Empty Follicle Syndrome EFS for 2 Cycles

Dr. Wisot
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Re: Empty Follicle Syndrome EFS for 2 Cycles

Post by Dr. Wisot »

Since most women with PCOS can be treated successfully medically I am not a fan of drilling.

It can help some ovulate on their own it does require surgery and can result in adhesions.

Arthur L. Wisot, M. D.
Reproductive Partners Medical Group
Redondo Beach, California
try4no1
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Re: Empty Follicle Syndrome EFS for 2 Cycles

Post by try4no1 »

Hi salma85

I just wanted to chime In on this topic. I have currently been through 4 Ivfs non so far have worked and I started the process just after my 28th birthday. On my first cycle I have the same issue. I have PCOS on ultrasound the typical presentation yet my blood work is always within normal.

On my first ivf cycle I did gonal f/menopur with cetrotide. I got 22 follicle all great size I used ovidril 250 on ER there was only 4 eggs retrieved one crumbled during icsi and 1 did not fertilize. By day 3 neither of the embryos had grown past 1 cell basically they arrested and I was left with nothing to even transfer.

My 2nd cycle I added metformin (which honestly in the future had really helped my pcos I wish I had just continued it) then did the lupron protocol with the 10,000 iu of hcg. I believe this was my game changer, my follicles grow slower I got 12 eggs from 14 follicles, 9 fertilized I transfer 2 and managed to get 4 to freeze at A grade blast.

I have since done FET however it now appears that I have an implantation issue and not an egg quality issue which I was told was the case after my first cycle. I will never use ovidril and I honestly hear more and more that young PCOS ivf patients are having this issue.

I am not a doctor and only speak from experience but just a change in protocol made a huge difference to me and at 28 I refused to believe I had poor egg quality especially as I had a good amh number and reserve. I honestly believe it's about luck, timing and mental state I thought at the time I was handling it well and I was ready but after taking a 8 month break (we are still on one) it took me 4 failed cycles to agree to a break I honestly could say it was the best thing I ever did and now we are going to try again with a fresh cycle in spring it's easy to look at so many different options but honestly fertility I have now learnt isn't an easy ride isn't guarantee and our bodies will do what ever they want and sometimes they just won't listen. As long as you are with a doctor that understands your needs and you are comfortable try not to look at a 1000 different options it will work some people unfortunately me being one it just takes time.

I hope this helps you and if you have any questions from someone that went through 4 cycles and tried to find everything possible to do, let me know. I know everyone will tell you ur young you have plenty time it doesn't make it easy in fact it makes me more annoyed but you just have to do what best for you and find a doctor that understands you and is just the right amount of compassion and aggressiveness and it will happen.

I wish you the best if luck.
Tac76
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Re: Empty Follicle Syndrome EFS for 2 Cycles

Post by Tac76 »

Dear try4no1,

I hope you are still active on this site as I have a similar story with 4 unsuccessful IVFs, all with normal blood and ultrasounds, many follicles, but then few eggs. My trigger was 5000 iu hcg, then I had two separate cycles with
250 Ovidrel, and then on my last try I used Decapeptyl and had the worst results yet as neither of the two eggs retrieved fertilized.

When you say your last protocal was a game changer, did you mean the 10000 iu Pregnyl or also the other aspects of your protocal?

I will start my fifth treatment soon and am looking for all the tips from those with this frustrating condition.

Thank you!
Dr. Wisot
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Joined: Fri Oct 14, 2005 11:16 am

Re: Empty Follicle Syndrome EFS for 2 Cycles

Post by Dr. Wisot »

I have found that 20,000 hCG works the best. My only concern would be if you have a risk of hyperstimulation. They should also be sure that they are not triggering you too early.

With a risk of OHSS you might try a Lupron trigger with 4 mg 12 hours apart with 1000 of hCG along with the first shot. Check a urinary LH and progesterone the day after the first shot to make sure it worked.

Arthur L. Wisot, M. D.
Reproductive Partners Medical Group
Redondo Beach, California
Sahar

Re: Empty Follicle Syndrome EFS for 2 Cycles

Post by Sahar »

hi, I'm so sorry for that. wish you luck next time.
My doc prescriped decapetyl for me 5th day after et? Which day did YOU take decapeptyl?
sarah85

Re: Empty Follicle Syndrome EFS for 2 Cycles

Post by sarah85 »

Dear Dr. Wisot

Last month I started new IVF cycle using short protocol with very Low dosage of Gonal 37.50 IU , I got 6 good follicles my doctor wanted to give me more time after HCG trigger shot “Pergnyl 10000 IU+0.2mg Decapeptyl”. We set the egg retrieval procedure after 40hrs of the trigger shot. Before the procedure the doctor cheked by Ultrasound and there was no follicle “All gone ” so IVF cancelled.
In the following Month because we used very low dosage my doctor said that there is no problem to give it a try in the next month. So, I started with the same protocol this month and only two follicle developed. Trigger shot was taken before 36 hrs before of the egg retrieval .

Yesterday was the egg retrieval and we got 3 eggs and just today they called us and said (( Egg retrieval yesterday was the most promising attempt.
We obtained 3 COCs (cumulo-oocyte-complexes – cluster of cells from follicle) of normal appearance. Normally inside the COCs there are eggs. But in your case all 3 COCs was empty – no egg inside.))



Doctor told me that he will repeat the same protocol but he will slightly modify it by adding HCG/LH from the beginning of stimulation.
Just to inform you that all my 3 egg retrievals which I did before were failed due to empty follicle and this is the first time that I got 3 from two follicles. Before they gave me only 5000 IU pregnyl.
What do you think Dr. Wisot about this ? and why those COCs didn’t contain egg as my doctor said ? Are there any advices that you can share with us to avoid this situation ? Do you encounter this issue before? Do you recommend to repeat the same protocol? I would be thankful if you could suggest something because I am totally lost.

Thank you very much

Sarah
Dr. Wisot
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Re: Empty Follicle Syndrome EFS for 2 Cycles

Post by Dr. Wisot »

I can't really recommend protocols. But if you read a couple of posts above you will see my recommendation.

An empty cumulus usually means they did not find the egg as there3 is usually an egg in the complex as they call it..

Arthur L. Wisot, M. D.
Reproductive Partners Medical Group
Redondo Beach, California
Tac76
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Re: Empty Follicle Syndrome EFS for 2 Cycles

Post by Tac76 »

Hello

I am very delayed to reply with my follow up here, but felt it important given this thread greatly helped me. My protocal with down regulation (Zolodex), Menopur and a 10000iu Pregnyl trigger did the trick for me. 13 eggs were retrieved and 9 fertilized. I attribute this to the trigger shot as the other aspects of the protocal where I had empty follicle syndrome were the same. I subsequently also had issues with implantation which my doctor attributed to endometriosis and had a recent surgery to remove the endometriosis. I did another transfer after the operation with my frozen embryos although unfortunately it again did not result in a pregnancy. I will start again with a fresh cycle. Anyway, I hope this information can help others with my same issues as I truly believe the proper protocal can solve for the empty follicles.
Tac76
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Re: Empty Follicle Syndrome EFS for 2 Cycles

Post by Tac76 »

Dear Dr. Wisot,

Can you confirm whether Choriomon and Pregnyl for the trigger shot have the same effect or do your recommend Pregnyl over Choriomon and if so, why?

Thanks for your help!
Lisa
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Re: Empty Follicle Syndrome EFS for 2 Cycles

Post by Lisa »

Hi, I am having similar issues.
I just failed ny 1st ivf and would like to know what might have caused it.
Egg retrieval done last friday, 11eggs retrieved(much lower than the anticipated 12 follicles each ovaries). 9 matures snd icsi was performed. The next day clinic told me only 2 fertilised. 2 no response. 5 deteriorating (the enbrologist saud it looks it looks wacky after icsi)! Today is day 3 and i just been told out of the 2 fertilised ones, 1 looks like arrested since day2 as it has only 4 cells.the other one defragmented badly. The 2 no response look the same.
My profile: 36, hubby 38. I have mild pcos fsh 6.8, Lh 11.no thyroid. Amh 35.8. I am only 43kgs. Hubby sperm check is ok except low mophorlogy 3%.
Protocol: birth control pill for 25 days. Stimm at day 3 after period. 13 days of gonal f (day 1-9 250iu, day 10-13 200i.u), 6days of cetrotide 0.25mg each. Trigger shot at stimms day 13 night. Trigger shot 0.2mg.
On the retrieval day, they managed to 10 eggs only (9 matures) despites the last follicles scan on day10 showing 24 follicles in total. I was having tummy pain few hours before egg retrieval. Doctor found a lot if fluid in my tummy as well.
I talked to the embrologist and ask if they think something were already wrong with the oocyte when they perform the icsi. They told me that there was very little resistance from the membrance when they pierce the oocyte. The oocyte however looks normal hence they perform icsi on all 9 mature oocyte.
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