Fertility Friends Support Forum banner
1 - 20 of 25 Posts

·
Registered
Joined
·
947 Posts
Discussion Starter · #1 ·
I am going to talk with my cons on Thursday and want to be armed with a little info before I go. Specifically does anyone know what the average size and number of lead follies should be for the go ahead for the trigger injection for IVF? Particularly in those women who respond well/are PCOS.

I had 20 eggs collected but of those only 3 were between 18 - 21mm and I am trying to guage whether I should have been coasted or was triggered too early as the fertilisation rate was less than 1%.

I appreciate everyone is different but I just want to go in with some informed comment for my discussion so am looking for averages here. Any help would be appreciated.

Thanks
Ba
x

 

·
Registered
Joined
·
6,581 Posts
Hello!

Well, the number doesn't matter, but however many you have you should be looking to have the majority above 18mm when you trigger.

They could be bigger than that for mature eggs - it does sound as if you were triggered a couple of days too early with only 3 the right size out of 20.

Immature eggs are much harder to fertilise usually - I'd be pretty frustrated if it were me.

Hope that helps.

xx
 

·
Premium Member
Joined
·
17,093 Posts
Hi

They would usually look for follicles to be a minimum of around 18mm before rupturing so with IVF, they would give you the trigger injection when they're approx this size to ensure mature eggs inside.

Do you know what the size of the other follicles were as you only had 3 at the 18-21mm size at trigger ?  If an egg is too immature or too mature then can cause no or poor fertilisation.

Take care
Natasha
 

·
Registered
Joined
·
947 Posts
Discussion Starter · #4 ·
Thanks for your replies

I think the other follicles were around 13mm although I do remember that alot where 8 and 9mm and I did have some 15mm. The lead follicle was 21mm. I feel sure that they should have waited but they where worried about OHSS. I have asked that they have details of my oestrodiol levels to see if they were rising coupled with immature follies.

The clinic has been evasive with their explanations. I was told all eggs were mature when collected - then told all eggs were immature at collection but matured over night (Isnt this still not good enough for fertilisation?).

I was told outright that I was triggered too early twice then they retracted this statement. They are trying to tell me its just one of those things but I feel that they did trigger me too early and that is not one of those things but clinic error and want them to subsidise my next treatment. Problem being they are the experts and I am uninformed so its hard to prove.

Any help greatly appreciated!
Thanks
Ba
x
 

·
Registered
Joined
·
6,581 Posts
Yes, they definitely triggered you too early - what a waste of eggs. The other eggs were far too small.

Were you displaying any symptoms at all of OHSS? It doesn't sound like it.

Note who said they triggered you too early and the time and date of the call. Write it all down and then you have a proper record. They owe you another shot I think!

Even maturing them overnight would not be enough - follies of 8/9mm would have needed a few more days - they should have sacrificed that lead follie, in my opinion, to allow the smaller ones to catch up.

get your battledress on!  ^bigbad^
 

·
Registered
Joined
·
947 Posts
Discussion Starter · #6 ·
Thanks so much - its good to hear someone else's opinion. Its difficult to know what to believe when you have been left uninformed and are being told that 'its just one of those things'.

I have a meeting on Thursday so am gonna push for a freebie with the head. If I dont get it I will complain to HFEA (I have a huge list of issues this is just one). I will let you know how I get on!
Ba
x
 

·
Premium Member
Joined
·
17,093 Posts
Yep, have to agree with Miranda.

Obviously I'm not a fertility expert but from what I've learnt (through so many questions about all my treatments), I would've thought it would've been better to allow you to stim for a while longer to encourage the other follies to grow....even if it meant that the maturer ones may have been lost....obviously it is quality over quantity but to have so many eggs collected and then lose 17 of them because too immature...I too would be annoyed when even 1 or 2 days of additional stimming may have meant a few more mature eggs.

How many follicles did you have as must've been quite a few if you had 20 eggs collected ?  Did they check your E2 levels at all ?  Were you showing signs of OHSS eg nausea, tiredness, very sore boobs etc ?  I partly understand their concerns re OHSS (although having the HCG injection before EC can actually trigger OHSS anyway) but it would appear they triggered too early and didn't allow the other follies a chance to mature.

I too have had 2 cycles where there's been concerns about OHSS but with one, I had EC brought forward a day so trigger was a day earlier than initially planned but they wanted to ensure I didn't lose any good eggs (ended up with 19 mature eggs from 28 follies on that cycle).....and then with our most recent, I had 40+ follies at last scan and they were very worried about OHSS and considered coasting me....they were not only concerned I'd lose some eggs but that may have to abandon completely.....was a bit touch and go from before EC onwards....as it turned out they collected 30 eggs and all were good and mature.

What I'm trying to say it's such a fine science and it's really important that your consutlant times things just right to ensure the best number of good quality eggs, alongside the risks to your health and make the decisions based on this, along with the embryologists advise.  We've been very lucky that on both occasions the consultants (one was private cycle, other was NHS but both at same hospital with same embryologists), have made the right call regards timing of HCG trigger jabs etc etc. and good monitoring on there part re E2 levels, scans etc.

Follies do grow approx 1-2mm per day and in my opinion you should have been allowed to stimm for an extra day or so with your clinic closely monitoring your E2 levels.

Take care
Natasha
 

·
Registered
Joined
·
817 Posts
my clinic wld have ignored anything less than 15mm for counting/collecting purposes. (now i understand why people on here get these huge egg counts if just larger than antrals are being counted) - we've had 100% fert each time and 40% blasts and I'm nearly 40 so the egg quality cannot be that great. It must be my clinic and culture medium.

overall, I think something went wrong with your cycle.
 

·
Premium Member
Joined
·
17,093 Posts
anna the third said:
my clinic wld have ignored anything less than 15mm for counting/collecting purposes. (now i understand why people on here get these huge egg counts if just larger than antrals are being counted) - we've had 100% fert each time and 40% blasts and I'm nearly 40 so the egg quality cannot be that great. It must be my clinic and culture medium.

overall, I think something went wrong with your cycle.
Hi

I don't think you can say this about all clinics so feel your comments a bit of a generalisation.

With all my cycles I've had lots of follicles.....21 follies & 10 eggs collected, 28 follies and 19 eggs, 27 follies and 16 eggs and 40+ follies and 30 eggs collected......these follies were good size and all the eggs collected were mature, good and healthy.....I did have more follies each cycle but they didn't include them in the last scan count as they were too small and wouldn't have had mature eggs......
Although you mention several times that your egg quality can't be that great, the fact you've had 100% fertilisation and 40% blastocysts seems to say otherwise.

Good luck
Natasha
 
G

·
Mmmmmmmmm - this is not good Davis! As has been said, def anything under 15 is unlikely to give you a mature egg so I can not see why they did not stim you for a bit longer? Even if the largest follies had gone on to reach 22-24mm these would still be OK.

Hi Minxy - I took Anna's point to mean that despite the fact she is 40 (when eggs are less good etc) a good clinic can still get good fert rates and get to blasts - all as a result of a good protocol, monitoring for the right follie-size and good embie cuture? (or is that totally wrong Anna? - would not be the first time ;D ;D ;D)....A bit off the subject ;) but I wish the HFEA would focus on standardising standards in clinics rather than taking an age to debate things that are way off the page.... :-\

Good luck Davis

xxx

xxx
 

·
Registered
Joined
·
817 Posts
Lukey, yes absolutely. The chances are high that my egg quality is poor but the fact that the clinic can this pretty efficient response from my eggs after EC indicates to me that the clinic (not I) is doing a good job! 

Minxy, unfort blast etc rate is not correlated with egg quality. Whether a fertilised egg gets to day 5 depends on superficialities such as energy, mitochrondria, cytoplasm, and uniformity. Chromosomes are at a deeper and, I believe, much more telling level entirely. This is why we read on ff of 25 year olds with grade 2 eggs that look awful having twins while 40 year olds with perfectly graded eggs don't. And it's why i strongly believe the best chance for an older woman is putting back as many eggs as possible to "find" the good ones. and that means naturally with injectables here or IVF abroad. 

good luck, xxx
 
G

·
Agreed Anna - and if the HFEA listened to the experts WHO KNOW THE PATIENTs BEST - I am sure they would see the light too ;)...if I get 3 good uns (big IF but let's start with some PMA eh?!)!) I'm having them all put back next time, so that is at least something I guess ;)

xxx
 

·
Registered
Joined
·
11,791 Posts
Hi

It sounds like they did trigger you too early.  I know with my last cycle I had about 6 follies that were below 10mm and 2 largest ones at 16 and 18mm they kept me stimming until the other 6 had reached 17mm and then got me to do the trigger injection.

My 2 largest ones at EC were 26 and 28mm and they got eggs from them both, and they both fertilised.

All the best

x x x x
 

·
Premium Member
Joined
·
17,093 Posts
anna the third said:
Lukey, yes absolutely. The chances are high that my egg quality is poor but the fact that the clinic can this pretty efficient response from my eggs after EC indicates to me that the clinic (not I) is doing a good job!

Minxy, unfort blast etc rate is not correlated with egg quality. Whether a fertilised egg gets to day 5 depends on superficialities such as energy, mitochrondria, cytoplasm, and uniformity. Chromosomes are at a deeper and, I believe, much more telling level entirely. This is why we read on ff of 25 year olds with grade 2 eggs that look awful having twins while 40 year olds with perfectly graded eggs don't. And it's why i strongly believe the best chance for an older woman is putting back as many eggs as possible to "find" the good ones. and that means naturally with injectables here or IVF abroad.

good luck, xxx
Anna....I do know that blasts isn't completely related to egg quality......after 6 IVF cycles I'm pretty clear about the treatment, blastocysts etc etc....what I was saying is that you regularly comment about your egg quality but you've had 100% fertilisation....something that does indicate pretty good quality....
...we got average 50-75% fertilisation (through 4 fresh cycles) so it's something we've discussed in depth with 2 consultants as my eggs appear very good quality but the lower fertilisation (and abnormal fertilisation of 3 nuclei) indicates otherwise...and fact we have problems getting to good grade blasts also indicates this.....so it's believed there may be chromosonal issues with my eggs, partly due to age.

Anyway, going off track......

Ba/Davis

I'd definitely put together a list of all your concerns to be raised at your appointment.

Good luck
Natasha :)
 

·
Registered
Joined
·
947 Posts
Discussion Starter · #16 ·
Thanks again for your replies, armed with a little knowledge I can ask them the right questions and hopefully get a good resolution.

I didnt have any symptoms of OHSS but had it on my previous cycle. I was being monitored closely with bloods every 2 days and had over 20 follies on each ovary.

If they collected immature eggs but they matured over night would this explain the low fertilisation rate (1%). Can eggs that mature in the culture fertilise?

Also my previous cycle I had around 45-50% (cant quite remember) fertilisation rates. One nurse asked my why we didnt do ICSI with such a poor fertilisation rate - one nurse said my fertilisation rate was fine and thats why they didnt recommend ICSI. I just dont know what to think! Does anyone know at what level they should consider ICSI. Obviously my 1% means ICSI next time but should a rate of 45-50% have been a trigger for the clinic to recommend ICSI for us so we didnt get this low rate?

Cheers
Ba
x
 

·
Premium Member
Joined
·
17,093 Posts
Hello again :)

Is your lower fertilisation due to poor sperm or poor egg quality ?  They can tell from the fertilised egg whether it's egg or sperm that's causing the problem.  In our case, the sperm are fine but despite my eggs looking perfectly healthy and mature, there's something that's causing increasingly lower fertilisation....well, lots of them fertilise but many have abnormal fertilisation where the egg allows more than 1 sperm in and doesn't throw off excess genetic material.  We've gone from 7 out of 10 eggs (and none abnormally fertilised )on 1st IVF to 14 out of 30 eggs on 4th IVF (can't remember abnormally fertilised, think it was something like 6.....)

Lots of luck....really hope you get some answers.
Natasha
 

·
Registered
Joined
·
6,581 Posts
Yes, they can fertilise, but it sounds as if they were collected too ealy to mature overnight - they'd have needed several more days. If you say the minimum size they should be to fertilise successfully is 16mm (and there are always exceptions to every rule), and they grow at about 1-2mm a day (ditto) your eggs would STILL be too small to have a chance.

Eggs matured in the lab can fertilise just as normal, but they still have to be mature enough to do so.

It's such a shame - there were so many eggs there but they took you off the boil too early and you've gone through all that for nothing. I'd be very angry, really I would, because the build-up to a tx is so intense.

Get compensation from them and gho somewhere else is my top tip. Why not go where I went - the Jinemed in Istanbul - they'd never make that sort of cock-up and charge you no more for ICSI either! And you get a holiday out of it...  :)

If you're happy to continue with them though, that's different. Once a clinic's made that sort of error though, I don't think I'd trust them again - after all, you're meant to be the patient, not teaching them how to do their jobs!

Go get em, Ba
xx
 

·
Registered
Joined
·
1,373 Posts
I totally agree with Miranda.  They triggered you too early and really messed you around by admitting it, then retracting it etc.  You deserve much better.

I would complain to them and, if they don't give you a refund, complain to the HFEA and also sue. 
 

·
Registered
Joined
·
947 Posts
Discussion Starter · #20 ·
Thanks so much I realy cant tell you how much your support means. I feel robbed but then question myself and start to think that Im over reacting. Its good to know that Im not and now Im gonna kick some butt!
Thanks again
Ba
x
 
1 - 20 of 25 Posts
Top