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“Empty Follicles” – An IVF Egg Retrieval Mystery Explained

Dr. Geoffrey Sher Recommends

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It is not uncommon to hear women report that their IVF-egg retrieval yielded far fewer eggs than was expected and that when asking for an explanation they were told by their doctor that many of their follicles were “empty” and contained no eggs. This is at best an oversimplification of a complex situation, or at worst a flagrant misstatement! All follicles by definition must contain eggs.

True, it is not unusual or irregular for egg retrieval to yield a few less eggs than the number of follicles would suggest. However, when less than 50% of follicles >15mm fail to yield eggs, something is wrong. So how and why does it happen?

First, a little background information…With the LH surge that precedes spontaneous ovulation and also with the hCG trigger shot given to induce ovulation following the use of fertility drugs, the egg undergoes “ripening” to prepare for fertilization. This involves (among other events) a rapid halving in the number of its chromosomes (meiosis). At the same time, enzymes are released that loosen the cells (cumulus oophorus) that surround and bind the egg to the inner wall of the follicle. This is necessary to enable the egg to come free at ovulation and/or at the time of egg retrieval.

The problem is that with poorly developed eggs, the latter mechanism often fails, leaving such eggs tightly “stuck” to the follicle wall and unable to come free, often in spite of vigorous attempts to flush them loose. That is why the more difficult it is to successfully aspirate an egg at egg retrieval, the more likely it is that such an egg is chromosomally abnormal and “incompetent” (i.e. incapable of developing into a normal pregnancy). This state of affairs is most commonly encountered in women with diminished ovarian reserve (i.e. “poor responders”), women over 40 and in women with polycystic ovarian syndrome (PCOS) who do not receive an optimal protocol of controlled ovarian hyperstimulation (COH).

So the term “Empty Follicle Syndrome” is a misnomer! Yet the circumstances surrounding failure of numerous follicles to yield the eggs they contain at the time of egg retrieval only serves to underscore the need to individualize COH protocols and to time the administration of the “hCG trigger”, precisely.

Tags: egg retrieval, empty follicles, In Vitro Fertilization (IVF), IVF Authority

44 Responses to ““Empty Follicles” – An IVF Egg Retrieval Mystery Explained”

raphaele says:

May 28, 2010 at 4:46 pm

Hello Dr Sher
I am 41 y/o. My two first long luppron protocol produced respectively 3 and 7 embryos (40 y/o at the time), the latter one with a pregnancy that ended at 7 weeks. A third long luppron protocol ended with a cancelled cycle which looked like oversuppression (with one ovaries that shut down and the other were only 2/3 follicles that developed). On my fourth attempts on a GnRH antagonists protocol, it seems that I ovulated 2 or 3 hours before the retrievals (while the last US indicated something like 8 /9 follicles)over 15 mm day 12 of the cycle. It seems my best cycle in term of stimulation but ended with no eggs retrieved. What can have happened ? how could this be avoided ? should I change protocol ?

Reply
Geoffrey Sher, MD says:

June 2, 2010 at 5:26 pm

It sounds as if you experienced a "premature LH surge", a condition where high LH levels cause “follicular exhaustion” resulting in poor egg quality and often failure of the egg to come free with aspiration . But the term “premature LH surge” is a misnomer since it suggests a sudden unanticipated rise in LH that occurs as a “terminal event” or an isolated occurrence. In actuality, what happens is the result of a progressive escalation in LH (the so called “staircase effect”) that through a persistent rise in stromal androgens, ultimately exhausts the follicle and damages the egg irreparably.
A more accurate term might be “premature luteinization.”

Geoff Sher

Reply
hajr says:

July 8, 2010 at 6:23 am

hai dr
my sister undergone for ivf 2 times . both time , the dr said there was no egg in follicles .is empty follicle syndrome and the above condition are same ?
what are the remedies other than doner / surrogacy .
also i am trying for 3 years , is it genetically happen or only coz of hormones

Reply
bi9thst says:

July 10, 2010 at 2:06 pm

I just finished a donor cycle. Can you tell me if missing 1 of the gonnul and 2 of the menopur injections could cause empty follicles? I confused my calendar and started both medicines a day and days (respectively) late. I didn't mention it to the doctor as I thought I still had time to make up the injections. However, seeing many follicles he called for retrieval 2 days later and so I was told to discontinue the medications and take the trigger shot. I didn't realize that not all follicles would produce eggs. We only retreived 3 eggs and I feel terrible, like I really messed this up. Please advise.

Reply
Geoffrey Sher, MD says:

July 13, 2010 at 11:57 pm

I suspect that the protocol of stimulation could have played a role in egg "competence" and that in turn might have prevented the eggs from detaching from the inner wall of the follicles after the hCG trigger. As this article indicates, tThere is really no such thing as an empty follicle.

Reply
Geoffrey Sher, MD says:

July 14, 2010 at 12:07 am

One of the commonest reasons for "empty follicle syndrome" is, in my opinion, a less than ideal protocol for ovarian stimulation.

Geoff Sher

Reply
Awaiting our miracle says:

August 15, 2010 at 10:16 pm

Dr Sher,

Thanks for such a great blog. I have just done my first round of IVF and with about 8 follicles between 13 & 16mm on day 12, I didn't get any eggs. Egg pick up was on day 15 with trigger 36 hours beforehand.

My E2 levels were 1020 on day 5, 1100 on day 9 and dropped to 700 on day 12. I was on 125iu of puregon, but they dropped it to 75iu from day 5 due to my PCOS and a risk of OHSS.

Is there any hope for me in future cycles? How can this be avoided in the future? I'm devastated and looking for answers.

Thanks, Kim

Reply
Geoffrey Sher, MD says:

August 18, 2010 at 4:45 pm

Thanks for your kind words. It sounds to me as if your last cycle was doomed because of premature luteinization (early LH rise). Clearly the protocol of stimulation needs to be seriously modified. Call 800-780-7437 and set up a free telephone consultation with me so we can discuss what needs top be done.

Geoff Sher

Reply
trufflesgonewild says:

October 3, 2010 at 4:12 am

Hello Dr Sher,

My partner has just completed her IVF cycle, with no egg retrieved from just one follicle. Her age is 42. She has been on Agnus Castus/natural herbs/acupuncture for two months to lower FSH levels. Day 2 FSH have been progressively lowering – from 30 to 21 and then 7 on Friday 24 September 2010 (LH had also lowered to 5 from levels in the teens and before that in the 20s and 30s. So with FSH 7 and LH 5 we decided to try IVF. As one failed IVF five months ago (one egg from one follicle, fsh injections of 300, no fertilization). So partner this time was placed on higher 375 fsh injections. At day seven scan we were told that partner had a 22mm x 16mm follicle and that 'she was ready'. But it was our decision to go ahead as only one follicle and chances were low. We went ahead due to partner's age etc. How can partner have such a mature follicle after just five nights of fsh injections. This seems far too early for any follicle to be ready. What implications does this have on egg maturity? The same morning as day seven scan partner was given first and only antagonist injection by clinic, and that evening we administered the hCG trigger. Saizen GH was injected on day seven (day of scan, antagonist and trigger) and day eight.

Thank you

Colin and Laetitia

Reply
Elena says:

November 17, 2010 at 4:10 am

Dear Dr Sher,

I have recently undergone my 7th ICSI attempt. I am a poor responder with good FSH but high E2. All my previous cycles (all bar one SP with SP giving best results) ended in transfer of 1-2 embryos. The last cycle, with 5 follicles, ended in retrieval of 1 immature egg. The other follicles were 'empty'.
I was down regulating for about 3 weeks and started stimulating on CD5 – I was on Merional during almost the entire cycle (which surprised me as, given that I am a PR, I thought it would be Follistim or something similar). I also had Clomid for 5 days and Cetrotide for about 4 days. I was stimulated for 11 days in total. I had a urinary HCG shot (10K IU) 36 hours prior to the retrieval.

Dr Sher, could you please give me your opinion of what could have happened here?
Thank you ever so much.

Reply
Elena says:

November 17, 2010 at 9:53 am

Dear Dr Sher,

I have recently undergone my 7th ICSI attempt. I am a poor responder with good FSH but high E2. All my previous cycles (all bar one SP with SP giving best results) ended in transfer of 1-2 embryos. The last cycle, with 5 follicles, ended in retrieval of 1 immature egg. The other follicles were 'empty'.
I was down regulating for about 3 weeks and started stimulating on CD5 – I was on Merional during almost the entire cycle (which surprised me as, given that I am a PR, I thought it would be Follistim or something similar). I also had Clomid for 5 days and Cetrotide for about 4 days. I was stimulated for 11 days in total. I had a urinary HCG shot (10K IU) 36 hours prior to the retrieval.

Dr Sher, could you please give me your opinion on what could have happened here?
Thank you ever so much.

Reply
Geoffrey Sher, MD says:

November 17, 2010 at 3:13 pm

This sounds as if it could be related to thje protocol of stimulation. I suggest you call 800-780-7437 so we can talk.

Geoff Sher

Reply
rems says:

January 13, 2011 at 9:55 pm

We underwent 2 ICSI .In the first ICSI i had 5 follicles and out of which only 2 could be retrieved and others were empty.Both fertlilsed but failed to cleave.In the second Icsi again 5 follicles but only 1 egg retrieved and others were empty.The egg fertilised again but failed to cleave.The Dr. asked us to do karyotyping but came out normal.Day 2 E2 , FSH , testosterone and AMH are normal.We used short protocol both times..tried Recagon and Gonal-F..Pls give us an answer

Reply
Kins says:

July 21, 2011 at 5:05 am

I am 32 and have done 2 IVF cycles, produced several follicles in each and no eggs were retrieved in either. I have always had very low estrodiol levels considering the number of follicles I have. I have also done a unstimulated cycle with just an egg retrieval. An egg was retrieved, and although it was mature, through in vitro maturation, it reached maturity, fertilized, and divided, just didn't make it to blastocyst. Have you seen any cased like this or have any thoughts on the cause of why my eggs don't respond to stimulation despite producing so many follicles?

Reply
Geoffrey Sher, MD says:

July 21, 2011 at 10:00 am

One thing is very likely and that is that failure to harvest an egg in the vast majority of cases has to do with egg aneuploidy (irregular numerical chromosome component). I would need to know much more about your case to comment. I suggest you call 800-780-7437 or 702-699-7437 and set up a free telephone consultation with me.

Geoff Sher

Geoff Sher

Reply
Ziz says:

September 16, 2011 at 11:47 pm

Hi Dr Sher,
I am hoping you can offer some advice on guidance on what we should do next. Here is my background on our IVF journey.

Me: 33 (had a fibroid removed mar 10 – discovered mild adenomyosis / laparoscopy dec 10: found mild endometriosis / tubes all clear

Husband: poor motility/morphology

Specialist advised to go straight to ICSI.

Jan 11: ICSI#1 – FSH 9 /Puregon 150iu / Orgalutran / Ovidrel trigger. Didnt respond particularly well, but still retrieved 7 eggs. 6 mature. 5 fertilised. 1 Blasto implanted / 1 frozen. BFN

March 11: ICSI#2 – FSH 13 – Synarel cycle / Puregon 225iu then upped to 300iu as not really going to well. Progesterone was 6 on day 8 so was told i couldnt have an embryo transfer, but could still go for an egg collection even though i only had 3 measurable follicles. Decided to go ahead with it anyway as nothing to lose.
Retrieved 2 eggs! I fertlised and made it to day 6 but was highly fragmented so not suitbale for freezing.

This cycle was disastarous from word go, and i dont even like to include this in the list!!! Synarel and me didnt get on!!!

I then had my AMH level tested and got the awful news that it is 3.1! This would explain why im not responding very well.

FS imeadiately put me on DHEA 75mg per day and said we would be going agressive from now on.

May 11 – ICSI# 3 (advised to do fresh to try and get more frosties due to low amh):

FSH 9 / Changed to Gonal f – 300iu / Orgalutran / Ovidrel trigger:

Responded much better with 15 follicles.

Retrieved 8 eggs (woohoo!) however only 4 were mature. Then the awful news that NONE of these fertilsed! Whats going on??

So, we transferred our frozen embryo from cycle 1 and would you believe it but i got BFP!!!!!

However, i had a missed miscarriage at 7 weeks and was absolutely devestated.
Had a D&C; on June 29.
Chromosone analysis: extra chromosone 21 and extra chromosone 11.

SEPT 11: Currently i am in ICSI# 4.

This has been my best cycle to date in terms of stimulation. Gonal f 300 / orgalutran / ovidrel.

I had 22 follicles and all looked sooo good. On day 13 i had an estrogen level of 5235 / P4- 3 / LH 1/ Follies ranged from 2.05 – 1.1

They let me stim an extra day as they wanted the middle cluster to grow more, and it would be worth it to gain say 6 eggs but lose the top 2.

Triggered at 8pm on cycle day 14 with egg collection on 15 September.

This cycle has now crashed.. i woke up to hear they only got 3 eggs!!!??????? Only 2 were mature. They said the rest were empty follicles????? How can this be happening after the stims went so well???

Anyway, only 1 of the 2 has fertilised and i am now waiting to see if it makes it to day 3 and then blasto by tuesday. I know the chances are slim.

What is going wrong with me??? Should i be going straight to Donor eggs or try a different protocol??

I cant understand why my first cycle was so good compared to the rest, and, I have successfully managed to get pregnant on only my 2nd transfer.

I know my AMH must have a lot to do with it, but i have friends who are alot older than me, with FSH numbers in the 20's who are getting much better yields of eggs.

Any advice on what i should suggest to my FS would be gratefully appreciated. The fact i have got pregnant is making me want to keep trying with my own eggs as im only 33, but, in the last 2 cycles combined i have had 11 eggs retrieved/ 6 mature and only 1 fertilise so im starting to panic.

I think the DHEA is responsible for the increase in follicle numbers, but im wondering if perhaps it is affecting egg maturity/quality.

Please help me!

Ziz

Reply
Geoffrey Sher, MD says:

September 19, 2011 at 11:29 am

Thank you for taking the time to reveal all this information. That having been said, I recognize that you are looking for substantive input and I am afraid that after all you have been through I can only contribute properly if we talk. I suggest that you call 800-780-7437 and set up a free medical telephone consultation with me so we can effect this.

Until then,

Geoff Sher

Reply
natasha says:

October 15, 2012 at 9:56 am

Hello i recently completed my second IVF round. The doctor has put me on a protocol which is apparently latest although i am not very familiar with this one. Protocol: Gonal F (450 IU), Luveris (150 IU), HCG (1250 IU), Lupride (only for first 3 days). Also from day 6 i have been put on antagonist cetrotide.

The response to the protocol was good with i having 10 follicles with most follicles between 15-22 on trigger day. (have low ovarian reserve so generally have 7-8)

However today to our utter shock only one egg was retrieved. The doctor mentioned that there was only follicle fluid in most. During 1st IVF 4 eggs were retrieved from 6. What could have gone wrong with the 2nd IVF?

thanks

Reply
- Geoffrey Sher says:
  
  October 15, 2012 at 11:35 am
  
  The protocol you were on sounds as if it was a combination of a a flare -Lupron (agonist) protocol followed by and antagonist. In my opinion, given that you have DOR,the initial agonist-flare could have so increased LH (and with it ovarian androgen production) as to have caused “premature luteinization”. This could explain the “empty follicle syndrome” (see below). I respectfully submit that this is not ideal , especially in women with DOR.
  
  Please go to http://www.IVFauthority.com and when you get to the home page find the “search bar” in the right hand column. Type in the following subjects into the bar and it will take you to all the relevant articles I posted there.
  
   “An Individualized Approach to Ovarian stimulation” (posted on November 22nd, 2010)
   “Ovarian Stimulation in IVF: Why is it important to down-regulate LH?”
   “Agonist/Antagonist Conversion Protocol”
   “Empty Follicle Syndrome”
   “Premature Luteinization”
   “Traveling for IVF from Out of State/Country– The Process at SIRM-Las Vegas” (posted on March, 21st 2012)
   “A personalized, stepwise approach to IVF at SIRM”; Parts 1 & 2 (posted March, 2012)
   “IVF success: Factors that influence outcome”
   “Staggered IVF”
   “Embryo Banking”
  
  You might consider calling 800-780-7437 or 702-699-7437 to arrange a telephone or Skype consultation (free of charge to those who reside in the United States or Canada). While an audiovisual (Skype) interaction is much more personable and preferable than a discussion by telephone, either will suffice.
  
  Geoff Sher
  
  Reply
  - natasha says:
    
    October 16, 2012 at 10:53 am
    
    thanks a lot doc for the quick reply. We shall schedule a call in next few days. Is there any possibility that the HCG trigger shot did not work. I was told if one egg was retrieved means that the HCG worked. Is there any way that the blood test now would detect the same – The trigger shot was given almost 90 hrs back.
    
    Reply
    - Geoffrey Sher says:
      
      October 16, 2012 at 2:35 pm
      
      There is no way to tell at this time.
      
      I look forward to talking to you.
      
      Geoff Sher
      
      Reply
Princess Chen says:

November 9, 2012 at 8:01 am

Dr. Sher, thank you for the Webinar last night.
I have 3 failed IUI this year: January, September and October, the doctor said I have diminishing ovarian reserve and advise us to proceed in egg donation because I produced 1 mature follicle only.
1. Is there a way to improve production of follicle?
2. Is it possible to retrieve an egg in 1 follicle and consequently fertilized and become pregnant?

Thank you very much.

Reply
- Geoffrey Sher says:
  
  November 9, 2012 at 10:09 am
  
  Please see above. And if possible go to the home page on this site, http://www.IVFauthority.com and when you get there find the “search bar” in the right hand column. Type in the following subjects into the bar and it will take you to all the relevant articles I posted there.
  
   “An Individualized Approach to Ovarian stimulation” (posted on November 22nd, 2010)
   “Ovarian Stimulation in IVF: Why is it important to down-regulate LH?”
   “Agonist/Antagonist Conversion Protocol”
   “Traveling for IVF from Out of State/Country– The Process at SIRM-Las Vegas” (posted on March, 21st 2012)
   “A personalized, stepwise approach to IVF at SIRM”; Parts 1 & 2 (posted March, 2012)
   “IVF success: Factors that influence outcome”
  
  Best wishes,
  
  Geoff Sher
  
  Reply
Claudia Boers says:

February 4, 2013 at 10:01 am

Dear Mr Sher,

Thank you so much for your generosity in sharing your time and knowledge. I’ve just had a disastrous IVF cycle at a well-known clinic in London and would really appreciate your input as to whether what happened was ‘just one of those things’ due to my age/amh or whether it could have been avoided or improved. The basics:

Me: 40

Previous 2 IVFs 1-2 years ago = 50% fertilization rate resulting in 3 and 6 good embryos respectively

Latest day 3 hormones: FSH 10.1; E2 45pg/ml; LH 6.0 IU/L; AMH 0.29ng/ml

Protocol: long day 21 on 300iu Puregon + 150iu Menopur throughout

Day 9 of injections: E2 649pg/ml

Day 11 injections: E2 1051pg/ml and follicles as follows: RHS 20.5mm 20mm 16.5mm 16mm 12mm 9mm 9mm ; LHS 16.5mm 16mm 8mm and smaller; Lining 8.9mm

Day 12: Trigger shot 250 micrograms Ovitrelle

Day 14: Egg collection (37hrs post trigger)

Result: 5 eggs collected but only 2 mature, neither of which fertilized.

I keep wondering what went wrong – what happened to to the eggs in the follies we were tracking? Did something go wrong at EC? Or given my age, were they just rubbish eggs? How come 3 were immature when the follies were the right size? I’d really value your input so much as I’m wondering whether to keep going or give up.

Thanks again and best wishes

Reply
- Geoffrey Sher says:
  
  February 4, 2013 at 1:20 pm
  
  The protocol of ovarian stimulation might need to be revised. Also, if Ovitrelle is used, I would suggest doubling the dosage.Please go to http://www.IVFauthority.com . When you get to home page, look for a “search bar” in the upper right hand corner. Type the following subjects into the bar, click on it and it will take you to all the relevant articles posted there.
  
  1. “An Individualized Approach to Ovarian stimulation” (posted on November 22nd, 2010)
  
  2. “Ovarian Stimulation in IVF: Why is it important to down-regulate LH?”
  
  3. “Agonist/Antagonist Conversion Protocol”
  
  4. “Immunologic Implantation Dysfunction” (posted on May, 10th and on May 16th respectively.
  
  5. “Embryo Implantation………” (Part-1 and Part- 2—-Posted August 2012)
  
  6. “Traveling for IVF from Out of State/Country– The Process at SIRM-Las Vegas” (posted on March, 21st 2012)
  
  7.“A personalized, stepwise approach to IVF at SIRM”; Parts 1 & 2 (posted March, 2012)
  
  8. “IVF success: Factors that influence outcome”
  
  Consider calling 8702-699-7437 to arrange a telephone or Skype consultation with me so we can discuss your case in detail.. While an audiovisual (Skype) interaction is much more personable and preferable than a discussion by telephone, either will suffice.
  
  Geoff Sher
  
  Reply
Claudia says:

February 4, 2013 at 10:13 am

PS I had 11 antral follicles total at my baseline scan

Reply
Claudia says:

February 6, 2013 at 2:21 am

Thanks so much for your reply Mr Sher – I’m of to do some reading now! Best wishes,

Reply
- Geoffrey Sher says:
  
  February 6, 2013 at 9:38 am
  
  Copy!
  
  Geoffrey Sher
  
  Reply
Nadia says:

February 7, 2013 at 10:30 am

Hello, I am trying to do natural IVF. I seem to ovulate through my cetrotide shot prior to ER. The dose was doubled and I still ovulated. I only had one successful retrieval and that was my first cycle when I was stimulated and produced only 1 egg which fertilized. I have read about a lupron protocol as well as using indomethacin to delay rupture of the follicle. Any advice would be so appreciated.

Reply
- Geoffrey Sher says:
  
  February 7, 2013 at 1:06 pm
  
  Hi Nadia,
  
  I think we should talk.Please go to the home page of this blog, (www.IVFauthority.com). When you get there look for a “search bar” in the upper right hand column. Then type in the following subjects into the bar, click and this will take you to all the relevant articles I posted there.
  
  1. “An Individualized Approach to Ovarian stimulation” (posted on November 22nd, 2010)
  
  1 “Ovarian Stimulation in IVF: Why is it important to down-regulate LH?”
  
  2. “Agonist/Antagonist Conversion Protocol”
  
  3. “Traveling for IVF from Out of State/Country– The Process at SIRM-Las Vegas” (posted on March, 21st 2012)
  
  4.“A personalized, stepwise approach to IVF at SIRM”; Parts 1 & 2 (posted March, 2012)
  
  5. “IVF success: Factors that influence outcome”
  
  6. “Micro-IVF”
  
  Consider calling 800-780-7437 or 702-699-7437 to arrange a telephone or Skype consultation (free of charge to those who reside in the United States or Canada) with me so we can discuss your case in detail.. While an audiovisual (Skype) interaction is much more personable and preferable than a discussion by telephone, either will suffice.
  
  Geoff Sher
  
  Reply
Mary Gaina says:

February 19, 2013 at 7:56 pm

Hello Dr. Sher,

I have read your past posts on the misnomer “Empty Follicle” terminology. I am 44 and just finished my 2nd round of IVF both turning out with 3 follicles each time and both times 2 follices were called “Empty” one egg fertilized each time. I have cysts as they have seen in the sonos I recently had with my IVF place. Do you think I should have a specialized protocol due to my cysts (I an aware my age plays a part too)Also, I have A- bloodtype…could this be some type of implication too for infertility?

Can you please give me some advice…Mary

Reply
- Geoffrey Sher says:
  
  February 19, 2013 at 7:59 pm
  
  No doubt the ideal approach by far at 44Y is egg donation but if you are wanting to use own eggs, you will certainly need a very individualized protocol and you should consider embryo banking too.
  
  Please go to the home page of this blog, (www.IVFauthority.com). When you get there look for a “search bar” in the upper right hand column. Then type in the following subjects into the bar, click and this will take you to all the relevant articles I posted there.
  
  1. “An Individualized Approach to Ovarian stimulation” (posted on November 22nd, 2010)
  
  2. “Ovarian Stimulation in IVF: Why is it important to down-regulate LH?”
  
  3. “Agonist/Antagonist Conversion Protocol”
  
  4. “Staggered IVF”
  
  5.“Embryo Banking”
  
  6. “Egg Donation”
  
  Consider calling 800-780-7437 or 702-699-7437 to arrange a telephone or Skype consultation (free of charge to those who reside in the United States or Canada) with me so we can discuss your case in detail.. While an audiovisual (Skype) interaction is much more personable and preferable than a discussion by telephone, either will suffice.
  
  Geoff Sher
  
  Reply
ophilia mbelli says:

February 23, 2013 at 7:46 am

I am 42 in march and thinking of traveling to see you for my ivf. Fsh was 11 and amh was 0.26. Based on my age and labs do I stand a chance? My doctor says not a candidate for them. Please help.

Reply
- Geoffrey Sher says:
  
  February 23, 2013 at 8:54 pm
  
  Hi Ophilia,
  
  Would be happy to talk with you, preferably via a Skype consultation.
  
  Call 800-780-7437 to set this up.
  
  Geoff Sher
  
  Reply
Caroline says:

March 10, 2013 at 6:59 pm

Hi Dr. Sher,

I just went through an egg freezing cycle. My E2 two days before retrieval was 1366. I was told that ultrasound showed 5 good sized follicles, and that the 6th might mature by retrieval. I was advised to go home that night and trigger. I was also told that I didn’t need to come in the following days for any tests, and to just show up to egg retrieval. After waking up from anesthesia, I was horrified to hear that only one egg was retrieved and that the rest of the follicles had just “disappeared”. I was stunned! The doctors said they would try to have to figure it out and had no probable explanation. All ultrasounds from beginning of cycle showed at least 5 good sized follicles with 1-2 smalls trying to catch up. I was on a lupron flare protocol (lupron/gonal-f).
I need to start looking for a new clinic, particularly of they can’t give me a possible explanation. It doesn’t make me have much faith in the clinic. I have been looking at your clinic. From what I am reading it appears that I may have ovulated early. Please tell me if you think it is possible. Thank you!!!!

Reply
- Geoffrey Sher says:
  
  March 11, 2013 at 12:52 pm
  
  This could have to do with age if you are in your late 30′s or 40′s…otherwise not or, the protocol of stimulation used. We should talk. Please go to the home page of this blog, (www.IVFauthority.com). When you get there look for a “search bar” in the upper right hand column. Then type in the following subjects into the bar, click and this will take you to all the relevant articles I posted there.
  
  1. “An Individualized Approach to Ovarian stimulation” (posted on November 22nd, 2010)
  
  2. “Ovarian Stimulation in IVF: Why is it important to down-regulate LH?”
  
  3. “Agonist/Antagonist Conversion Protocol”
  
  4. “Egg Banking”
  
  5. “Traveling for IVF from Out of State/Country– The Process at SIRM-Las Vegas” (posted on March, 21st 2012)
  
  6. “Fertility Preservation”
  
  Consider calling 800-780-7437 or 702-699-7437 to arrange a telephone or Skype consultation (free of charge to those who reside in the United States or Canada) with me so we can discuss your case in detail..
  
  Geoff Sher
  
  Reply
  - Caroline says:
    
    March 11, 2013 at 4:34 pm
    
    I’m am 34. I have dimished ovarian reserve, but I have not heard of follicles “disappearing”. I have heard of empty follicles at retrieval, but here the doctor insisted that the follicles had disappeared, not that follicles were there with no eggs inside. Thank you your time. I will read some of your articles and set up an appt. Any thoughts on whether early ovulation was possible? I definately need to try to prevent it in the future. The clinic never checked my lh or progesterone before hand.
    
    Reply
    - Geoffrey Sher says:
      
      March 11, 2013 at 6:36 pm
      
      I am also confused. I too am unaware of sudden disappearance of follicles unless you ovulated prematurely. If that happened your progesterone blood level would so indicate.
      
      Geoff Sher
      
      Reply
Caroline says:

March 12, 2013 at 4:17 pm

I called your clinic to make an appt. Your first available is not until end of March so I have to confirm my schedule. Per our prior discussion here on 3/11, I had my progesterone tested. The result was 19.10. Does this level indicate premature ovulation? If so, I am definately leaving my current clinic. Thank you.

Reply
- Geoffrey Sher says:
  
  March 12, 2013 at 6:00 pm
  
  Yes! You are probably ovulating!
  
  Geoff Sher
  
  Reply
Julia says:

March 16, 2013 at 10:53 pm

Hi!
I just had my 6th egg collection, I normally get the same number of eggs out of folicoles minus 1 or 2. This time I had 11 follicoles, none < 10mm and after EPU there were only 2 eggs collected… We have ruled out early ovulation, other hormone problems. Dr thinks something went wrong at EPU (my dr didn't perform EPU) What can go wrong in EPU? You explain all the things that can go wrong with the women but possibly what can happen as human error on the day? Thanks for a great and interesting blog!
JJ

Reply
- Geoffrey Sher says:
  
  March 17, 2013 at 8:07 am
  
  That is a very tough question…probably best addressed in a direct discussion.Please consider calling 800-780-7437 or 702-699-7437 to arrange a telephone or Skype consultation (free of charge to those who reside in the United States or Canada) with me so we can discuss your case in detail.. While an audiovisual (Skype) interaction is much more personable and preferable than a discussion by telephone, either will suffice.
  
  Geoff Sher
  
  Reply
Susara says:

May 13, 2013 at 5:42 am

Good day dr, I am South African 40 years old. Normal bloods. Donor sperm. AMH 4.50. I have failed 3 IVF cycles. FIRST CYCLE: OC for 1 month then Menopur3 amps daily, ovidrel 500 trigger, 3 oocytes retrieved 1 embryo fertilized with 3 cell still dividing. SECOND CYCLE OC for 1 month then stims with Fostimon 4 vials and Lucrin 10 units, only 2 follicles of suitable size, no oocytes. 4 days prior to retrieval cetrotide daily. Trigger Ovitrelle 250. THIRD CYCLE: OC for one month, 14 antral follicles, Menopur 3 amp and Fostimon 1 amp daily. Cetrotide for four days prior to aspiration. Ovitrelle 250 trigger. One oocyte retrieved, embryo showed 0pn 1PB on day 1. Normal lapscope. Could you pls advise me on what protocol will produce better results?

Reply
- Geoffrey Sher says:
  
  May 13, 2013 at 10:03 am
  
  Please go to the home page of this blog, http://www.IVFauthority.com. When you get there, look for a “search bar” in the upper right hand corner. Type the following subjects into the bar, click on it and it will take you to all the relevant articles posted there.
  
  1. “An Individualized Approach to Ovarian stimulation” (posted on November 22nd, 2010)
  
  2. “Ovarian Stimulation in IVF: Why is it important to down-regulate LH?”
  
  3. “Agonist/Antagonist Conversion Protocol”
  
  4. “Immunologic Implantation Dysfunction” (posted on May, 10th and on May 16th respectively.
  
  5. “Embryo Implantation………” (Part-1 and Part- 2—-Posted August 2012)
  
  6. “Traveling for IVF from Out of State/Country– The Process at SIRM-Las Vegas” (posted on March, 21st 2012)
  
  7.“A personalized, stepwise approach to IVF at SIRM”; Parts 1 & 2 (posted March, 2012)
  
  8. “IVF success: Factors that influence outcome”
  
  9. “Staggered IVF”
  
  10.“Embryo Banking”
  
  11. “Egg Donation”
  
  Consider calling 702-699-7437 to arrange a Skype consultation with me so we can discuss your case in detail
  
  Geoff Sher
  
  Reply

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