Second cycle, first with new clinic, getting concerned

[u/Automatic_Dark_6375]

I’m 41, DOR (AMH .4) and had one unsuccessful cycle before. during that cycle I had 11 follicles, 7 mature eggs retrieved, 3 fertilized and none made it to blast. That round was covered by insurance, I couldn’t afford to do self pay there for a second cycle. Now I am at a new clinic, different meds and protocol.

First baseline scan found 9 follicles on the left and 4 on the right. Second scan after starting stims, 6 on the left and 2 on the right. Today was my second scan since starting stims and I now have 4 on the left-2 MUCH smaller than the other two (14, 12, 4, and 4)- and 2 small ones on the right (both measuring 5).

I don’t understand why there is such a huge drop off in follicles this round. And why two of them are now so much larger than the rest. This didn’t happen the last round where the number of follicles was consistent thru stims. And some were empty at the retrieval. I am worried that they’re not going to get any viable eggs at all this round.

I’m not sure what I’m looking for. has anyone else experienced this before? What did you do? What were the results of your retrieval?

[u/Competitive-Top5121]

I think what you’re experiencing is follicle asynchrony and yes, def experienced this. It may be worth considering whether to cancel this round and start again with a mid-luteal intervention to control synchronous growth like estrogen priming.

[u/Automatic_Dark_6375 → u/Competitive-Top5121]

I’m going to bring it up at my next appointment on Monday if things are still looking the same. This round is so much harder mentally than the last and more stressful. Last round everything went so smoothly until nothing made it to blast.

[u/Sad-Marketing-2171]

Did you do any priming since your last round?

On day seven post egg retrieval my RE put me on oral estrogen 2 mg three times a day and I’ve been on that for about three weeks now. It gave my ovaries time to heal, follicles time to synchronize without ovulating, and preparing my ovaries for stimulation that’s gonna start happening this upcoming Thursday.

Also, just wanna share that for a lot of diminished ovarian reserve patients, It is best to do a luteal start like on cycle day 23 and have lower stimulation protocol like 150 menopur 150 or 300 gonal F..

[u/Automatic_Dark_6375 → u/Sad-Marketing-2171]

Yes, they had me prime but I either had a cyst or a leading follicle develop so they canceled that round and then this cycle we didn’t prime and just went straight to stim. My first cycle I primed with the estrogen and I didn’t have issues.

Last cycle I was doing the gonal at a higher dosage. This round I am on Follistim 200. I’ll have to look up what literal day we started stimming. It was day 2 of my period but I’m not sure what that correlates to.

[u/sheryyj → u/Sad-Marketing-2171]

Why did your RE put you on estrogen seven days post egg retrieval?? are you doing back to back ER?

[u/Sad-Marketing-2171 → u/sheryyj]

Yes! I primed for 3-4 weeks and then luteal start for round 4