Lone embryo arrested at 4 cells/did I stimulate too fast?
1 Replies
AgnesG - October 23

Dr thank you so much for taking the time to answer my questions. I apologize in advance for the long post.
I started my first IVF cycle a couple of weeks ago. My protocol was follistim 325 once a day starting on day 3. On day 2 , I had 9 antral follicles ( i am 40 years old). After 4 days of shots, I had BW/US: estrogen at 883, LH at 12 and 5 follicles 10-15.9, 4 follicles 4-8. I was told to start antagon but keep follistim at 325. 2 days later my estrogen was at 1300 and I had 3 follicles 17-19, 2 at 14, 4 at 7-11. I was told to keep the same dose and come back the next day as i was close. That next day my estrogen was 1600, and I had 4 follicles 19-21, 2 at 14 and 3 at 8-11. I was told to take one more dose of follistim and antagon that night and trigger at 1 am. I went for retrieval 34 hrs later, where they only retrieved 3 eggs /9 follicles, only one which turned out to be mature and fertilized and grew to 4 cells and arrested.
I am trying to understand what went wrong. Did I stimulate too fast causing the lone mature egg to not mature properly? should I have triggered earlier to capture more mature eggs?
Thanks so much for you advice and comments

 

Dr Smith - November 7

From my calculation, your stimulation was for 9 days. That's fine. However, the elevated LH on on the 4th day of stimulation is worrisome. Premature exposure to LH can compromise the egg maturation process leading to "post mature" eggs. The Antagon would bring the LH back in line, but once elevated, it could cause trouble.

We expect to obtain eggs from follicles over 16mm at the time of hCG. Follicles smaller than 16mm will either not yield eggs (as in your case) or yield immature eggs. At the end of the stimulation, you had 4 mature follicles. So, its 3/4 eggs retrieved, not 3/9.

As to the low fertilization results - if there's something wrong with the egg (i.e. genetically abnormal) it will not fertilize or it will not activate when a sperm gets inside. Effectivly, the egg is a dud. This is nature's way of preventing the development of abnormal embryos. This becomes more common with advanced maternal age (i.e. >35). You are 40 and the simple truth (although you probably don't want to here it) is that you're going to have a hard time getting pregnant because your eggs have passed their prime. Sorry to be blunt, but I call's them as I see them.

I hope you have better luck if you chose to try another cycle, but you should try to keep your expectations in line with the biological reality. Best of luck.

 

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