Dear Ladies and Gentlemen
Unfortunately, our current 4th transfer was also negative again and we are back to square one - our last subsidized and therefore last financially possible attempt.
Perhaps I can tell you briefly about our journey in the hope that you might be able to give me some input on what we can improve, as our actual doctor is away from the clinic for a long time and we are happy to hear any suggestions we can make ourselves.
We came to the fertility clinic because I no longer had my own cycle after bowel cancer and, as it turned out, my husband suffers from cryptozoospermia.
It all started in 2023. 2024:
1st ICSI - 16 mature eggs - 11 fertilized only 2 blastos... but the first cryotransfer was successful and we were able to give birth to our son in January 2025.
We have been undergoing treatment again since the end of 2025:
1st cryo from 2024 5AA - negative (progesterone far too low on transfer day - only supplemented with Prolutex from TF+1).
2nd ICSI - 8 eggs, all mature, 7 fertilized - 2 blastos: 1st fresh transfer early blasto negative, 2nd cryo: 4BB negative (progesterone with 3x 400mg again too low, supplemented with Prolutex from transfer)
Uterine endoscopy - correction of the caesarean section scar and isthmocele, result: killer cells bordering on elevated, plasma cells significantly elevated - 2 antibiotic rounds of doxycycline still positive, then ciprofloxacin and metronidazole - no longer tested
3rd ICSI - 11 eggs - 10 mature - 6 fertilized - 1 blasto cryotransfer with 3BC blasto negative (3 times a day 400mg Cyclogest and Prolutex from one day before transfer, progesterone on transfer day at 11.8)
As I don't have my own cycle, I am completely dependent on artificial cycles, but we seem to be slowly finding an oestrogen and progesterone dose with which everything is building up... even if the mucosa is only ever at 7-8mm.
There were no problems with our son at the time: 1-1-1 Progynova and 2x 400mg Cyclogest - and all values were top.
Stimulation was always with Pergoveris and Orgalutran and triggered with Ovitrell on the 1st and 3rd attempt, on the 2nd with Triptofem
Now to my question... our biggest problem according to our doctor seems to be the poor blastocyst yield and quality due to the poor egg quality and spermiogram.
Now my question to you, I'm 37 and our doctor suspects endometriosis - which can't be operated on due to my abdominal surgery in the past.
Do you have any protocol suggestions or ideas that have positively influenced the quality or growth of blastocysts?
My doctor mentioned the long protocol at my last consultation. Can I start this without a cycle at any time after my period?
Do any of you have experience of the dual trigger with HCG and Triptofem?
Our doctor wanted to take another close look at our findings before the next stimulation, but unfortunately she is now out of the office for a while and so I will receive a protocol proposal by email next Wednesday from another doctor. I would like to contribute my own thoughts in order to make the best possible use of the last attempt.
We always had >19 large follicles in the last two ICSIs, but it was always only possible to puncture significantly fewer... Once we were told there were only 8 and once we were told the rest were cysts... Here too I think that something in the protocol may not quite fit.
Thank you very much for reading this long text!!!
Poor egg and blastocyst quality - long protocol? Dual triggering?
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Leonard -
May 25, 2026 at 9:09 PM -
Thread is Resolved
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Dear Leonard,
Thank you for sharing your long journey with us. I will do my best to give you some answers, although I must remind you that these cannot be considered as authoritative medical recommendations in a forum, as I do not have your full medical history and have not seen you in person, nor do I know your examination results or ultrasounds.
Apart from that:
On embryo quality:
Ideally, you should have a PGT-A (PGD-A) performed on the blastocysts to rule out that there is a genetic problem that could be the main cause of all these cycle failures. With the long protocol in this case, there is a higher risk of ovarian hyperstimulation (you usually start a week before the expected onset of your period, not at any point in the cycle), and this could also be the reason why you were not given a double trigger based on previous hormone checks.
The poor fertilization rate may also be due to sperm quality, and I hope I am correct in assuming that you are both taking antioxidants, are non-smokers, lead a healthy and active lifestyle and monitor your weight regularly.
On the quality of the uterine lining:
As far as the uterus is concerned, it is important to reassess the endometrial quality. You can have a more specific test such as the ALICE/EMMA. Vaginal probiotics can also improve the uterine flora. Thrombophilia testing may also be indicated, even if there has already been a pregnancy, as we also need to consider current implantation dysfunction.
I hope this helps you,
Yours sincerely,
Dr. Estefanía Rodríguez
