Stimulation Protocol - Immature Eggs
13 Replies
pst - April 22

I am in the process of my 4th IVF. Unexplained Infertility. This cycle I was using Lupron and Follistim. I started Lupron on CD21 and got my period late, so I was taking Lupron 2 days longer. I was on 300 Follistim and 5 units of Lupron during stimulation. On the 8th day of stimultaion the DR. called to tell me to go to 75 units of Follistim because my etradiol levels were 2100. Unfortunately, I had already taken the 300 units before I checked my messages. The next day my levels were 2800 so I took 50 units that evening. But on the following day my levels were 4600+ so I took the hcg that night. My DR was hoping to go another day based on the u/s but didnt want me to hyperstimulate. I had 24 eggs retreived but only 12 were mature. The embryologist call this morning -
Half ICSI - 5 fertilized
Half Inseminated - 3 fertilized
During my last cycle on Antagon/Follistim, 18 of the 24 retreived eggs were mature. 14 fertilized and 4 made it to the compacted morula; we transfered all 4 on day 5 but BFN. I think I was stimulated for 11 days.

Do you think being on Lupron 2 extra days will have a negative impact on the embryos/cycle?
Do you think the high estradiol levels will have a negative impact embryos/cycle?
Any thoughts are opinions aare appreciated.
Thanks so much, pst


Barry Jacobs, M. D. - April 22

I cannot second guess your RE. He/she was there. I was not. The protocol you used is different than what I use. We have patients on birth control pills and start Lupron on pill day 21. That eliminates some uncertainty. In our experience, egg retrieval before day 12 of the stimulation cycle produces a larger percentage of immature eggs.
Good luck.


pst - April 22

Thanks Dr. I appreciate the input. I think I may have posted my situation to you before. I have unexplained infertility. Im 32 and Dh is 37.
1st cycle - Gonal-f, pill, Lupron; 17 retrieved, all stopped growing at 2-4 cells by day 3 but transferred 4 anyway. BFN
2nd cycle - Gonal-f, Lupron, Repronex; 21 Retrieved, Day 3 transfer of 3, 6-8 cell embryos average to below average quality, embryologist was afraid to transfer more than 3 for fear of multiple pg. Assisted Hatching & half were ICSI. BFN
3rd cycle @ new clinic - Follistim, pill, Antagon; 24 retrieved, 18 mature, 14 fertilized, By day 3 I had 9 or 10 embryos, mostly grade 1's and 2's. By day 5, the embryos were growing slower than they like to see. I had 4 compacted morulas transferred. BFN
4th cycle - Torromow will be 2 days post retrieval. 8 fertilized. See above post.
Both Dh and I had lots of testing. The doctors at both clinic said they cant see any reason why Im not getting pregnant. I feel so lost and confused. If I get a BFN, I still will try 2 more times. I was very unhappy with my previous clinic/doctor. Is there anything you suggest I try or anthing I bring up with the doctor in case this cycle does not take. Im so upset, each cycle was a big improvement over the previous, so I was hopeful this cycle would have been "the" cycle. Im still trying to keep positive but its tough. I didnt want to do another day 3 transfer, but with only 8 fertilized eggs on day 1, Im a little weary. I will hear from the embryologist tomorrow...time is going by so slowly. Any advice is greatly appreciate.


Barry Jacobs, M. D. - April 23

I really do not know what to tell you. Since I have not been involved in your care, I do not know what else to offer. It has been over a decade since I have not been able to find an explanation for a couple's impaired fertility. You may wish to see the information on our web site, <>. There may be something there which would help.
Good luck.


pst - April 23

Dr. Jacobs,
Thank for your advice. I have two more questions for you. The embryologist called -
Day 1 - 8 fertilized
Day 2 - Of the 8, four of them are perfect grade 1 and one stopped dividing. Also, 4 more fertilized. So I have 11 embryos total - All grade 1's and 2's.
I had a lot of immature eggs this cycle so Im guessing thats why the 4 fertilized on Day 2.
If an egg fertilizes on Day 2 is it likely/unlikely that it could develope to the Blast stage?
Also, Im taking prednisone, doxy and progesterone shots. What is the prednisone used for?
Thanks so much for your responses. pst.


Barry Jacobs, M. D. - April 24

There is a chance that those which fertilized on day 2 will become blastocysts. Predisone is a steroid, and is an anti-inflamatory agent. Inflamation impairs implantation.
Good luck.


pst - April 24

Thank you. Your help is greatly appreciated. pst.


pst - April 25

My transfer is scheduled for tomorrow. I just came across information regarding intercousre being beneficial to embryo implantation during the time of transfer. This is the first Ive ever heard of it. Is that something youd recommend to your patients before their transfer? Thanks, pst.


Barry Jacobs, M. D. - April 25

I have not seen any data to support the information you have found. I have no reason to believe intercourse the night before transfer would either help or hinder.
Good luck.


pst - April 26

I had my day 5 transfer this morning. 4 compacted morulas were transferred. 2 grade 2 and 2 a little less than grade 2. The embryologist said he wouldnt transfer then if he ddint think they had a chance. Do you think theres a chance that they could make it to blast? Since they werent blastocycsts today, does that mean theyre growing too slowly? Have you experienced this in your clinic and had success? Thanks.


pst - April 26

FYI - grade 1 is the best


Barry Jacobs, M. D. - April 27

I am the wrong person to ask if your morulae will become blastocysts. The embryologist working with them has a far better chance of giving you an accurate answer. There is a chance they will cotinue to develope, but I really have no way of knowing the odds, in your case.
Good luck.


dema0418 - May 4

Hi Doctor Barry Jacobs, I suppose you could help in this. I am on a natural cycle with IUI. I had two follicles with size 16 and had LH surge today(05/04/06) around 9 am this morning. Mydoctor gave me hcg shot of 5000 imeediately and asked us to come for iui tomorrow at 7:30 am. I am not sure about the timing after the hcg shot. My question to you are is the timing for iui is right after the hcg shot. Will i require two iui? and will hcg shot works for everyone. thank you.


Barry Jacobs, M. D. - May 4

I do not do natural cycle IUI. Our experience with that protocol has been very disappointing. I do IUI after stimulating ovaries with an FSH product. Insemination is 36 hours after hCG injection. The data in the literature indicate that more than 1 IUI in the protocol I use does not improve pregnancy rates. One group of investigators thought they found a benefit, but when they re-examined their data, there was no benefit to the second IUI.
Good luck.



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