6 follicles retrieved in IVF cycle… doc says it’s great?

[SamTTC]

Hi ladies and maybe gents,
This is my first post, hoping for some clarity/reassurance.

Just started IVF after four failed IUIs. I’m 33 (turning 34 later this month), AMH is 17 pmol/L and my antral follicle count was 16. No fertility issues that they can detect, and I’m using donor sperm.

I was on stims for just 8 days when my clinic decided to schedule my trigger (day 9) and egg retrieval (day 11). At the time I had two follicles on my right ovary (17mm and 13mm) and about five on my left, (one 15mm, the rest were 11-13mm).
I thought it was a bit early to trigger, but the doc insisted because the one on my right was so big.

At retrieval I had all six out, only one from my right side and the rest on my left. The left ovary was still full of follicles but she said they were all too small to be extracted.

Obviously I don’t know whether to feel happy or sad with the cycle until I know how many make it to blasts, but I’m wondering why my doctors insist that six eggs is a great number for me. At my age with my decent AMH and antral follicle count, would this result not be a red flag that I perhaps have D.O.R, or that I was dosed too low/for too short a period of time?
Any input is welcome! I’m trying to figure out if my clinic is trying to write me off and I need to advocate for a better protocol, or if they really are right that six follicles is a good result…
Thank you

It depends on a few factors really? What dose of stims were you on?

I was on Menopur with a dose of 150 iu. My antagonist was Cetrocide. I’m with a London clinic :)

Maybe I’m overthinking it. I’m really just trying to figure out why they weren’t more ambitious with me.

Was it ABC?

@SamTTC,
I have had a very similar 1st cycle. Also Menopur of 150 but with Decapeptyl, also age 33 (3 months before turning 34). My AMH was never checked but AFC was 10-12 on each side. No known issues, male factor. I had that cycle after 2 failed IUIs.

I was only 7 days on Menopur and 5 follicles grew with the largest being 18 cm if I remember correctly.
I was a bit taken aback when they scheduled the trigger at my very first scan and was also told "5 is a good number".

Unfortunately for me it was unsuccessful. From 5 eggs injected we had 3 fertilisations out of which only one developed to an early blastocyst stage on day 5 and nothing was frozen.

There were more follicles that could have grown if the dose was upped or I stimmed for more days...It all went to so fast and completely with the opposite result than I had anticipated and I was blaming the clinic for blowing my cycle.

I changed the clinic after that and in the 2nd clinic the doctor also mentioned that she saw no reason in prescribing Menopur to me (which I was also wondering since I read it was used mainly closer to age 40).

I really hope you have a different result in your cycle (so many people are successful even after the 1st transfer) but I felt our preconditions were so similar that I wanted to share.

And I also had only one egg retrieved from the right side, and the other 4 from the left one:)

Wow, I can’t believe our cycles were almost identical, that is pretty crazy! And I’m sorry to hear that your cycle was not successful. I expect the same outcome, based on the numbers.

But honestly that is not what concerns me the most (I know that can happen, and I’m prepared to try more than once, even right now when my insides feel like minced meat), it is the fact that my clinic insist the result was good, when it so obviously was not optimal, both for my age and based on general odds for egg > blast ratio. I don’t need my ovaries’ ego stroked, I need proactive adjustment suggestions for kicking them into higher gear!

Did you have a better experience at the other clinic? I unfortunately don’t have the option to change clinics at the moment, but I am really hoping that they will be open to changing my protocol and seeing if we can get more eggs out next time. Or at least give me a proper explanation for why they think I should aim for this low number (a ‘less is more’ policy I am unaware of? That is the only possible explanation I can think of…)

@SamTTC, you are right, they often say quality over quantity. It is of course a numbers game considering there is drop off at every stage of the process, but if all 6 you have collected are mature and you get most of them fertilised, you have a good chance of a couple of blastocysts and i think it is then a very good result. Our issue is a heavy male factor which also influences the development of embryos, and in your case you are using donor so that should not be a problem!

The second clinic is a lot better. I was already talking to them before my 1st cycle in the previous one, because everything was bad there. The communication, the planning, the wait, the mere fact we lost more than half a year with them waiting or doing IUI with those sperm results was outrageous. Unfortunately still had the 1st attempt there.

Now, the second cycle I was stimmed with Gonal F 225 (the max they prescribe) for 9 days. The trigger was not scheduled even when there were already follicles of 20+ cm to let the smaller ones grow for one more day. As a result, 16 eggs were collected but unfortunately 8 were immature. Out of 8 injected we got 5 fertilisations. It is hard to compare the number of embryos because in the 2nd clinic they (unfortunately!) still do mainly day 3 transfers and freezings. But it was definitely still more and better quality as all 5 of them were either frozen or transferred and at least one made it to an expanded blasto (they let one develop till day 5). The latter unfortunately resulted in a chemical pregnancy.

We still have 1 day 3 embryo frozen there.

I am confident that should you need to go for another fresh cycle, your clinic will be making adjustments to the protocol. My first clinic was saying the 1st cycle was just a trial to see what works/what does not. I really wish they took it more as it “let’s do it as effective as possible from the start” but I think clinics are normally being cautious about the dose in regards to OHSS etc.

But again, in terms of numbers for example my 2nd clinic’s website says they aim for 8 to 10 eggs per attempt, which gives an optimal chance of good embryos and therefore a pregnancy. You are already not that off with your 6, and with an increase of FSH you can probably easily get more.

Still, i really hope you are successful this time around!
When do you know about the progress of embryos?

I had a cycle like this at Lister, also with four follicles on one side and only one on the other. They felt something wasn’t right and advised cancelling after six days of stims and starting afresh with a different protocol. So your concerns don’t sound unreasonable and I would be asking the clinic for more info when you can. If you end up doing another cycle and they don’t suggest making any changes, I’d probably go for consultations at a couple of other clinics too and see what they recommend. (Although hopefully this round will work and that won’t be necessary!)

I collected 8 eggs in first cycle and got 4 blastocysts, one of which became my dc. Numbers aren't everything. I had amh of 8 and a dose of 450 per day gonal f. I was 36. I have done 3 rounds in total, getting between 8 and 12 eggs. Each time my doctor said it was a great result. The reality is that with your numbers you do have a decent chance of having a baby, and that would be a great result so your doctor would be right!

But perhaps I think it sounds as though you triggered quite early, although I also did on my first round. Those measurements don't sound that massive for lead follicles. Not really an expert obviously!

I think it's indeed good number. Quality over quantity every time.

A small update if anyone is curious.
Turns out one of the follicles was empty, leaving me with just 5 eggs.
Initially everything looked very good, all but one developed properly, and by day 5 I had 4 blastocysts and had one transferred.

Unfortunately the remaining 3 did not develop into high enough quality blastocysts to freeze. Needless to say I am feeling less than optimistic, as I can’t imagine the odds are great for the one that was transferred.

Now I’m even more unsure about how to proceed. Since my attrition rate was technically very good (4/5 survived till day 5), it might make sense to trust the protocol, but if none of the blasts were actually viable in the end, would this not suggest poor egg and/or sperm quality? Or at least mean that I should aim for more follicles to have a better statistical shot? (My clinic does not offer pgt testing of embryos). Ah this process is the worst, I feel like such a failure. :’(

@SamTTC, sorry to hear you feel this way, and totally understandable. I felt devastated so many times at different stages of this journey that I can absolutely relate. But! You have a chance with the embryo on board and the result of the other ones tells absolutely nothing about this one. So try to keep positive about the one in you.

About the other blastocysts… were they left till day 6? Did the clinic explain what exactly was wrong with them that they couldn’t be frozen? It would be good for you to get a follow-up on this and the possible reasons…

I just wanted to add a surprising follow up to this, that apparently I did get two embryos frozen on day 6 (some kind of internal messaging error meant that I was listed as having zero ). So that’s good news!
They haven’t given me any info on quality, but I assume they only freeze the viables.

So out of five eggs, having three good embryos (even if only 1-2 of them can be expected to be genetically viable, without pgt testing) is a good result I think - my clinic was right

I just had a negative beta after my fresh transfer, but the message that I have two frozen embryo attempts before potentially having to do another retrieval has really softened the blow.

@SamTTC that's great! 3/5 is really good and points to the egg quality probably being reasonably good, no guarantees of course. I got 50% on both cycles, 4/8 on my first cycle and 1 became a baby. 6/12 on second and am pregnant with twins. It's definitely more than possible one of your two will work out. Annoying that they got it wrong and caused you upset though!

I'm currently pregnant with one of my day 6s. They say the stats for day 6s are not quite as good as day 5, but they definitely can and do make babies. Often girls I hear ;-)