Confused after follicle check day 6 - low responder?

[MWC30]

So I’ve just started my first round of IVF and just had my follicle check on day 6 on Gonal-f, apparently I only have 4 follicles growing at this time..

I’m 30yrs old with a good AMH and AFC, doing IVF because of male factor infertility.

Is 4 follicles after 6 days a very poor response?

I’m not sure what to make of this, and if I should be worried or not.. Anyone with a similar experience?

[Astride0]

Hello,

It's hard to tell, but it seems fairly low. I think they are being cautious with Covid to avoid OHSS, especially if you are young and it is your first cycle.

They started me on a low dose too as I was in my early 30s, and increased the dose with my second cycle. It didn't actually improve the numbers but we had a better fertilisation rate, so It shows there are several factors at play and no one cycle is the same.

More follicules tend to appear on later scans, but you can definitely call your clinic and ask for a doctor call back to ask how many they would expect at this stage.

You could also ask to change medication next time, for instance if you want to try Menopur instead.

Good luck

[MWC30 in reply to Astride0]

Hi,You’re probably right. Was told I was at risk for hyperstimulation and they probably were too cautious, like you said.. I’m going to ask about Menopur next round. I’m hopeful there’s still room for improvement..

Got to speak to my doctor, we’re increasing the dose and I’m to go back for another scan tomorrow, although I don’t know how much it could have improved in such a short time..

Thanks for the reply, it’s comforting to know I’m not the only one that this has happened to.

[Astride0 in reply to MWC30]

Absolutely,and I agree with the comment below. Follow your gut instinct and it might be a good idea to look at progress tomorrow and have a frank conversation with your doctor and ask if cancelling and starting fresh next month might give you a better chance, or if they think stimming for longer will get you there. They call the first few day the recruitment stage, but perhaps you can just catch up with a longer stimulation.

Starting again is hard but you only lose the cost of some drugs and two scans, while a full cycle is a bigger investment financially and emotionally. Make sure you getting a treatment you are happy with.

I was on 225 Menopur first cycle and I think I had 8 follicules on one ovary and 11 the other. I ended up with 28 but again I have PCOS.

I was put on 300 for my latest round and had the same number of follicles and one less egg. I went ahead while sick, and I wonder if this had a negative impact and I would have been better of delaying. It is so hard to make these types of decisions, but I would say just trust your instincts.

On a positive note, with every cycle you learn how your body works and your clinic will adjust the protocol

[MWC30 in reply to Astride0]

You’re absolutely right, this does at least give us some more clues on what could work in terms of dose and type of stimulation needed, so I’m hopeful for next time we try this. Sounds like I’ve lost all hope for this round, I haven’t really since my doctor thinks we could make it with a higher dose and stimming for a longer period of time, and that a fewer number of eggs (but hopefully good quality) will be OK this time around.. so I guess I’m cautiously optimistic😊 The doctor still thinks it’s the best option at this point to keep going, so I’m trusting the experts and just going with it. Practicing patience, Netflix and lots of chocolate should do it!

I’ve wondered about that as well, if being sick could affect this process. I had a cold with a sore throat when I started stimming, maybe that could have had a negative impact on my eggs? I heard on the podcast BFN that it shouldn’t, unless you have a high fever or infection, but I don’t know??

[Astride0 in reply to MWC30]

That sounds really positive. I'll be rooting for you. If that's any reassurance for the sickness/egg numbers, today was day 5 for us and we ended up with more to freeze than last time, despite collecting less eggs and being sick and mostly bed ridden the first week of stimming.

[Jjleo]

I would say this is low too! I am also 30 but have very low AMH and at my first scan they counted 7 follicles. I was on 225 ovaleap. I think you need to speak to the consultant at the clinic as they may be able to increase dosage your ok or suggest cancelling and starting again with a higher dose. It is important for you to feel you are giving yourself the best chance and feel confident with your cycle. X

[MWC30 in reply to Jjleo]

Thanks Jjleo, it’s helpful to have something to compare to. This was surprisingly difficult to google! True, they’ve increased my dose a bit and going back for a scan tomorrow, but I don’t feel very hopeful about this round being successful. You’re right really, maybe it would be better to cancel it and start over, I’ll see what the doctor thinks tomorrow after looking at my scans.. didn’t know I would feel so drained by all this, feeling hopeful and hopeless every other minute 😣

[MrsOrangejuice]

I have a very high AMH and always had a lot of follicles naturally so they started me on low levels of stims. Something about the meds didn't really agree with me and at first scan I only had two smallish follicles first round so they kept upping the meds and only towards the end did a load more come through and catch up - got 9. Second round I was on higher meds to start but had just one dominant follicle >15mm at first scan. They suggested cancelling but because of prior round I asked to up meds and continue - again, more came through towards the end and got 5 that time. I stimmed for 17 days both times and neither my NHS or private clinic get my response and tbh it's probably not optimal at all given my natural amount of follicles - they called me a 'weird responder' - but we got frosties and second time we got all to blast (and I'm currently 25 weeks pregnant with one of those) so overall it's been successful. Maybe check with your clinic if you can up the meds and stay on them for a while longer, as in my experience a lot can change very quickly. I was also told I could cancel any time up to trigger or collection so maybe check this too. Best of luck.

[MWC30]

That sounds just like me, a weird responder 😅this story gave me some hope back, I’m so glad it worked out for you! I didn’t even know stimming for so long was an option, I’ll see what they say on my second scan tomorrow.. thank you, you too 😊

[MrsOrangejuice in reply to MWC30]

Glad it helped and yep apparently you can be on them that long and at high doses and be ok - not saying that's true for everyone and I was really worried when my clinic said the big ones would become cysts, the little ones wouldn't catch-up and I'd 'waste' my round but we got eggs from all that I had (and more we're coming through so who knows maybe I could have got more, but probably not very good for you to be on meds that long). The clinic didn't like my weird response and maybe if they'd had any alternative options I would have given up and changed, but they didn't have any suggestions at that point so I just kept going, but it wasn't an easy decision. There's also a bit of a debate over number of eggs vs quality and how many good blasts you get - e.g., could get loads of eggs and still a low proportion get to blast/freezing, or you may be lucky and most do - can all be very unpredictable (and stressful) but don't necessarily worry if you don't get as many as they predicted initially.

[MWC30 in reply to MrsOrangejuice]

Good to know. My scan today showed only 6 follicles growing, but apparently they seem to be in a good stage and hopefully they’ll keep growing at a steady pace. We’re upping the dose and will keep stimming for a longer period.. it feels good to have a plan! My doctor seems to think that a retrieval of 6 eggs is still ok for this round, and seeing as I’m young, a high percentage of them are expected to be of good quality (I think she said that?) and therefore there might still be a chance of one or a few good embryos despite the low number of eggs.

[MrsOrangejuice in reply to MWC30]

Last round we got five eggs but all went to good day5 blasts (a better outcome than when we got more eggs initially) so it is possible. The first lower fertilization round it was a sperm quality issue though, which was resolved by the second, so also remember it's not all on you and your eggs, even though that's what clinics seem to focus on. Best of luck.