IVF: low fertilization

[JenJen0806]

Hello there-

This is my first post on this forum. I recently underwent my first round of IVF. I am 38 years old, been TTC for one year, husband has a low sperm count. We knew pretty early on we were going to need IVF most likely, but we tried 3 IUIs first bc his sperm count had gotten quite a bit better for a while. IUIs failed bc the sperm count drastically went down during that time.

For myself, I am 38 years old. AMH= 5-7 (depending on the lab), FSH around 4-6, follicle count typically 40. No PCOS.

My follicle count to start was 40. Going into this the doctor said I could get about 20 eggs with my follicle count. At each step along the way with stims, I was told things were progressing very well and I was responding well. The day they were going to trigger me I asked "about how many eggs do you think we'll get?" and the nurse said I had 9 mature. I was shocked. Given my AMH and AFC... why only 9? She didn't sound concerned and said that was normal.

Yesterday I did my egg retrieval and they retrieved 20! I was happy with that, although confused. Today they call with the results and say I have 5 fertilized. Of the 20, 14 were discarded and only 6 were attempted to be fertilized with ICSI. Of those 6, 5 fertilized. She did not know why 14 were discarded... but I am reaching out to the doctor for more information.

Based on the other information.. I feel like maybe a lot retrieved where not mature or post mature. Anyone have a similar situation? This frustrates me and makes me think I was not given the right protocol. I know the results aren't terrible per say... but given my stats going in... this is a very unexpected result. On my last scan, I had probably about 5-6 eggs at the right size (16-18mm).... 2-3 that seemed big (20mm or more) and the rest below 15mm.
I was not given birth control to start. Is that big of variation in size normal?

Now I am just praying these 5 make it to blast. I didn't expect this big of a drop off this soon. The nurse was saying.. its very much case by case and all 5 could make it. I also then have the PGA testing to worry about.

This is all so stressful each step. Today's news was such a massive blow.

To add, I am also just generally worried about the quality in regards to the discard of my eggs. I know that can be an issue at 38 as well. At this point I don't know why so many were discarded. But based on the earlier scan it sounds like there is a decent possibility there were no where near 20 mature.

Your follicle count is very high in relation to your AMH so if I'm honest I'm not surprised with the result OP - IME there is an optimal number of follicles - above which quality just gets spread too thinly. Getting 5 fertilised is much more reflective of your AMH level?
In terms of follicle size too - was your last scan the day of trigger? I did several rounds of IVF and found anything smaller than 14mm on day of trigger didn't yield a mature egg so of you had 7-9 16mm and above on that scan then this also supports the number also fertilised? I know that all sounds really depressing sorry x

Thank you for your reply.

I think you misread or misunderstood my AMH level. It is 5.14 on one test.. but when the clinic tested it it was 7.2 or something that's measured in ng/ml. So I have a very high AMH.. which accurately correlates to my follicle count.

This is why this is so confusing.

I personally feel like I was given a low dose of drugs due to risk of hyperstimulation and bc I was not being monitored by my actual doctor... but nurses and other techs... it wasn't addressed that I could have been doing a lot better in terms of maturing more eggs.

Ah ok - is this a U.K. clinic as they tend to use the other reading (age 35 my AMH was 12.9 which was considered below average for my age)

Did you have a double trigger shot?

What level of stims were you on?

No this is US. Sorry should have mentioned that. I just did the conversion. I'm guessing the UK using pmol/L. The conversion would be an AMH level of between 40 and 50. Just so you can get a sense.

Its really aggravating to me that I walked in the "ideal candidate" and walked out with 6 eggs worth fertilizing. I was actually fearing this EXACT thing. That I wouldn't be monitored too stringently... bc they always say "you have a TON of follicles!" or "you're super fertile" and then I would be put on low dose and not get what I could. Just seems like money down the drain. Most of it was covered with insurance... but the PGT biopsy part is not and I have to pay for that in advance.

I don't know much various drug protocols, so here is what I was on:

• No Birth control to start
• Starting day 3: 100 units of Gonal F, 1 vial (75 IU) of Menopur powder (once daily at night)
• Starting Day day 7: 50 units of Gonal F, 2 vials (75 IU) of Menopur powder, 1 vial of Cetrotide (Once daily at night)
• Trigged day 10: Dual Trigger- 40 units of Lupron, 1000 units of HCG

I don't know much about the drugs... but when i read other peoples forums it sounds like they are dosing more than once a day?