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doglover - November 8th, 2009 9:48 PM

Hi Dr. Jacobs-
I would appreciate your opinion on a recent failed IVF cycle. I have a healthy son from my first IVF cycle which was a Serono study using Gonal-F. My husband has male factor issues, and I tend to have a thin lining (never thicker than 8mm). I am 33/my husband is 32.

For our second IVF, I was placed on Bravelle and Menopur (2 vials of Bravelle/1 vial of Menopur) for 10 days. At time of hCG trigger, I only had 1-2 follicles over 18mm. The remainder were around 14, 15, and 16mm (approx 6 total). At retrieval, 5 eggs were obtained. The doctor said the remaining follicles were empty. They did not do ICSI. 4 out of 5 fertilized. On day 3, I was told that they all looked good and that I should return on day 5. On day 5, we had one perfect blast and a grade C morula. The others were discarded due to poor quality.

So we transferred both embryos. I had an 8mm lining, and my blood levels apparently looked good each time they were taken. Unfortunately, I got a negative test result.

My questions are:
1. Do empty follicles imply a problem with egg quality?
2. Shouldn't the hCG trigger be given when follicles are mature (ie ]18mm)?
3. Does a problem after day 3 of development indicate a problem with the sperm DNA?
4. Do you have an opinion on why this cycle failed?

Thanks so much for your help!
Sincerely,
Lindsay

B. Jacobs, M. D. - December 4th, 2009 6:00 PM

1. "Empty follicle", in this case means that your RE could not get an egg out of it. I cannot get an egg out of every follicle, either.
2.There are a number of differrent variations of protocols. I do not know which 1 your RE was using.
3. Genes from sperm start playing a role in embryo growth and developement on day 3. A decline in embryo quality after day 3 is generally thought to be a sperm issue.
4. Without evaluating you or participating in your care, I cannot make a meaningful recomendation.
Good luck.

angelbaby - January 12th, 2011 10:25 PM

Hi Dr,

My first IVF cycle was converted to iui, because i produced only 2 good eggs, resulted in negative.

I have PCOS,(33age, BMI 26) so my gyne believes that i'm being resistant to drugs.

I was put on metformin, 3 times a day. and I'm still continuing.

On my second cycle Dr changed from Gonal F 150 iu(tried during first attempt- 2 eggs)Puregon 200iu and menopur 75. My scan revealed a good results. i had around 30 eggs, Dr was scared about hyper stimulation.

But on egg pick up day, Dr retrieved only 7 eggs, out of which only 3 fertilized, resulted in 2 good embryos.

Even my blood test on HCG trigger day revealed that my estrogen level was around 6000. They said it's almost matches with number of eggs that were retrieved.

My biggest worry is what is causing empty follicle syndrome? How can i improve my chances of producing healthy eggs?

Considering my age, this problems seems rare and it really worries me.

I really appreciate your guidance to my problem.

B. Jacobs, M. D. - January 12th, 2011 11:17 PM

There are a number of different stimulation protocols, and some other may be of benefit t you. I get better quality eggs if I do not add the LH that is part of Puregon. I typically use a "step down" protocol with straight FSH starting at 150 units twice a day.
Good luck.

angelbaby - January 13th, 2011 6:09 AM

tnx for your reply. but what is causing empty follicles? that my biggest worry in next attempt of ivf

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