Immature eggs

[Francesmalin]

My partner (M39) and I (F36) have had a rough day yesterday. Egg collection yesterday afternoon with 12 eggs collected after a short course mild IVF (in UK). This was initially great news as there were only 5 viable follicles at our last scan on Monday. We triggered 36 hours prior to collection with 2ml buserelin.

Bad news came later today when the embryologist called to say all 12 eggs were immature.

This was our second cycle. A few months ago we did our first cycle. Same drugs but slightly different doses. The outcome that time was 10 eggs collected. 9 immature. 1 mature egg failed to fertilise with ICSI.

At this point I know that these results are really unusual but I want to know if anyone has been through anything similar? The clinic we are with seemed very surprised by the first cycle result but seemed confident we could succeed by tweaking the dosage and timings. We haven't spoken to the consultant yet about this latest result.

I'm worried that (1) The clinic may have badly misjudged my treatment (this seems somewhat unlikely as all my bloods and hormones were pretty normal this time, first time had higher estrogen level with risk of OHSS and so lower trigger) (2) There could be a deeper underlying issue with the egg production/ovaries that is causing such a bad rate of immature eggs. From online research this seems very hard to diagnose. (3)The clinic has a vested interest in continued cycles of IVF and so may not advise there could be an underlying issue with the natural egg production/ovaries, preferring to suggest tweaks to the protocol and continued cycles (we can't afford financially and emotionally to keep going over and over)

We will see what the consultant has to say in our follow up consultation. I'm really hoping the problem is not (2) and there is a way forward. At the moment we're both pretty devastated and grappling with the idea that we may be infertile.

Whatever they say I feel like it would be a good idea to go to an independent gynaecologist or reproductive endocrinologist who can look at the treatment we've received and the results to get a second opinion of where we're at. This may address concerns (1) and (3).

If anyone has any advice or has been through anything similar I'd love to hear from you.

Thanks

I'm sorry this has happened. I did mild ivf in May and triggered with ovitrelle - I wonder if you were triggered too early, what size was your biggest follicle on trigger day? I wonder if the trigger drug was not right for you either? I've heard of people double triggering as well.

Hopefully some others will be along to offer some insight too. Sending love xx

@venusstarr I triggered with buserelin both times and that might be the problem. First time I couldn't do ovitrelle cause I was at really high risk of developing ohss. This time they did the same cause they thought it wasn't safe for me to use ovitrelle but they doubled the dose. Same outcome, I think this second round was even worst. The top 5 follicles were between 17 and 21 before the trigger. After I don't know cause I haven't spoken to the clinic about this yet. I don't think the trigger was too early cause I already was at day 11 of the cycle. I don't know I just don't trust my clinic anymore and won't be having another treatment there. (Also can't afford it really!!!)

Hi OP, I would visit an ivf specialist to get a second opinion, not just an obgyn. Maybe everything that the clinic did was correct, but just to put your mind at ease. Good luck!

Hello,
I’m on my 1st round of IVF, had my egg retrieval yesterday. 12 eggs collected and only 1 mature. Nothing to suggest that this would be the outcome. Both the clinic and myself are confused. I had 1ml buserelin trigger shot. Waiting to hear if any of the other 11 eggs have matured. I’m in total shock. Unlikely we’ll be able to afford another round.

I was hoping you could follow up with what your next steps were? I think it was the trigger shot for me that wrecked this for us. The clinic were very worried about OHSS and changed my trigger last min.

Would be grateful for any update… I’m in a complete fog of how to feel.

thanks!

Hello JTF,

Sorry to hear about your situation. Unfortunately I can't bring good news cause mine is a very challenging situation and unfortunately I never managed to mature any eggs in another cycle. Although mine is a very rare situation and most likely I have a genetic (unknown) problem, I know about a lot of people who managed to be successful with a different protocol.

Firstly you need to find out how big your follicles where when they triggered you as this can give you a better view for the future. Secondly, if you go for another cycle, the clinic could:

1. change protocol and stimulate you for a longer period; 2. Use a double trigger.

Before you think of another cycle ask for a follow up with your clinic and also get a second opinion from another clinic/IVF specialist. I was fool not to do so after my first cycle.

Hope this helps

Hi @JTF Did you have blood tests throughout your cycle to see what your estrogen levels were? I know some clinics do it and some don't... Since I've changed to a clinic which does this, it has been helpful to determine what number of mature eggs I'm likely to get. I think it's roughly 1000pmol for one mature egg (online I've seen people saying 800-1000), and that's always tallied up with my results. I've got severely diminished ovarian reserve so I have only got 1-2 eggs at every cycle but it's always matched up to the bloods. So I guess going in to your cycle this would have given you some info about the liklihood of eggs being mature? Something to ask/think about next maybe

Also.. the time where I had no eggs collected, I triggered with Buserelin too.. since then I have had a double trigger shot of Gonasi (2x 5000) so maybe that helps too

Thanks so much for your replies.

We’ll have a follow up with the clinic this weekend. it’s really hard to fault them as bloods and scans were regular - and other than the OHSS we were on a smooth course. Estrogen levels also suggested that we were in a good place, follicles were at the right size. we were predicted 12 eggs with 70% of them being mature. The clinic is stumped.

I will be ask for all the info sent over to digest (bloods etc). I was diagnosed as ‘unexplained fertility’ on the NHS, so no health implications. I do not meet criteria for IVF via NHS as I have one child naturally conceived.

We have had a further call to say that some of the immature eggs have since matured today. I have everything crossed.

Really appreciate the support, thank you.

Hi @JTF Do you mind me asking how many of the immature eggs have matured? Do you know what they did to enable that? And do you mind me asking if they have fertilised etc?

I'm just asking as I remember my clinic saying once about there being something they could do to try and mature an immature egg but then I had 1 immature egg I think on a cycle and they just said it wasn't suitable for freezing (I'm doing egg freezing not IVF at this stage). Just pondering how much of a fuss I should make about them trying to mature any immature eggs in future...

tia

I would second the suggestion for dual trigger - there is some research which shows that it is more likely to result in mature eggs so definitely worth raising with your clinic.

best of luck with your journey xx

Hello again, sorry for delayed reply it’s been a bit of a rollercoaster as I’m sure you can imagine,

out of the 12 eggs collected only 1 was mature. We then received a call the following day to say that 9 eggs had matured. I did ask if these eggs had been treated in any way and they hadn’t. They’d been left over night and monitored.

6 of them went onto fertilise and 1 of them made it to blastocyst stage.

So from 12 eggs we have 2 embryos which have been frozen. The original egg which was mature on day of collection and one of the eggs which matured outside of the body.

Everything crossed for PGTA results now 🤞🏼

Hey @JTF did you do ICSI and the clinic has the eggs in the machine to mature or just normal IVF? That's interesting

We had ICSI, which couldn’t be done until the eggs were matured. To be honest, I’m not entirely sure about the equipment used to store the eggs whilst they weren’t mature.

Hi Ladies, I’m having a similar problem. 7 eggs, 1 mature which has happened twice. The second round the clinic were supposed to give me a few extra days of stimulation but because my follicles were bigger they collected 1 day earlier. Although the egg collection was at 36 hours rather than 32 it made no difference. I suggested a double dose of the trigger during the next round as I’d found something that suggests this could help but has anyone found any other solutions? My clinic are at a loss as to what to do next so we are now getting a second opinion from another clinic.
Has anyone found a solution of had success? Any advice greatly appreciated! We are going for third round but really anxious about a similar result!

Follow up question - when you say double dose or duel dose, does that mean 2 shots/doses of the same trigger or a combination of two different triggers?

@Juliette23 It means double the dose of one trigger- so for me I have 2 x 5000iu gonasi- so you can either mix the two vials up and do 2 injections or just mix one then use the liquid from that when mixed to then mix the second vial and do one injection

sorry I don't have more ideas for you except to echo the same thing I said in my last post which is when I was asking do the clinic you're using do bloody tests regularly? As if so then I would have thought they would know in advance how many mature eggs you're likely to get? (Although I see from others posts that even clinics who do those blood tests seem to still get it wrong sometimes)

I had no blood tests during either of my cycles. My last bloods were over a year ago (we’ve had 2 cycles since then). We are just about to start the process with a new clinic and they want bloods before a consultation so hoping thats a good sign. We were referred due to male factors so the fact that we can’t now get mature eggs from me is so frustrating. Feels a bit hopeless right now. 😔

No, it's regular blood tests (oestrogen and lh) throughout the stims part that they need to do. So they can get an idea if the follicles that are growing have a mature egg in or not! Otherwise they're just going in blind in my experience! See my previous posts.. should be (right before egg collection) approx 1000pmol of oestrogen for every mature egg...so if there's say 7 large follicles before egg collection your oestrogen should be 7000pmol..if it's only, say 2500 then you know there's only likely to be 2 mature eggs and they can plan accordingly to go ahead with EC or not...it's not an exact science but that's what I've read online and I've done 9 egg collections and that's been the case for me every time. (I'm not sure if it might be slightly different if you've got lots of eggs as I've only ever had 1-3 collected a cycle but that's my experience)

Oh my goodness, 9 collections! I really hope you’ve had some success in there. Thank
you for that info, I will definitely raise that at our consultation with the new clinic x

We had these issues. I can say that the oestrogen levels corresponding to mature eggs don’t always work. My bloods were always fine and indicated 7/8 mature eggs.

After two totally disastrous rounds with 1 mature egg out of c 20, what worked for us was a protocol with human growth hormone preparation then oestrogen priming on the “AACEP” protocol. We used Pergoveris & Gonal F to stimulate and did a double trigger of Ovietrelle with a few extra hours before egg collection.

Good luck 🤞 It is apparently one of the very hardest issues to resolve.

@Porridgeislife i did exactly that and it didn't work for me. Unfortunately I have some sort of failure with egg maturation or very very poor egg quality. I recommend that you keep trying if your consultant says so. It's hard to get mature eggs when this issues show up but it's not impossible. I have spoken with few consultants in europe and you can sort this out. In my case, I did 4 cycles and the eggs came out oddly shaped in the last 2 cycles and my consultant said that there is no way I will have a bio baby.

@Francesmalin Im so incredibly sorry to hear that things still haven’t worked for you.

We were lucky enough to welcome a baby off my 6th round. I had silent endometriosis which they think was the cause of the immature eggs.

Hi @Juliette23 just wondered if you've had any further progress?

I am due to start my next cycle next month after getting many immature eggs last round. This time they are adding in LH, increasing the stim dose and giving me two different trigger shots.

I'm just hoping this may help get a better result.