Hello Dr Sher,

First of all I would like to thank you in advance for giving me a chance to ask you a question and for answering if. I really appreciate it.

I am 33 years old, have a good egg reserve (PCO), all my hormonal blood tests came out good. My FSH on cycle day 4 is 8, LH is 11 and AMH 4.71 ng/ml.

For my first IVF cycle (Feb 2022) I was on Gonal F 225 only and was triggered with Ovidrel when my leading follicle was not very big – 17mm. As a result, I got 24 eggs retrieved, but only 3 mature and unfortunately one fertilized but abnormally. So it was a first IVF failure…

I then switched clinic, did a second IVF cycle (July 2022) and I had a change of protocol. I was on Menopur 150 and Rekovelle 9 mcg. I was triggered with a double trigger (HcG 2500 units and suprefact 1ml) when my leading follicle was 20mm. As a result, I got 16 eggs retrieved, only 2 mature and one fertilized and I had a fresh day 3 embryo transfer (8 cells) which unfortunately was negative….

Before doing my third round of IVF, I did my blood tests again, had 3 different genetic testing (caryotype, infertility female panel and the gene mutation TUBB8 were all tested and nothing was found). I had a slightly different protocol: menopur 150, Rekovelle 7mcg this time because of my weight, and they added Letrozole 5mg which I took during the entire stims for 13 days. I was triggered when my leading follicle was bigger at 22-23mm and they gave my a double trigger with an increase of HcG at 10,000 units this time along with Suprefact 1ml and they waited 37 hours before doing my egg retrieval. As a result, I got 19 eggs, but this time zero were mature!!! They manage to mature 4 of them in the lab, and only one egg fertilized and arrested at day 3 with 7 cells… (they wanted to push it to day 5 this time…)

I feel completely at loss and I don’t know what to expect next… are my eggs the problem and I need to turn to donor eggs? Or is this more of a protocol issue? I feel like the leteozole made things worse as this was the worst results of all 3 cycles and the “new” thing that was added was the letrozole… Any advice would be appreciated. Thank you so much! 🙏🏻