What Questions Should I Be Asking RE Before Second IVF Cycle?

[Anonymous]

I just had my first stimulated IVF cycle and am debating whether to pursue a second cycle. I'm 36 and while the doctors said I was responding nicely during stimulation, they only retrieved eight eggs from over 16 follicles. Five of the eight fertilized and I am told to anticipate a 50% reduction for Day 5 blasts and another reduction after PGT testing. I realize I am lucky to have gotten as far as I have, but I was hoping to have more than one or two embryos on ice. Does anyone have any advice as to what questions I should ask my doctor before starting on another IVF cycle? Is it also silly to start another cycle and not first do more testing to see if I have PCOS or endometriosis or other issues? I feel like these clinics just do the minimum testing and are not very wholistic about diagnosis.

[Anonymous]

Questions:

Why were half of the follicles empty/eggs not mature? What will you do to prevent that next time?
Will you increase stim medications? How? Why?
If you took BCP prior to starting the cycle - will you be told to do that again? Why or why not? Would it work better to suppress with estrogen pills instead?

[Anonymous]

Do you have any reason to think you have endo or PCOS? I agree that clinics are not super holistic, but that’s because testing costs money and without a reason, why do the tests?

I would wait and see how many PGS normals you get. 1 or 2 is a totally normal (and good!) outcome. If you are sure you want more than one child, you should probably do another round. I would ask the RE why so few eggs per number of follicles. My guess is that he/she will day it was a fluke and to try again with the same protocol. Have you been doing supplements?

[Anonymous]

Pp here. I don’t think PCOS testing or endometriosis testing make sense here yet.

[Anonymous]

OP here. After my egg retrieval, I inquired why so many follicles were "empty" and my doctor asked if I had PCOS. After some Googling, I don't think I meet criteria for PCOS, but it runs in my family. No supplements this round other than folic acid.

[Anonymous]

You can start taking ubiquinol for egg quality while you gear up for the next step.

[Anonymous]

Eight eggs is a good number, especially at your age. I would wait to see how many embryos you wind up with from the cycle. You could very well have success on your first transfer with a fresh embryo or later on with frozen. You could press ahead and do another immediate egg retrieval, but unless you wind up with no embryos from this round, I would not go that route. More time, more cost, more strain on your body. And it may be totally unnecessary if you have viable embryos to work with from your first cycle.

More eggs doesn’t always mean more viable embryos. I’m actually a good example of that. During my first IVF cycle, I had 23 eggs retrieved. They were all mature and they all fertilized and we wound op with 5 embryos. After a few rounds of FETs we still weren’t pregnant. I did another egg retrieval and we only retrieved 5 eggs. I was absolutely devastated and cried all the way home. If we could not get pregnant when we started with 23 eggs how would we ever get pregnant when we only had 5 eggs? Well, surprisingly, we wound up again with 5 embryos. So the same number of embryos from a large number of eggs and a small number of eggs. (And we got pregnant from one of those 5 eggs). Wishing you luck.

[Anonymous]

I recommend the book It Starts With The Egg

[Anonymous]

If you can afford another cycle, I think it's a good idea. I did two cycles back to back to bank eggs- the first round I got 12 eggs and ended up with 2 PGS tested embryos. The 2nd round I got 3. My first FET ended in an MC, the 2nd is my almost 3 year-old DD, and my 3rd is my almost 1 year-old DS. We always wanted at least 2 kids, and I am so grateful that I had that second round to fall back on. We are debating #3 now, and are so glad we have that choice.

[Anonymous]

Anonymous wrote:If you can afford another cycle, I think it's a good idea. I did two cycles back to back to bank eggs- the first round I got 12 eggs and ended up with 2 PGS tested embryos. The 2nd round I got 3. My first FET ended in an MC, the 2nd is my almost 3 year-old DD, and my 3rd is my almost 1 year-old DS. We always wanted at least 2 kids, and I am so grateful that I had that second round to fall back on. We are debating #3 now, and are so glad we have that choice.

I'll add that my 2 retrievals were when I was 34. I ended up not having my first til I was 36, and my 2nd when I was 38. If I had tried to do another retrieval at 37 (after weaning my 1st), I doubt I would have been able to get as many eggs, if any.

[Anonymous]

Thanks for all the responses. I am leaning towards a second cycle, but am having doubts with my clinic. I actually do not know the total number of follicles that were emptied at my egg retrieval, I just know at my last ultrasound the nurse counted around 12 (and I had to ask her to count and tell me), but they couldn’t see them all, so I assume I had around 15 follicles at my retrieval. Talked to my RE recently. I asked how many follicles they emptied at retrieval and they said they did know and they don’t count when they do an egg retrieval. They also would not recommend anything different if I were to do a second IVF round. Is this a red flag? Should I be worried? Do most RE’s not know how many follicles a woman has going into an egg retrieval?

[Anonymous]

Anonymous wrote:Thanks for all the responses. I am leaning towards a second cycle, but am having doubts with my clinic. I actually do not know the total number of follicles that were emptied at my egg retrieval, I just know at my last ultrasound the nurse counted around 12 (and I had to ask her to count and tell me), but they couldn’t see them all, so I assume I had around 15 follicles at my retrieval. Talked to my RE recently. I asked how many follicles they emptied at retrieval and they said they did know and they don’t count when they do an egg retrieval. They also would not recommend anything different if I were to do a second IVF round. Is this a red flag? Should I be worried? Do most RE’s not know how many follicles a woman has going into an egg retrieval?

Do you know how big the follicles were at your last ultrasound? Follicles less than 16mm are unlikely to yield a mature egg. They should be able to see more than 12, and at that number you could have plus or minus on or two, but unlikely. Also did you trigger with lupron or hcg? Lupron triggers can sometimes result in empty follicles. We’d have to know your AMH and AFC along with your protocol to assess whether this makes sense or not.

[Anonymous]

My clinic recommended vitamin D3 to anyone cycling. Has yours been tested? Even if it’s normal-low (which it often is) it won’t hurt to supplement

[Anonymous]

Good ideas on supplements. I am not looking for a second opinion on my treatment response, but just wondering if it is accepted practice to not count follicles during IVF. My doctor literally said they had no idea how many follicles they emptied. Just seemed weird to me.

[Anonymous]

Anonymous wrote:Good ideas on supplements. I am not looking for a second opinion on my treatment response, but just wondering if it is accepted practice to not count follicles during IVF. My doctor literally said they had no idea how many follicles they emptied. Just seemed weird to me.

You original post asked for what you should ask your RE before starting another cycle and whether you should request additional testing. I think people provided a lot of really good ideas. I’ve never been told how many follicles there were. Just how many eggs.