Follicles too large at trigger?

[lucymills1234]

Hi,

I'm concerned my follicles are too large at trigger and wonder if anyone else has had a similar experience.

This is my third cycle of IVF, each time long protocol with 300ui Ovaleap. First two rounds at age 41 resulted in 6 high quality blasts - 3 BFNs, 1 chemical, 1 lost in the thaw, 1 still in freezer. I got 12 eggs first cycle, 18 eggs second cycle, all from one ovary (the other was removed a long time ago).

I'm now 42. Friday was stims day 8 and I had 10 follicles over 10mm. I was told to continue stims and return for a scan yesterday, day 11. At yesterday's scan I had 7 follicles between 20 & 23mm, and another 4 between 16 & 19mm. I was told to take my day 11 stims late afternoon (earlier than normal) and wait for a call with a time for my trigger shot, ahead of EC Wednesday.

I also had a blood test yesterday, something my clinic has never done during stims before. I came home, did my stims late afternoon as instructed, then got a call about 7pm to say my estrogen was at the high end of their range and not to do my final stims dose. I said it was too late, I'd already done it as instructed. They then said ok, go ahead and trigger at midnight.

I'm now concerned that this round is a mess. Firstly, that doing another large stims dose when the majority of my follicles were already 20-23mm means they'll be too large at point of collection, meaning dud eggs (I was told before that 26mm and over is 'too large'). There's 48 hours between the last scan and EC so they would've grown even without those stims. Secondly, I've read multiple studies that high estrogen has a negative effect on implantation, and I was planning for a fresh transfer. If I have to switch to freeze-all, the timing is awful as timings would mean an FET would fall right in Christmas week, when the clinic is closed - I imagine it would get pushed back to January (at 42, every month lost is bad news!).

Has anyone else had any experience of large follicles ahead of trigger and how did that impact your results? Or any experience of high estrogen at this stage?

@lucymills1234 no direct experience as the clinics rarely tell you when they do something wrong...but our response appears to be quite similar to meds.
My day 8 scan was also Friday and I had lots of large follicles - if I wasn't on day 8 they would have triggered me....i said absolutely not, my second round I was triggered on day 8 and I had very poor quality eggs that were mostly immature so I didn't want that to happen again. They haven't scanned me again since but did the trigger on Sunday night and ive had eggs collected today. Just been told I have 8, presume I've lost the big ones that were ready on Friday? I'll ask them though when they come back in to tell me what's gone on! I wonder if due to the Sunday closures they've left you too long and you should have been triggered Sunday night like I was?
Re- oestrogen levels, I don't know. But mine have also gone very high in previous cycles and I've never had a fresh work. My oestrogen levels also haven't been taken this cycle so no idea what they are now. Bit of a worry if that's true about it being a problem for implanting. Hard to believe I'll have anything to freeze with only 8 eggs collected. Urgh, IVF is such an arse!!

Hi @MrsC2018 hope your EC went well! So long as the ones that were large on Friday didn't go over 26mm by EC I think you're fine. I don't think over-mature eggs go anywhere, they can be collected still but quality will be poor - my concern that I want to ask the dr is whether they can tell if an egg is over-mature and exclude it (same way immature eggs are). I looked into it and the issue is that over-mature eggs don't divide properly so make aneuploid blasts, which you obviously don't want in the mix if you can help it.

Yes, I agree the fact I didn't have a day 10 scan is far from ideal. I asked before I started stims and then again at my day 8 scan on Friday about a day 10 scan and was told waiting until day 11 was not an issue.

With IVF you already know there are so many factors that you can't do anything about, so you put your trust in your clinic to give the best advice on the things that can be controlled - such as medication. I really hope that things go ok with EC tomorrow and beyond but if they don't I'll be wondering whether this mess has been a contributing factor. It's already looking really uncertain whether I can collect again due to lack of funds, so making a decision gets even harder when there's potentially been another problem clouding the outcome - you don't know what the result might've been without that issue. One step at a time, I know, but it's so hard not to think 10 steps ahead!

Hope you recover swiftly from EC. As you say, IVF is an arse!