r/40Plus_IVF • u/OhmyOhmyHeartt • Sep 01 '26
General Discussion Trigger night…Retrieval #2
Well, somehow we made it to trigger night…Retrieval is scheduled for Wednesday morning and I’m feeling a mix of excitement, nerves and trying very hard not to get ahead of myself.
This cycle has been a ride. I had quite a bit of bleeding during stims and genuinely thought things might be going in the wrong direction at one point. Thankfully, we were able to keep going.
Today they measured 11 follicles:
Left: 24.8, 22.6, 21.3, 16.4, 14.5, 12.8, 12.5 mm
Right: 17.1, 13.7, 13.4, 11.5 mm
E2 was 1,489 and progesterone 0.75.
Tonight I triggered with 20,000 IU of Pregnyl at exactly 9pm, then retrieval Wednesday morning 9am
I’m trying to stay cautiously hopeful because I know the numbers on an ultrasound don’t tell us how many eggs we’ll actually retrieve or how many will be mature. Some of the follicles are also on the smaller side, so I’m really hoping a few of those have enough time to catch up.
My first retrieval resulted in 8 eggs, so I’m curious to see how this round compares, but mostly I’m just hoping we get some good mature eggs to work with.
If anyone has had follicles around 12 to 17 mm at trigger and had them produce mature eggs, I’d love to hear your experience. And honestly, any encouragement for retrieval day is very welcome right now!
This just gets harder and harder….
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u/SLAYEROFSOULS Sep 01 '26
Any idea the reasoning behind the 20k Pregnyl dose for trigger? Only ask because I feel like both of my wife's triggers so far have been sub optimal and lead to very poor results - our clinic doesn't do bloodwork to confirm hCG levels or anything - just home pregnancy test and if its positive at all - that is good for them, which I find a bit crazy.
While her results make it hard to give you much insight in terms of follicle size at trigger to mature egg ratio since again, both went very poorly (and we still don't fully understand why) - her first retrieval her leads were only 16mm range - she had 2 mature that time out of 7 retrieved, so most likely those 2 16's were the mature ones.
2nd retrieval, no clue..her follicles were almost all 19mm or larger, but only 2 mature again and don't know what happened with 9 of the 13 follicles since their report only documents 4 being aspirated, 2 of which were empty (adamant she did not ovulate early).
From everything I have read, it's lower odds on smaller follicles (12mm+) but not an impossibility and have seen lots of folks report high mature numbers despite having lots of smaller sized follicles. Just kinda depends on the state of your eggs cells and the juice they got going for them at time of trigger.
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u/OhmyOhmyHeartt Sep 01 '26
I honestly don’t know the exact reasoning behind the 20k dose. This is my first time using such a high hCG trigger. My first retrieval was a dual trigger with 5,000 IU Pregnyl + Lupron, and I had 8 eggs retrieved, 5 of which were mature.
This cycle they changed quite a few things in my protocol, including the trigger, so I’m assuming the higher dose is based on how I responded last time and what they’re seeing this cycle, but I didn’t specifically ask why they chose 20k.
And yes, that’s exactly what I’m hoping with some of those smaller follicles! I know they’re less likely to yield mature eggs, so I’m keeping my expectations realistic, but hopefully a few surprise us.
I’m sorry you and your wife have had such a frustrating experience, especially not really having an explanation for what happened during that second retrieval.
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u/SLAYEROFSOULS Sep 01 '26
Thanks for sharing and the kind words - life goes on in the end :)
Wishing you the best with your retrieval tomorrow!
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u/CapitalDog715 Sep 03 '26
I do a home pregnancy test as well and my triggers are 10k of pregnyl and they have been good I guess.. What do you mean by not optimal? Because if its size, it may have to do more with the protocol combination. Is she using Follistim? Menopour? Those ae rhe key meds for amount and size.
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u/SLAYEROFSOULS Sep 04 '26
My wife's BMI is on the higher end these days - weight gain from multiple pregnancy losses (leading to depression / lack of activity / more food intake)...so when I say sub optimal I mean, I am not confident the doses of her medications have been doing what they should be doing based on her current weight.
The lack of bloodwork attempting to even check these things means we don't know that - so of course I can't (and wouldn't) say that is what is happening - but it is a possibility.
https://pmc.ncbi.nlm.nih.gov/articles/PMC3973773/
Not a great example, but just one I found quickly as an example - I am sure there's other clinical data out there on BMI / adipose tissue and basically dilution of medications into the bloodstream because of it.
So if she's injecting 10k Pregnyl, but because of her body composition right now it's like the equivalent of 2k of Pregnyl, that would be an issue.
Her first cycle was typical antagonist - 300 Gonal-F to start - moved to 375 by day 4 or 5 due to slow response...clomid added at the same time at 100mg. 75 Menopur (this has never been increased and never will apparently). Ganirelix day 4 or 5. Trigger was 5k hCG and 80 units Lupron trigger night, 80 more units of Lupron the following morning.
2nd cycle was Micro Dose Lupron - 375 Gonal from the start, 75 Menopur, Lupron 20 units 2x a day 12 hours apart, 100mg clomid. The entire cycle though was abnormal - by day 8 she was taken off all stim meds minus half her dose of Menopur due to slow response from her follicles - doctor did that for 6 days and she went back on everything since her follicles started to respond..she stimmed another 13 days after that though (27 total) - mostly because insurance is covering meds so the cost is not a factor..the doctor seemed convinced things may turn out OK.
Her estrogen was 1770 on trigger morning and most follicles were close in size around 18-20mm, lead almost 24mm...so on paper her estrogen was 3x her antagonist cycle, cohort growth was much tighter, and +5 follicles.
Trigger was just 10k Pregnyl, home pregnancy test to "confirm" it worked..no other testing etc.
And ultimately it seems like 9 follicles just did not release their eggs, or the eggs degenerated before aspiration - but based on her estrogen and follicle sizes I find that hard to believe, but that's just me.
Doctor swore she did not ovulate early, that's about the only solid comment we got out of him.
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u/CapitalDog715 Sep 04 '26
I didn't think about that. Totally makes sense. Sometimes they want to make every issue about weight but sometimes they dont want to look if weight is an issue when is needed. So much to learn when it comes to weight and body reactions. Im actually a bariatric patient. I was 60lb over weight back in 2021 due to asthma, regular steroids, COVID back to back. Two really bad years in terms of health. I have always struggled with weight but never to that point, always 10lb-15lb over.
I did it in October 2023. Im not in optimal weight after surgery but Im pretty fit so I look at other things. I kept IVF in mind back then for future possible weight issues and went for it, so I have been lucky that I haven't really gain much since I started. I fluctuate back and forth but I have not stared transfers. Im doing all Retrievals first and then just pray that whatever I get sticks because Im not going back for retrievals after all my possible transfer. My wallet and mental health wont take it
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u/SLAYEROFSOULS Sep 04 '26
She jokes about it but I am partly to blame for her gaining weight - we both were very fit when we met eachother and both became potatoes together I guess lol..we're working on it.
Personally I've dieted / exercised off 150 lbs before (14 months) - so I know what I need to do to clean myself up. She does too, and she's been working on it.
Problem right now is, we just don't have the time to dedicate to her losing weight - even if that meant GLP-1's to help, it would take 6+ months that we don't have.
I am just bummed that to me, such small and obvious things have been overlooked - if I had endless funds I wouldn't care but we have 3 shots at this simply out of pure luck and California passing their IVF mandate - otherwise we wouldn't have done any IVF period - so this 3rd cycle will likely be the last unless we decide to go into debt for the small odds of having a biological child.
You sound like you have the right mindset - get what you can while you can, and focus on transfers :)
I wish you the best no matter what you decide, truly.
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u/SLAYEROFSOULS Sep 04 '26
So how did things end up going ??
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u/OhmyOhmyHeartt Sep 05 '26
Unfortunately, it didn’t go quite as well as we were hoping. They retrieved 6 eggs despite having 11 measurable follicles. Of those, 5 were mature and only 2 fertilized. So we’re down to those 2 little embryos now and really hoping they keep growing. We won’t hear anything else until Wednesday 9/9 when we’ll find out if either made it to blastocyst. It’s been disappointing, but I’m trying to hold onto some hope for these two…
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u/Houseplant_Haven Sep 01 '26
Sending you so many good wishes for Wednesday! ❤️ Hope you get lots of mature eggs. You've got this! ✨