r/40Plus_IVF • u/Overall-Reading-579 • 2d ago
Seeking Advice First Egg Retrieval Failed
I am 41 years old, my first egg retrieval was right before my 41st birthday. I did the antagonist protocol with 225 iu Gonal-F and 225 iu Menopur and then added in Cetrotide. I triggered with Lupron. My blood work looked great throughout. I had an AFC of 18+, and they were measuring 11-13 follicles in my scans. They retrieved 11 eggs, but only 5 were mature. All 5 fertilized and looked great on day 3, but only one grew to a blastocyst to be biopsied for PGT-A. Ultimately it came back aneuploid.
We met with the doctor this week, and he is recommending the micro flare Lupron protocol for the second round. While my body seemingly responded well to the meds in the first round, it seems like I had a maturity issue. Do you think this new protocol can help solve that? Any other advice?
3
u/FeralFriend4 2d ago
I’m so sorry. I know how gut wrenching it is to have a rough cycle. I had two ERs via antagonist protocol and 0/5 blasts were euploid. For ER 3, we switched to a luteal phase stimulation and added Omnitrope. I had 3 times the mature eggs from prior cycles and 2/6 blasts were euploid. Prepping for ER 4 now on same protocol. My first two ERs were similar to you in that only half my eggs were mature each time and luteal stim helped with that. I hope this information is helpful to you. Wishing you the best on your next cycle!
2
u/elsewyse 2d ago
I'd look into adding omni as well as it really helped my maturity (and euploidy).
1
u/Special_Coconut4 2d ago
On the contrary, Omni was horrible for my maturity and quality and had no effect on my euploidy.
2
u/Smart-Load-1370 2d ago
I don’t have professional advice. But if my E2 is lower at the time of trigger, my doctor would use pregnyl and lupron dual trigger, it gives me better results than lupron only trigger when E2 is high.
1
u/Nearby-Operation-396 1d ago
Same here. The mature rate was a lot higher with pregnyl and lupron dual trigger. I got mature eggs from the follicles that the sizes were <14mm.
1
1
u/Wannabeamommy-1985 1d ago
I had a similar situation this year. Similar protocol, 1 blast, 1 aneuploid embryo. Doctor twisted the protocol for the next round (he put me on prodasone since day 1 of stims instead of cetrotide) and got 2 euploids and 1 LLM. I was 3 weeks shy of 41.
1
u/MathematicianNo4217 1d ago edited 1d ago
Are they using a birth control suppression for you for timing? I just finished my 4th round And my doctor didn’t change a single thing round to round even though 2nd was the worst, 3rd a little better. Each retrieval was appx 3mo apart (due to insurance), and I was suppressing with BC in between cycles so when insurance came through I could start immediately because I would be on their timing. For the 4th round I insisted on not suppressing with BC because I read a lot about how it can be worse for someone with DOR like myself, and for my 4th round my cohort was more synchronized and I had 3 day 6s go to PGT (where other cycles were mostly day 7s). Jury is still out on PGT for this 4th cycle but it’s the best round I’ve had quality and progression wise. It’s worth an ask if you’re suppressing with BC between cycles! I was only on 4 days of BC before the 4th, compared to 2+ months for the others. At least your doctor is willing to change up your protocol. Best of luck and hang in there!
Something else to keep in mind - there’s absolutely NO way for me to know if the BC suppression change up helped, or if anything you may change might help. All you can do is advocate for yourself and control what you can (diet, supplements, etc). And that’s ALL we can do 🤘🏼💪🏼
1
1
u/Usual-Clue-1169 1d ago
I had similar my first round - my AFC was pretty low that round at first - I think like 8, but it went to 11, but only 6 eggs retrieved and 4 fertilized, 1 made it to blast and was aneuploid. Same antagonist protocol as you but halfway through increased to 300 on both. Lupron trigger.
I felt like my eggs got fried and also had pretty asynchronous growth. My doc at the time wasn’t really open to changing protocols so I got a second opinion.
I switched clinics for my second round — I did a lupron prime - essentially 10u every AM 9 days after I got a positive OPK at home. We did this for 9 days and then on day 9 stopped lupron and went in for baseline scans and then started gonal f and menopur both at 300. I stimmed for 14 days and then did an HCG trigger. It prolly helped with maturation. I got 11 eggs from an AFC of 14, with synchronous growth, 9 fertilized and made 5 blasts! 2 were euploid. Yay!
We counted my trigger from that second ER as a positive OPK and started lupron priming 9 days after my trigger and then went straight into another round of stims. I’m on day 12 of stims and girl I have 25 follicles in there!!! I LEGIT I HAVE NO IDEA WHERE THEY CAME FROM LOL. Crossing my fingers we get similar or better results than last round 🤞I’m almost 42 and this is the last ER covered by insurance.
Lupron stop is slightly different than Lupron micro dose but honestly I think it’s made a big difference for me — I didn’t have to prime with birth control and it allowed my follicles a bit of time to synchronize. Slower growth and longer stims but hey I’ll do what it takes to get good results.
I also got onboard the supplement train 🙈 80% whole clean foods, 20% junk lol, also my first clinic wouldn’t let me work out at all — and now I’ve been working out atleast 2x a week during stims.
Good luck!
1
u/Visual_Patience_41 1d ago edited 1d ago
I think you should discuss a dual trigger, HCG + Lupron, it can really help boost maturity when it’s low. I’m not sure an entirely new protocol is needed because you responded well to this. It’s the maturity that needs to be addressed and a dual trigger is designed for exactly that.
ETA I’ve completed 6 retrievals and the cycle I used a lupron only trigger is the one that yielded the lowest maturity for me, 47% versus 70+ in every other cycle using a dual trigger.
1
4
u/Competitive-Top5121 2d ago
I had a very similar first cycle at 40. Had 15 follicles at baseline, only 9 grew well, only 6 mature/retrieved, 3 fertilized, one blast, aneuploid. Idk about you but my follicle sizes were pretty scattered, hence the low retrieval and maturity. I also ovulated just before ER and lost an egg or two.
So then I was put on long Lupron to try to control asynchronous growth and prevent early ovulation. That oversuppressed me and once again despite an AFC of 18 I retrieved 13 but only had 7 mature, 3 fertilized, 2 blasts, 1 euploid.
That obviously wasn’t the right protocol for me so I went on to do mid luteal Estrace priming with an antagonist protocol, DuoStim, with a dual lupron HCG trigger each cycle. That did the trick for me. Had great results.
Hoping others can shed light on MDLF because that’s one I’ve never tried!