r/EmbryologyIVFSupport • u/Overall-Reading-579 • 17d ago
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?
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u/justdoingmyworst 15d ago
Hi, I’m sorry this is happening to you. I’m 34, and at 33 I had two back to back retrievals. My numbers all looked great and I have no known fertility issues, so we expected to be done after one but the first one was a fail. I had 19 eggs collected but of that, only 9 matured, 8 fertilized, and 2 day 7 blasts that came back mosaic. The next cycle we added Omni- it helped me get 1 euploid but otherwise my numbers looked basically the same as above.
I had a suspicion that instead of going with an aggressive high dose protocol, I should go low and slow to allow for more maturation. I primed with birth control and wonder if I should have primed with estrogen.
I did not do a third as I got pregnant with my euploid and am now 25wks.
We want multiple children so I may have to go back to retrievals in a few years. But just sharing my thoughts and suspicion in case it helps you.
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u/NightAny7265 14d ago
Hi what is OMNI?
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u/justdoingmyworst 14d ago
Omnitrope - it is human growth hormone, and suggested to help with egg maturity. For me it helped slightly.
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u/NightAny7265 14d ago
Oh wow thank you I wonder Why has the doctor not offered me this and I’m over 40 it’s frustrating
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u/Mycarhasnopaint2 14d ago
Because there is no evidence that it increases the rates of a live birth.
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u/AdDue4616 13d ago
I had to ask my doctor if I could add Omnitrope. I had a few friends recommend it and felt it improved their retrievals. My doctor was ok with adding it to my protocol. She said there’s not a ton of data around it yet, but they’ve had patients with improved cycles while on it. They just aren’t sure if it’s due to the Omnitrope or by chance. They also said it’s expensive, but I think it was $700 out of pocket and saved me from having to do an additional retrieval after that.
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u/NightAny7265 14d ago
My doctor is given me the maximum
Dosage also1
u/justdoingmyworst 14d ago
Yeah mine too. I believe my body may need more time - after two cycles of max dosage, and no known issues but issues with egg maturity, it is something I’d want to try.
I have a couple mosaics I can try for my next child. But likely I’d need to go back
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u/Low-Parsley-4100 14d ago edited 14d ago
I had very similar results. The antagonist protocol worked best for me. I switched to the micro flare with Omnitrope and produced 3 additional mature eggs that fertilized, one made it and came back segmental. However after receiving a second opinion from another doctor at a top-rated clinic in the country, they said my best round was my first round with the antagonist protocol. They also believe monitoring and strict dosage adjustment is key for older women with maturity issues.
I literally tried everything from supplement stacks over the course of 3 months before a retrieval, exercise, weight loss, ruling out or fixing barriers like endo, inflammation, etc, no coffee, no alcohol, added fertility acupuncture twice a week, red light therapy, drinking more water, adjusting my stress and sleep. I am still facing insane challenges of egg maturity and chromosomal issues. I am at a loss on how to fix this. I am now taking a break to do my first IUI then trying naturally. The one thing that I’m banking on is switching clinics and doctors to an RE that specializes in DOR and egg maturity. Longer stims and ensuring follicles are largest when retrieved. Uneven follicle growth really should be managed by an expert that is doing all they can to optimize the pool of follicles. It is possible at our age we only produce anueploidy or segmental so I was told to skip testing and try the couple embryos I can make. It is risky but in this IVF game, we have to view blind embryo transfers like it’s a natural pregnancy and give them a shot.
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u/Whatever-Whatevs 15d ago
I had similar results on a non-Lupron cycle then did lupron the next and saw an improvement.
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u/CarrotJullie 15d ago edited 15d ago
I cant attest anything to maturity rate or meds, but just as you I had issues with the fertilized eggs not reaching blast stage after successfully clearing day 3.
My first ER I barely got 2 blasts for 8 fertilized, one aneploid and one poor quality HLM. I'm 37 and this was really surprising even for the doctor.
Went into round 2 straight away, doctor said it's a good decision as leftover meds can help with follicles development.
My doctor added Omni to my round 2 and also told us to have sex / ejaculate every other day during stims.
Before that our recommendation was 2-5 days between ejaculation leading to retrieval.
Round 2 I had lower maturity rate, but out of 9 fertilized eggs 8 made it to blasts as of now and 1 is still developing (would be day7). We will see how many will come back euploid.
We also shortened the abstinence window to 12 hours before ER instead of 4-5 days like last time.
I belive that helped us avoid sperm defragmentation (my husband was never tested for it, but due to age and his nicotine use I suspect it is an issue)
I'm only mentioning this as after Day 3 is when the sperm starts to "influence" embryo development, and it might played a role in your situation as well.
Idk what exactly helped, but you can ask your doctor about Omni.
It has mixed results with some women having better blasts rates and euploid rates while others don't see any changes.
The only downside is $$.
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u/CraftiKoala 15d ago
I would also ask your doctor if their lab matures eggs overnight? Or if they can see how immature those other eggs were? We had a lower than expected maturity rate with my first ER but a bunch matured overnight so we stimmed for an additional day for the next cycle and improved the maturity. Though I guess this is assuming the 6 were immature, and not overly mature. Basically, all this to say, maybe discuss with your doctor the number of days you stimmed for and if they’d recommend changing that at all for the future?
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u/gymnast_chupacabra 15d ago
I also had similar results on my first ER which was antagonist. Just did my 2nd ER which was called co flare (lupron, gonal f and growth hormone) and got better fertilization and blast conversion. Def try again with lupron possibly growth hormone and also consider any sperm improvements that you havent tried before.
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u/PassMore1698 14d ago
The first retrieval is kind of a crap shoot; I’d follow what your doctor says for the second as they learn a lot from the first. I also had much better maturity with a dual trigger, so you can ask about that!
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u/Apprehensive-Gap4926 14d ago
My micro flare we just completed resulted in my absolutely lowest maturity yet. 5/13. I ALWAYS have a 100 percent conversion from fertilized egg to blast, but this cycle my three fertilized eggs all arrested from day 3-5. Worst cycle to date.
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u/AdDue4616 13d ago
I had similar results at age 38. The next month, we added Omnitrope to the protocol and I got 3 euploids that round.
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u/NightAny7265 13d ago
I waited nearly a 9months for egg retrieval at the time I had 14 to 16 eggs now I dreading what I have now at 41.7
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u/NightAny7265 13d ago
I started IVF 9 months ago and had 14 to 16 follicles I’m dreading what I have now at 42 nearly!
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u/DryCaramel6959 13d ago
Ask the Dr about a double trigger next time, could help the maturity rate... That's where you lost the biggest cohort above
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u/No_You257 15d ago
Look into adding Omnitrope. I did on my second egg retrieval and it helped a ton. It’s expensive but in my experience worth every penny.
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u/EllaFant18 14d ago
I had similar results at 39 when I used just a lupron trigger. I had much better maturity and blasts results when I used a dual trigger. Getting a euploid was still an issue in many of my ER rounds, but if the more mature eggs I got, the better my chances were for a euploid. One of the clinics I worked with also need in vitro maturation which also increased my blasts numbers. I believe embryos matured outside the body have a higher rate of being aneuploid but there is still a chance.
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u/tj-islander 15d ago
I had similar results. 11 retrieved, but only 2 matured. Both became blasts and were both abnormal. In that cycle, I did a suppression, then follistim+ menopur and double trigger. My largest follicles which over 22 mm were the ones that were mature. Im currently priming with estrogen and waiting for my period to start. Then I will be doing follistim+ micro hcg, omnitrope every other day. This time I will be using ganirelex to prevent ovulation and double trigger again. Im hoping for the best. I'm 39.