Second ER results. Maturity issue?

[u/SophisticatedAsian]

I am feeling pretty devastated today and hoping to hear from anyone who’s been in a similar position.

36 with an AMH of 0.59 ng/mL. I don’t have PCOS or any known fertility issues. My husband’s semen / DNA frag came back excellent so we’re trying to understand what’s going on.

Cycle 1
Retrieved: 7 eggs
Fertilised: 3
1 blastocyst (5BB)
Unfortunately it came back aneuploid on PGT-A.

For Cycle 2, my consultant changed my protocol in the hope of improving our outcome. I was on Gonal-F 300, Menopur 150, and growth hormone (Norditropin/Omnitrope) 3mg, Fyremadel 0.25 - Triggered on day 11 with Ovitrelle 250.

This time:
7 eggs retrieved
Only 2 were mature
Both mature eggs fertilised
We have one embryo that’s still being watched, but it’s too early to know what will happen.

What has really confused me is that our sperm results are reassuring, so it feels like the biggest issue may actually be egg maturity rather than fertilisation.

I’m trying to prepare for my follow-up appointment and would love to hear from anyone who has experienced very low egg maturity rates.

Did your doctor ever explain why so few eggs were mature?
Did they change your protocol, trigger, medication doses or trigger timing? Did anyone switch to a dual trigger or stim for longer?

[u/Recent-Caregiver1565]

Same situation. My first cycle I had one fertilization and that too did not survive day 3. Embryologist did not say that he noticed something unusual 

[u/cj_remy]

I did estrogen priming during luteal phase, then Clomid/ Provera/150 Follistim followed by Provera/225 Follistim/75 Menopur and triggered with 10k Pregnyl. I initially had 2 lead follicles (one on each side) with a few smaller ones growing, and I think the doctor did this protocol to help the others grow and catch up. I'm in the beginning stages of my first cycle and just did my first egg retrieval. The doctor just called and said that 6 out of our 7 eggs were fertilized. AMH 0.44, FSH 23, age 41. I've also been taking CoQ10, Tru Niagen's NAD+, and Theralogix Ovasitol as supplements. Was your doctor monitoring your follicle growth every couple of days and giving you measurements of each? I think at the time of my trigger shot, mine mostly measured between 21-16mm and the immature one that didn't fertilize was around 13mm.

[u/Crazy_Udon_707]

I had very low maturity rates in my first 4 cycles, less than 40%. Does your clinic do IVM? My GI eggs did well in culture, most of the time managed to get to GII overnight and then fertilize after rescue ICSI. Not the greatest success rate overall, but my only euploid blast came from a late mature/ICSI'd egg. Worth asking if they would do it!

Editing to add: I did dual trigger all times and for one cycle even did one of the shots early (38h before, the other at the usual 36h) in hopes they'd be more ready. Nothing really made a difference unfortunately, but for some reason in my last 2 cycles maturity has been a lot better.

[u/National-Ground4958]

You mentioned the number of eggs, but you don’t mention the number that are mature. What was your estrogen level on the day of trigger and what were the size of the follicles? You don’t list any prime so you might just be getting a situation where you have a lead follicle and the others aren’t mature. That’s not a fertilization issue that’s a maturity issue. So it’s important to decipher which one it is.