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I know it is hard to fathom, but it looks like your RE may be right. The "tough oolema" means that the egg's plasma membrane (the membrane that separates the inside of a cell from the outside) was abnormal and probably nonfunctional. When ICSI is performed, the plasma membrane must "heal" around the sperm injection site. If the plasma membrane is too rigid (or "tough"), it will not heal properly and the cytoplasm leaks out, and the egg degnerates. The unusally high rigidity observed may have been caused by a imbalance in the chemicals that make up the plasma membrane (too much cholesterol in the membrane). When left to their own devices, eggs with rigid or "tough" membranes usually do not fertilize "naturally" as they are defective to begin with. Having almost half your eggs degenerating after ICSI is unsual and supports the conclusion that there may be an inherent "egg problem".
It is not clear at this point whether this just a "bad" crop of eggs or not. It is impossible to draw conclusions from a single failed cycle. The type of stimulation and management of the stimulation can make a difference in egg quality. I think you should give it another chance. If, however, similar results are obtained, I think you will have your answer.
It is imposible to increase the absolute number of follicles/egg with medication (gonadotropins), so going from 16 to around 30 is simply impossible. What the medication can do is to modulate the growth of the follicles that began to grow on that particular cycle. The speed of follicular growth can be optimized into the 9-11 day window to maximize egg "quality". That's all the medication can do. The medication has no effect on how many follicles start to grow at the beginning of a cycle. The number of follicles that begin to grow on any given cycle is dependent on your age and your ovarian reserve. If it was a simple as just taking more medication, then everyone (even 45 year olds would have tons of eggs).
I recognize that you are disappointed, but the reason that it didn't work doesn't necessarily have to be anyone's "fault". I see your expections were very high because you were taking the big jump to IVF. Keep in mind that IVF, in addition to its therapeutic value, provides invaluable diagnostic information about why you weren't getting pregnant in the first place. You may very well have an inherent "egg problem". And, if that's true, there's not much that can be done about it except what your RE has suggested - change the stimulation to obtain as many mature eggs as possible and hope for a "good" one.
Second opinions are useful. However, it is easy for a doctor to criticize what has already been done (after all, it didn't work, right?). Hindsight is 20/20. The real question to ask in second opinion consult is "What would you do differently?" and "Would it make a real difference?", or are they suggesting something different just for the sake of doing something different. After the consult, take the information from the second doctor back to your original doctor and see what they have to say about it. Then decide the pros and cons of each approach.
Best of luck.
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