Sperm problem or egg problem?

Dear Professor Winston.
Thank you so much for dedicating your time to people like me! My other half and I are both 35 and recently had our second failed IVF. The first attempt got us 11 eggs but we had zero fertilisation which was devastating. I’d love to know your thoughts on this as there is relatively little info out there regarding this matter. For our second IVF we added ICSI but I responded poorly – we only collected 5 eggs, only one of which fertilised with ICSI. I would like to ask you what your advice would be to us now? Thank you so much. S

Dear S,

With so little information, it is tricky to give you much of an answer. Assuming the IVF clinic has a robust system there are a number of possibilities. Here are just a few:

  1. First it is worth checking whether any other patients in the month or so when you were treated had any similar problems. There should be a record for both times you were treated as a matter of quality control. Obviously, if a clinic is only doing very few IVF cycles this record may not be very useful, but IVF clinics should be able to tell what their normal fertilisation rates are both currently and historically at different times, as nearly all clinics can have a dip in fertilisation success rates.
    2. There can often be a problem with the eggs which have not matured properly, or some abnormality of the eggs. Failure of good maturation may follow hormonal stimulation methods which did not suit you. So it is important to check the interaction between sperm and egg. Did the eggs look normally mature? Did the sperm show good motility when in culture with the eggs? Did many sperm attach to the surface of the egg? Was there evidence that sperm penetrated and entered to the egg?
    3. How variable have the sperm counts been before treatment? Did they respond well to a swim-up test? Has the clinic done any other sperm interaction tests – such as the Hamster egg test which admittedly nowadays is hardly ever used. I still believe that post-coital tests (PCT) are valuable – you seem to imply that you have ‘unexplained infertility’ and if so the PCT can give valuable insights. My little book – The Essential Fertility Guide (profits to Genesis Research Trust) may give you a few clues about further tests on sperm.

On balance, your question seems to raise the likelihood of an egg problem rather than one with the sperm – in which case, ICSI may not be particularly helpful and will certainly add to your expense. I think you need to have very thorough discussions with the consultant in your clinic.

Best wishes
Robert Winston