The immature egg problem

panda100

There seems to be a huge problem with immature eggs during IVF. Many ladies are having a good number of follicles growing and their RE's are triggering them at what seems to be a good size and yet they still come out with immature eggs. I had is on my first cycle and on my recent cycle all eggs were immature. This problem is devastating to anyone who has experienced it and there isn't a whole hell of a lot of of information out there in the Internet world about how this problem back be helped. I have even seen posts on various websites where a few ladies are getting ALL immature eggs in all IVF cycles and their doctors are telling them this is an intricate problem and the IVF world may not catch up to them for many years so its best to use donor eggs. Because I have had mature eggs a previous cycle, don't believe this is 100% true. I am hoping that some ladies who experienced this problem can join and if your doctor told you anything to what may be causing this if you could share. If your doctor did anything to help this the next cycle could you please share also? I'm hoping to get as much as I can in one place. That's in advance ladies

blueeyes233

As for me, my RE told me it was a common problem with PCOS patients.  He said that a change in medication can help (for my second cycle we dropped Menopur and added microdose hCG instead) but that its really hard to get the cycle right the first time since they can only go with their past experience with similar patients. 

I had obviously immature eggs though.  My first cycle we kept switching doses to try to get smaller follicles to catch up.  We knew when I triggered that only a handful would be mature but since I was on day 12 of stims I was at risk of losing all of my mature eggs due to degeneration if we continued to try to get the smaller ones.   

Cycle 1: 37% maturity

Cycle 2: 62% maturity

blueeyes233

Oh and I did ask about IVM, in vitro maturation, after my first cycle.  Its where they take immature eggs from unstimulated or mildly stimulated ovaries and mature them in the lab.  My RE didn't recommend it for me since he said the pregnancy rates were lower with IVM vs IVF but for those who aren't getting any mature eggs at all it might be an option.  I've also heard of some clinics giving immature eggs from IVF a chance overnight to catch up and mature so that they can try to fertilize them, though I'm not sure how common that is.  

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katers79

I'll ask what my RE thinks when we go for our next appt. 43% mature with only 6 of 14 making the grade. BUT 5 made it to blast. I'm interested to see what others have to say-- thanks for posting!

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blueeyes233

@panda100 I started hCG when I started stims.  Its a micro dose, like with Lupron you use the insulin needles.  My dose started at 5 units then slowly increased to 20 units at the end.  That cycle I had 62% maturity which was much improved from my first cycle.  Also with doing the hCG my FSH (Bravelle) stayed constant at 300, the only medication that changed was the hCG unlike with my first cycle when my dose of Menopur and Bravelle changed after every appointment trying to get even follicle growth and the smaller ones to catch up. 

Huskers96

Hi Panda:) I'm one of those ladies that have had ALL immature eggs for both my retrievals. I was on an antagonist protocol for both cycles. The second we added a low dose HCG during stims, a human growth hormone "saizen", we double triggered with 10000 units HCG and 4 mg lupron. We also waited for my lead follicles to measure over 22. Still I got 17 eggs, all immature. My first cycle I got 19 all immature. I'm hunting high and low for answers and really haven't gotten any. I am reaching out to doctors overseas and have had 3 new consults where I live in LA. Two have suggested varying long lupron cycles. One said she would never do that and would just do another antagonist with some variations from my last. There seems to be no magic bullet for this issue. I think maybe you posted on Dr. sher's website. I did as well but I got a very vague response from him with no helpful information. Please let me know if you find out anything and I will do the same. I have a Skype consult with him in late January but I think by then I will have picked a pony and moved on. If you know how to private message me please do so. I made an account here just so I could comment on your post! I don't see a way to private message tho:( By the way I think your name is Amanda and so is mine:)

mariana81

Hi @panda100 and @Huskers96‌,
My name is Mariana, last month I went through my first IVF, I had 8 eggs, all immature. Antagonist protocol.. I was so disappointed and crazy for explanations.. I have posted on dr. Sher's website as you mentioned, and he gave me some ideas.. Estrogen Priming Protocol (epp) and his idea of a mix between antagonist and agonist protocol.. According to my RE it is just a matter of finding the protocol which my body will fit best.. So next month we will try EPP. I am still looking for answers tough, but meanwhile we will try something.. I agree with @Huskers96‌ there are many protocols out there and different bodies with different reactions to the treatment, so I guess we should try and hope for the best.
Good luck to you all!

Grateful&Thankful

****PAIF

I also have an egg maturation issue. I'm sorry that we all have to deal with this.Even though I am DOR, my best responses have been with the long lupron protocol. Something about ganirelix & my eggs don't mix. Adding large doses of menopur helped slightly but it also affected my quality. For my last few cycles I only used half a vial of menopur & the quality of the mature eggs that I difd retrieve was so much better. 

PS- S.I.R.M helped me achieve this pregnancy but I did not do well on the agonist/antagonist conversion. I know that's the protocol they are famous for but it just didn't jive with me. After I bombed on that, I will say that the doctors there were willing to think out of the box & try different protocols with me. Even though a long lupron protocol is rare for a DOR girl, they allowed me to try it. I really respected that because my previous clinic never listened to any of my ideas or concerns. My old doctor's ego was out of control. BOL to everyone!

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Grateful&Thankful

panda100 said:

@Grateful&Thankful‌ what is it that you think the ganerelix did that was detrimental to you eggs and how did you bomb on the agonist/antagonist conversion protocol? Is it because you only had one mature egg? Did you ask them why this happened and if so what was their explanation? This is the protocol sher suggested for me too and I'm just curious about what could go wrong in this protocol even though every women's response my be different.

I'm not sure what it is about me and ganirelix but everytime I've used it, it's either stunted my follie growth or my e2 tanked a bit & never recovered. I know obviously many women do ok with it but every cycle I used with it was not a good cycle. On the agon/antag conversion protocol it was a miracle I even got one mature egg. My e2 was never great. For once my follicle count was really good at baseline (for a DOR gal) so I was hoping for the best but I knew when my e2 was low throughout the cycle that the end result wasn't going to be good. They did not have an explanation for me (besides the fact that I have DOR, which I already knew) & I think that's part of the reason that they began to let me try out-of-the box protocols. I poured over my own data that I collected each cycle and started to look at trends in my e2 & what meds I used. That's how I came up with the decision to try Long Lupron. As you can see by my siggy, I had to try this protocol a few times with slight changes along the way. I wish there was some magic solution that worked for everyone :-/

Huskers96

I have low thyroid and a goiter. I have been on synthroid for maybe 4 years. I always wondered if my thyroid had any impact on my fertility and both my endricrinologist and last RE said no. I have gone to other REs for other opinions and out of 3 doctors one mentioned testing for anti ovarian antibodies. I didn't even know there was such a thing as anti ovarian antibodies or I for sure would have tested for those months ago! Well news flash, The test revealed that I do have antiovarian as well as anti thyroid antibodies. These are antibodies that attack my own tissues as my immune system is confused and thinks it needs to destroy cells in my thyroid and appears it could be attacking certain mechanisms in my ovaries. It's a form of autoimmune disease. From the reading I have done online it seems the thyroid and ovarian antibodies seem to often go hand in hand. Why I'm telling you all this is my well known and experienced doctor never even tested me for these antibodies. I went through two IVF retrieval with horrible outcomes with no extra tests of any kind. Maybe your RE hasn't thought of testing you either. I'm not saying this is the cause of my immature egg problem as only time will tell if treatment for these antibodies will turn things around for me. I have made an appointment with two reproductive immunologists for a full work up and opinions on treatment.

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blueeyes233

No, elevated progesterone was not an issue for me during stims.

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Grateful&Thankful

panda100 said:

@Grateful&Thankful‌ could you please at your own convenience PM me? I've been trying to PM you for like a week and it won't let me for some reason

YGPM!

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mariana81

@panda100 next week, december 2nd, I will have my WTF appointment and let's see.. my RE said she has something for us... I guess she will increase the trigger shot dose, and I will probably suggest micro hcg shots.. how was your protocol? did you feel any improvements?

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mariana81

Great!!! Thank you @panda100 FX for you!!