Egg Retrieval
1 Replies
LS2005 - August 16

Age 29 diagnosis Male factor only
I just got back from my 2nd IVF cycle: 11 eggs were retrieved.
1st IVF cycle 19 retrieved. I was on the same dosage of follistim 225 U once a day for both cycles. Had similar number of follicles and very similar E2 levels through out the cycle and at trigger. We did expect a few less...but not this many!! If my stimmulation was so similar....why did we get such different results? At trigger my E2 level was 3200 (isn't E2 level supposed to be 200 per mature follicle) which is about 15 eggs? I am soo confused. Of course, I am looking for quality not quantity. Could this mean I have better quality eggs?


Dr Smith - August 17


The first thing to realize is that the stimulation medication does not make more eggs. The function of the stimulation medication is to sustain the growth of all the follicles that start growing on a given cycle. It does not alter the number that start growing. There is some cycle-to-cycle variation in the number of follicles that begin to grow, but it has nothing to do with the medications. Changing stimulation protocol can result in better follicular growth, but, again, will not change the number of follicles that begin to grow on that particular cycle. No medication currently available can recruit more follicles into the growing pool on a cycle (i.e. make more follicles).
So, on the first stimulation, you had 19+ few more follicles begin to grow and on the second cycle you had 11+ a few more begin to grow. That is within the expected cycle-to-cycle variation we frequently observe in patients. The variation in the number of follicle from one cycle to another leads to the MYTH that one medication/protocol is better than another (which, heavy sigh, is plastered all over the internet). The success of a stimulation is more related to who's doing it (i.e. the RE) than anything else.

We expect around 200 pg/ml of E2 for each MATURE follicle (i.e. >16mm on the day of hCG). So, the E2 level is not directly porportional to the total number of follicles, only the mature ones. The quality (i.e. maturity) of the eggs is associate with the E2, but again, its not a simple 1:1 relationship. There is an optimal range of E2, but its very wide. We have found that the optimal number of follices for the highest porportion of mature eggs is betwee 12 and 15 mature follicles. But, as I said, the medications can only modulate the growth of the follicle, not change their number.



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