To cancel IVF cycle?

[Ohana2020]

Hoping someone can shed some light/experience on this for me!

I’m currently having my 2nd IVF(IVSI) cycle. Have one 3y/o conceived naturally but struggled with secondary (unexplained) infertility for 2.5 years. First cycle I had Gonal F and things looked ok on scans in terms of follicles (left side I had between 6-10 good sized follicles, right side didn’t have any of a decent size). Egg retrieval they only managed to get 2 eggs and said the other follicles were empty. Transferred one day 3 embryo which didn’t stick and the other didn’t make it past day 4.

so for this 2nd cycle I’ve been switched to Meriofert 300 and been advised to take a double trigger prior to egg retrieval. I had my day 8 scan yesterday. Again I’ve got 4 good follicles and about 5 lagging behind but they’ve hoping over the next few days they’ll catch up.

the clinic has given me the option of cancelling this cycle (no financial implication as with access fertility) and restarting the next cycle on Meriofert 450 and adding in IM progesterone on top of cyclogest if I can to transfer again. I’m really unsure what to do as I’ve read that increased doses may just increase egg quantity but not quality. And I’ve also read empty follicle syndrome is primarily an issue with the trigger rather than the stims. I’d be happy with this cycle if there was any guarantee the follicles all contained eggs but obviously no-one knows that until egg retrieval.
so I suppose I’m asking if anyone has cancelled a cycle just to increase their dose of stims and if that made a difference to the number of follicles. And if anyone has had empty follicle syndrome and only changed the trigger dose? Just trying to work out if stims are the issue or the trigger.

thank you in advance!

Hi, I had 'empty follicle syndrome' though my consultant said at the time he does not believe follicles are empty, but that the eggs inside them are not mature and 'stick' to the follicle wall so cannot be retrieved.

I had 2 egg collections - both quite awhile ago now, so I don't remember exact numbers of follicles and things. Early 30s, no known fertility issues, normal AMH. Was doing IVF after 4 failed medicated IUIs using donor sperm.

First egg collection was a long protocol with Prostap to begin with, then I used Menopur (possibly some gonal f in there too?) with (I think) an ovitrelle trigger. Scans before egg collection didn't suggest loads of eggs, but more than we got. We only got 2 mature eggs. Both made to day 5. Fresh transfer BFN, FET was a CP.

For second egg collection we changed EVERYTHING - partly on clinic advice, partly because I didn't just want to do the same thing with a poor result. So we did a short protocol and went to higher dose of Ovaleap (I think 400iu - originally it was meant to be higher but one of the other consultants said no as my AMH was good and they were worried about OHSS...). We had a Busserelin trigger. I wanted to use a double trigger but they said no (I cant remember why - i think they said no evidence for it?). They left more time between trigger shot and egg collection to give eggs more time to mature. They also let my follicles grow larger than they would normally - so idea was actually to partly sacrifice my lead follicle to give others chance to grow. We got 6 eggs from that collection, still less than expected when you counted follicles in scan before hand, but this time all mature. They all made it to day 5, but only 3 were deemed suitable enough to freeze. The others were actually left to day 6 but non were considered suitable to freeze at that point either. My first frozen transfer is my DD, and my second frozen transfer is my current pregnancy (24 weeks) with 1 embryo still frozen.

So for us changing everything up definitely worked. I was never in a position where they were suggesting cancelling the cycle though (we also used Access Fertility) so didn't need to make that decision. I don't know what aspect of what we changed made the difference, or whether it was just natural variation in successfulness between cycles. I also took Coenzyme Q10 and did acupuncture for my second egg collection too.

So no advice here really on what decision to make. You might find you've already changed enough to get a better outcome this time though

@2mumlife thank you so much for taking the time to reply.
i’m glad to hear that your second round was a success!
I just find it quite frustrating that the overall message is “it’s entirely your decision” about whether to cancel or not - I’m not a specialist and find it quite a burden to make that decision!

@Ohana2020 Its really difficult when its left for you to decide. So much of IVF is just a 'try and see' type approach. Its hard when there are no certainties. As you say 'more eggs' doesn't always = more embryos. It sounds like the decision is really about whether you feel an increased dosage of stims will make any difference? How do you feel about the possibility of cancelling and having to go through stims etc again? Is this your last egg collection on your Access package? I think if you have more egg collections covered by your Access package I'd be tempted to continue with the cycle. I think I'd think about cancelling more if this was your last egg collection that's covered by the package. But it really is your decision. Is your clinic giving you a timeframe by which you need to make a decision? It could be that if you have another scan you could decide at that point based on how many good follicles / eggs they think they would collect at that stage?

@2mumlife
yes it’s our 2nd and ‘last’ cycle of this package. Still undecided about whether or not we’d go for a 3rd cycle after this.

The process of taking the stims hasn’t bothered me - and they’ve said there’s no reason to wait if we do decide to cancel this cycle- I could get going once my period arrives. So really we’d be looking at a 2-3 week delay which is nothing.
I'm due another scan tomorrow to see if the other follicles are catching up (they did last cycle but was kind of pointless seeing as they were “empty”). It’s so hard as no-one has a crystal ball but maybe I’d be best cancelling and trying the increased dose of stims. But there the voice in my head saying “but what if it’s THIS cycle that’s the one”. But equally if I don’t cancel, and it’s unsuccessful, would I always regret not trying the higher dose.
This whole process is just emotionally so draining. Sorry for the rant!

@Ohana2020 Urgh there really is no easy answer. I think all you can do is get as much information as you can, and try to make the decision based on what you feel you'd have the least regrets about in the future.

I would be slightly cautious about doing back-to-back cycles if you did cancel, and I'd be tempted to let your body have the usual 1 natural cycle before trying again to 'reset', just because I think stims screw with your body so much and not sure if you might be left with less follicles in early stage of development to recruit for next cycle if you went straight away?

Good luck whatever you decide to choose to do x

It’s a tough choice. And IVF is just so random with a lot of chance involved, which makes it really hard to make a decision as any of those eggs could be your lucky one!

I’ve read so many different stories - people with 20+ eggs but no pregnancy and people who are told they’d never get pregnant falling pregnant. And every possible outcome inbetween!
There’s no guarantees so it is a bit of a gamble.

I did two rounds of IVF, I responded very badly - even worse the second time when we switched up the drugs and protocol. I only had a few follicles growing so we were offered to cancel, but decided to go ahead with egg collection. I only got one egg collected. But I am glad we went ahead as I'm currently 6 weeks pregnant from the one egg collected.

@2mumlife thank you for the advice re back to back cycles-it isn’t something I thought of so will definitely raise it with the clinic if I do end up cancelling.

@AnnieStar12 thank you so much for replying.
And congratulations on your pregnancy!
You’re right - you can read every eventuality about IVF online and I do believe luck/chance is a big part of it all!
I leaning more towards just continuing with this cycle but will see what the scan shows today and I guess take it from there.