Huge gap between lead follicles and smaller ones

[Anonymous501]

Hello, I'm going out of my mind here so wanted to reach out as there is a huge gap between my lead follicles and smaller ones which don't appear to be responding I'm 38 and on my first egg freezing cycle. I can't remember my fsh/amh levels but the doctor said it was excellent. I had 35 follicles on my base/consultation scan.

They put me on low dose menopur and zomacton (I think only my clinic uses the latter, it's a growth hormone to help with quality I think).

We were aiming for >15 eggs from this cycle and hopefully the same for my second. (I know this might seem like a lot and that I should be grateful but so many eggs don't survive the vitrification process and therefore have a lower success rate compared to ivf.)

So I started on 112.5 menopur, this went up to 150, and now on 187.

But it seems like only 3 lead eggs are responding, and now I'm getting more smaller follicles but there's a huge gap between the smaller ones and lead eggs.

I'm now on day 12 of my cycle / day 10 of injections.

My results were;

1 follicle at 18mm

1 at 17

1 at 16

1 at 15

2 at 13

3 at 12

1 at 11

3 at 10

3 at 9

2 at 8

2 at 7

4 at 6

5 at less than 6

Is it likely that the smaller follicles will catch up without me losing the bigger ones?

I'm waiting for a call back on whether I need to trigger tonight but it feels like it's not worth going a head if I'm not going to get something closer to 15 and I'm gutted.

[IVFat40]

In my experience (I've just had my 4th egg collection) it's really normal for the follicles to grow at significantly different rates (at my last scan before this collection I had 2 around 23, some in between and some less than 10). That said, don't get my wrong it's super frustrating, I anyways feel so disappointed that I can't collect all the eggs that are stimulated.Yours looks like a really nice crop of eggs, well done and good luck!

[Anonymous501 in reply to IVFat40]

Thank you. It wasn't something I was anticipating so I didn't realise that could happen.

[Ranchu90]

Your follicles are looking good, try not to stress too much (easy said than done). They are looking very similar with my ones on my first retrieval but my clinic NHS was so scared they asked me to trigger after 8 or 9 days of stm (cannot remember exactly)with 150 Menopur. They only collected 6 eggs and 3 were mature. I was very disappointed at that time. We changed the clinic and doctor this time let me stimulate until day 9 with 225iu Meriofert until my lead follicle was 26mm and they collected 16 eggs. Hope they will not push you to trigger too early. What is below 10mm are unlikely to catch up and bigger ones can go above 20mm but your clinic need to monitor you very closely to not ovulate. I am keeping everything crossed for you and if you ask me... I wouldn't cancel this cycle. ♥️💪🤗

[MariaHdz in reply to Ranchu90]

If may I ask, why they got scared? They let me stimulate for 16 days for the others to catch up.

[Ranchu90 in reply to MariaHdz]

They got scared that I will ovulate and at the NHS clinic where I was they have a very strict rule once 3-4 follicles are above certain size (cannot remember exactly the size required, I am getting old now 😁) they will ask you to trigger, hence plenty immature eggs. Absolutely silly rules, they didn't adjust my protocol at all I was just part of a standard procedure.

[MariaHdz in reply to Ranchu90]

Ok! Now I get it, they didn't give you the cetrotide or other antagonist to prevent ovulation!

[Ranchu90 in reply to MariaHdz]

They did, I was taking Buserelin (the evil drug 🙄😤)

[MariaHdz in reply to Ranchu90]

Those things to not ovulate are awful. Also i find it awful when the estrogens get higher. I know it even before seeing the labs.

[Anonymous501 in reply to Ranchu90]

Thank you. Glad you got good numbers second time round! The clinic have called and asked that I continue on menopur but on a 225 dosage for the next 2 days. My next scan is on Wednesday. 🤞

[Ranchu90 in reply to Anonymous501]

I am glad that you are stimulating for few more days 🤗 good luck 🤞❤️ and keep us updated

[DianeArnold Partner Nurse Fertility Network UK]

Hi Anonymous. Well there is at least 4 that should be fine, and waiting another couple of days may bring a few others along too. Fingers crossed for you. Diane

[Anonymous501 in reply to DianeArnold]

Thank you.

[MariaHdz]

Hello! I have PCOS so my AMH is also high. I produce many small follicles and then I don't ovulate. I had 1 egg retrieval and the same happened to me. I was some sort of "slow" over responder. The first 8 days i had 3 follicles a bit bigger but still too small. I started with menopur 150. They increased to 225 and I had not much of a difference. Just 3 lead follicles. Then i had many follicles (like 12 i total) but with a too big size difference (still 3 big ones)I was out of my mind worried, because I thought they wouldn't catch up. 2 days after I had 30 follicles and then on day 16 i triggered. They caught up, and i over responded. I had to trigger with lupron to avoid OHSS and i could not have a fresh transfer. So I know it is very hard, but try not to stress. The doctors probably want to be careful so that you are safe and so they will be increasing the dosis slowly. I had around 16 days of stimulation and the first 12 days I had a minimal response. And then suddenly it was too much. Also, remember that quantity is not always a synonym with quality and surprising enough sometimes they retrieve more (or less) than they expected

🤗

[Anonymous501 in reply to MariaHdz]

Wow, that is a huge jump! It really does sound and feel like a roller-coaster.

Can I ask what happened to the 3 lead eggs and how many mature eggs you got in the end?

[MariaHdz in reply to Anonymous501]

Of course! They grew to over 24 mm, and I got very worried (because I read in a research that when they are very big, then it could happen that they don't get an egg from them and it is also no good). The doctor told me that the smaller ones did not have to reach 18 mm, that 14 or 15mm could be ok, so they waited until they reached this size. So i was a nervous wreck, because i thought "the big ones will be too big, and the small ones too small". I ended up having 26 follicles (not 30 after all) and 23 mature eggs. It is a roller coaster. I read below that your doctors increased the menopur. Good luck!

[MariaHdz in reply to MariaHdz]

I am taking myoinositol and folic acid, my doctor recommended it. supossedly it helps with the quality (specially with PCOS).

[Lkc2015]

My last cycle was like this they let me stim an extra 2 days and from 20 follicles got 15 mature eggs so I think you’ll be fine. Good luck with everything 🤞

[Anonymous501 in reply to Lkc2015]

That's good to hear! 🤞

[Anonymous501]

Thanks for the responses!

Just an update; My clinic called, they've upped my menopur dosage from 187 to 225 for the next 2 days. My next scan is on Wednesday. I have my fingers crossed the smaller ones catch up without me losing the lead eggs 🤞

[Zami98]

I had a similar situation with my fresh cycle. I had 5 looking decent and a huge amount of eggs in a group growing more slowly. After much consultation among several of the consultants at my clinic they settled on stimming for longer and taking the risk. I ended up with 20 eggs by waiting as opposed to 5. Good luck 🤞🏻

[Anonymous501 in reply to Zami98]

That gives me hope!

[BBHH1]

The ones 12mm of larger have a good chance on giving you eggs. The rest less likely but even 8-12 can have some eggs. So you may get 10 or so, maybe lucky and more...

Next cycle they can adjust the medications!

[Anonymous501]

Just wanted to post an update.

I had my egg retrieval today. Only managed to get 10 follicles with 8 eggs. I'm gutted. My doctor was so hopeful that I would get AT LEAST 15. My cautious goal was to get 30 eggs (optimistically was hoping for 40) from 2 cycles. That now looks very unlikely.

There were 28 follicles growing in the lasts scan during stimming. (35 follicles on my base scan). To only get 8 is so disappointing.

Whilst I appreciate many would be glad with 8 eggs, I don't have a partner so this is for egg freezing, which only has a 60-70% vitrification survival rate. (Embryos have a much stronger survival rate). That will only leave me with 4.8 eggs to play with before getting to fertilisation then losing more along the way.

A huge point of having egg freezing done is to have some reassurance whilst you try to find the right partner. Numbers were important for that. I've paid thousands for it but I haven't got it even though I had the potential.

I was worried from day 1 that my menopur dose was too low. (112 for 3 days, 150 for 3 days, 187 for 3 days, 225 for 2 days).

I don't want more than 20 from one cycle as I understand that too many eggs from one cycle can be low quality. From research papers I've read, 15-20 appears to be the ideal target. And my Doctor was very worried about OHSS so said she was going to be cautious. But this was too cautious.

I'm planning on doing my second cycle in May so now will now have to accept what I have and focus on the next one. Just wanted to rant.

[MariaHdz in reply to Anonymous501]

I am sorry to hear it was like this (I think I stimmed for like 14 days and around 9 were with 225). I hope that next time it goes better for you, to avoid OHSS they gave me decapeptyl as a trigger for ovulation, instead of pregnyl (other persons get Lupron). Maybe it could be an option to ask your doctor about it, for stimming a bit longer and getting more eggs but reducing the risk of OHSS. I will be crossing fingers for you.