Hello doctor, After a year of attempting to become pregnant through natural means, my wife and I just went through our first use of assisted reproductive technology. We had an IVF/ICSI. Six eggs were produced, my fresh semen sample was used, three eggs became embryos, two embryos were transferred on the third day after retrieval and no sac was ever found. Is there any other information that would be helpful? We plan to try again and would like to learn from this experience and our personal medical data to improve our chances. We would like to know: 1. What happened that terminated the process (no sacs were found) and why? What are the possibilities and what is the most likely possibility? 2. What could we do differently now that might be better? 3. What is the quality of the embryos overall and in terms of their number of cells, cell appearance score, fragmentation and cells being of equal size? 4. What might have contributed to any problem with the embryos? 5. What can be done to improve the quality of the embryos? 6. What is the quality of my sperm overall and in terms of motility, morphology, round cells, agglutination, debris, etc.? 7. If I abstain for 5 or more days, there are no motile sperm. Is that normal? 8. What might have contributed to any problem with my sperm? 9. What can be done to improve the quality of the sperms? 10. Is it unusual or problematical to have a sperm concentration of 0 whenever abstinence is 5 or more days?
Hi,  Welcome to icliniq.com. Following are answers to your queries,  1. The process you experienced is likely biochemical pregnancy. It mostly happens when embryos do not have the potential to grow and give healthy live birth as outcome. The cause of many such losses is unknown, but most likely lies in the genetic aberrations in the embryo.  2. The success rate of any ART procedure is not 100 %. As there was pregnancy in the first attempt and most of the things appear fine, there is good chance of pregnancy in subsequent cycle. For oligoasthenospermia (low sperm count, motility), we generally prescribe antioxidants to male partner to improve sperm health and to reduce oxidative stress. You can discuss with your doctor for the same. The simplest nonprescription antioxidants are vitamin A, C and E. You can take supplements containing same for not more than three months (Vitamin C not more than 15 to 30 days). Co-enzyme Q is another good antioxidant.  3. The images of embryos you attached is 2-dimensional. To assess quality we need to see 3D view to be able to see all the cells in embryos. But still, looking at the first embryo, it appears to be of good quality, with cells of equal size and almost no fragmentation. The second one has unequal cells, though it might happen when cells are dividing. There appears around 10 % fragmentation in second embryo, still it appears fine. Both appear suitable for transfer (attachment removed to protect patient identity).  4. The answer lies in point 1.  5. The quality of embryos looking at morphology is already good. Still, if ovarian reserve of wife is on lower side, DHEA 75 mg daily might help, though evidence supporting its use is not so strong.  6. Quality of sperm in terms of morphology cannot be assessed from the given video. As far as round cells, agglutination, debris are concerned, all these do not affect ISCI outcome, as sperm processing takes care of those factors. Regarding motility, it appears fine.  7. The more the abstinence, lesser will be motility in semen sample. As the baseline motility itself is low, this phenomenon is normal. Nothing to worry about it. 8. There appears to be no problem. So cannot hypothesize any reason.  9. Please refer to point no. 2. Also you can reduce exposure of heat to testes if it is there.  10. Sperm concentration generally does not become zero after increased abstinence, but motility might reduce.