QuestionHi Dr,
My first IVF cycle was converted to iui, because i produced only 2 good eggs, resulted in negative.
I have PCOS,(33age, BMI 26) so my gyne believes that i'm being resistant to drugs.
I was put on metformin, 3 times a day. and I'm still continuing.
On my second cycle Dr changed from Gonal F 150 iu(tried during first attempt- 2 eggs)Puregon 200iu and menopur 75. My scan revealed a good results. i had around 30 eggs, Dr was scared about hyper stimulation.
But on egg pick up day, Dr retrieved only 7 eggs, out of which only 3 fertilized thru ICSI, resulted in 2 good embryos.
Even my blood test on HCG trigger day revealed that my estrogen level was around 6000. They said it's almost matches with number of eggs that were retrieved.
My question is what is causing empty follicle syndrome?
How can i improve my chances of producing healthy eggs on my next attempt?
Considering my age, this problems seems rare and it really worries me.
I really appreciate your guidance to my problem.
AnswerHello Angelbaby from Malasia,
First, you don't have empty follicle syndrome. That is when no eggs are retrieved. Often in PCOS patients, there are lots of small follicles counted so that the number is high. However, these smaller eggs do not have the chance to mature so that they do not release from the follicle wall and are not picked up. As a result, there is a smaller number of eggs retrieved.
From the information you told me, you did hyperstimulate. An estradiol level of 6000 is much higher than we want to achieve. We prefer that it is below 4000. The difficulty with PCOS patients is that the follicles will often develop in asynchronously, which means there is a variations in sizes and development. There is nothing you can do because we have to balance preventing you from developing OHSS and getting an adequate number of follicles. Your stim seemed to be better in the second cycle, and based on the number of follicles and estradiol level, I don't think I would make any changes to it.
The problem you have is not rare. It is fairly common all over the world and is a difficult problem to treat. You have to keep trying. That being said, keep in mind that pregnancy rates can vary considerably between clinics and are very clinic and doctor specific. In our area there is a clinic that only has a 10% pregnancy rate for your age group, whereas my rate is 76%. As you can see there is a big difference. So, having a failed cycle does not necessarily mean that there is something wrong with you!
Good Luck,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf
