Q: I have tried in vitro several times without success. I have no problem with egg production and my husband has “A” sperm, yet we end up with nothing in the fertilization process—zero embryos. Any thoughts on what may be our problem?
A: One of the most upsetting things that can happen to a couple undergoing in vitro fertilization (IVF) is to have no embryos. To have the same thing happen on multiple occasions is even more disheartening. I’m sorry you have had to experience this disappointment. Having said that, let me move on to some more constructive comments.
Unfortunately, unexpected failures of fertilization do occasionally occur in IVF, despite good egg number and even with a normal semen analysis. A normal semen analysis does not necessarily guarantee that the sperm will fertilize the eggs. Sometimes the real reason for a couple’s infertility is because sperm are unable to fertilize the eggs on their own. This problem frequently goes unrecognized until the couple goes to IVF. Then after egg retrieval and insemination, none of the eggs fertilize and the couple is devastated.
At our IVF center (Reproductive Biology Associates in Atlanta, Georgia) we use the ICSI (intracytoplasmic sperm injection) procedure to minimize the risk of fertilization failure. In a woman’s first IVF cycle, even if the husband’s semen analysis is normal, we divide the eggs retrieved into two groups. In one group, we conventionally inseminate the eggs (where it’s every sperm for himself). In the other group, we do the ICSI procedure (where a single sperm is injected into each egg with a tiny micropipette to accomplish fertilization). Many couples that are unable to produce embryos through conventional insemination will be successful with ICSI. The next day, we look at the eggs to see which group did the best in terms of fertilization; and in the following days, which had the best embryo development.
It is extremely rare to have a complete failure of fertilization (that is no embryos at all) with the ICSI procedure. When it does occur, there is either a defect in the eggs themselves or a defect in the sperm. Sometimes a change in the stimulation protocol (the medications used to produce the eggs) can improve egg quality and improve the chances of fertilization with ICSI. However, if protocol changes fail to improve the outcome, it may be wise to consider the use of donor eggs or donor sperm.
If in doubt about your treatment plan, ask your doctor to explain and don’t hesitate to get a second opinion if you still have unanswered questions. You can get information about IVF centers in the United States in your area from SART (the Society of Reproductive Medicine) or from the CDC (Centers for Disease Control & Prevention Division of Reproductive Health). These two agencies compile data annually from all member IVF centers in the US and publish it.
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