Dear Prof Winston
I am 31 yr of age, AMH >65pmol/L (no other signs of PCOS) and Day 3 FSH of 10 with no menstrual problems. We started ICSI earlier this year due to male infertility. However, my 1st cycle on a long protocol was abandoned due to poor follicle growth as I was on low dose stimulations. My 2nd cycle on a short protocol resulted in only 6 eggs of which 4 were mature but all had fertilisation failure at day 1. Eggs were commented on as looking dark but not necrotic. My 3rd cycle on a long protocol but much higher stimulation doses compared to cycle 1 and using Fostimon instead on Menopur resulted in 14 eggs of which 12 were immature (I triggered at Day 16, using 5000units of hCG, oestradiol levels of 16,349pmol/L). Out of the remaining 2 eggs, 1 did not survive the ICSI process and the other had zero fertilisation after 20 hours. Again, eggs were commented as being dark.
My question is, is there any other protocol you would suggest to try the next time or am I realistically looking as donor eggs only to successfully have a baby? Are there any known causes of ‘dark eggs’?
Thank you very much, SR


Dear SR,

Your FSH is relatively high for a person of your age and I wonder whether this is not a more reliable test than the AMH in your case. If so, it could be that your ovaries are not capable of an adequate response to stimulation. If you were my patient I would repeat the FSH at intervals two or three times over the next three months and then consider the issue of donor eggs again.

Best wishes
Robert Winston

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