Dear Dr. Sher, I am in my late 30s and have an amh of 0,3. My period is very regular with regular ovulation (day 11 to 13) and I do not have any problems in the luteal phase like spotting. I concived naturally with my husband 5,5 years ago without any problems. 2 years after giving birth (me 35 at that point) we started again trying to get pregnant. Unfortunately without success. After some time we consulted a fertiliy clinic and tried with ICSI as this was the most promising apapproach. As I do not have much follicels and the first approach with high dosage of pergoveris in an antagonist protocol failed due to no oocytes retrivation and me having difficulties to adjust to the drugs (depression), we decided to just proceed with mini ICSI. I know you’re not a fan of that, but we tried some rounds and got promising results. We’re using 75 IE of Gonal F starting on day 3 and the trigger is with ovidrel 250 mcg.
1 round: 8 cell B quality oocyte transferred on day 3 after egg retrieval. Negative
2 round: 9 cell B quality oocyte transferred on day 3 after egg retrieval. Negative
3 round: on the ultrasound 3 promising follicels were seen. 2 bigger ones and one smaller. On the day of egg retrieval only the egg of the smaller one could be retrieved. Because I was awake during the procedure I noticed that after the punction the doctor noticed none or just a small amout of fluid coming out of the bigger follicels. After that I asked her if she suspects that the follicels already released the eggs naturally (which would be consistent with the lack of fluid) or that the eggs were still sticking at the follicular wall (she washed them out multiple times – this scenario would be the same as with the high dosage pergoveris and would suhggest that 250 mcg is not sufficient if having more than one big follicel).
She suspects the latter one suggesting dual trigger (agonist + 250 mcg ovidrel) or using 500 mcg hcgr) What would you suggest? Does it seem plausible to you that the trigger shot waas not efficient considering the lack of fluid? Unfortunately she did not any blood work or measured the two big follicels when doing ultrasound before egg retrieval. So I have limited information.
It seems also that doing ivf is the same as trying to get pregnant naturally in my case. Nothing happens . There is no indication however of one embryo trying to implant. Because with my son the afterbirth was not successful naturally I got a curettage. I want to have a biopsy test for chronical endometritis, even though I do not have any signs of something like that. What do you think about that? The sperm of my husband meets the WHO criteria in most cases. So it seems like there is no bigger sperm problem, except dna fragmentation which we did not test.
I have hashimoto but my tsh is well adjusted at approx 1. TPO is 95 where less than 35 is normal.

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