Egg Count Mathematics: Why the numbers change between retrieval and transfer.

February 28, 2011Carole 203 Comments »

Recently, I got some really good questions from a reader who wanted to know why there is sometimes a discrepancy in the number of eggs initially reported at the retrieval and the final egg count. This reader also asked how does the embryologist know that eggs are mature–is it the size of the egg?-  and what does a “bad” egg look like?  She also wanted to know why the number of mature eggs and the number of eggs fertilized isn’t always the same. I thought that other readers might have similar questions so I thought I’d post my answer to her here:

Regarding egg count at retrieval: The embryologist’s first look at the egg is obscured by a cloud of cumulus cells that surrounded the egg inside the ovarian follicle as it developed. The oocyte cumulus complex or OCC consisting of both the egg and surrounding cumulus cells is sucked out during the egg retrieval. These cumulus cells make it hard for the embryologist to see an egg structure called a polar body which is produced and extruded by the egg when it is mature. The polar body is a cell membrane enclosed sac of excess chromosomes that the egg must remove before it can successfully combine with the sperm DNA during fertilization. The polar body is extruded by the egg into the perivitelline space, the space between the egg and the surrounding shell (zona pellucida).

So, how and when does the embryologist know the egg is mature? Immediately at retrieval, the most the embryologist knows is the number of oocyte-cumulus complexes retrieved. Occasionally, clouds of cumulus cells are recovered at retrieval that don’t contain an egg. That is why the doc and patient may get a report of say- 20 eggs- retrieved and later the report is revised to less than that. If the eggs are to be injected, then the cumulus cloud is removed from the egg by the embryologist to allow visual verification of the polar body and hence maturity of the egg.

You will get the most reliable count of mature eggs at the time of cumulus removal for ICSI- sometimes cumulus removal is called “stripping” the egg. Only eggs with a polar body (=mature eggs) can be injected. Eggs do mature naturally in vitro if they are real close to maturity at the time of retrieval, so sometimes you might gain a mature egg the next day and have a late egg injected at that point, again causing a change in the number of mature eggs.

Regarding size and maturity, egg size at retrieval is usually not a distinguishing factor. It is true that over the months it takes an egg to mature in your body, it expands dramatically in size but by the time of retrieval, eggs that are retrievable are usually very similar in size. Sometime extra large eggs double the size of the others are recovered but these jumbo eggs invariably are chromosomally abnormal, usually containing multiple extra sets of chromosomes.

“Bad eggs” at retrieval are usually dark in color, and may appear very grainy,  shrunken or actually broken, with or without leaking cytoplasm. The number of eggs that fertilize is very frequently less than those that are initially retrieved for all the reasons above. The reduction in egg number at each step is due to the fact that not all cumulus complexes retrieved contain eggs, not all retrieved eggs are healthy or mature, and even some mature eggs may not fertilize. You can see pictures of normal cumulus eggs and later stages of embryo development at this previous Fertility Lab Insider post:
http://fertilitylabinsider.com/2010/…s-progression/

Maybe it’s just February doldrums or a slow news cycle but I am struggling to come up with interesting posts. I would love to hear from you if you have any burning embryology questions or topic ideas that you’d like me to discuss.

© 2011, Carole. All rights reserved.

203 Responses to this entry

  • Carole Says:

    Hi Dee,

    This previous post might help you with what embryologists look for on each day of development. http://fertilitylabinsider.com/2010/11/embryo-stages-progression/ While there is some variation among a group of embryos regarding the rate at which the embryos develop, (which is probably mostly due to different times at which fertilization occurred), generally speaking there is an expected rate of development for normal embryos. If an embryo deters too far from the expected rate,it is likely not to go on.

    On day 2, the normal embryo starts to divide into two, then four cells. By day 3, the embryo reaches on average 8 cells (6-10 can be normal too). So your embryologist will be looking for the timely appearance of these milestones over the days in culture. Hopefully, at least one of your embryos will reach the expected stage on the transfer day. I really hope you get some good news and wish you all the best for a pregnancy sooner rather than later! Good Luck!

  • Ann Says:

    Hi Carole,

    I really enjoyed reading your responses. I am a 38 year old woman who has recently completed one round of egg freezing. They retrieved 5 eggs and froze 5 eggs (I was quite surprised at the low number and received confirmation that women my age at this clinic get significantly more eggs). I asked and they could not tell me if the eggs were quality eggs and said that only becomes known once they are fertilized. During my treatment, I was on 150 iu of follistim and 150 iu of menopur, however, around day four, my dosage of follistim was increased to 300 iu for the remainder of the treatment. Before I started my injections, the fertility center ordered an ovarian assessment report from ReproSource and my levels were as follows:

    FSH 12.1
    Estradiol 22.6
    LH 8.38
    AMH 2.75
    InhibinB 85.0

    I’m giving myself a one month rest and then plan to do one more, final, round of egg freezing. The doctor said she thought I would respond to the medication better than I did and she said she will put me on a more aggressive treatment plan next time.

    I’m surprised that my egg count was so low and I don’t even have the comfort of knowing whether they were quality eggs, although I’m assuming since all 5 retrieved were frozen, that means they must have been fairly sturdy for lack of a better word. How does my case look according to the levels I specified above? Does it seem like I’m on the low end of the fertility spectrum for my age (38)? Assuming I go on this more aggressive treatment for the next round, does that mean there could be more eggs but not necessarily the same quality eggs as before?

    I should also mention that my doctor said before the cycle even started that 20 eggs banked would make a reasonable chance of a pregnancy. It seems to me that this is the number that a particular clinic is comfortable with in achieving a pregnancy and some clinics feel fine with half that number. But if I want to achieve a pregnancy with frozen eggs with this clinic, then 20 should be what I aim for.

    Thanks so much!
    Ann

  • Carole Says:

    Hi Ann,
    Regarding your questions – below in italics:
    How does my case look according to the levels I specified above? This is really a better question for your RE as it pertains to your hormone levels. Here are a couple of websites that have pretty good info about AMH levels (yours was normal) and FSH levels (if yours was measured on day 3 (?) then it was perhaps slightly higher than optimal) http://www.fertilityassociates.co.nz/information-for-gps for AMH. /amh-explained.aspx This link http://www.advancedfertility.com/day3fsh.htm for more info on day 3 FSH. It is not unusual for an RE to adjust medications up as the cycle progresses if the response was less than expected.

    Does it seem like I’m on the low end of the fertility spectrum for my age (38)? Again, I am not an RE but your response was not abysmal– but was reduced, what I might expect for age 38- all things being equal. Again, your RE should be happy to sit with you and go over this in detail.

    Assuming I go on this more aggressive treatment for the next round, does that mean there could be more eggs but not necessarily the same quality eggs as before?
    Yes, it is likely that more aggressive treatment will result in more eggs, and yes, you are correct, more eggs does not necessarily more high quality eggs. In my own experience, it was not unusual to have patient A have 10 eggs, patient B have 20 eggs and patient C have a record number (50 eggs!!), and yet each end up with similar numbers of eggs that fertilized normally AND developed to a more advanced stage in culture so that they could be transferred or frozen. The rare patient had a large number of all high quality eggs.

    I think you should ask your clinic some tough questions– I have a list of them here in this earlier post: http://fertilitylabinsider.com/2010/08/finding-a-good-egg-freezing-clinic/ You also might read this post about the loss of “experimental” designation for egg freezing and the possible implications for patients. Before you invest more in your next cycle- be sure that your clinic has a good track record of getting live births from frozen eggs. Whatever you decide, I wish you all the best! Good Luck!! Carole

  • yogesh Says:

    My wife, aged 34, had egg collection yesterday, 9 eggs being retrieved
    6 were mature but grey, 3 were immature….
    Plz tell us about the scope of success, v r really worried- it was 2nd chance.

  • Carole Says:

    Hi Yogesh,
    You should ask your lab what they mean by “grey” eggs AND what has been their experience with eggs that looked like yours. They are in a much better position to answer these types of questions. Try not to worry. I have seen pregnancies with unlikely embryos. Wishing you Much Good Luck!! Carole

  • Cherie Says:

    Hi Carole,

    I had my egg retrieval yesterday – 11 retrieved, 8 mature and 7 fertilised through ICSI. When I asked the nurse about the egg quality she said that it’s below average.

    My question is – would the egg still fertilise even if they are below average? Does an embryologist know about the quality of the egg once they are retrieved OR does fertilisation have to happen first?

    I’ve been called for a day 3 transfer and getting nervous about it due to the below average egg quality which I don’t fully understand.

  • Carole Says:

    Dear Cherie,
    The facts you have shared: 11 retrieved, 8 mature and 7 fertilized are completely expected for most patients- and this is NOT a bad result! The nurse really has no business telling you that your eggs have below average egg quality unless she has much more info. For example, were the eggs dark or abnormally sized or had extra thick zonas or WHAT? If you want to know more, you should speak with the embryologist that is working with your eggs/embryos. This is an example of POOR communication where just enough info is given to worry the patient without explanation of potential impact, expectations based on previous similar cases, alternatives – day 3 vs day 5 transfer etc. Re: Your second question, in my experience, if the egg has the requisite polar body (the sign of maturity) and no obvious signs that the egg is dead, eggs get injected with sperm (ICSI procedure) . If regular IVF (not ICSI) is being used, the sperm is added to eggs that are still cloaked in their cumulus cells so we don’t get a good look at the eggs until the next day when these cells are stripped away to look for fertilization signs. Even suboptimal eggs fertilize- where we often run into a problem is when the new zygote has to divide and keep going. This is a more difficult task than fertilization and here is where you often start to see the problem if egg quality is suboptimal. Day 3 transfer is a fine option if the best one or two embryos are already obvious so I wouldn’t stress over that. It used to be the only option before extended culture systems were developed. Please contact your embryologist -you might have to call the doc or nurse and ask the embryologist to call you- but the types of questions you have can probably be best answered by the embryologist. Good Luck!!!

  • Cherie Says:

    Thank you so much Carole for your quick response and detailed explanations. You make me feel a lot better! I will either speak with the embryologist tomorrow or just go for my 3day transfer and hope for the best! I know that there is nothing I can change at this point so I can only keep up the good spirit and positive vibes.Thank you!

  • Shawna Says:

    Hi Carole-

    I’m saddened to say Ive had to turn to you in my past “not going as planned” IVFs and am back again. But I am very thankful for your expertise and the support you give.
    So a little background: considered DOR, age 36 but have big swings In FSH/AMH/AFC to the point where I’m not sure if I’m DOR or normal or what. Point being is Ive had pretty consistent and low responses to meds. AFC usually 8 to 14 (so could be recruiting more in my opinion). But in three failed cycles Ive had
    1. 7 eggs w 5 mature 3 fertilize (looked to be about 7 over 15mm at trigger) so a good/expected result for a low stim IVF
    2. 8 eggs 5 mature 3 fertilize (per u/s that’s pretty much what we expected as far as mature. Low stim protocol)
    3. Different protocol..more stims – 7 eggs, 5 mature 4 fertilize (w 2 being NEFs on day 2 but grew on). Again pretty consistent w 6 or so above 15mm on trigger day.
    So been a consistent robot until now. ER today- similar protocol to #3 but w long estrogen priming and a very sad result of 9 eggs and only 2 mature w 3 intermediates.
    – Tracked 3 large leaders in right ovary, grew together to 18-21mm but yielded 2 immature (should I ask if these are GVs?) and 1 intermediate egg. Devastated!
    -Left ovary had 6 eggs pulled (only saw 5 on u/s) but follicles were only 10 to 15mm on trigger. From here 2 mature 2 intermediate. Not that surprising I guess based on foll sizes.
    I’m so confused. I seem to have a both a high rate of immaturity (25-35% cycle 1-3 and now 80% this cycle).
    These are finally my questions:
    1. they told me right away about the 4 immature, 2 mature and 3 intermediates. Prob like 1 hr after my ER. Is is possible to disgnonse some as GVs that fast and then those are totally discarded right away? So I just want to clarify w them I had 4 GVs it sounds?
    2. Is normal immaturity level like 10-20%, mine is much higher even w follicles over 15mm it seems. I have done ok w fert but not stellar at around 60% of mature eggs. My RE has said nothing about modifications for more mature. Thoughts?
    3. They mentioned to me that they would let the intermediates culture for 6 hours to have a look. That’s it. I’m concerned and its too late to protest. Why would they not look tomorrow and try to overnight mature them? What chance do you usually give the intermediates to become M2s??

    I’m so spent out and devastated pumping myself w drugs to have very little embryos to show. I guess I could get a few of the intermediates to go but Ive lost hope. They said they would only call tomorrow to tell me but if they will know after 6 hrs in culture why could they not tell me now! Thanks again!

  • Carole Says:

    Dear Shawna,
    I am sorry you are having such a hard time. To answer one of your questions, yes, an embryologist can tell a GV stage egg right away (after removal of any cumulus cells that are surrounding it and cloaking it. GV eggs do not have a extruded polar body, but they do have a large internal vesicle ( called the germinal vesicle–that’s where the name GV comes from. It is very big and obvious and hard to miss) However, I think it is very difficult to mature GV eggs. Personally, I’ve had very little success. These eggs may spontaneously proceed an additional step toward maturity but they typically lack the cytoplasmic maturity to fertilize properly and grow.

    I think the bottom line is that IVF is not working very well for you. In a good cycle, most of the eggs will be mature, most will fertilize and more than half will get to blastocyst stage. This has not been your experience. It could be due to egg or sperm issues, doctor or lab issues. A poor stim results in immature eggs even if egg quality is good. A good stim protocol won’t help if there are intrinsic problems with the egg. It is often really impossible to tell what is the cause of poor IVF outcomes.

    Of course, this assumes that you have done your homework and are going to a lab with great results in your age group (36 is not that old), then you might be facing intrinsic problems that even a good doc and good lab can’t fix. If you are not sure how your IVF clinic stacks up against others, please check the CDC or sart rates for your clinic and compare to national and other local clinics.

    I don’t know if seeing another doctor for a second opinion would make any difference, but that is certainly an option. However, consider that every person reaches a point where they have to stop, give themselves an emotional time-out, and assess if this is their very best path to parenthood. There is no shame in that. If you have ruled out lab and doc issues, and this cycle doesn’t work, it may be time to look at all your options. I wish you VERY MUCH GOOD LUCK going forward.
    Carole

  • Shawna Harrison Says:

    Thanks Carol- I appreciate your honesty.
    Just to clarify the below quote was pointed at GVs and not intermediate M1s. Do you have a different take for an M1 (which I had three of) or pretty well very little success there as well. When I asked the Embryologist of the likelihood of taking the M1 to M2 she said that in more than half the time there is some success. She seemed a bit hopeful but yes agreed it seemed the totally “immature 4 eggs” possible GVs (through she did not use that term) were already discarded. Thanks for your thoughts!

    “However, I think it is very difficult to mature GV eggs. Personally, I’ve had very little success. These eggs may spontaneously proceed an additional step toward maturity but they typically lack the cytoplasmic maturity to fertilize properly and grow.

  • Shawna Harrison Says:

    Carol-

    Just thought I would update you since your blog was still open on my computer…I was a lucky gal I guess and I had all three M1s come to maturity in the lab last night. Of these and my 2 already mature eggs all 5 fertilized and are at 2 pn stage where I am freezing/vitrifying. I am doing this to bank with my next ER and grow them out all together. CCRM prefers 2 pn freeze vs blast freeze when banking. So just wanted to give you the last bit of news as it might be helpful to others or you. Thanks so much for what you do for us lost IVFers!!

  • MRD Says:

    Hi Carol- I am hoping you might have some insight for me. I’m 40 and just finished a low stim cycle. I had 24 follicles at ER, but only 12 eggs. Of the 12, only 6 were mature. All 6 fertilized via ICSI, but on day 3, only 2 were considered FAIR, the rest poor (even though some of the poor ones were 8 cells). We froze them to do another cycle so we hopefully have more to send to PGD. Do you have any insight on why I may have had so many immature eggs, or anything I can do to try to increase the chances of getting more mature ones next time? I did accupuncture, Omega 3, COQ10, etc. My meds were menopur, clomid, lupron ganirelix, saizen. Thanks!

  • Carole Says:

    Hi MRD,
    I really can’t advise you about the best stimulation protocols. I know that some stims are better than others for some patient and we can see markedly better egg quality if the patient gets a suitable stimulation protocol. I would ask your doctor whether he/she has any ideas for what might be done differently for the next cycle. IF he doesn’t have a lot of options to try, you could seek a second opinion. I am assuming that you are already going to the best program in your area based on a comparison of pregnancy rates. (www.sart.org)for patients in your age group. I would run all the supplements you are taking past your doc. Some supplements can negatively impact the efficacy of stim drugs. For example, here is a physician post about use of DHEA and stim drugs. http://haveababy.com/fertility-information/ivf-authority/dhea-and-ivf-harmful-in-certain-cases/ Good Luck!! Carole

  • Circle + Bloom | Communication with IVF Lab Says:

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  • lynn Says:

    age 34 first IVF. We had 14 mature eggs out of 19 retrieved with 2 “natural and 5 with ICSI fertilization on day 2. How normal is this? How many is average to lose by day 5? Thank-you

  • Carole Says:

    Hi Lynn,
    If you needed day 2 -“rescue ICSI”- that suggests that there is a problem with fertilization. It could be with the sperm or with the egg. It is possible that the eggs were not really mature but that was not obvious until the next day when the eggs were stripped of cumulous cells (necessary to see the egg structures that indicate fertilization called pronuclei) and found to be unfertilized, but now showing a strong polar body. Then they did the ICSI on these with a polar body. I will wager that your clinic would recommend ICSI from the start if you have to have another cycle. Your fertilization rate (7 out of 14= 50%) is on the low side, but not terrible. On average, we saw a fertilization rate of 75%. At least 50% of our fertilized eggs would go on to blastocyst stage. We did blast transfer on pretty much everyone unless they already had only 1-2 embryos so there was no need to culture longer to identify the 1-2 for transfer. I think you will likely have embryos to transfer and possibly even some to freeze. Good Luck!!
    Carole

  • lynn Says:

    Carol, thank-you for your quick response. I may have given you the wrong info. We had retrieval 8am on Monday, they did fertilization that afternoon and notified us morning of day 2. Does that change anything in your mind? This is so stressful. The nurse called and said they did not want to bother the embryo’s today ,Wed. They also said we would probably lose more. Is that to be expected? I asked if we needed 3 day transfer and she said our doc said no everything was o.k. at this point.

  • lynn Says:

    Carol, I am confused. What day is Tues. after retrieval on Monday? They told me Sat would be 5 for transfer. Tues is when they notified us of fertilization.

  • Carole Says:

    Hi Lynn,
    Here’s how we would count the days so that day 5 is blastocyst day.
    Day 0 is retrieval day and combining egg with sperm (by ICSI or regular IVF)
    Day 1 is fertilization check day in the morning. Fertilized eggs have two pronuclei.
    Day 2 is often not checked–embryos would be 2-4cell stage.
    Day 3: embryos are usually at 8 cell stage.
    Day 4: embryos are at morula stage; a transitional stage between cleavage stage and blastocyst stage.There is not a good grading system for this stage since it is so irregular.
    Day 5: Embryos reach blastocyst stage and are transferred to the uterus. Sometimes, they are cultured another day and reach blast on day 6 and transferred or frozen then.
    So you are on schedule with a transfer on Saturday. Please try to distract yourself with other things this week and until your pregnancy test. Embryos are tougher than we think– life finds a way if at all possible. And rmember, you don’t need 7 embryos to get pregnant, just one good embryo at a time- so if there are some losses along the way, it will still be alright. Wishing you MUCH GOOD LUCK! Carole

  • lynn Says:

    You are such a blessing to everyone. We heard from the embryologist today. All 7 met criteria to go forward to day 5. She said they all looked good! Thank-you sooooo! much.

  • Stella Says:

    Hi Carol,

    What a great forum!! Glad I found it. I am 36 years old with severe endometriosis, stage 3-4. My left fallopian tube is destroyed from the endo. I have had 2 surgeries and have low ovarian reserve with my highest FSH test at 18.9. Others were 6.5,7, and 10.4. So, I decided to try egg freezing as I don’t want to give up all hope of having my own kid one day. I had my first egg retrieval yesterday with 5 eggs. My doctor emailed me today saying that they were able to freeze all 5. 2 were mature and 3 were “almost mature” and all of them could be used in a future pregnancy attempt. So, my question is, ” What does almost mature mean?” Do these have a low chance of being good eggs? I guess they were good enough to freeze but beyond that can they be a decent option? I will ask doc tomorrow just wanted your opinion as well. I’m also planning to do more in order to get an egg count that I would be comfortable saying I have a decent chance of pregnancy with.

    Thanks,
    Stella

  • Carole Says:

    Hi Stella,
    “Almost” mature could mean a germinal vesicle stage egg which would have to undergo some in vitro maturation before it was usable. This technique- in vitro egg maturation– is not widely used- many eggs get stuck at GV stage so there is no guarantee that these will be useful. SOme spontaneously mature but not all after retrieval. If an egg has one polar body, it is a metaphase II stage egg, and is ready to be fertilized-so it is mature. You really need to get your doctor to explain what they meant by “almost” mature. And what plans they have to get the “almost” mature egg to a mature stage. A few more mature eggs in storage would be beneficial. Also, get them to share their results with warming vitrified eggs and getting fertilization and most importantly, pregnancies for patients. Good Luck!! Carole

  • Reeves Says:

    I have a few questions I am 33. Looking to go through my first IUI. My land are as follows. E2 22.6 progesterone 0.6 and FSh 4.1 and LH 3.6 are these all good to continue?

  • Reeves Says:

    All labs are cycle day 3

  • Carole Says:

    Dear Reeves,
    These questions are all more appropriate for your RE to answer. My expertise is in lab related topics.
    Good luck. Carole

  • Julie Says:

    Hi Carole,
    I’m 38 years old and have only one ovary. In my last stim cycle, 12 large follicles (18mm-26mm) were measured, but only 6 eggs were retrieved. My RE said that some of the large follicles are empty. I’ve read an article from Dr. Sher who said that there is no such thing as an empty follicle. Can you weigh in on this? What are some of the likely reasons for why only 6 eggs were retrieved from 12 follicles?
    Many thanks!

  • Julie Says:

    Hi Carole,
    I’m 38 and have only one ovary. In my last stim cycle, 12 large follicles were measured (18mm-25mm). However, on the day of the retrieval, only 6 eggs were retrieved. My RE said that many of the larger follicles were empty. I’ve read an article from another RE that said that there is no such thing as an empty follicle and that all follicles have eggs. Can you weigh in on this? What are some of the likely reason why only 6 eggs were retrieved from 12 follicles.
    Many thanks!

  • Carole Says:

    Hi Julie,
    Sometimes and egg is so immature, it can’t easily be sucked out of the follicle. As the egg matures, the follicular cells inside the follicle produce a lot of follicular fluid and over time, loosens the egg’s grip on the follicle wall so it comes out easily. It is more a technical issue than anything but if it immature, you really can’t do anything with it in most labs. Some labs have developed egg maturation protocols to culture the immature egg in special media for several days to coax it to final maturation (if it is fairly close to being mature) but most labs don’t do this routinely. Immaturity is the biggest reason that the retrieved egg count is almost always less than the follicle count. Sometimes there are anatomical issues that prevent the doctor from reaching a follicle. Also, as in every other surgical technique there is a learning curve for understanding how to find the egg on the ultrasound, pierce the follicle and apply the right amount of suction. As doctors gain experience, they usually get better at finding and recovering all the eggs. As always, you should also ask your doctor why they think only 3 were retrieved- they were there and probably have an opinion. Good Luck! Carole

  • Cathy Says:

    Hi Carole,
    I am 39 years old, I just had retrieval yesterday.
    I had about 8 follicles at baseline ultrasound, but after 4 days of stimulation, I used 450 unit bravelle and 15 unit low dose HCG, only 3 or 4 follicles were growing, one follicle size was 20, the small ones were not growing, my RE asked me to have 2 more days stimulation, so totally I had 6 days stimulation, then I was told to trigger, evenally they retrieved 5 eggs, 4 were mature, but i was told ths morning only 2 were fertilized. My question is why my other little follicles didnt grow? fYi, I took birth control pills for 22 days, was my overies over supposed? I had seven IVF cycles before, I had 7-10 eggs. It’s possible that my overies are not sensitive to the drugs anymore? That’s why the small follicles didnt grow? But why the 3 big ones only took 6 days? This is very unusual cycle?

  • Carole Says:

    Hi Cathy,
    It is very normal to have fewer eggs retrieved than are visible on ultrasound. It is also not uncommon to experience diminishing returns on subsequent cycles especially in women over 38. There are a variety of possible stimulation protocols which your doctor could consider in future cycles if this one does not work. (Keep in mind, you still have two fertilized eggs and may still get pregnant this cycle so don’t give up quite yet). 🙂 I would really ask your doctor these questions because he/she has the most information regarding your specific cycle. I wish you much good luck going forward! Carole

  • tracy Says:

    HI Carole,

    Thank you for this information and taking the time to answer everyone’s questions! Your answers are extremely helpful on many fronts. I am 38 and just had my IVF #1 egg retrieval today and out of the 2 good sized follicles I had, only 1 immature GV egg was retrieved. She said the other one was empty. When I told my RE I read that empty follicles don’t exist and asked if it was because I had ovulated or perhaps it was too immature, she said, No it’s probably because you have low egg quality and DOR. I’m glad to hear you second Dr. Sher’s thought that there is no such thing as an empty egg follicle. I know my chances are very low that my GV egg will mature in the lab. I appreciate your true comments about the low probability.
    My RE then proceeded to do an IUI after the egg retrieval, just in case. This didn’t seem like standard protocol, but I’m all in if it helps our causes! What are your thoughts on why she also did an IUI? Perhaps because she may have missed a follicle?
    Thank you again!

  • Carole Says:

    Hi Tracy,
    Regarding you question- why she did the IUI?, it might be in the hope that any eggs left behind might just manage to ovulate on their own a few hours behind the rest that were recruited- and then there would be some sperm around to possibly fertilize them. Almost all docs will miss a follicle- some are missed deliberately because they are too small (and so expected to be immature) and not worth recovering. Sometimes the follicle is anatomically located so that it is difficult to reach. You might ask your doctor or another doctor whether a different stimulation protocol would make a big difference. You need to get more than 2 mature eggs per retrieval to have a good chance at pregnancy. I wish you much good luck going forward! Carole

  • Julie Says:

    Hi Carole, I had posted here on March 21s with 6 eggs retrieved out of 12 follicles. I’m happy to report that 5 of those fertilized, 3 made it to blastocyst, and 2 PGS tested normal. It’s amazing how the number dwindled from 12 to 2. Nevertheless, I’m happy with my chances at this point and I’m doing a single embryo transfer in 2 weeks. Many thanks for your answer and support.

  • Carole Says:

    Hi Julie,
    Glad to help. Wishing you all the best going forward. 🙂

  • raj Says:

    Hi there,
    This is my first ivf, they retrieved 28 eggs. Is it a good number for fertilization when my husband has about 96 percent abnormal sperms?
    Also I am having discomfort after egg retrieval. What can be done to reduce bloating?
    Thanks

  • Carole Says:

    Hi Raj,
    Your egg number is on the high side so probably some of the eggs won’t be mature but you will likely have a good number for transfer and freezing. As far as the bloating question- you need to ask your clinic’s doctor or nurse to advise you. Good Luck!! Carole

  • raj Says:

    Thanks for your reply carole
    Out of 28, 27 firtilised. Im happy for that. But the discomfort im experiencing after that is too much. My abdomen is hurting like muscles are pulling. I called my nurse but apart from panadol or drinking fluids they didn’t help me. My transfer will be on monday. But will this pain affect the embryo implantation. I appreciate your spontaneous reply. 🙂

  • Anna Says:

    Dear Carole,

    Thanks for such an informative article!
    I was wondering if you have heard of a case such as mine before. I 39 yrs old with low amh and high fsh, had a previous cycle where 15 eggs were retrieved, 8 mature, 4 fertilised with ICSI. This time my dose of menopur was increased to 450 and Human Growth Hormone was added to my protocol. I also ate lots of protein, Maca, L’Arginine and Ubiquinol, and the results were astounding.
    Despite being told on my stim day 6 scan that my cycle may have to be cancelled due to poor response, I ended up with 7 eggs, all of which were mature and fertilised without icsi. Amazingly on day 5 I had 2 X 6AB hatched blasts transferred and 1 X 6BB blast frozen. On day 6 the remaining 4 made 5B+B- grade and were all frozen!
    Have you heard of 100% fertilisation and 100% going to quality blastocyst before? Do you think the supplements and protein caused this? I believe I am an interesting experiment. Currently in my 2WW! Thanks

  • Anna Says:

    I meant to ask, isn’t this too good to be true? What percentage of these blastocysts would you expect to be chromosomally normal?

    Thank you

  • Carole Says:

    Hi Anna,
    I am glad you had so many embryos to choose from. On average, because of your age, we might not expect such a good outcome. If you have a 100 IVF cycles of women in your age group, the individual results will be all over the place. Some patients will have zero fertilization, and some will have 100% fertilization. The largest numbers of patient will likely fall somewhere in the middle. If you plot it on a curve it makes a rounded bell shape. So averages are only guidelines for individual experience- which can vary widely outside the average. I don’t think supplements and protein caused this. I think overall good health and overall good nutrition can be a positive influence but are only part of the picture. You can be in perfect overall health and still have a large number of eggs with an abnormal number of chromosomes. http://fertilitylabinsider.com/2010/05/embryo-score-and-maternal-ag/

  • Carole Says:

    Anna,
    I don’t have an expectation about your case. You might have a particularly good DNA replicative machinery that does not make the chromosomal errors in the final stages of egg production/maturation that become more common as we age. Why shouldn’t you be luckier than average? Someone has to be. It is encouraging that you had good progression to day 5. I wish you MUCH GOOD LUCK going forward!! Carole

  • Anna Says:

    Dear Carol,

    Thanks so much for your honest, very kind, and very prompt reply! Keep up the great work!

    All the best,

    Anna

  • Anna Says:

    Dear Carole,

    I thought I would send you an update: I am 11 weeks pregnant with triplets!

    Again it is a bit of a mystery as only 2 embryos were transferred, and that was at day 5, yet they all have their own sac and placenta (tramniotic trichorionic). Everything I have read says that if an embryos splits after 3 or 4 days the babies would share a sac and placenta. Can you offer any explanation for this?!

    Many thanks Carole,

    Anna

  • Carole Says:

    Anna,
    Congratulations on your pregnancy! Well, the simplest explanation I can imagine is that the tech picked up three embryos instead of two when they loaded the catheter. This is easier to do than you might think, especially if the embryos are being plucked from a droplet or a dish containing all of your cultured embryos. Other than that, it is difficult to imagine how it might easily occur but then embryos have surprised me before. I wish you much good luck–and a good maternal fetal specialist(!) – for the remainder of your pregnancy. Best Wishes, Carole

  • Amanda Says:

    Losing Hope & devastated-

    At age 18 I was diagnosed with premature ovarian failure. I used a young 25 yr old egg donor. Her retrieval was yesterday and my Dr told me over and over she was going to make 25-30 eggs.They actually gave her a med to make her stop. Today I get a phone that only 8 eggs were retrieved, all of them immature and many of her follicles were empy, 4 fertilized over night, 2 more are going to be fertilized tomorrow. What went wrong?!?! I’m so devastated, this was suppose to be the easy part since I went with a donor. Also, is my changes slim to none of a viable pregnancy since these eggs started out immature?

  • Carole Says:

    Dear Amanda,
    I am so sorry that the donor egg cycle isn’t working. I can’t tell what might have gone wrong, but I have a few suggestions if you try this again. 1) Always ask to work with a donor who is a repeat donor with live pregnancies to her credit (her own or clients). Often we diagnose a donor’s own infertility with her first donor cycle. Young age is not a guarantee of fertility. 2) the clinic seems to have had some surprises in her stimulation. This could be due to the donor or because the doctor is new to stimulating donors. They need a lighter touch. If the clinic is new in offering donors, find a more experienced clinic. The GOOD news -if I understand what you wrote- at least 4 are confirmed fertilized – meaning ICSI or IVF was performed and the techs saw signs of fertilization in the eggs the next morning (evidence of two pronuclie (aka. 2PN). IF the eggs fertilized, they were mature when egg and sperm where introduced. Four fertilized eggs from a donor may still result in a pregnancy for you, but you might not have any extra embryos left over to freeze. So it’s too early to despair. Wishing you MUCH GOOD LUCK!! Carole

  • Amanda Says:

    Carol,

    Thanks for the fast response. I talked to a different nurse today and I guess I had it a bit confused. Here’s what I was told today, many of the follicles were immature and empty. They retrieved 11 eggs, 7 were mature, out of the 7, 4 of them fertilized. The wait for tomorrows 3 day phone call is killing me. They will only do a transfer if it’s a 5 day blast. What is my honest chance of getting to that point?

  • Carole Says:

    Hi Amanda,
    Your lab techs, not me, would be able to best predict your possible results because they know how patients like you have done in their lab in their hands. In my lab, 4 fertilized eggs would almost always have half go to blast stage and a transfer, and you may or may not also have something to freeze. I would not give up on your chances here. Please try to distract yourself with something else. it does no good to fret. I wish you MUCH GOOD LUCK going forward!

  • Amanda Says:

    Day 3 update:

    All 4 eggs are growing like they should, all 8 celled. They told me statistically 1 or 2 will probably drop off by day 5. Transfer is this Saturday. Praying for a good outcome, for this is my one and only shot financially.

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