Baseline follicle count vs mature follicles post-stims

[Hopeful_88]

Hi, I hope you're all keeping well.

I was wondering what people's experience is with the baseline follicle count vs the number of follicles they get above cut off for IVF (16mm in my clinic) post-stims?

At baseline I had 19 follicles (AMH 16.6). After 11 days on Meriofert (starting on 225 IU, then 300 IU) I only have 4 follicles above 16mm. 4-5 follicles are between 10 and 16mm so they may catch up (the clinic have upped my dose to 375 IU for 2 more days before next scan).

I guess I'm asking if there are any similar experiences or opinions on whether this conversion rate is to be expected? I asked my clinic and the response was quite vague and can't find anything online. This is my first IVF round so I'm not fully sure what to expect but for sure I assumed there would be more follicles than this. I had such high hopes and now I feel completely crushed.

Appreciate any feedback or information and sending lots of well wishes. X

[Tnthketnf]

I can't remember every single retrieval but it always started with a good number of follicles and gradually reduced. I had 5 retrievals. And i usually had follicles growing at different sizes. I had a cycle where the little follicles caught up but most of the eggs from were not mature.

For one cycle had 18 follicles and ended up with one embryo. OK I have an egg quality issue and I am older but in general terms it goes like below:not all the follicles from the baseline scan will grow. From them growing not all will be big enough at retrieval and from the number of eggs retrieved no every egg will be mature and not every mature will fertilise and so on.

Unfortunately there is not a formula to convert numbers of antral follicles or AMH to mature eggs or embryos.

[Hopeful_88 in reply to Tnthketnf]

Hi Tnthketnf thanks for the sharing your experience and for the info, I feel reassured to hear that it's normal to have follicles of all different sizes as you go through the stims and that most of them won't catch up. In terms of the numbers I guess I wasn't expecting so few and was thinking I'd have more along the lines of what I had at baseline. Good to have more understanding and I feel a bit more prepared now, thank you x

[JA-fnuk Partner Nurse Fertility Network UK]

Each cycle of treatment can be entirely different and your response has been good ! Great that you have 4 bigger than 16mm + 4 or 5 just bubbling under The increase in meds can make all the difference to the ones between 10- 16mm So good luck with scan in 2 days time

Take care of yourself

Janet-Partner

[Hopeful_88 in reply to JA-fnuk]

Hi JA-fnuk thank you so much for the reply, it's so positive to hear your response and I feel so much more optimistic! Really appreciate the info and I feel a lot more informed now. Thank you for the luck, fingers crossed 🤞 x

[raverg]

I’m following this topic as I was wondering as well about the disparity between how many follicles you start the cycle with and how many eggs you end up with at the end of treatment.

I went into my previous stim cycle with 14 follicles but after 10 days of treatment (225 Menopur) only 4 were over 16 mm. We went into collection and they were able to retrieve 7 eggs, but only 4 were mature enough to fertilise. Probably the bigger ones we’d seen at the last scan. I was so disappointed and crushed as well!

They were decent quality though as 3 fertilised and 2 made it to day 5, and the nurses said that that’s pretty average and what most people get. Which checked out as in my group of friends one ended up with 1, two with 2 and another one with 3. So I suppose that that’s what matters most.

But I did ask my doctor about the disparity as I was so angry and they told me that they had not achieved the balance between safety (avoiding OHSS) and efficacy, and next time they’ll give me a higher dose to get more eggs hopefully and have more choice. Now the next cycle is coming up and they decided to put me on two types of stims (both Menopur and Gonal F, in case I didn’t respond well to the Menopur alone) so we’ll see how that goes. They might tweak the dosage as they go like in your case as they are planning to see me again halfway through treatment which they didn’t during my first cycle.

So I suppose that it’s normal, and it would be great if a few more caught up by egg collection day. They are clearly giving you time and a stim boost so good luck!

[Hopeful_88 in reply to raverg]

Hi raverg thanks so much for your reply. It's good to hear that your eggs were good quality despite getting lower numbers than you had hoped, and that this was on a par with your friends. I think I had read somewhere that slow and steady stims can lead to better quality eggs than very high doses. However I can totally share your frustration with the disparity. It's really not what I was expecting!

It's good they will scan you halfway through this time, my clinic only scanned on day 11 which has frustrated me as they could have upped the stims sooner. Although I read a paper that said changing the stims dose by more than 5% of the starting dose can lead to more irregular sized follicles and fewer mature eggs retrieved, so I think ultimately I was on too low to start with. I guess like you suggested they would rather play it safe in the first cycle whilst they are figuring out how you respond.

Wishing you all the luck for your upcoming cycle and hoping the tweaks will do wonders for you! Thanks again for the reply, it's so helpful hearing other stories in this lonely journey x