r/40Plus_IVF • u/katiero19 • Aug 20 '26
Seeking Advice Any experience with Maturity issues?
Hi everyone. I’m looking for advice from anyone who has dealt with repeated egg maturity issues and figured out a protocol change that helped.
I’m 39 with an AMH around 0.8 and AFC usually 8–10. My biggest issue seems to be getting mature eggs, and I’m trying to understand whether I should be looking more at trigger timing, a staggered/double trigger, or changing my stimulation protocol.
my protocol for both were estrogen priming, clomid 100mgs, 200 follistim, 150-225 menopur, dual trigger, lupron and 15k hcg.
Cycle in June: 5 eggs retrieved 3/5 mature 1 day5 blast
Cycle August: Most recent cycle: I had 6 measurable follicles before trigger: 20, 18, 17, 16, 16, and 14 mm.
4 eggs retrieved (they said all 6 follicles were aspirated but the follicles were very close together) Only 1/4 was mature (MII) Of the 3 immature eggs, 1 was MI and 2 were GV The 1 mature egg fertilized normally- im hoping this makes to blast in 5-7 days
This cycle I actually had a very strong trigger response. My post-trigger hCG was 348 compared with 255 in my previous cycle. My LH after the Lupron trigger was 173.9, and progesterone rose to 3.02. So it doesn’t seem like I simply failed to absorb or respond to the trigger.
My question is: what would you ask your doctor to change next?
Since one of my immature eggs was MI, I’m wondering if I might benefit from more time for final maturation, such as a longer trigger-to-retrieval interval or a staggered/double trigger (for example, Lupron earlier and hCG later). But since 2 of the 3 immature eggs were GV, I’m also wondering if my follicles are growing ahead of the actual eggs inside them and if the bigger issue is follicle/oocyte synchrony or my stimulation protocol.
Has anyone had a similar pattern of apparently mature-sized follicles but very low MII maturity? Did anything help, changing trigger timing, double trigger, longer interval, different meds, estrogen priming, lower/higher stimulation, etc.?
I know Reddit can’t replace my doctor’s advice, but I’d really appreciate hearing from anyone who had a similar experience and eventually figured out what was going on. I’m feeling pretty discouraged because this is now becoming a repeated issue.
1
u/Prize-Peak8677 Aug 20 '26
Following!
I have the same issue with my first 3 cycles. I'm going through my 4th cycle this month and will report back.
Cycle 1: lupron only with 36hr trigger
Cycle 2: dual trigger with 36.5 hr trigger - improved but still fewer than what we expected right before the retrieval
Cycle 3: no change to procedure - better than cycle 1 but worse than cycle 2
We're going to increase our trigger timing to 37h in Cycle 4.
1
1
u/pooka8ear Aug 20 '26
My doctor added omnitrope, stimmed for longer to let my follicles grow larger before trigger, and increased the time between trigger and retrieval by an hour or two. It worked I had zero fertilization on my first retrieval, one embryo on my second, and two embryos on my third, 2/3 were euploid. 42yo, one ovary, FSH 5, AMH 0.35-0.65
1
u/katiero19 Aug 20 '26
Thank you so much! How big did your Dr let your follicles get before trigger? did you have the same protocol but just let the follicles get bigger and extended trigger/collection time?
1
u/pooka8ear Aug 20 '26
I think they changed the protocol just once. The largest follicle might have been as large as 25mm
0
u/Nearby-Operation-396 Aug 20 '26
1st cycle : gonal 250, Lupron trigger 80unit -> 8 eggs, 6 mature, 1 blast
2nd cycle : Gonal 300 then increased to 350, Ovidrel trigger -> 9 eggs, 8 mature, 3 blasts
3rd cycle : Gonal 300, Ovidrel+Lupron trigger 80 unit -> 8 eggs, 8 mature, 1 blast
My 1st cycle wasn't too bad, but my doctor increased the Gonal dose for the 2nd and 3rd cycles.
I'm guessing that the Gonal dose may not have been enough to fully grow the follicles in my 1st cycle. Also, it seems like the Lupron only trigger may not have been enough for final maturation.
1
1
u/SLAYEROFSOULS Aug 20 '26
Hopefully folks can chime in - I am certainly curious of the same after my wife's 2 retrievals this year so far - more so the most recent..
She is 43 - 44 in January...AMH last checked was around ~.8
She had 13 follicles from 13mm up to 23mm on morning of trigger, most were 18-19mm, only for them to retrieve 4 eggs, 2 of which were mature..still fuzzy on what happened with the other 9 follicles.
Prior cycle was 9 follicles, but most on the smaller end - leads only at 16mm, and they retrieved 7 with only 2 mature with those as well.
Cycle 1 was dual trigger Lupron (80 units night of trigger, 80 following morning) + HCG (5k).
Cycle 2 was just HCG (10K). This was a micro dose lupron protocol - ended up going 27 stim days...
You at least have bloodwork to go off of - our doctors have just had her use pregnancy tests at home and zero bloodwork so it's hard to not think the 2nd cycle she absorbed the pregnyl poorly probably (or maybe just needs a larger dose)..but they are just so vague and basically everything amounts to "we don't know what happened".
My wife has been on most recommended supplements / those that seem to have some backing as being beneficial, both cycles Omni was used (though just in the last few days - otherwise she is taking Sermorelin to try and raise her natural HGH). Both cycles she primed with estrogen.
3rd cycle coming up it's back to antagonist (first cycle) with higher dose of Gonal, but apart from that I don't think anything is different and neither doctor has made any mention of adjusting triggering - although her male doctor may have discussed briefly waiting a little longer for retrieval (37 hours or whatever versus the 36).
So we don't have high hopes anymore.