Empty follicles?

Answered on 21st October 2014 in Fertility

Hi there, I am quite upset as just had my egg pick up last week and they retrieved only two eggs (which appear to be not right either). This is my second cycle. Our history: 3 miscarriages in 9 months (all very early), then moved on to IVF to try to bank some embryos to implant later with immune treatment.

First IVF cycle, no pill prior to it, Puregon 225IU daily and a day 10 collection and 5 eggs retrieved, though they were very different in sizes and only two over 17mm at trigger. None made it to blast. They did a 3 day transfer of a 10 cell embryo with mild to moderate fragmentation which didn’t work.

Second cycle, (current) they put me on the pill for 21 days, I then came off it for two days and started stims right away on second pill free day – 300 Puregon, 75 Menopur. I also was on Growth hormone for 8 days – 2.5iu daily.

My ultrasounds were showing six follicles that appeared to be mature (one in the left ovary and the rest in the right), sizes 14,15,16,17,19 and 22. Others were under 11mm. My oestrogen was 2045 pg/ml (I thought this would mean at least 4 mature eggs). However, they only got 2 eggs! This was a freeze all cycle, but seems like it was all for nothing!

I am 35 years 8 months, have an AMH of 8.6 (in Australian measurement which is 1.2 in USA measurements), my day 3 FSH has been between 6-8 (6 was more recent). Do you think this protocol is what has caused such a bad result? What do you think went wrong??

A blood test four hours post-egg pickup showed 140IU HCG (i.e. trigger worked), LH 0.1, Progesterone of 15.1. So I guess this is genuine empty follicle syndrome? What would you suggest in future? Should I bother going on the pill to cause more even growth?

I don’t know if there is any point doing IVF for us. The only things they have found is high uterine NK cells and homozygous MTHFR. All my T cell surface markers and cytokines have been in normal ranges last 2 months. Any help is very much appreciated!

Our Expert's Answer

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Please note that all the answers we give are on a generic basis only, as we cannot provide more in-depth answers without access to your medical history. If you need a more detailed response, tailored to you, we would recommend a consultation with one of our Fertility Specialists for more comprehensive medical advice.

My impression is you have been not lucky in this cycle. Although your follicular response appeared reasonable, the oestrogen level remained relatively low. As eggs were collected, it is not empty follicle syndrome. There is some evidence that contraceptive pill may reduce follicular response. In this way next cycle I would recommend no pill preparation. You could try higher dose (450 unit to start with) as well. Best of luck!