Hi,

I had my aspiration today. A little bit of history. My husband and I have been trying to conceive for 4 1/2 years. I am 29 years old. We tried IVF last year using Lupron, Follistim, and Menopur and birth control first. We got 3 good size follicles, but being we only had 3, the cycle was turned into an IUI cyce. This time around, we used Micro-dose Lupron, Follistim (225 units), and Menopur (225 units) along with birth control first.  On the final ultrasound before aspiration,  I had 4 good size follicles each measuring 23 and I had 3 follicles measuring 11 each. They went ahead and I gave the HCG shot Friday night. Today when they went to do the aspiration, none of the big follicles had eggs in them and I ended up with 1 immature egg. They are going to incubate the egg and give us a report tomorrow to see if my husband can go in and we’ll do ICSI.

My question is why didn’t those follicles contain eggs even though my estradiol was at 1351. I was certain we would get 7 eggs. My doctors don’t have any answers for me and I was wondering if anyone has seen a case like mine and what could be done differetly to produce the results we are looking for. Is there anything else they should be looking into before going ahead with IVF #3?

Thank you for your time.

bnel - 05 October 2008 03:35 PM

Hi,

I had my aspiration today. A little bit of history. My husband and I have been trying to conceive for 4 1/2 years. I am 29 years old. We tried IVF last year using Lupron, Follistim, and Menopur and birth control first. We got 3 good size follicles, but being we only had 3, the cycle was turned into an IUI cyce. This time around, we used Micro-dose Lupron, Follistim (225 units), and Menopur (225 units) along with birth control first.  On the final ultrasound before aspiration,  I had 4 good size follicles each measuring 23 and I had 3 follicles measuring 11 each. They went ahead and I gave the HCG shot Friday night. Today when they went to do the aspiration, none of the big follicles had eggs in them and I ended up with 1 immature egg. They are going to incubate the egg and give us a report tomorrow to see if my husband can go in and we’ll do ICSI.

My question is why didn’t those follicles contain eggs even though my estradiol was at 1351. I was certain we would get 7 eggs. My doctors don’t have any answers for me and I was wondering if anyone has seen a case like mine and what could be done differetly to produce the results we are looking for. Is there anything else they should be looking into before going ahead with IVF #3?

Thank you for your time.

Dear bnel
This is a sign of ovarian dysfunction - we do not know what causes this but this is one symptom of your ovaries not working well.  We would recommend careful review of your cycle, most likely adjust your protocol and use different criteria for determining the day to give the hCG.  This may help improve the egg yield.  You may be a good candidate for an antagonist cycle or a luteal phase priming cycle or both.  You should sit down with your doctor to discuss your options in detail.
Since you are very young, you should still have a reasonable chance of success at a good ivf program if embryos can be obtained.  Since this appears to be an egg issue, another option would be ovum donation, although we would not recommend that until you had exhausted all options with your own eggs.
Hope this helps.
Very best of luck,
Serena Chen, MD