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Failed IVF: Empty Follicle…Should I Try Again?

QUESTION:

Hi Dr. Ramirez,  I had an failed IVF attempt last week. It was my first attempt. I am 41 yoa. My estrodial was 1950 and I had 5 follicles (14, 16, 20, 20, and 25). No eggs retrieved. My injections included Lupron 20, menopur 250, and Gonal 250. My dr. flushed my follicles 3 times. My FSH is 6 with low AMH and endometriosis. My dr. is perplexed and has told me to move to DE. I on the other hand believe we just need more HCG or I probably should have come back the next day for another retrieval attempt. Please tell me what your experience tells you is our next step. M. from Colorado

ANSWER: Hello M. from the U.S. (Colorado),

Although this is unusual, it happens and has happened to me as well.  Women do have follicles that are empty with increasing age.  Certainly the sizes of the follicles should have led to a mature egg being retrieved, but assuming that you did not ovulate prematurely, and your doctor flushed the follicles several times, it should have yielded an egg if it were there.

Donor eggs certainly is an option, but continue to try with your own ovaries is an option also, since your ovarian function is still good.  Every cycle is a unique and different cycle and new follicles and eggs are recruited.  Just because this batch yielded nothing does not mean that it will happen again.  I think that if you are willing to take the risk (financially) and continue trying with your own ovaries, then that is the way you should go until you convince yourself otherwise.  You can always do donor eggs in the future if you have to.

I have had patients in the past, younger than you, with empty follicles at retrieval and I think it was due to inadequate activation by the HCG.  At the time I was using generic HCG.  Since then, I have switched to Ovidrel to be absolutely sure, but still have had some empty follicles in older patients, but none in younger patients.  If you check out my blog, www.womenshealthandfertility.blogspot.com, you’ll find more information regarding this subject, but the purpose of HCG is to put the egg through its final phase of maturation.  Without this, the egg does not release (pinch off) from the wall and cannot be retrieved.

Good Luck,

Dr. Edward J. Ramirez, M.D., FACOG

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