IVF - OHSS risk?

[123penguin123]

Hi everyone :) I'm 27 and on my first round of IVF, as both my husband and I have fertility issues. At my day 5 scan I was really disappointed as I only had 8 follicles, and they were all quite small. However today on day 11 I have 28 follicles! They have said they are still not ready for collection as only one is 19mm, then I have 14 that are 13-15mm and the rest are 1cm or less. I have been given an extra 3 days of injections and my collection date has bee put back to Monday. As excited as I am about the higher numbers, it only occurred to me afterwards - am I at risk of OHSS? I was told that each egg could still grow 3mm a day, which seems like I could end up with quite a lot that are big enough! I have an AMH of 16.7 and some symptoms of PCOS. Will the quality also drop if I produce too many? Thank you in advance for any info, and wishing you all the best in your own journeys :)

The more follicles you have the higher the risk, but you won’t get mature eggs from the small ones. So there needs to be a balance. I have PCOS and had 40 follicles, 30 eggs, only 16 mature in my successful cycle — mainly because the clinic decided not to be as cautious that time around and decided to let my follicles grow.

I did have mild OHSS and was given medication afterwards to help my follicles reduce in size.

Hi Teddybear. Thank you so much for your reply - it's really helpful to know other people's numbers so I can get a feel for what to expect! I really appreciate your help thank you :)

I wouldn't worry about the ones that are 1cm or less at the moment, they may not grow that much.

Clinics in general are very good at managing the risk of OHSS- I was admitted to hospital for it and my consultant said I was the first person in a year that it had happened to, and she was pretty annoyed about it too! For me it was late onset and indicated that I'd become pregnant- at that point it was twins so obviously HCG was very high. Usually if you're at high risk they'll do a freeze all cycle to let things calm down which is frustrating but much better than putting your health at risk.

There is a school of thought that fewer eggs=better quality but it is a balance as obviously more eggs=more chances to successfully fertilise and develop. I read somewhere that 15-16 eggs collected is about optimal. But as ever with IVF it's all about statistics, and you can be the one that defies the statistics or is unlucky to be on the wrong side of them. Unfortunately the outcome is pretty binary- pregnant or not pregnant and there is no in between so worrying about this stuff and over-analysing doesn't help anyway.

Try to trust your clinic, drink plenty of fluid (incl electrolytes) and eat plenty of protein.

Good luck 🤞

Hi Katniss. Thank you very much for your reply - I'll up my protein intake and keep my fingers crossed for 15-16 :) Thank you!

Just wanted to add this link to The Duff, as I found it really useful when learning more about OHSS. Our clinic put me on a freeze all cycle to reduce the risk, and they also adjusted my medication and key dates according to how my follicles were doing. OHSS is a worry, but I think clinics are really very aware of it and will try and manage the risk carefully. Good luck, hope it all goes well for you!

theduff.co.uk/ovarian-hyperstimulation-syndrome-ohss-ivf/

I had 25 follicles and 22 eggs collected (I don't have PCOS)
I was at risk of OHSS but was fine, still have to do blood thinners until I'm 12 weeks as a precaution
I also had to measure my intake of liquid and how much I was peeing (fun right?) to check my kidneys were working
My clinic said over 15 eggs collected you're at risk but I was fine, I bloated for about a week after collection but had no issues since.
Fingers crossed that you don't have OHSS and that everything goes well for you!

Also in regards to quality, I had one transferred and four frozen so not necessarily

Actually fertility clinics aim for 10 mature eggs to produce 1 blastocyst to transfer fresh and hopefully 1 blastocyst to freeze. Most people who go through IVF will not have any blastocysts to freeze.

Mincedpea - thank you so much for the link, it was really helpful! I had really misunderstood what OHSS was so it makes a lot more sense now thank you :)

DaisyMay - thank you very much for sharing your numbers - it's good to know that 20s can be okay :) Oh dear about the liquids! An extra dignified element to add to the rest of the fun :P Best of luck on your journey!

Sorry posted too early - very bloated throughout both cycles and uncomfortable from collection - didn’t have ohss but had two weeks off work both times. Second time I looked about 4 months pregnant the day I got my bfp (also knew it would be positive) had people commenting on my pregnancy before I was even 12 weeks as I remained so bloated (I am normally a size 8 though).

Make sur Troy have some comfy leggings!!!!

Argh! Having a nightmare with my messages - somehow posted the second half first?!?

First half said - despite low amh and high fsh I got 29 follicles cycle 1, 20 mature eggs, 14 fertilised embryos and no wood quality blasts on day 5 - we were heartbroken and had no idea this was possible after so many fertilised.

Cycle 2 we surgically retrieved DH sperm and got 32 follicles, 22 mature eggs, 13 fertilised. One baby (!) and two Frosties.

My situation is rare but I wish someone had told me lots of eggs isn’t necessarily lots of blasts. It would have spared us a lot of heart break.

@123penguin123 Glad to have helped! I scoured The Duff for all sorts of stuff about IVF and it was the first site that helped me understand OHSS from a patient point of view. My clinic told me I was at risk of it because of a high AMH. I didn't really question them at the time, but have since read more on it and am glad they took precautions. Hope it all goes well for you!

My wife had 21 eggs on egg collection day on the 7th January. However only 5 fertilised and all had to be frozen due to the risk of OHSS. They didn’t want to risk doing a fresh transfer in case as her levels were high and having a pregnancy will elevate them even more so they froze all 5 eggs at day 2. She had some mild bloating and soreness but it had gone within a week.

We have just had a frozen transfer on the 22nd May, they put 2 back in of our 5, both 4 cell grade 1 embryos. We are currently 8dp2dt and have taken a pregnancy tonight and have just got a BFP on both a clear blue digital saying pregnant 1-2 weeks and a first response test. We never thought this would happen and are daring to dream this could be it for us.

It is such a long and hard process this old ivf journey, I hope all goes well for your cycle and lots of baby dust to you both, it sounds very promising x

hoping2018 - thank you so much for your message. I'm so sorry that you had to go through that, but congratulations on your baby! I'm so pleased things worked out for you! :)

Pose34 - congratulations on your BFP - you must be over the moon! I wish you all the best through the pregnancy and with your future bundle of joy :) And thank you very much for sharing your numbers too - I ended up with 17 eggs, and found out this morning that 10 have fertilised, so we're keeping everything crossed!

Great numbers penguin, best of luck 🤞