Empty follicle syndrome?

[dtao]

So I had my egg retrieval the other day, and I'm really disappointed to have only retrieved 4 eggs out of all the good follicles that were growing. Even my doctor was surprised.

Background:
I had an IUI converted to IVF 2 years ago on Bravelle. We got 7 eggs, 5 fertilized, 2 transferred, 2 frozen. And those 7 all came from my right ovary because the left was in an awkward position.

This time, we went in intending to do IVF, stimmed on follistim and menopur, and all looked good until the retrieval when apparently most of the follicles were empty. We were only able to get 2 eggs from each side when there should have been a good 10. Fertilization rate was also atrocious. We did get 2 beautiful embryos out of it, so I'm still hopeful, but this is definitely not what we expected.

I don't understand. Research on the Internet and asking my doctor have not cleared this up. Has anyone encountered this or know the cause?

[to_have_fun08]

i had empty follicles on my first 2 egg retrievals. my RE's had no reasoning for this. I then went to another clinic. I have found that many RE's believe that there is no such thing as empty follicle syndrome. The eggs are just not mature enough to detach from the follicle. This could be because of the protocol used during the stim phase or the trigger used for ovulation. For my 3rd through my 6th IVF cycle i either did 2 ovidrel shots for trigger or I did 10,000u HCG. i didn't have any problems with empty follicles after that. My protocols were also changed so i don't know if it was the trigger shots or the different protocols.

Good Luck with your 2 embies. Hopefully you won't have to worry about empty follicles again cus you'll bet a BF.

[dtao]

Do you think the antagon disrupted the final maturing of my eggs then? I took it 27 hrs prior to the HCG shot, which I didn't have at all the first time. I know I felt different after that: less bloated, no more cervical mucus.

[to_have_fun08]

I wouldn't think that taking the antagon 27hrs before would have an effect. I think that is pretty much what everyone does on that protocol.

[dtao]

I ask because for my first IVF I did not inject any antagon. Maybe it's bravelle vs follistim/menopur?

[isbn]

Don't lose hope! Often it is a matter of just getting the medication right for you. I had my first experience with empty follicles about a year ago, and after a year of trial and error, I am now pregnant with triplets (my only two embryos that made it through the process both took, and one split).

I am a huge responder - with barely any stims (menapur/follistim) I would produce 30-40 large follicles. My first retrieval I triggered with Lupron instead of HCG due to the risk of OHSS, and there were no mature eggs retrieved. The second retrieval I also had a risk of OHSS, so was triggered with 5,000 mg of HCG - again, no mature eggs and they stopped after the right side. That night they had me trigger again with 10,000 mg of HCG and tried a second retreival on the left side two days later. They were able to get 4 (out of 20+ follicles), and only one was mature and fertilized (did not take). While disappointing, we were pleased they at least got something.

My last cycle was in March/April this year. Again I had good number of large follicles and they had me go a day or two longer than previously to get them as big as possible. I triggered with the full 10,000 mg of HCG. They were only able to retrieve 6 mature eggs, but that was huge progress. And turned out to be enough. 3 fertilized, 2 made it to blasts, both took, one split, and now I'm expecting three girls.

Just wanted to share my story. It was such a long and frustrating process and there was very little information out there to give me any hope regarding empty follicles.

By the way - I'm young 30's, not overweight - so those classifications often associated with empty follicles did not apply.

[nycgal]

I know I'm a bit late to this thread, but wanted to chime in since I just had my first IVF and experience with empty follices. I had 15 eggs that were >16MM and my Dr was unable to retrieve a single egg. It was absolutely devastating news to hear while recovering from anesthesia. As background, I have PCOS- I'm in my early 30s and not overweight. I am however an avid athlete and exercise obsessively. I was on the Lupron protocol and administered HCG correctly, which I've read is one of the main reasons that leads to empty follicles during retrieval. I was on Follistm 150 with Lupron 5 units. Novarel was the HCG shot I administered myself 36 hours exactly before retrieval. I took a pregnancy test the morning after and it showed positive, so did my urine test from the procedure which registered 109% HGC in my body. Given this, my doctors were able to rule out that I inadequately administered the shot. I ended up in the ER after my procedure due to fluid/blood that was under my diaphragm that caused acute pain and shortness of breathe. I'm absolutely devastated and concerned that I'll never be able to successfully conceive. Has anyone else experienced something similar with positive results from a 2nd retrieval. I've been told that I'm going on the Antagonist cycle next month and will be either given recombinant HCG or a higher dose of uHCG. Ether way, I'm absolutely terrified that my dream of being a mother is never going to become a reality.

[dtao]

I just saw this new reply to my post a year ago, and it still feels sad to remember how devastated I was at the time. As you can see from my signature below that it was a failed cycle after all as I predicted, but I did go on to learn some answers I think, as well as have a successful 3rd cycle resulting in twins. I am currently doing well at 22 weeks.

So after my BFP during the discussion with my RE he mentioned that he thought my ovaries didn't feel maneuverable as they should. I guess normally he can sort of manipulate them to access all the follicles to get out the eggs. On top of that, we already knew I had my left ovary pretty high up sort of hiding behind my uterus in an awkward position which he wasn't even able to reach the first time around at all. So that time he couldn't get to all of the follicles, and the ones he did reach we're probably not the best ones. Therefore we had such a low retrieval rate and fertilization wasn't great.

He said he thought there might be some scar tissue attaching my ovaries to something not allowing them to move freely. He suggested that I have a laparoscopy to see what was going on in there before moving forward with another IVF. Due to insurance issues and whatnot, it took another 5 months before I as able to get the procedure covered by my insurance with my OB doing it. Indeed, there were some slight adhesions that were removed, and my 3rd IVF cycle resulted in twins.

So that's my story. I guess not really "empty follicle syndrome" after all.