Question to Ghost + others on # follicles & Menopur dose

[Josefin]

Hi All,
we failed 2nd IVF trial now in March as none of the eggs fertilized.
Until egg picking we received continously positive feedback that I responded well (8 follicles in total) to treatment but at egg picking 4 follicles were empty and of the other 4 eggs that were retrieved none fertilized.

In the feedback session, the doctor, seemed to think that the reason was that they started ovulation one day too late. I wonder if I simply was on too high dose Menopur (7 capsules / 525iu increasing to 8 capsules / 600iu) and if Menopur can have a negative impact on the quality of the eggs if dose is too high.
Therefore three questions
1. What is the avg. # of follicles which is normal for a 39 year old women (with no known medical / hormonal issues-all test results ok)? I have only had between 8-10 follicles in total (4-5 per side) and maybe this is below avg. for my age and therefore they had to use such a high dosage.

2. Is it possible that such a high dose of Menopur has a negative effect on egg quality (I come from Sweden and there the highest applied dose of Menopur is 6 ampules or 450iu, meanwhile I do the treatment here in Switzerland as we live here since 10 years where they seem to be comfortable in giving such high dose)?

3. Does one day (ie starting ovulation one day too late) make such a large difference between success and failure?

Would appreciate any statistics or avg. values to compare with.
Wish all of you all the best
Josefin

[sprouthaus]

Josefin - I am not an expert and don't really have answers - but I can share my experience.

I have never been on pure Menopur - always a combo of Menopur and FSH (Follistim). Between the two of them, I was on 750IU/day - and I remember my RE saying that was the max dose recommended. So, I don't know if too high a dose can damage eggs - but....I don't think your dose is as high as they do in the US.

Regarding 8 follicles - this sounds like a great number for someone who is 39. I've had two REs tell me that they aim for between 8-10 follicles/cycle - they consider that optimal. Unfortunately, I have no experience to share about empty follicles are lack of fertilization.

The timing of retrieval is very important - too early or too late after the HCG shot could impact the maturity of your eggs and thus fertilization. Do you know how long between the HCG shot and ER?

[Ghost]

Hi All,
we failed 2nd IVF trial now in March as none of the eggs fertilized.
Until egg picking we received continously positive feedback that I responded well (8 follicles in total) to treatment but at egg picking 4 follicles were empty and of the other 4 eggs that were retrieved none fertilized.

In the feedback session, the doctor, seemed to think that the reason was that they started ovulation one day too late. I wonder if I simply was on too high dose Menopur (7 capsules / 525iu increasing to 8 capsules / 600iu) and if Menopur can have a negative impact on the quality of the eggs if dose is too high.
Therefore three questions
1. What is the avg. # of follicles which is normal for a 39 year old women (with no known medical / hormonal issues-all test results ok)? I have only had between 8-10 follicles in total (4-5 per side) and maybe this is below avg. for my age and therefore they had to use such a high dosage.

8-10 follicles is typical at age 39. It varies a lot, though. Some have zero, others have more than 20.

2. Is it possible that such a high dose of Menopur has a negative effect on egg quality (I come from Sweden and there the highest applied dose of Menopur is 6 ampules or 450iu, meanwhile I do the treatment here in Switzerland as we live here since 10 years where they seem to be comfortable in giving such high dose)?

Some have claimed that too much FSH harms the eggs. I'm not sure how true that claim is. I'm not convinced that, within reasonable limits, there is much effect.

3. Does one day (ie starting ovulation one day too late) make such a large difference between success and failure?

It can, although I am not sure exactly what your doctor meant. You may have ovulated just a little early, which could explain the empty follicles. There are other factors at work that depend on the clock. For example, Kolibianakis published an interesting study a few years ago where he showed that triggering time can significantly affects endometrial receptivity. That was not your problem, of course, but the clock is always ticking in these cycles.