Good AMH but bad quality eggs?

[Hatethewait85]

Hi all, wondering if anyone has a similar scenario and maybe a success story to share?

Here's the deal - I'm 28 yo (hubster is 30) and we've been diagnosed with unexplained infertility. ZERO bfp in the 2.5+ years we've been ttc. We recently went through an IVF cycle using the antagonist protocol - doc was worried about OHSS given age and great AMH (4 on the US scale) and wanted to trigger with lupron. I responded well to the meds and had 22 eggs retrieved. However, during my stims my progesterone levels rose to be >5 on the day of retrieval. In that scenario (progesterone >1.5 on ER day) my doc will freeze all the embryos because of the effects the progesterone will have on the lining (age of the lining won't match age of the embryo so success rates plummet). Out of the 22 eggs, only 11 fertilized, and then only 3 made it to blast with good enough quality to freeze. We did two FETs with BFN each time.

All that to say my doc thinks I have an egg quality issue even though I look great on paper. She said I responded well to the meds but most of the eggs collected were immature. She said my premature rise in progesterone also points to poor egg quality. BUT she doesn't know for sure given how good things look on paper and my 'young' age. She said it may have just been a bad month or it may have just been the protocol. She said we may have completely different results with a different protocol and would suggest trying the long/lupron protocol if we want to try again. If we get similar response it would 'confirm' an egg quality issue and then she'd recommend donor egg/embryo or adoption.

What I want/need to know- Is there anyone out there who had a similar response that went on to have a successful IVF cycle?? If so, what protocol did you use and how many times did it take?

We're also looking into immune testing to rule out other causes before deciding on another round of IVF. Some success stories would really help make our decision a lot easier!! Thanks in advance

 

[MoBaby]

i am surprised the antagonist protocol was the first one used... however i dont think your scenario is unusual. my egg quality is fine and cycle 1 i had 14 embryos w/ 2 blasts (19 eggs collected); cycle 2 9 embryos w/ 2 blasts (17 eggs? i cant remember); cycle 3 22 eggs collected 12 embryos with 6 blasts froze 4 used all 6 to finally get my bfp.... i think your re is calling poor eggs due to you not having bfp yet. progesterone does sometimes start to rise as body tries to ovulate and it will affect the implantation. how many days stimms? i dont think re should say bad eggs until youve at least had another cycle w/ different protocol.

are you possible pcos? its not uncommon if so that a bunch of eggs are collected and a bunch are immature. also triggering with lupron and not hcg leads to less mature eggs as hcg does the final maturation.

you may want to consider a second opinion at this point. if re is calling bad eggs now then re may be reluctant to try new things and may start pushing donor eggs on you. I think aniother try with a different protocol would be best for you.

 

[bugs]

I have an ok AMH not great but not on the floor. We have had 8 full cycles ranging from short to long, high stimms to low and we always produced 60% immature eggs and the embryo's left we're never of great quality. My uk clinics answer was to put me on a crazy high dose of menopur to which we got 17 eggs only 7 could be used and not a single one fertilised.
After having one last attempt in January with my own eggs on a lower dose of stimms and a double dose of trigger shot it made no difference still immature eggs and poor quality embryo's. My doc said it is very rare but she believes I will not be able to change this no matter what protocol we use so we made the decision to move to donor eggs.

Good Luck with whatever you decide xxx

 

[Hatethewait85]

MoBaby- Congrats on your bundle of joy! Thanks for sharing your experience! It gives me a ray of hope!! What kind of protocols were you on each time? Did you do anything different for your 3rd cycle to make it work?! I know the long/lupron protocol is the most common but my doc wanted to be able to trigger with lupron to help prevent OHSS so she used the antagonist protocol. I can't remember exactly how long we stimmed but I think it was 10 days so not too fast. The other fs in the practice was the one I saw during my stims when my progesterone started to rise. He said it wasn't uncommon to see that if you made a lot of eggs... but it sounds like in the end my progesterone got higher than most. If we try again, our goal would be to stim a little slower/longer to hopefully get fewer eggs but better quality. I'd like to see 15ish vs the 20+ we got. She hasn't given me the definitive 'death sentence' of bad egg quality yet. She said in the end she really didn't know and couldn't make sense of things. Like you've said, another round is not unreasonable and she suggested trying a different protocol to see if response was better. One thing I love about my doc is she's gone through all of this before (and unfortunately, was never able to carry a pregnancy to term) so I know she feels for us going through this.

bugs- You are so strong! It sounds like you have tried everything to make it work with your own eggs. Did you try acupuncture or herbs at any point? I hope your donor egg cycle gets you your rainbow baby. In the end I worry I will have similar results as you but I think I will always wonder 'what if' if I dont try again...

I really appreciate your responses. I'm definitely leaning towards a second IVF cycle using the long protocol this time. But I think I am going to wait a couple of months and use herbs/acupuncture in the meantime to try and get my body in the best possible state. I'm also trying to get in to see a reproductive immunologist in the area to rule out any autoimmune issues. Although it appears I have to fill out paperwork to see if I 'qualify' so I guess we will see what they say.

 

[MoBaby]

I did the long lupron first two then the successful one (or fresh cycle where LO came from) I did microdose lupron flare. I had 10 ( or was it 11) days of stimms every cycle but I did make the most eggs in third cycle. But I also had 5 that didnt fertilize in that cycle whereas in previous cycles everything mature fertilized. Our embryo issue was crappy sperm which caused the embryos to be poor quality and also most likely the mcs even though both were genetically normal. In ink it just takes the perfect egg/sperm combo and unfortunately it takes a little longer in some of us.

When I got a second opinion I was going to be on antagonist but with high amount of stimms and lupron trigger b/c that RE wanted a bunch of eggs to work with so we could do PGD and freeze all normals and do single FET. But we decided last minute to do our last chance FET with our current RE which worked.. We almost didnt do it. Good luck with your upcoming cycle! The long lupron really isnt bad. You should respond well and your RE can start low on the meds so you don't make too many eggs or grow too fast.

 

[Hatethewait85]

Thanks for sharing mobaby. Although I hate to see other people have to fail IVF more than once, it really make me remain hopeful that I'll get there in the end. I know the long lupron isn't too bad - it's just knowing how long it takes that stresses me out! I loved how quick the antagonist protocol was.

Does anyone else have any promising stories?

 

[MoBaby]

The microdose flare protocol is super fast too.

 

[Hatethewait85]

The microdose flare protocol is super fast too.

Hmm. I'll have to look into that. Thanks!! I know there was one protocol that was bad if progesterone rose during stims but I can't remember if it was the flare or something else.

 

[meli505]

Hey Hatethewait85,

I know this is a super old thread but I'm dealing with such a similar issue right now I was hoping you might still see my reply! My 4th IVF cycle just got cancelled today, on day 5 of stims at the first monitoring appointment. I had a huge 19mm dominant follicle and elevated progesterone already, on only day 5! My last IVF, which failed, I made it to retrieval but I had very elevated progesterone before retrieval, and ended up having a high rate of immaturity in the eggs they did find. 20 decent sized follies at trigger, only 10 eggs retrieved, only 4 mature! Did you ever get an explanation as to why your progesterone rose prematurely or why you had a maturity issue? Are the two related? My doctor is at a loss, I have already gotten two second opinions and I'm losing my mind slightly... Hope you ended up fairing better than I am right now, hope to hear from you!