The question
Dr. Sher,
I have a problem with my right ovary. Every time if we have more than one follicle > 17 mm in diameter on this side, we cannot retrieve the eggs (experienced that 3 times). We tried multiple protocols, even a natural cycle but it is every time the same. Last time we used 500 mcg Ovidrel (+ FSH stimulation on day of trigger), same outcome, no eggs on the right side. If there is just one big follicle on the right, it will be able to do the meiosis with just 250 mcg Ovidrel and the quality of the egg is good. I do not have such difficulties with my left ovary. 250 mcg Ovidrel is enough to be able to retrieve those eggs. The only thing I an think of now is to try 10000 rHCG (Ovidrel) + 0,2 Decaptyl. What do you think? In my mind there cannot be such a coincidence that every time there are multiple big follicles on the right, they are always to a very high degree chromosomal abnormal. And if this is not the case, the retrieved egg is good. Sounds very strange. That is why I am assuming that rHCG alone is somehow not efficient enough.
Best Patricia
Answer from Dr. Geoffrey Sher
I suggest you call my assistant "Patti" (702-533-2691) and set up an online consultation with me to discuss...see below.
- EMPTY FOLLICLE SYNDROME”
“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.
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Herewith are online links to 2 E-books recently co-authored with my partner at SFS-NY (Drew Tortoriello MD)....... for your reading pleasure:
- From In Vitro Fertilization to Family: A Journey with Sher Fertility Solutions (SFS) ; http://sherfertilitysolutions.com/sher-fertility-solutions-ebook.pdf
- Recurrent Pregnancy Loss and Unexplained IVF Failure: The Immunologic Link ;https://drive.google.com/file/d/1iYKz-EkAjMqwMa1ZcufIloRdxnAfDH8L/view
I invite you to visit my very recently launched “Podcast”, “HAVE A BABY” on RUMBLE; https://rumble.com/c/c-3304480
If you are interested in having an online consultation with me, please contact my assistant, Patti Converse at 702-533-2691 or email her at concierge@sherivf.com\
General information only, not medical advice for your own situation. For that, book a consultation.