IVF Egg Retrieval

Post Reply
john_ling

IVF Egg Retrieval

Post by john_ling » Fri Aug 28, 2015 12:46 pm

We conceived our first child (boy) one month after our wedding and the pregnancy went smoothly with no known complications. My wife is now 29 years old and we are experiencing secondary infertility for the last 18 months and it has been diagnosed as “unexplained”. All her hormone levels are within normal range including an AMH of 3.1, however we did get a reading of a day 3 FSH of 10, which was described to us as moderately elevated for her age group. She does not suffer from PCOS, Fibroids or Endometriosis. Her periods have been like clock-work, 27-28 day cycle with LH surges ranging between day 10-14
We have tried one cycle of non-medicated IUI and two IUI cycles with clomid/ovidrel to no avail. Each time the ultrasound did show a follicle measuring 18-20mm and evidence of rupture/ovulation. Due to the IUI failures we decided to proceed with IVF with 150 units of Gonal-f-rff for 5 days and 100 units for the next 4 days. The Ganirelix was started on day 6. During the stimulation phase her blood-work showed good Estrogen levels and a follicle count of 8 (the RE voiced no concerns on the counts).
On day 10, the ultrasound showed 5 follicles in left ovary, 2 measuring 18mm, one 19mm and one 33mm. The right ovary had smaller follicles, one measuring 16mm and the rest under 13mm. Even though my wife was put on BCP (Loestrin) prior to the IVF cycle the follicle growth was asynchronous. The ESTRADIOL on day 10 was 1285 pg/ml. The same night (Day 10) we were instructed to administer the hCG trigger shot and the retrieval was scheduled for 36 hours later (Day 12). After the retrieval, the bad news was communicated to us that they were only able to retrieve a single egg and the brief explanation that was provided was that the other eggs were “stuck” to the follicle wall and did not come free. Needless to say this was extremely disappointing and left a lot of questions unanswered. The sole egg that was retrieved was classified as immature and therefore unable to fertilize. The HCG BETA on day of retrieval was 238 mIU/ml.
Was this a case of not receiving an optimal protocol of controlled ovarian hyperstimulation and/or the timing of the hCG administration, or is there is an underlying issue with diminished ovarian reserve at a relatively young age?

Dr. Wisot
Site Admin
Posts: 1208
Joined: Fri Oct 14, 2005 11:16 am

Re: IVF Egg Retrieval

Post by Dr. Wisot » Fri Aug 28, 2015 2:32 pm

Without seeing all the details (although your description is very good) I cannot exactly pinpoint the problem. She should have done much better with her AMH.
It could be the stimulation protocol, the timing of Ganirelex, the response to the hCG (so-called empty follicle syndrome).

Bottom line. Take your records to another RE in another center and get a real second opinion.

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

Post Reply