Has anyone ever had empty follicle syndrome (EFS)? Trigger issues?

[Milly_Oz]

My last cycle we did a down reg and scans all showed at least 8 good sized follicles (and some smaller ones) all growing together (we always had them growing at different rates before). Oestrogen levels before EC all lined up too and then I only got 2 eggs. I was devastated to say the least. Dr thinks trigger didn’t work properly and so eggs got stuck to wall of follicle. Apparently ovaries can get less receptive to the meds. We had done double trigger with pregnyl and ovidrel. Has this happened to anyone else?

About to try one last time and really don’t want this to happen again. Potentially going to add another trigger that works slightly differently.

Keen for other perspectives.

Thanks milly x

[Skittles11]

Hi Milly. Sorry to hear this happened to you. I have had a similar experience.

My first egg collection was heartbreaking as no eggs were recovered. It sounds like you've had previous goes, were they different in terms of your egg collections and expected numbers?

In my case there were several things changed for the following cycle including drug type, trigger timing and protocol type. Although we still haven't had a happy outcome in becoming pregnant, I did have more success after these changes. I hope the same will be true for you.

It sounds like the doctor has explained what may have gone wrong and there are plans to address this in your upcoming cycle. It's horrible not knowing for sure if things will be better or not but it certainly sounds like there is hope there and by changing the trigger you could be looking at a completely different outcome.

Wish you luck with it x

[Milly_Oz in reply to Skittles11]

Thanks for your note skittles11. I’m sorry you’ve had to go through this too. It is awfully disappointing. What did you change with your trigger?

This was my 4th cycle and worst result. We’ve tried various protocols and timings.

Cycle 1: day 12EC, 13 follicles, 6 eggs (2 semi mature) 0 fertilised

Cycle 2: day 16EC, 12 eggs (9 mature) 0 fertilised (tried natural insemination but needed ICSI 😥). We added a double trigger here and stronger meds.

Cycle 3: day 14EC, 8 eggs (4 mature) 1 embryo (now frozen)

Cycle 4: day 15EC 2 eggs 0 fertilised (potential trigger fail)

This time going to back to protocol of cycle 2/3 but perhaps doing something additional with trigger. Bit apprehensive but we got such a great egg result at round 2 we really want to give it one last shot.

Good luck with yours x

[Skittles11 in reply to Milly_Oz]

Completely understand giving it another shot.

With my trigger, we changed the timings so I had it 38 hours before egg collection rather than the standard 36 hours which I had had initially in cycle 1. The trigger itself stayed the same, its called Oviterelle.

I have low AMH so not many eggs would be expected per cycle but it improved from zero to six being collected on both cycles 2 and 3.

With your fertilisation rate, have they been doing ICSI on your later cycles? Has your partner had any testing done, I hear a lot about DNA fragmentation tests being worth doing if fertilisation is fairly low.

Do you know when your next cycle will be?

X

[Milly_Oz in reply to Skittles11]

We’ve been doing icsi except for 2nd cycle when dr recommended trying natural insemination (eggs flimsy on first cycle) but they hadn’t realised my husband has 100% sperm antibodies which make it difficult for sperm to get in the egg. Sod’s law that was my best egg retrieval but nothing fertilised! I haven’t done DNA fragmentation..I’ll look into it thanks.

Next cycle starts end of august so just wanting to get the right protocol this time. Will also do 2 weeks priming with testogel and oestrogen before stims which apparently helps with making ovaries more receptive to stim meds. 🤞🤞🤞

[Aussie83]

Hi Milly,

Sorry to hear you’re going through this, it’s so bloody tough.

I have had similar experiences as well. My first 3 collections I got 2, 0 and then 3 eggs - all on different protocols. On my 4th collection my dr added in HGH and a new hormone called Pergoveris, we also had a 15000 Gonasi trigger - I ended up with 18 eggs, all mature & fertilised & 7 D5 embryos.

We haven’t had a BFP yet but the we could see with the chance of protocol that my body can work properly.

I know how heartbreaking it is when collection after collection goes badly. I thought I was headed to donor eggs but it turned out I just hadn’t found the right protocol for me.

Definately think a higher trigger is beneficial.

All he best with it all, wishing you loads of luck this next collection x

[Milly_Oz in reply to Aussie83]

Thanks for your reply. Wow 18 eggs and 7 D5 embryos that is just amazing! I definitely agree it’s just finding the right protocol for you individually it just depends how many goes your willing to try finding it. Your story makes me feel a lot more positive 😊

I’m going to check out that trigger and the pergoveris as I haven’t heard of those.I did use HGH from 2nd cycle. When did your Dr recommend you start the HGH and what dose?

Mine said to start on day 2 but I’ve read reports of HGH being used weeks ahead. It’s just very $$$

Wish you all the luck in the world with your embryos x

[Perello]

Hi there Milly

So sorry this has happened. I can completely understand what you've been through. This happened to me and it's so devastating and brutal after all the injections and build up.

I'm not a great responder to fertility drugs and after a number of normal ivf cycles on maximum dose of stimms I was all but ready to give up as on all rounds I either didn't have enough follicles or the only time I did get to EC, all follicles were empty and had zero eggs.

After a break, I decided to give one last chance at a new clinic and do natural modified ivf which was much milder and suited me much better and I seemed to respond well. First round same thing happened, all empty follicles. Again was completely devastated and started to question why I was putting myself through this again. But then the next time they added tamoxifen to the mix and pleased to say I had 3 eggs retrieved with 100% fertilisation, 2 made it to blasto, then the 3rd round, 4 eggs retrieved had 100% fertilisation and 3 made it to blasto. I've got 4 in the freezer now and one was put back but sadly had a miscarriage earlier this year.

I know everyone is different and one thing might not necessarily work for another, but just wanted to share my story that changing things up even a little can make a huge difference. In my case, stim drugs and trigger remained the same brand and same dose on all cycles at the new clinic; it was just the addition of tamoxifen that seemed to do the trick. It does sound like your doctor has a plan to change things up a little so wishing you all the best for the next cycle x

[Milly_Oz in reply to Perello]

Thank you for sharing your story. I’m sorry about your miscarriage that must be heart wrenching after everything else. I’ve had them too before I started this ivf journey.It’s amazing that you got such great quality eggs and high fertility on the new protocol. Hopefully your next one will be the golden embryo 💖I will look into tamoxifen. My Dr is very willing to try new things which is great.

Good luck! X

[Aussie83]

I started HCG on day 2 on alternate days for 5 days.

Yes do, Pergoveris is VERY expensive but I feel was worth the price!

Thank you so much x

[Milly_Oz in reply to Aussie83]

What dose was the HGH you used? I was on 2.5mg daily from day 2.

[Aussie83 in reply to Milly_Oz]

I was on 4mg for 5 alternate days. Day 2 as well I think.

[Milly_Oz in reply to Aussie83]

Thanks I’ll ask my Dr whether this could be a better way to have it

[Milly_Oz in reply to Aussie83]

Btw Aussie83 when you had gonasi trigger 15000 what did you have as trigger/dose in your previous cycles. Did you get OHSS?

I used pregnyl 10000 initially and then asked if I could use higher in 2nd cycle. I was given a dual so pregnyl 10000 and ovidrel 250.

Thanks!

[Aussie83 in reply to Milly_Oz]

In the previous cycle it was also Gonasi but a lower dose of 10000.

Yes I was close to OHSS in both my latest cycles so was closely monitored.

Because I had so many follicles in that cycle (17) but only 3 eggs, for my most recent cycle they were throwing everything at it to get them out.

[Milly_Oz in reply to Aussie83]

This is exactly what I need. So frustrating seeing everything on scans and bloods and then waking up after the op to be disappointed. Thanks so much!

[Sunshine809]

This happened to me on my last round - 8 good sized follicles and only 4 eggs. I was told perhaps the needle missed the egg or maybe they were empty.

Thank you to everyone for your stories and suggestions. I didn't realise there was so much variation in the drugs that can be taken etc! We've got a debrief with our consultant soon and I was nervous she was going to say 'let's just do the same again' for the third time, so it's good to have some information on other things i could suggest.

Really hope things go better for you next time Milly xx

[Milly_Oz in reply to Sunshine809]

Sorry to hear it happened to you. My nurse said it does happen quite a lot.Yes there’s so many protocols. I didn’t realise either but you learn new stuff everyday going through this. The Dr should have a good idea if there are eggs in the follicles by the level of estrogen on last blood test before the trigger. Apparently it should be ~500-700 per egg. When I had my poor result my estrogen level was 8000 so that’s why my Dr thinks the eggs were there but trigger hasn’t worked properly.

I’ve also been having double triggers and slightly longer at 38 hours rather than 36.

Still looking for my magic formula!

Good luck x

[Sunshine809 in reply to Milly_Oz]

My clinic doesn't do a blood test before the trigger! It's strange having so much variation at different clinics. That doesn't help either! I might ask about the blood test for next time. Thanks for the info and good luck to you too x

[Milly_Oz in reply to Sunshine809]

My blood test was along with my last scan when they tell you when you should trigger. I think I had to trigger that night. Hope you find some answers x

[Bella_Bee]

Something similar happened to me. My right ovary was empty on my first round. It was a short protocol and I triggered with a single ovidrelle. None of the 5 embryos made it to day 5. On my second round, I did a long protocol (I stimulated for 16 days!!!!) and used a double ovidrelle to trigger. They collected 18 eggs in total from both sides, 13 fertilised and 7 made it to day 5. Currently 9 weeks pregnant on my first transfer and 6 more in the freezer. Cautiously elated. It was probably a combination of twenty different things but this has to have been a huge element. Good luck xo

[Milly_Oz in reply to Bella_Bee]

Wow that’s so good to hear! Can I ask if you’re over or under 40? I’m 41

[Bella_Bee in reply to Milly_Oz]

Was 37 on the first try and 38 on the second. So I got a better result 6 months older. 😊 Amh of 9. I also started taking DHEA, CoQ10, melatonin and high dose folic acid four months before the second attempt and blood thinners during stims and after ET (I have APS). And, as I'm doing this on my own, chose genetically tested sperm from a US clinic and got genetically tested myself the second time. Also chose one of the highest rated clinics in London (with the accompanying price tag 😖 ). After 2 miscarriages following natural conceptions, 3 failed IUIs and a failed IVF round, I was done fckn about.

[Milly_Oz in reply to Bella_Bee]

Congratulations! Love hearing good stories. It’s such a complex and challenging journey. Wish you all the best with your pregnancy x