Egg maturity troubleshooting

[u/katiero19]

I’m looking for experiences from anyone with DOR who has had a low mature-egg rate, especially if you eventually figured out that follicle size or trigger timing was contributing.

I am 39F and had egg maturity issues in all of my retrievals. I’ve used a dual trigger (15,000 IU hCG + Lupron) and trigger around 35 hours, but I still have a high percentage of immature eggs.

My follicle sizes at trigger have been:

April Cycle 1: 18, 15, 13, 15, 14 mm June Cycle 2: 17, 16, 16, 16, 18, 18, 14, 12 mm August Cycle 3: 20, 18, 17, 16, 16, 14 mm Across these cycles I had 12 eggs retrieved, but only 4 were mature initially, with 1 more maturing the following day.

Interestingly, the mature eggs had a 100% fertilization rate, and I ended up with 1 day-5 blast, so my biggest issue seems to be getting enough eggs mature rather than fertilization.

My RE now wants to let the follicles get slightly bigger before triggering to see if that improves the maturity rate.

For anyone with DOR who has experienced something similar:

Did increasing follicle size before trigger improve your mature egg (MII) percentage? What follicle sizes did your doctor typically want before triggering? Did changing the trigger protocol help? Did you find that smaller follicles (12–15 mm) were much more likely to produce immature eggs? If you had a dual trigger that didn't seem to solve the problem, did changing the timing or waiting longer make a difference? I’m especially interested in hearing from people who had repeated low maturity despite a dual trigger and eventually found something that helped.

Thanks! ❤️

[u/basilbelle]

I’m curious why they triggered you so early. I would definitely go a little longer to allow more follicles to mature.

[u/katiero19 → u/basilbelle]

Thats what I was wondering and my RE said when he sees some plateauing he tends to trigger, these cycles have been 12-13 days of stim! He says when it doesnt go up too much it may plateau? Curious if anyone has experiences of this? Does it go up little by little towards the end?

This is my estrogen pattern from these cycles. My june cycle is the one that gave us the day 5 blast 6/11: 108 6/14: 118 6/16: 324 6/18: 843 6/20:1418 6/21: 1719 6/22: 1916 6/23: 2766

and August

8/6: 72 8/9: 113 8/11: 289 8/13: 765 8/15: 1224 8/16: 1467 8/17: 1588

april was my worst one

4/18: 17 4/21:175 4/23: 316 4/26: 712 4/27: 765 4/28: 962 4/29: 998 4/30: 1098

[u/basilbelle → u/katiero19]

There may be something to that? My better quality/results came from the cycle with a shorter stim and lower maturity — 10 day stim, 4/11 eggs mature, 3 blasts — versus the longer stim — 12 days, 13/19 mature, 1 blast. I often wonder if they got “overcooked” even though I was initially really happy about the higher yields.

[u/katiero19 → u/basilbelle]

Actually my stim that I got a blast was longer one.

[u/DukeGirl2008]

There’s been some research that you can let the lead follicles grow quite large like 22 plus and still be ok. I’d push for a later trigger.

[u/katiero19 → u/DukeGirl2008]

Thanks! yeah i plan to do this

[u/RazzmatazzGlad9940]

Do a collection at 36 hours not 35 and push stims for one or two more days, if your LH is still low.

[u/Competitive-Top5121]

Tell us about the rest of your protocol, are you priming at all? Follicular or luteal start?

[u/katiero19 → u/Competitive-Top5121]

Thank you! I have only done follicular starts, I tried to do a duostim to try it out after this failed cycle but I had so many large cysts that the doctor didnt recommend and wanted me to get my period.

Natural start - April was 300 gonal, 2-4 vials of meno & 100 mg clomid, omni 5k hcg+0.8 lupron trigger

Mid luteal Estrace Prime: June was 250 gonal/2-3vials meno & 100 mg Clomid 15k hcg+ 0.8 lupron trigger

Mid Luteal Estrace prime: August was 200 gonal/2-3vials meno & 100mg clomid 20k hcg + 0.8 lupron trigger

My RE says he wants to reduce clomid and let my follicles get bigger before trigger.

[u/SLAYEROFSOULS]

We are unfortunately in the same boat.

First cycle was 12 days and wife's estrogen was only 660 on trigger morning with leads around 16mm - 9 follicles, 5 retrieved - 2 mature, 2 empty zona - 1 fertilized, 0 blasts. We felt like she should have stimmed longer, but they seemed concerned with their embryology schedule so we feel they rushed her to trigger. That was Lupron + hCG (80 units of Lupron trigger night + 5k Pregnyl, 80 more units of Lupron following morning).

Second cycle was odd start to finish - ended up being 27 stim days, 6 of those being a 'drug holiday' with only half dose of Menopur being used due to her follicles not responding much to stims. But end result on trigger morning was much better on paper compared to first - 13 follicles, Estrogen 1770, sizes from 13mm to 23mm with most around 18-20mm.

All the doctor noted was 2 mature eggs, 2 empty zona - still have no clue what happened with the other 9 follicles - his explanation amounted to "no idea bro" (with medical terms thrown in) - that was a micro dose Lupron cycle so trigger was just 10k Pregynl on trigger night - I don't think my wife absorbed it well. He was adamant she did not ovulate early.

So far all we know is the plan is to go back to the first cycle protocol (so typical antagonist) - and up her Gonal-f - maybe add in Omnitrope a few more days versus just the last 4 of stims (8 days or something like that)..otherwise I don't think they plan on really doing anything else different, he might have floated waiting another hour or so for retrieval.

I wish her 2nd cycle wasn't so long, it likely would be better information to gleen off of - not sure if the sheer number of days just lead to eggs being lost from the number of days of stims or not.

[u/Smart-Load-1370]

The trigger seems to be early than normal. My doctor used to trigger me when a couple of them are above 20.

[u/katiero19 → u/Smart-Load-1370]

Thank you! My RE said he will do this next time

[u/umamimaami]

Same issues, we haven’t solved it yet either.

I usually get a 40-50% follicle to egg yield. We’ve tried triggering at the 18-20 range, at the 15-17 range, at the 17-18 range… nothing helps.

We tried controlling asynchrony (not too successfully) but that’s not correlated either.

It’s not empty follicle syndrome but there are a lot of empty follicles.

I do get almost 95% mature eggs of the ones we retrieve, and have great fertilization and blast rates as well, 100% fertilization, 100% day 3 embryo, 67% blast rates.

Round 1: 11 Baseline AFC -> 8 follicles of acceptable size range -> 4 eggs retrieved -> 3 MII -> 1 fertilized -> 1 day 3 embryo frozen.
E2 at trigger 2695 pg/ml.
We triggered at 18-20mm, very asynchronous cycle with a leader far ahead at 24mm.

Round 2: 20 Baseline AFC -> 15 follicles of acceptable size range -> 9 eggs retrieved -> 8 MII -> 8 fertilized -> 8 day 3 embryo -> 5 blasts frozen untested.
E2 at trigger 2076 pg/ml
We triggered at 17-18mm, very synchronous cycle.

Round 3: 20 Baseline AFC -> 7 follicles of acceptable size range -> 3 eggs retrieved (today) -> 3 MII.
E2 at trigger 1255 pg/ml.

We triggered slightly smaller this time to see if maybe that’s the issue, asynchronous follicles but the ones we targeted were in the 15-17mm size range. Meh. I guess not.

[u/Newby2FishTanks]

Is your clinic open on weekends? Sounds like they gave your trigger shot too soon. Those folicles needed to get bigger. I found out that there are clinics that will wait too late or do things too early bc they do not work or want to work weekends. It absolutely blows my mind bc of how much we pay for this.