Follicle size discussions

DahliaFlower

I have noticed a lot of discussions related to follicle size and what constitutes a mature-size follicle, as well as people talking about what is "over mature."  

I am just curious how some of you have come to the conclusions that a certain size is preferable.  I know that a lot of RE's trigger at 20-22, but if your natural follicles develop to a larger size, my impression is that 20-22 may be too early.  Sometimes the final maturation of the eggs is not normal if they are not quite ready to launch, according to what I've been told.    

I am wondering if anyone's RE has talked with them about actual research on this topic, or is it just their opinion.   

I am interested because I think I may have been triggered to early on some occasions.  My natural follicles get to the larger end of the spectrum.   

jeannaqueena

I totally agree.  My RE triggered me with:

Left ovary: 21.3, 18.4, 14.5, 18, 14.3, 17.8

Right ovary: 27.25, 18.6, 17.5, 15.3, 17, 19.2

We only got 5 mature eggs.  Even at the time I questioned if it was too early.  

Looking forward to reading others thoughts...oh I wonder if dr. google has any good articles on this topic. 

nawlinsgrl

I got 20 mature eggs.  The morning of trigger, I had 20 follies ranging from 13 to 19 (3 each at those two extremes).  I also had 2 7mm, 2 8mm, an 11mm and 2 12mm.  So, in my case, it seemed to be a good time to trigger. 

I believe the general school of thought tends to be to trigger when there are at least 3 at 18 or larger.  

DahliaFlower

jeannaqueena:

I totally agree.  My RE triggered me with:

Left ovary: 21.3, 18.4, 14.5, 18, 14.3, 17.8

Right ovary: 27.25, 18.6, 17.5, 15.3, 17, 19.2

We only got 5 mature eggs.  Even at the time I questioned if it was too early.  

Looking forward to reading others thoughts...oh I wonder if dr. google has any good articles on this topic. 

 

I don't have my numbers in front of me, but on our second go-round, we got many fewer than expected, and several that we did get were not mature, and a couple had matured abnormally.  I believe I was triggered too early for me.  My new RE is very interested in natural follicle size, and it turns out my natural follicles get to like 26 or so.   

TripMomma

I am not an RE or a pro, but from my own research...gone through 8 IUI cycles myself, speaking to my RE and other BTDT ladies I have come to the conclusions that I have.

I believe the kind of meds, if any, make a big difference in what size of follie will contain a viable egg.

Clomid I wouldn't want less than 19mm, prefer 20mm-22mm before trigger.

Injects, I have heard as small as 14mm being mature...but usually 18mm-22mm are prefered. It is generally thought that the meds in the injectables help produce a healthier quicker growing follie/egg.

Unmedicated cycle, usually you only have one lead follie and that needs to be at least 20-25.

Also remember when you trigger a mature or very close to it follie, the trigger itself will help the final maturing take place. If you trigger an immature follie it will do the opposite and sort of kill it.

I personally wouldn't want to go over 25mm meds or no.

flows912

I've only been monitored on injects and the smallest the RE's had me trigger was 16mm and that was my only BFP. The past 2 times I've triggered with 18mm and 20mm. But I also respond really slowly to the meds so I'm sure they didn't want me taking the injects for too long (last cycle I triggered on CD19).

ChiTown Bridget

My RE will trigger when your follies get to 17mm (which seems early to me) and considers anything in the 18-30mm mature.

queenbone

I have never done IVF, so take that with a grain of salt.

My understanding is 18-24 is mature, My RE tried to pull some BS about that being the guideline for the east coast and that they trigger earlier on the west coast, but I've never, ever heard that anywhere else and frankly feel like he was being overly conservative because I said I wouldn't want to reduce if it was multiples. 

On letrozole I responded early and was already at 23.5 and 25 at the first u/s, they triggered me immediately. I assume they were over mature since it didn't work. He triggered me several times when I was in the 15-17mm range and all those were failures. I had success with DS2 with (1) 18mm and (1) 18.5 mm follicle and with DC3 with (1) 18mm and (1) 19mm follicle.

Obviously things are different for IVF since you want more eggs to work with, but I would never accept a trigger before I had a few over 18 mm.  I'd rather the lead ones over mature and have the bulk of the mid size ones get to mature range. I realize that is a delicate dance of avoiding over stimulation issues.

DahliaFlower

Interesting responses, ladies.  Well, I don't really know what to think.  I know that I got KU twice on my own, most likely with large follicle size.  I know that for one TI and two IUI cycles I had BFN when triggered earlier.  I have a sense that maybe I was triggered a bit early for IVF #2, where we ended up with nothing to transfer.  

Pattern

This is interesting... with my son my RE triggered me when my ONE follicle was a 16...it was getting late in my cycle, said we just had to go with it.  I didn't realize that was considered small.  It was a big improvement over my ONE follicle the previous cycle at 13.