QuestionQUESTION: Hello Dr.
I am from Cuba but I live in Miami. I am 40 y/o now. I had
my first IVF cycle at 39 that failed, back in July. I
started 2nd round in Sept.- Oct. but it was cancelled due to
empty follies. It is possible that I have no more eggs in
my ovaries? I have another theory but I am not an expert and
I don't know if it is possible to be true. The first step
was taking birth control pill. I took then for 21 days.
After that I had NO PERIOD. I did have symptoms "as if" my
period was there (cramping, pain) but no bleeding. I did an
ultrasound but the endometrio was not big enough to shed. At
day 7 after the last pill, my Dr. told me to start the
stimulation for IVF anyways. There were 6 follies formed but
empty. What do you think. Could this be the cause for no
eggs retrieved? Thank you very much. I am very frustrated.
ANSWER: Hello Teresa from the U.S.,
We tend to see a higher incidence of "empty follicle syndrome" with increasing age. This is indeed because there are fewer and fewer eggs left. However, no eggs at the time of retrieval is not related to having used the BCP and not having a period. There are other reasons, besides age, where no follicles are retrieved as well. I have had several cases of EFS in my career (16 years) of doing IVF and in some cases they were in younger women, so the age factor did not apply. Those younger cases I attributed to a lack of adequate HCG triggering. I used to us a generic HCG, and it is possible that either the medication was not stored correctly and lost its efficacy, or it was not injected properly, or it was a bad batch of medicine. For that reason, I switched to Ovidrel, which is what I still use. I have not had a case of EFS in a young woman since. I still do see older women that have no eggs retrieved, however, and that is the age factor. Nothing can be done about the age factor except continuing to try in the hopes that (1) the next cycle will yield some eggs and (2) there will be a good one in the group.
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
---------- FOLLOW-UP ----------
QUESTION: Thank you very much Dr. for your answer. Now that you gave
me new information I have to tell you a new fact that I
didn't think it was important but now it is. I didn't
receive the Ovidrel shot (as in the first cycle). The clinic
run out of it and they gave me a doses of Lupron instead,
saying that it mimics the Ovidrel function. Could this be
the problem?
AnswerHi Again,
Lupron should have worked just as well as the Ovidrel. I use that exclusively in my PCO patients to prevent hyperstimulation syndrome.
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
