naturally for 6 months. We then started the above evaluation. Unfortunately, while my husband still produced alot of spserm after the chemo, those that he produced were not very motile and ther were not alot of normal forms. Therefore is was suggested that we use his frozen sperm. The pre freezing analysis demonstrated good concentaration, forward progression.
It was recommended that we undergo ICSI. I had about 10-12 follicles on the day of retrieval, however only 3 eggs were able to be retrieved. When my husband's sperm was thawed - we were told that it still had good motility and "look good". With the three eggs - all three were fertilized with ICSI. But only 2 were satisfactory for implantaion on Day 3 - one was an 8 cell Grade A and the other was an 8 cell Grade B. The third was a 4 cell Grade D and was discarded. Embro transfer occured on D3. My progesterone Level was 70 on Day 8. ON Day 14 I had the hcg which was negative. I had some spotting the night before the hcg test and by the afternoon of the hcg test had just about full flow (and before I had stopped the progesteron injections). I am slender in build.

Needless to say, we are upset and feel like we were not given info and other options that we may have been available to us - ie Day 5 transfers and assisted hatching. We did not know about thses things until we read your website.

We would be most appreciative if you could provide us with your insight to the following questions-
1.Why could the ICSI trial have failed - we though we had a pretty good prognosis?
2.At my age, should we have had assissted hatching?
3. Should we insist on Day 5 transfer? This was not discussed with us - so I assume our facility may not offer it. What is the data that this is better?
4.Since the thawed sperm were ok - would we have a better chance using conventional IVF?
5. Why could more eggs not be harvested?
6. Do people using thawed sperm in general have a lower sucess rate?

Thanks for your time in providing your advice.

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My husband has bilateral undescended testicles. Is there any chance of us being sucessful with ISCI? He is 57 and I am 35. I have never tried to get pregant but assume all is well with me.

Thnaks

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It is unlikely that sperm are being produced in the undescended testicles. Your husband should see an infertility-trained urologist to determine whether or not sperm recovery is possible. Otherwise, it using donor sperm would be the only other way.

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Reply to cde:

A1. Your prognosis is relatively good - for your age. However, you must consider that at 39, the majority of your eggs are anueploid and that, even if fertilized with good quality sperm, only about 20-30% of the resulting embryos are capable of development to the blastocyst stage. Then, each blastocyst stage embryo has only about at 25% chance of attaching, implanting and going the distance to a term pregnancy. If you do the math, you'll need at least 10 eggs to have a decent chance of beating the odds. In your age bracket, the chances of a successful term pregnancy are about 27% per attempted cycle. That means the chances of failure are 3 times that of success. First and foremost, you must be realistic about your chances.

2. Assisted hatching of Day 3 embryos has been shown to be effective in patients over 39 and those with a failed IVF attempt. I would recommend assisted hatching in your case.

3. The pregnancy rate for Day 5 transfer is about the same as that of Day 3 transfers, BUT the implantation rate for blastocysts (implantation/embryo transferred) is double that of Day 3 embryos. That is to say that if the same number of embryos are transferred (say two embryos to reduce the chances of high order multiple gestation), the pregnancy rate for blastocyst transfer is double. But that's not what happens in real life. To compensate for the lower implantation rate of Day 3 embryos, more embryos are transferred. The major advantage of Day 5 transfers is knowing (not hoping) that the embryos that are transferred are capable of attachment to the endometrium and implantation. With Day 5 transfers you get answers about the quality and developmental potential of the embryos transferred. Then, if it doesn't work, you can focus on other issues such as implantation problems.

4. ICSI is the preferred method for achieving fertilization with frozen-thawed sperm due to the decrease in progressive motility and the shortened lifespan.

5. There should have been more eggs retrieved. Somebody goofed up the stimulation, timing of hCG or the retrieval?

6. No. When ICSI is employed to achieve fertilization, the pregnancy rate for frozen-thawed sperm and fresh ejaculated sperm is equivalent.

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