The question
Hi, I'm on my first round of ivf due to same sex relationship. Im from the UK. I have just had my first egg retrieval and I'm bitterly disappointed with the amount of egg they collected. I'm 37, amh 14.1, fsh 7.1 I did 10 days of stims, 225 meriofert staring 0.25 Fyremadel on day 6. Triggered with 1ml suprecur. On my last scan on day 9 I had 16 follicles. 20, 18.5,18.5,18,18,18,17.5,17,17,17,17,16,16,15,15,15.6 egg reatrived, 4 mature, 3 fertilised today. 1 slow to fertilis.
Do you think it's a problem with me? I thought my amh was ok for my age and I had an AFC of 21 at bassline scan. Or could it be a protocol or trigger problem.
I would be so grateful for some advice.
Answer from Dr. Geoffrey Sher
Empty Follicle Syndrome" is a misleading term because follicles always contain eggs. However, some eggs may have difficulties detaching and being retrieved. This is more likely to happen when multiple attempts are needed to retrieve an egg from a follicle, indicating the egg may have chromosomal abnormalities.
The hormonal environment created during controlled ovarian stimulation plays a significant role in egg development. In certain cases, follicles may not release their eggs during retrieval, leading to the misconception of “empty” follicles.
This situation is most commonly encountered in older women, those with diminished ovarian reserve (DOR), and women with polycystic ovarian syndrome (PCOS). To address this problem, personalized protocols for controlled ovarian stimulation and careful administration of the hCG trigger shot are important.
The hCG trigger shot is given after optimal ovarian stimulation to initiate the process of reducing the number of chromosomes in the egg. It also helps the egg detach from the follicle's inner wall. This allows for easier retrieval during the egg retrieval procedure.
Women with increased LH activity, such as older women, those with DOR, and women with PCOS, are more susceptible to the negative effects of LH-induced ovarian testosterone. Excessive LH activity can compromise egg development and increase the chances of chromosomal abnormalities. Medications like clomiphene and Letrozole can stimulate LH release, and certain drugs containing LH or hCG can have negative consequences.
Individualizing the controlled ovarian stimulation protocol, determining the correct dosage and type of hCG trigger, and administering it at the right time are crucial. The recommended dosage of urinary-derived hCG products is 10,000 units, while for recombinant DNA-derived hCG, the optimal dosage is 500 micrograms. A lower dosage of hCG can increase the risk of chromosomal abnormalities in the eggs and negatively impact the outcome of IVF.
Understanding the role of LH activity, the effects of medications on hormone release, and the importance of personalized protocols are vital. By optimizing these factors, the risk of failed egg retrieval and "empty follicle syndrome" can be minimized, improving the chances of successful IVF outcomes.
If you would like to discuss your case with me , email my assistant (702-533-2691 and set up an online consultation with me,
General information only, not medical advice for your own situation. For that, book a consultation.