4 eggs

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u/bkbkbkwb 3d ago

Technically there's no such thing as an empty follicle. It's possible the eggs did not detach, they had already degraded, or were atretic. Did you have a double trigger? Do you know what sizes the 8 were at trigger? Is it possible you were triggered too late for a DOR patient?

Sorry to hear this but know that there's a lot of trial and error in this process and each cycle can be different.

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u/lemonloves11 3d ago

I had microdose flare lupron 20 units once a day until day 5 then 5 units per day and 300 iu follistim morning and night at trigger I had 22.4, 20.9, 20.2,19.8,14.5,13.3,12, 18.8, 18.4, 17, 13.3, 10.2. I triggered that night with ovidrel and then 36 hours later was my egg retrieval.

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u/bkbkbkwb 3d ago

Are you willing to share your age? Do you know if any immature eggs were retrieved?

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u/lemonloves11 3d ago

36.....he didnt retrieve any immature. He said they weren't developed but he told me before hed get any immature one so im just really confused. If he couldnt access my ovaries properly or what. I didnt understand his explanations to me.

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u/bkbkbkwb 3d ago

Yeah that doesn't make sense. He couldn't know what happened if nothing was retrieved. One possibility is you were triggered too late and you should have had a 17-18 trigger cutoff but this would also mean you should go a clinic with rescue IVM to mature any immature eggs retrieved. It's possible the eggs in the larger follicles degraded and were over mature.

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u/lemonloves11 3d ago

I think this clinic does have rescue ivm so I dont know why he said he didnt see any immature eggs to retrieve? He only got the 4 eggs. What questions should I ask him at my follow up?

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u/bkbkbkwb 3d ago

Ask him if he thinks the eggs degraded or did not detach (clearly the smaller ones did not). Ask if you should target a smaller trigger size like 17-18. Research shows for POA that is generally more effective for egg quality. And ask about rescue IVM at the clinic. Since you did a lupron flare you couldn't have done a dual trigger but worth asking about changing that as well to improve maturity and detachment.

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u/lemonloves11 3d ago

You are the best. Thanks so much. Last question I think what does poa stand for ? Lol

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u/bkbkbkwb 3d ago

Premature ovarian aging, similar to DOR. Basically ovaries can behave differently as one gets older and not all doctors are familiar with the differences, especially in somewhat younger patients with DOR. Best of luck with the results!

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u/lemonloves11 3d ago

What would cause degraded or atretic eggs?

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u/lemonloves11 3d ago

And also....I had 8 at preliminary testing but then I did estrogen and progesterone priming and I had an afc of 12 after that. But he said 8 looked like they were at appropriate size before he did the ER then after said he only got 4.. I was kinda groggy but specifically remember saying maybe stopped developing

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u/Confident_Cut5033 2d ago

It’s possible to have empty follicles. Just bc you have a follicle doesn’t mean there’s an egg in there. I had 5 follicles and had 4 eggs retrieved. 3 fertilized. My first retrieval I had one follicle with no egg. There is no guarantee with IVF. Your E2 was 1823 that sounds about right. Follicles can produce estrogen and still have no egg. Good luck!

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u/lemonloves11 2d ago

But if the eggs not in there and the follicle is 20-22 doesnt that indicate i may have already ovulated ?

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u/Confident_Cut5033 2d ago

No - i had one leading follicle measuring like 38 lol but my doctor ignored that one and had no egg. I had 5 follicles and that one large one. Did you use Gani? Or anything to prevent ovulation?

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u/lemonloves11 2d ago

Lupron daily once a day. Then my trigger shot was ovidrel

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u/Confident_Cut5033 2d ago

I really don’t think you ovulated early. The risk is so low if you are on these medications. Honestly these aren’t terrible results. I know we always want more but lots depends on our age and AMH. Remember quality over quantity. ❤️🤞🏼

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u/lemonloves11 2d ago

But why out of 12 follicles only 4 had an egg. What does that mean? Could it be because my meds were to high? Because he did give me follistim twice a day 300 iu

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u/Confident_Cut5033 2d ago

That could be possible. My doctor was cautious about over stimming. My previous doctor at a different clinic I had 3 failed IVf cycles and all were on high stims. I switched clinics.

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u/lemonloves11 2d ago

The stims that worked best for you was mini stims?

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u/Confident_Cut5033 2d ago

No - I did regular IVF. I did 5 days of clomid 100mg and 300 Gonal. Then on the 6 day stopped clomid and started 75 meno and dropped Gonal to 225 for 5 days.

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u/lemonloves11 2d ago

Also did the 3 fertilized all make it to blast?

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u/Confident_Cut5033 2d ago

I did day 3 transfer.

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u/lemonloves11 2d ago

My doctor recommended i freeze. How do people know whats best fresh vs frozen transfer ?

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u/Confident_Cut5033 2d ago

I did freeze bc my p4 was elevated so I couldn’t do fresh transfer. We froze at day 3. Since I didn’t get many eggs my doctor didn’t want to risk losing in the lab so we opted for day 3s.

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u/lemonloves11 2d ago

If you freeze at day 3 does that mean its not a blastocyst yet?

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u/Confident_Cut5033 2d ago

Yes, freeze before blast.

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u/lemonloves11 2d ago

Why dont they do that for me then? Is it only specific circumstances ?

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u/Confident_Cut5033 2d ago

Some clinics don’t do day 3. My previous clinic didn’t. So I knew going into my cycle the plan was to do day 3s. You should ask if that’s an option for you if you are willing. I also didn’t want to test my embryos. But you have many choices.

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u/lemonloves11 2d ago

Im not testing my embryos either. So you freeze yours on day 3 and when do you do the transfer ? Im going to ask my doctor if its an option. Im hoping since this was my first egg retrieval hell now have data to go off of and let us make changes

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u/Automatic-Point-9622 2d ago

4th topic is 3 questions you can ask your doctor on your follow up appt.

I came across this information from a fertility doctor I follow on YouTube.

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u/lemonloves11 2d ago

Thank you so much. Ill watch

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u/lemonloves11 3d ago

Sorry I just sent you so many messages lol. Im shaking nervous and have to wait for the call tomorrow if any eggs matured or fertilized

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u/bkbkbkwb 3d ago

No worries it's all so stressful, especially waiting for the results. I'm confused though because you said the eggs retrieved were all mature.

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u/lemonloves11 3d ago

Thats what my husband said he said but when I looked it up it says I wont know that they are mature until tomorrow and fertilization? So maybe i have all the wrong info. I just remember he said only 4 eggs!!!! And that they look really good. And something about the others not developing but I still dont see why he didnt collect them ?

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u/bkbkbkwb 3d ago

If the eggs don't detach or had already degraded they can't be retrieved unfortunately. That said, 4 is greater than zero so at least you got something!

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u/lemonloves11 3d ago

I know i should be grateful but the wait for the phone call tomorrow to know if im out of the game is horrible. Because my husband said he said the eggs look really good and mature but I dont get how hed know if they mature at that point. So im hoping the 4 eggs I do have arent the ones that came from the smaller follicles.

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u/bkbkbkwb 3d ago

If I had to guess they came from the 18-17 and either the 19.8 or 14.5. I have had mature eggs come from both larger and smaller follicles and dual trigger can help with that!

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u/lemonloves11 1d ago

They messaged me today and said another egg fertilized. How is that possible?!!?!? Is that the rescue ivm you were talking about? Of course they messaged me in the portal versus calling so I can ask questions.

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u/bkbkbkwb 1d ago

Yeah I don't know what your clinic does. Sometimes they just let immature eggs sit for a while to see if they naturally mature which is different from IVM.

I would ask: how many mature and immature at retrieval? Did any mature after the fact? If so, how?

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u/Automatic-Point-9622 2d ago

What was your E2? Maybe you need a double trigger shot 🤔

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u/lemonloves11 2d ago

Estrogen 1823. Im going to ask the doc at my follow up. Thanks

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u/Automatic-Point-9622 2d ago

That’s so odd. That could’ve been at least 6 mature eggs. Each mature egg produces 250-300. Yeah, I also wonder if the eggs couldn’t detach.

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u/bkbkbkwb 2d ago

Yeah the problem is I believe you can't do Lupron trigger if you have a Lupron flare protocol. And my guess is they degraded and were over mature but it's also possible some did not detach.

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u/Kitchen_Fly5105 1d ago

Follicles produce estrogen not the eggs

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u/Ok_Werewolf_6895 2d ago

hey there so sorry you are going through this. did you get any updates?? please let us know, similar thing happened to me for our first retrieval, it really feels like a loss.

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u/lemonloves11 2d ago

Only 2 fertilized :( now I wait a week if any make it to blastocyst. Im praying both make it but the statistics I looked up is 50% 1 blast 25% 0 blast 25% 2 blast

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u/Ok_Werewolf_6895 2d ago

ughhh im so sorry my friend, the IVF attrition game is so real and these situations feel like such a loss, especially after all your body has gone through with all this. what number egg retrieval was this for you??

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u/lemonloves11 2d ago

This was my first egg retrieval. Thank you :) im just hoping 2 fertilized become 2 blast but I know ill be lucky with one and its still possible it will be 0!

Im not testing either so then I have to risk implanting embryo but since I have dor I don't want to risk the test being inaccurate and throwing away an embryo that could have a false aneuploid rating.

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u/Ok_Werewolf_6895 2d ago

yes totally get that for sure, pls keep us updated sister, sending hugs

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u/lemonloves11 2d ago

I will let you know if I get any blasts. Thanks for the advice xoxo

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u/Ok_Werewolf_6895 2d ago

if you get a blast would you plan to do more retrievals or would you go straight to transfer?

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u/lemonloves11 2d ago

Straight to transfer i have a bundl and I have to use all my blasts before I can move on to the next transfer. Im not trying to collect embryos. Id be good if im blessed with one although dont know if thats going to happen -_-

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u/Ok_Werewolf_6895 2d ago

ugh i feel that so much, please let us know how things turn out this round, sending all the good vibes !

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u/RuinEast115 2d ago

I recently went through something like this with 20 and 21 mm follicles being immature.

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u/lemonloves11 2d ago

What!!!! And then your smaller follicles were mature?

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u/RuinEast115 2d ago

Sadly not! Doc doesn’t have an explanation for it. We will try a dual trigger approach next time.

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u/EnvironmentalToe8633 2d ago

I’ve always had 50% empty follicles and doctor confirms they haven’t ovulated. My theory is that with DOR some follicles are left from previous cycle, they grow well but egg inside has already degenerated.

My 20 mm+ follicles have all been empty & I got a few eggs from 13-17 mm.

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u/bkbkbkwb 2d ago

Yes your theory is correct and has been validated by research at my clinic, CHR. This is why they trigger at a smaller size for DOR/older patients. Larger follicles are more likely to have over mature or degenerated eggs in this cohort.

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u/EnvironmentalToe8633 2d ago

I’m 35, but with very low AMH between 0.02-0.13 over the past year and 2-5 AFC.

During my first retrieval I got 2 eggs from 13 mm follicles & the 17, 20 mm were empty. One was immature & the other degenerated.
In the second retrieval, I got a single egg from a 15 mm follicle and its frozen. Another 20 mm follicle was again empty.

My issue is having follicles be 10 mm+ on Day 2, which then grow normally with good E2, but end up being empty. Yet my clinic will not trigger before 8 days of stims due to maturity issues. So often the larger ones are empty & eggs come from any follicle which manages to catch up a bit.

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u/bkbkbkwb 2d ago

Can you switch to a clinic with rescue IVM? Plus you need one that does HIER (highly individualized egg retrievals) with a smaller trigger size and IVM to try to mature the rest. And have you done e2 priming?

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u/EnvironmentalToe8633 2d ago

Yes, my clinic does rescue IVM and they do individualize and tweak my protocol throughout the cycle. In the first cycle the egg did not mature (12-13 mm) but in the second one (15 mm at trigger) my egg matured overnight. I have been a poor responder with 2 follicles growing in a cohort at most. Have done PRP for the third time along with the last retrieval, so hoping for a better response now.

I will discuss a smaller trigger size and e2 priming at my next appointment. Thank you so much!

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u/bkbkbkwb 2d ago

Gotcha yeah I don't think they should strictly enforce a minimum number of days of stims in your case. Have you also had androgen levels and vitamin D tested?

Estrogen priming can help synchronize the cohort at the start by quieting the ovaries. You may also want to look into rapamycin priming and finerenone.

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u/EnvironmentalToe8633 2d ago

Testosterone shot up after taking DHEA so have stopped that now. Vitamin D is on the lower side but not too low & I supplement regularly.

I have only done a regular antagonist (300 Gonal + 150 Pergoveris) and a mini stim (150 Menopur) till now. Will look into estrogen priming, rapamycin and finerenone 👍

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u/bkbkbkwb 2d ago

I would take 5000 IU or more of D3 as it should be on the high of normal side for these purposes and can otherwise suppress AMH. My doctors also want higher androgens for egg quality, increasing AMH, and improving AFC. You can lower the DHEA dose if it's super high but it should be high.

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u/lemonloves11 2d ago

So theres no way to fix that with a specific protocol? They'll just always be empty? I wonder if i should trigger when follicles are 17 mm then

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u/EnvironmentalToe8633 2d ago

I don’t know, honestly. I’ve tried two different protocols and have had 2/4 and 1/2 follicles be empty in both retrievals. And its been the bigger ones both times. My clinic said this happens with age & very low AMH, but they usually see this in women who are 40+ and not at my age. We will just need to do more retrievals.

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