Embryo batch freezing (antagonist protocol)

[jinis]

Hey lovelies,

I just finished a 3-cycle back-to-back embryo batch freezing and wanted to share my journey with you, with the hope that this would be useful for others going through it right now or thinking of in the future.

Background:

I’m 32 and have low antral follicle counts (10) and AMH (11) for my age (below 25th percentile). Decided to freeze embryos to preserve fertility for the future.

Protocol:

Short antagonist protocol with Bemfola for follicle stimulation, Cetrotide as an antagonist & Buserelin as a trigger (agonist).

Cycle 1:

Day of trigger: D10

Trigger: Buserelin 1ml

Eggs retrieved: 5

Eggs fertilised: 4

Embryos frozen: 2 (x1 D3, x1 D5)

Cycle 2:

Day of trigger: D11

Trigger: Buserelin 1ml

Eggs retrieved: 1

Eggs frozen: 1

This cycle was rather traumatic - as I was coming out of sedation and still not very “there”, the doctor who performed the procedure came in and told us that she could only retrieve one egg. I was devastated. Follicles were intact and she aspirated/flushed them multiple times, but with no sign of eggs. At the follow-up consultation they pinned it down to “failure to trigger” - an unexplained phenomenon that’s observed in about 1~5% of the time with any trigger. This means even though the right dosage of trigger was injected at the right time, somehow it failed to trigger ovulation. Everything from the size of the follicles & hormone levels were on par with the 1st cycle, so stimulation was definitely working.

We then were recommended to freeze this egg without fertilising it, as we only had 2 straws of sperm & wouldn’t have been worth thawing it, especially as we still had one cycle left. We were told that this egg could join the next batch to be fertilised together.

Cycle 3:

Day of trigger: D11

Trigger: Buserelin 2ml

Eggs retrieved: 7

Eggs fertilised: 4 incl. one from cycle 2

Embryos frozen: 3 (x1 D3, x2 D5)

This cycle the follicles were growing on average ~2 to 4mm behind other cycles (so 1~2 days in real term). Ideally we would have liked to stimulate another day, but my oestradiol level was already quite high (~7300) and due to my BMI (19) they recommended triggering on D11 to reduce the risk of OHSS.

Given the last round's failure to trigger, the consultant gave me two options: 1) using another trigger (Ovitrelle) or 2) triggering with a double dose of Buserelin. There was no reason to think that Buserelin won't work, as it did work for the first cycle. I also really wanted to avoid OHSS, so I went with a double dose of Buserelin.

This time they scanned my follicles before being sedated just to make sure they were intact. As planned, the egg from cycle 2 was thawed & fertilised along side 7 eggs collected.

Total embryos frozen: 5 (x2 D3, x3 D5)

Things I wish I had known:

- Some batches of Bemfola pens leak - ask for needles from another batch if this happens consistently. I have notified the clinic of this and they said they will contact the manufacturer.

- Buserelin trigger induces bleeding ~5days after the egg collection - this will be ignored for the reproductive system to recover & you have wait for the next natural bleed. So it’s not actually back-to-back in a sense you might imagine.

I think that's it for now! I'll add more if I remember anything.

For all the people going through their fertility journeys - sending positive energy your way x

[JoyfulStar]

Hi there, your 3 cycle journey is actually quite similar to mine with some minor differences eg medication used etc. Interestingly I had a disastrous second round as well. I had lots of eggs retrieved but no day 5 blastocysts. You are lucky that your hospital freeze some embryos on day 3. All mine were taken to day 5 to be frozen. I had 3 in total,

Cycle 1: 2

Cycle 2: 0

Cycle 3: 1

Wishing you the very best in your journey 🙏🏾

[jinis in reply to JoyfulStar]

Hi JoyfulStar ,

Cycles do really differ from one to another, don't they!

I'm glad you managed to freeze 3 D5 embryos

Wishing you the best results in your journey too x

[JoyfulStar in reply to jinis]

Yes I feel blessed! 🙏🏾

All the best with your journey too! 🌹

[DJ202]

Thanks for sharing, Jinis, this is a very interesting read! How are you feeling about your experience? How much time did you leave between the respective egg collections? Have you considered duostim, ie 2 rounds of stimulations in one cycle? My understanding is this may increase the number of eggs retrieved in the second collection. How much bleeding have you experienced after the trigger? I assume this would complicated egg transfer in that cycle? Sorry about all the questions, I'm curious! Wishing you all the best! x

[jinis in reply to DJ202]

My pleasure DJ202 !

> How are you feeling about your experience?

Despite a few hiccups along the way, overall my experience is positive - 5 embryos is not a huge number, but at the same time I feel that we would have a decent go at conceiving in the future.

> How much time did you leave between the respective egg collections?

The time between the EC and the first day of the next "natural" cycle was 5 weeks in my case (including the trigger induced bleeding 5 days after the EC).

> Have you considered duostim?

I went for a mild approach so didn't consider duostim.

> How much bleeding have you experienced after the trigger?

The bleeding after the EC is a full-on period - quite heavier if anything than my usual ones! I usually felt quite faint due to having 2 full bleeding in the space of 2 weeks, so tried to keep iron-rich diet.

> I assume this would complicated egg transfer in that cycle?

The trigger I used (Buserelin) is not suitable for fresh transfer. If you are doing a transfer cycle they will prescribe another trigger (Ovitrelle or similar).

Hope this helps x

[DJ202 in reply to jinis]

Hi Jinis, thanks a lot for all the extra detail, much appreciated! It is great to know about other experiences and helps me prepare for my own! I hope you're doing well and your journey is progressing smoothly!