Key facts to share with each clinic. Most have received medical records already.
| Eggs retrieved | 7 | |
| Fertilized (conventional IVF) | 6 | 86% |
| Developing at Day 2 | 4 | 67% of fert. |
| Transferred (Day 3) | 3 | 8c leader + two 3c |
| Remaining in culture | 3 | |
| Reached blastocyst (Day 5+) | 0 | 0% blast rate |
| Implanted | 0 |
| Type | Minimal stim + antagonist |
| Stim meds | Clomid 50 mg (AM) + Puregon (follitropin beta) |
| Puregon dosing | Alternating 200/400 IU for first week, then flat 200 IU. Dr. Cheung's rationale: more hormones wouldn't recruit additional follicles at that point. |
| Antagonist | Orgalutran, added stim day 9 (when lead hit 13 mm) |
| Stim duration | ~14 days (Mar 5–18) |
| Trigger | Ovidrel (HCG), Mar 18, 11:30 PM |
| Indomethacin | Started trigger day (Mar 18), last dose Mar 19 — prevents premature ovulation before retrieval |
| Monitoring | US #1 (day 5): 6–8 follicles ~7.5 mm. US #2 (day 9): lead 13 mm (R), cohort 7–8 mm (L). |
| Follicle sync | Significant asynchrony — lead on right ran ahead while left cohort lagged by ~5 mm. Stim extended to let left side catch up. |
| Priming | Letrozole (CD3–7, Feb 8–12), then estradiol suppression from CD21 (Feb 26) |
| Fertilization | Conventional IVF (not ICSI) |
| Transfer | Day 3 fresh (3 embryos). Lining was good. No PGT-A. |
| Embryo quality | Leader: 8-cell, 16/20. Others: 3-cell 15/20, 3-cell 14/20 (significantly lagging). |
| Luteal support | Crinone gel (progesterone) 2x daily from retrieval (Mar 20) through period (Apr 4) |
The 0/6 blastocyst outcome could be egg quality, sperm DNA integrity, or both. Here's what the evidence points to and what tests can narrow it down.
| Hypothesis | Evidence for/against | How to test |
|---|---|---|
| Egg quality |
Likely DOR diagnosis, low AFC. 2/3 Day 3 embryos severely lagging (3-cell). Follicle asynchrony suggests some eggs may have been over/under-mature at retrieval. 0/6 blast rate is consistent with compromised oocytes. |
No direct test for egg quality pre-retrieval. Indirectly assessed through response to stim, embryo development patterns, and PGT-A results across cycles. A different protocol that improves follicle synchrony is the main lever. |
| Sperm DNA fragmentation |
Possible 86% fertilization rate with conventional IVF (no ICSI) means sperm can penetrate eggs fine. But DNA fragmentation doesn't show up on SA or fertilization rate — sperm can fertilize normally but carry damaged DNA that causes embryo arrest at the Day 3–5 transition (when the paternal genome activates). |
Sperm DNA fragmentation test — simple lab test, results in days. Can be done in Canada before departure or at the Czech clinic. Ask each clinic if they offer it. If high: lifestyle changes (3 months lead time), antioxidants, shorter abstinence before sample, or TESE in extreme cases. |
| Lab/culture conditions |
Possible but hard to assess Lab quality varies between clinics. Culture media, incubator type, and embryologist skill all matter. Switching clinics inherently tests this. |
Ask each clinic for their blastocyst rate (specifically for DOR patients). Ask about time-lapse incubators, culture media, and whether they culture to Day 6–7 for slow growers. |
| Protocol-related |
Possible contributing factor Clomid can affect oocyte quality in some patients. Alternating doses may have caused uneven follicle recruitment. Follicle asynchrony meant some eggs were likely over/under-mature. Stim was extended to 14 days (long). |
Try a different protocol next cycle — this is what you're consulting about. Pure gonadotropin (no Clomid), consistent dosing, different trigger type are all levers. |
Check off as you ask. State persists per clinic — switch tabs to track separately.
Clinic-specific things to ask or flag based on communications so far.