High % of immature eggs: possible solutions?

Hi lovely ladies,

Another question for you. Yet again, different doctors seem to have conflicting opinions on this. I have done two rounds of ICSI, with very low egg maturation rate.

First round: I got 14 eggs, but only 57% were mature.

Second round: I got 13 eggs, but only 46% were mature.

The maturation rate is way below average.

Some doctors say low maturity is caused by the protocol and I should try a more natural cycle with less hormones, others say it is an indicator of poor egg quality and shows there could be an inherent (chromosomal) problem with all my eggs because they are very slow at developing, which would also explain why we are not having any luck gettings blastocysts.

Is anyone in the same position? Does anyone have any recommendations to get a better maturity rate?

As always, thanks so much xxxx

[Reb990]

Hi Anna,

My first cycle had a really low number of mature eggs (7 out of 18) so for my second cycle the consultant suggested using a dual trigger shot.

Second round we had 14 eggs but 12 of them were mature. Don’t know if it was 100% the dual trigger that done it but it’s certainly worth a try.

Hope your next round goes well x

[Hidden in reply to Reb990]

Thanks so much! What is a duel trigger? Double the dose? xxxx

[Gueritarubia in reply to Reb990]

Had a similar experience. Double trigger did the trick and I ended up with 8 high grade blasts (none the first cycle). First cycle was long protocol, usual trigger. Second cycle was short protocol double trigger. Good luck!

[hifer]

Hey, I’m really interested to know the response to this from people. I know nothing about the medical reasons but I wonder if it could be in the trigger? The whole point of the trigger is to mature the eggs so I wonder if you can ask them about that? I had a few eggs not mature and I wonder if mine were just collected a day too early (although I felt more than ready to get them out!!) I really hope you manage to get to the bottom of it xx

[Hidden in reply to hifer]

Seems that doctors are conflicted on this one....as usual!

I am speaking to the Medical Director at a top clinic in London today, so will keep you posted xx

[Shirazlover2013]

Hi guys, I was wondering about a double trigger shot myself for this issue so it’s interesting to read Reb990s reply. My recent round I had 11 eggs of which 6 were mature and only 2 fertilised normally with icsi. I haven’t yet had a follow up with the clinic about why we had 2 steep drop offs so early on. We may also have age = quality issues with myself and hubby being 38 now. Please let me know how you get on with your research xx

[Hidden in reply to Shirazlover2013]

As per my reply above....seems that doctors are conflicted on this one....as usual!

I am speaking to the Medical Director at a top clinic in London today, so will keep you posted xx

[Shirazlover2013 in reply to Hidden]

I should add that I’m doing mild ivf, my first cycle was very low dose and only 3 eggs were collected, all were mature and fertilised but only 1 made it to day 5 and it was still an early blast so couldn’t be graded. 2nd cycle my dose was almost doubled (200iu Gonal F.) so now not sure if that’s still mild ivf or if that’s a normal dose...... So maybe there is something in the more natural ivf element but it hasn’t worked for me.

[Hidden in reply to Shirazlover2013]

I was on 150 units of Gonal (with Menopur) and that was considered an average, medicated dose....

So maybe it is worth doing a more natural cycle. Did you get any blastocysts with the second cycle? xxxx

[Shirazlover2013 in reply to Hidden]

I got one blast on my 2nd cycle, currently back inside and nervously waiting for OTD on Friday!

[Hidden in reply to Shirazlover2013]

Good luck xxxx

[Lindt83]

I had 50% maturity too. 6 eggs collected but only 3 were mature. At my consultation I asked about a double trigger but I was told it didn't really help. Then my second question was to have EC at 38 hours after the trigger but they said the eggs can sometimes start to ovulate by then. I'm interested to see what people say as I'd like to know too for my next cycle xx

[Hidden]

Interesting...the doctor didn't give any alternative solution? Only a double trigger? Did s/he suggest a more natural cycle?

I am speaking to the Medical Director at a top clinic in London today, so will keep you posted xx

[Lindt83]

I don't think I can have a more natural cycle, my AMH is quite low and so I was on 375 Gonal F which is quite a high dose. Good luck with your phone call, hope you get the answers you're looking for xx

[Hidden in reply to Lindt83]

Thanks so much xx I will keep everyone posted on what he says xx

[MofM]

The same here: just 40% of mature eggs collected (6 out of 15 follicles aspirated), 4 fertilised, and 1 good quality blasto (which I miscarried at 6+5). The consultant suggested for this 2nd cycle: 1) having a priming with progesterone (I am on the short protocol, and last time after 14 days of BCP my follicles were a bit all over the place) 2) using both Gonal-F and Menopur, and 3) going for a dual trigger if not at risk of OHSS (yet, if I am at risk will we go again for <50% eggs collected? This sucks...) .

Following to see what other people say!

[Hidden in reply to MofM]

I am so sorry to hear about your miscarriage xxxx

I have similar results: in two cycles we got 27 eggs and only one blastocyst!

Surely they will know if you are OHSS by your AMH level?

Is double trigger, just double dose? If so, I had double the dose on my second cycle and it made no difference - I got even less mature eggs (47%)!! I was also on Menopur and Gonal.....

I am hearing from several doctors that it is better to go on a long protocol with a lower dose for better maturity rates, but I will see what this "top doctor" says today...will keep you posted xx

[MofM in reply to Hidden]

You know that I have honestly no idea of what a double trigger is? So far I believed it was two different drugs, but that's just the way I imagined it to be... 😳

I was borderline OHSS last time (my AMH level is supposedly OK for my age), and this is why the doctor preferred priming+short protocol instead of a long protocol and why he keeps the trigger option open. He will also use lower doses of medications (last time I was 300IU Menopur for 10 days), or so he said in January. Finger crossed, I am due to start this week, just waiting for my period to start 🤞🤞🤞

Looking forward to listening to what this "top doctor" will say to you today! Thanks for keeping us posted!

[Hidden in reply to MofM]

Ha ha! I will ask the doctor what it is

Lots of luck with your next cycle. I will keep you posted xxxxxx

[Gueritarubia in reply to MofM]

My double trigger was two different drugs

[MofM in reply to Gueritarubia]

Confirming that dual trigger is two different drugs, at two different times: one 37h before EC (one our more than usual), and one 36h before EC.

🤞🤞🤞that it does the trick!

[Gueritarubia in reply to MofM]

Fingers crossed! It did the trick for me. First cycle I was on long protocol, plenty of eggs but nothing to transfer. Second cycle was short protocol with double trigger and ended up with 8 highest quality blasts. The first one they put back gave me my girl and literally about to go to the clinic for my first FET to give her a sibling. You can read some of my old posts if you want more details. Good luck!

[MofM in reply to Gueritarubia]

Not sure it did the trick for me.

First cycle: 15 follicles, 7 eggs collected, 6 mature, 4 fertilised

Second cycle (with priming, dual trigger and longer lighter stimulation): 15 follicles, 10 eggs collected, 7 mature, 6 fertilised.

Just got an extra mature egg from the same number of follicles 😥 Start to suspect it is due more to egg quality than to the stimming protocol 😭

[Gueritarubia in reply to MofM]

Sorry to hear it isn’t quite what you hoped for, though I’d say it’s 50% better so far! I’d look at the number closest to your end goal (baby!): 4 fertilised vs 6. On my first cycle I had a decent number fertilised, but they didn’t divide properly and got all fragmented or stalled. The second cycle, all fertilised ones became high grade blastocysts. When did they retrieve? Give it a few days to see what will happen next... crossing my fingers for you!

[MofM in reply to Gueritarubia]

My partner said exactly the same: 50% more fertilised!

Last time two got to blasio in 5 days (one good quality transferred and miscarried, one too fragmented to be frozen), the other two were lagging behind and stopped developing on day 6. Let's hope this time there is quality since for sure there is no quantity 😅

EC was yesterday, next update will be on Thursday (if the do a 3 day freeze all) or Monday (day 5 freeze all).

Thanks for your encouragement 🤗

[MofM in reply to MofM]

Since I find annoying reading post with "incomplete" stories, here is my update (sorry Hidden for hijacking your post): out of the 6 eggs that fertilised, 4 reached day 5 blasto stage, not sure about the quality (our clinic does not provide grades) but hopefully good enough to be freezed and give us some hope 🤞🤞🤞

[Hidden]

Hi ladies,

I want to pass on the advice I was given about immature eggs:

A low maturity rate indicates poor egg quality, but it also depends on the drug regime and length of stimulation:

1) Extend period of stimulation and adopt a long protocol of stimulation (more than 12 days).

2) Don't use cetrotide for the Trigger, because it can cause more immature eggs. Use "Sucrofad" (think I spelt it wrong)

3) Delay the trigger up to 48 hours

4) Use a freeze all cycle, because the lining of the womb won't be ready for a transfer using long protocol

5) Never repeat the same protocol twice if you don't get good results. If you have immature eggs you can't do "conveyor belt" treatment, you need bespoke treatment

6) High doses of Gonal and Menopur is unforgiving for immature eggs, so you need a different protocol over a longer period of time

Improve blastocyst formation:

1) Take growth hormone during stimulation to improve egg quality (a shot every other day)

2) Take 1mg of steroids for 10 days to improve egg quality (it allows the doctor to delay the trigger because it reduces progesterone secretion)

3) TESE can give better sperm with less fragmentation

4) In month leading up to treatment, take 2 tablets of Norgesterone (once in the evening and once in the morning) from Day 14 to Day 25 before before stimulation (apparently this is very important)

I hope this is useful. If anyone asks their doctor about the above, please keep me and everyone else posted xx

[Chegotsi in reply to Hidden]

Hiya,Did this protocol work for you? I find myself in the same situation and I wondered if I should suggested the same to my clinic?

[Alpatchino]

My opinion, as someone who is definetly not an expert and purely based on what I have read, I would say that it is more about the protocol than the quality. You will see the quality more in fertilisation and blast percentages. What we're the sizes of the follicles the day of the trigger? If the sizes where good then an appropriate trigger pays the most important role.