Higher stims but less eggs?!

[MollyHar]

Hi ladies

(age 39, AMH 19.8, male factor infertility)

Just had my egg collection this morn and feeling confused and disappointed

First time round was ovaleap 225, we got 11 follicles and 7 eggs

Second time they upped my stims to 300 menpur saying they wanted "to get as many eggs as possible"

However, with this higher stims we got 13 follicles but only 5 eggs I thought this higher stims would guarantee more eggs. Ill find out tomorrow how many are mature/fertilise.

Has anyone else had their stims upped, but ended up with less eggs? xx

[Fruitandflowers]

Yep, it doesn't always work the way the clinic said. Higher stims can sometimes mean more eggs, but can also mean fewer, sometime affects quality sometimes doesn't. Everyone's very different and it can even vary from collection to collection. I had very low stims as they thought i was at risk of OHSS but nothing happened so they upped it during the round, stimmes for 2 weeks and got 9 eggs but poor fertilisation and 2 blasts one which ended early (they dod later say they thought this was a one-offsperm issue so who knows). Then new clinic started higher and still went up by end (2 weeks again) but that time I got 5 eggs all to blast so much better and I have a daughter from that and frosties. Then a further round (original clinic) on highest stims for a short time and I got 1 egg which did fertilise but that was a never viable and ended in a PUL. I think for me the ideal would have been starting on the lower or middle stims then increasing gradually over a long time. But I can only guess at that and it's trial and error and sometimes just your body's response that particular cycle. As all my 5 eggs went to blast I wouldn't rule yourself out or be disappointed as sometimes fewer eggs = better quality.

[MollyHar in reply to Fruitandflowers]

thank you for your kind reply. And so wonderful you got your daughter <3. It really is a guessing game, even with all these variables and the clinic saying one thing, and it being the opposite. Just wish my clinic was a bit more informative as never knew upping it could acutally result in lessers numbers x

[Fruitandflowers in reply to MollyHar]

It's disappointing when all the promotional material and what they promise is about getting loads of eggs so it makes you feel like anything lower than about 20 is a disappointment. But a lot of this is just eggs and sometimes egg banking only (not IVF), not quality or fertilisation and ultimately having success. It's better if they can give you all the info and chances and explain why they're going with a particular option but even then it may not work how they expect. I do wonder if you did a poll on here whether you'd find much of a correlation in reality between number of eggs and success.

[neonpg in reply to Fruitandflowers]

Completely agree. I've always been a bumper crop egg producer (15 and 9 mature eggs on each of my rounds with only 225-300 iu) and yet I struggle to get barely any blasts. Proof that it's about quality not quantity.

[Sja1981 in reply to Fruitandflowers]

What is higher and lower stims? I don't understand the difference.

I'm currently on 225 of Pergoveris for 10 days. Low AMH and I've just turned 43. I've had 9 eggs then 4 last week at my baseline scans. So body is still producing and regular cycle. All bloods normal. They selected Pergoveris as I'm older and low AMH. So is this high or low stims?

[MollyHar in reply to Sja1981]

It sounds low at 225.. as my lower was 225 ovaleap and I then went up to high stims-300 menopur. However we are talking about different stimulation drugs, so maybe for your one this is a high dose? I’ve not actually heard of pergoveris, I don’t think my clinic offers this one xx

[Sja1981 in reply to MollyHar]

I think because I'm already growing a healthy number of eggs, they've put me on a low dose. I much prefer the idea of slow and steady based on all the comments in this chat.Pergoveris is used for older women I think so isn't perhaps widely used xx

[Fruitandflowers in reply to Sja1981]

I was on gonal-f so don't know about pergoveris and whether they can be compared. With gonal-f I started on what they said was the lowest dose (150 I think) then kept upping it until it got to 300 which they said was the max. I wish for my last round i'd gone with my gut and started low/medium and stimmed for longer as I got much better results that way than when they put me straight on 300 and stimmed for a shorter time. Fingers crossed for your collection!

[Sja1981 in reply to Fruitandflowers]

Thanks for sharing, that's interesting about your preference for low and longer. Id feel same especially knowing how sensitive my body is to hormones. I'm injecting for 10 days (argh, my fear of needles is high but it's getting slightly easier). No awful side effects yet. Just the stress of the needles! X

[Fruitandflowers in reply to Sja1981]

Yeah, you have no clue really when you start how you're going to react but I think after three rounds (plus one cancelled) either low and increasing or medium and increasing, and stimming longer, would be my preference as those got me a good number of high quality mature eggs and second round they all made it to blast. When they went straight to 300 for a shorter time I got one egg and it ended in a PUL and I wish I hadn't done that round at all, or that I'd gone with my instincts and cancelled. But it's all so unpredictable and you can do exactly the same protocol and get different outcomes, it's just feeling you've given it your best shot and not regretting.

[Sja1981 in reply to Fruitandflowers]

I'd be wary of a higher dose too, just feels too harsh on your body, especially at my "advanced" age of 43.

I'm on 225 which I think is medium?

Did you do anything specific to create a fertile environment for your good eggs, to increase chances of implantation? I seem to feel more worried about that bit right now x

[Fruitandflowers in reply to Sja1981]

The meds didn't agree with me when I started out at 35 so I think it can also just be how your body reacts. I think 225 would be medium if the meds are comparable and probably where I'd want to start. On having a good environment for implantation I think just based on how I reacted, what worked and didn't and how I felt instinctively, the main thing was doing a FET rather than a fresh transfer. I felt it gave my body time to recover and naturally my cycles were regular and my hormones were good, so was my lining... and FETs tend to have slightly higher success rates, especially as we age. It depends on a lot of factors and ask your clinic but that was the biggest thing for me. Other things were extra and different forms of progesterone and then possibly things like aspirin, and I took supplements and added a lot of what I thought were good things to my diet (didn't abstain from anything) but if those things were the answer then noone would need IVF(!) So maybe they fall in the possibly helped/didn't hurt pile.

[Sja1981 in reply to Fruitandflowers]

I have no choice but to do a frozen transfer. Will my cycle still be regular after all this treatment? Sorry I'm confused about a lot of your message as it can be read different ways. Hormones were good when? What depends on a lot of factors?

Yeah Ive been taking progesterone pills. Should I take other forms?

Specifically, I'm worrying about implantation success. Do you have any thoughts on that based on your FET experience, as I'm also doing frozen x

[Fruitandflowers in reply to Sja1981]

Sorry if my messages are confusing! Could you PM me as conscious we've crashed a different thread and am very happy to answer any questions you have (and will try to be more clear).

[Sja1981 in reply to Fruitandflowers]

Good point, thank you! Will do! X

[Hidden]

hiya - sorry you’re going through this. This happened to me, my stims dosage was too high so I was pushed too hard too fast and actually got a low number of eggs/mature eggs. We lowered my dosage and I stimmed longer for my third round and had a much better result.

With an AMH over 19 I wouldn’t have thought you’d need a high dosage. Good luck with your consultant. It really does just take one so wishing you lots of luck x

[MollyHar in reply to Hidden]

Thank you my love. Yes I queried the high dose and iwith my amh being good for my age. All they could say was it’s down to your age and the more we can get the better. I was never too confident with the change. But fingers crossed and like you said only takes one xx

[Twiglet2]

yes just happened to me I only got 6 eggs this round and only 4 were mature I normally get 8or 9 and mostly mature. I only stimmed for a week and had lots of follicles so I was really disappointed. I’m eating to hear today if any of the 2 still in the running at day 3 made it to blast for a transfer. They have said it’s due to my age increasing it’s only been 5 months since my last collection but I am 41 but I honestly feel going a wee bit slower would have been better! They said that was too risky though and we might not get many eggs and advised me against it. 🤷🏻‍♀️ xx

[NemoFish]

My AMH was a lot lower than yours (2), but I went from 225 ovaleap where I got 5 eggs to 450 ovaleap and only got 4, none of which fertilised. It was a very expensive experiment! I’m surprised with your AMH level they are pushing for higher stims though, so much of it is luck x

[Newbies1]

hi sorry you are going through this I agree with what the others have said and think everyone is different in how they respond, My stims were upped on my second round from 225 to 300 in the hope that I would produce more eggs. My AMH was 16.9 at the time so lower than yours. My first round I got 10 eggs but none fertilised, my second round on the higher dosage I only got 7 eggs but all fertilised and 5 made it to blasts and I have a son from that round so although less eggs the quality was much better for me on the higher dosage, although I did also push for a double trigger too on this round and believe this did help with ensuring all the eggs were mature. So much is a guessing game which is so frustrating! Praying for good fertilisation results for you and wishing you all the luck in the world for successful transfer take care xxx

[SarahHit]

How many follicles developed when you were in down reg phase? When I had that I had 5-6 follicles during down regulation and only got 2 eggs from that round. I normally get 7 eggs. So the follicles that developed didn't respond to stims and had no eggs.

[Banana77]

Hiya - stay positive, it really does only take one to stick - wishing you positive vibes x

[Spicycurry]

With my clinic, it was split with 225iu meriofert and 225iu fostimon which worked well. Also even though your amh is really good, what is your fsh like? As your amh is good, they could have done the long protocol which would have turned everything off to ensure more even growth of all follicles? As you have male factor infertility, IMSI might be better than icsi.

[MollyHar]

thank you for all you lovely replies ladies, it is appreciated. So after long protocol which was extended by a week and upped stimms, we got 5 eggs and just found out none have fertilised (ICSI) we are heartbroken. We have had total fertilisation failure! Which I’ve heard is super unusual

With our good result first round and my good amh I wish I had put my food down and said I didn’t want the higher stimms that I was never really comfortable with. I think intuition is always right. And I feel at a loss now as to what could cause full fertilisation failure my review appt isn’t until some weeks off

[Newbies1 in reply to MollyHar]

Oh I’m so sorry to hear this update, was praying for a good outcome for you today sending you big hugs. Our first round was zero fertilisation from 10 eggs so I know how devastating it is to get that call 😢 Please don’t lose the faith as some little changes can make all the difference next round. For us following total fertilisation failure we both took ubiquinol and went for a double trigger on the next round, we also only abstained for 2 days before sperm sample rather than the 5 days on the first round as read some studies that suggest shorter abstinence can have better results in terms of ivf outcomes and ended up with 100% fertilisation on round 2. Stay strong and be kind to yourself sending you lots of love xxx

[MollyHar in reply to Newbies1]

Thank you for your sweet words, they are comforting. As it is male factor and frozen sperm unfortunately life style changes won’t make a difference for OH, but I will add the double trigger to my list of questions. It’s the not knowing why that is sometimes the hardest xx

[Newbies1 in reply to MollyHar]

Aw so sorry didn’t realise it was frozen sperm, I agree the not knowing is the hardest. I do believe the ubiquinol helped my egg quality and the double trigger helped to ensure all my eggs were mature I’ve also know others who had used Artificial oocyte activation (AOA) which has helped with fertilisation so definately worth asking about at your review meeting. One thing I’ve learnt from this awful process is we need to be our own advocates so ask the specialists as many questions as you can. You’ve got this sending you so many positive vibes and the biggest hugs XXX

[Orttc in reply to MollyHar]

If you go again, I would recommend asking about using Calcium Iphonophore if you haven't already had it - they add it in during the fertilisation stage (also gets called AOA) but apparently it is worth it for frozen sperm. We have frozen sperm and used it and had normal fertilisation rates (which we were pleased with). Haven' tried without it so can't guarantee it's that that makes the difference but I suspect it's worth a try (compared with everything else, its not that expensive .