What should we try after 3 attempts at ICSI?
Dear Prof. Robert,

I just finalized my third ICSI attempt and it didn’t turn out well. My egg reserve is very low (0.15) and I am 39 years old. The clinic chose low dosage stimulation in the first two attempts. In the third attempt the doctor even tried it with a lower dosage and used Fertomid and two Gonal F injections (Single egg approach not to harm egg quality like you explained in one of your videos).

I produce around 3-4 eggs and the fertilized day-6-embryos (blastocyst always delayed) are genetically abnormal (PGS conducted all three times).

Before these 3 attempts I had a miscarriage from a natural conception.

What would you kindly recommend us as the way forward? We are very sad and hopeless at the moment. Or is there any hope that I can still produce good eggs?

Thank you so much and kind regards from South Africa,



Dear Nora,

I am sorry to be so downbeat but I am sorry to say that I think your poor egg reserve is likely to be the basic issue. What you don’t tell me is why you need ICSI?  Does your husband have a serious impairment of fertility – if not, it certainly is not justified to undertake this.  Also there is no evidence that PGS is any advantage in this situation – indeed it may even reduce the chance of pregnancy because the embryo biopsy can only assess the genetics or chromosome status of the cells removed – not those which remain – and by no means necessarily represents the rest of the embryonic cells.  Indeed, it can even lead to discarding an embryo which may be capable of normal implantation.  I know what I am saying because it was our work at the Genesis Research Trust which first developed PGS and with which we treated the first patients 20 years ago. The work which has resulted in normal babies being born where there was a probability of a serious abnormality was entirely funded by donations from patients like yourself.  PGS is really only likely to be useful where there are specific abnormalities of the karyotype – which will be unlikely to relevant relevant in your case and with your history.

Yes – the blastocyst development is commonly delayed in people who have problems with their eggs, usually due to the ageing process. Trouble is you don’t give me enough information so it is difficult to say with any certainty what is most likely to be wrong.   But my key question is your partner’s fertility – because if you do not need ICSI, people like you are much more likely to conceive without IVF, in my view.

People like yourself are much more likely to produce good eggs naturally and without stimulation and undergoing any form of IVF reduces your chances of conception just before, during an IVF cycle, and probably for a month or two afterwards.

I am truly sorry I cannot give better advice,

Best wishes

Robert Winston

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