First retrieval - what questions should I ask at follow-up appointment? Is anything in my protocol/results you'd question?

[sophstartingout]

(Tw: decent results)

Hi everyone, after over a year of planning (and faffing!), I finally did my egg freezing cycle last week, and got 17 eggs retrieved and 13 frozen.

I have a 30 minute follow up with my doc on Monday, and I'd love to know what are the most important questions to ask about my cycle, and about a potential second cycle (and to be confident on whether it's best to stay with this clinic or go elsewhere).

I'm wondering if there's anything in my protocol / response to it worth flagging up?

I had regular scans/blood tests, and my protocol was tweaked several times. Frustratingly I don't know all my stats - only ones I remembered to ask - but hopefully this is enough info:

Age: 36

AFC: 21, AMH: 33.9 pmol/L (4.75ng/mL), FSH: 6.9 IU/L - all tested in December

Day 1: 14 follicles

Day 5: 21 follicles, 1 follicle 12mm, 6-13 <12. LH 5.3

Day 7: Estradiol 3000+ pmol/L (~820 pg/mL)

Day 10: I think 24 follicles. 9 > 13mm, biggest 19mm. Estradiol ~9300 pmol/L (~2500 pg/mL)

DAY 12: 30 follicles. Biggest 22cm. Estradiol: ~18400 pmol/L (~5000 pg/mL). LH 1.4, Progesterone 4.2

Day 14 - RETRIEVAL: 17 EGGS, 13 FROZEN (4 discarded: one M1, two GV, one ‘degenerate’)

My protocol:

Gonal F 300 IU - Day 2-4

Fyremadel 250mcg - Day 5-12

Pergoveris:

Day 5/6: 250 IU

Day 7/8: 200 IU

Day 9: 175 IU

Day 10: 150 IU

Day 11: 125 IU

Day 12: 75 IU

Trigger, Day 12: Buserelin (Ganerelix) 1ml

Any thoughts on this protocol/my response?

It was pretty clear to me from my second scan onwards was that my follicles were all kinds of different sizes. My Dr explained that it was a balancing act of letting smaller follicles catch up without losing larger ones (and avoiding continuing to recruiting follicles that wouldn't yield mature eggs but would increase estrogen/OHSS risk).

Is there anything that could be done to help the follicles grow more evenly if I do another cycle? eg, down-regulation (I know nothing about this!) Anything else I should ask about follicle uneven-ness?

And is there anything else worth asking about? Could a dual trigger be worth looking into for next time?

I also am curious about the fact a quarter of my eggs were immature, which seems high.

Tl;dr - if anyone has advice on the most important questions to ask the doctor after egg retrieval, and/or thoughts on anything in my protocol/numbers I should raise with them, I'd be SO SO SO grateful!.

Thanks so much 🙏

[cantbearsed]

Did you do a short or long protocol? The long protocol usually involves downregulation e.g. buserelin. The benefits of the long protocol are that you should in theory get more even follicle size growth. So I would definitely start by asking your consultant if they feel whether a long protocol would help - it isn't suitable for everyone so maybe not an option, but no harm in asking.

[sophstartingout in reply to cantbearsed]

I did a short protocol, my dr didn’t mention long protocol as an option, but I will be sure sure to ask this! Thank you x

[Brillanni25 in reply to sophstartingout]

You seem to have a high AMH so a long protocole might not be suitable because of the risk of OHSS.

I think your protocole was successful. 13 mature eggs is exactly what most clinics aim for for a safe retrieval (10-15 target).

I would focus the conversation on whether you need more ER for the family size you are hoping for.