AboutEdward Joseph Ramirez, MD, FACOG Expertise I am a specialist in infertility and advanced gynecological care. I can answer questions about infertility, gynecology related ills, menopause...virtually anything that affects women's health. PLEASE tell me where you are writing from as I am always interested.
Experience I have been practicing as an Ob/Gyn and Infertility Specialist for over 23 years. Gynecology, advanced laparoscopic surgery, basic infertility, IUI's, IVF, reproductive surgery, and ovulation induction are all areas of my expertise. I am Board Certified. I have been doing In Vitro Fertilization in my clinic for 15 years.
Organizations American College of OB/GYN, American Board of Obstetrics and Gynecology, American Society of Reproductive Medicine, Society of Assisted Reproductive Technology, American Association of Gynecologic Laparoscopists, Fellow of The American College of Obstetricians & Gynecologists,Resolve-National Chapter, Open Path - Northern California, Board of Directors Monterey Medical Society
Publications American Journal of Obstetrics and Gynecology
Education/Credentials Medical Degree from Stanford University, Residency at Tripler Army Medical Center, Reproductive Training at Pacific Fertility Center, San Francisco
Question I have recently performed a FIV cycle. I am 31 years old (secondary amenorrhea for 3 years / 54 Kg and 1.65m) and my husband is 32 (no problem, good semen quality). We previously attended 4 AI with negative result in all of them. The treatment I received in the FIV was the following: Procrin (0.15 ml during 15 days, then 0.07 ml until the last day of stimulation) / Menopur (75UI) + Gonal (225 UI and the last 3 days 150, 150 and 75 UI) / Ovitrelle. Doctors checked me by ecography and estradiol levels. Everything seemed ok as follicles were growing synchronized and estradiol levels were acceptable. After 13 days of treatment, doctors saw about 20 follicles of about 15-25 mm by ecography. That day they told me to administer Ovitrelle and two days later the recovery was programmed. The bad surprise was that they only recovered 6 ovocites of the total 20 follicles. They told me that I probably had the empty follicle syndrome. 5 of the 6 ovocites were good and used to fertilize. 3 were fertilized by ICSI (2 were successfully fertilized) and 2 were fertilized by FIV (all fertilized). Of the 4 fertilized eggs 2 were of quality I (the best one) and used in the transfer. 1 of them didn't evolutionate and the other one was of quality III and so neither transferred nor frozen. Transfer was performed 2 days after recovery and so embrios had 4 cells Relating to all of this I have some questions: - I had never heard about empty follicle syndrome. What does it implies (my ovocites are of no quality, I have some other metabolic problems)? - If it is not an empty follicle syndrome but spontaneous ovulation, does this can affect the implantation of the two embrios? - Do you consider the fecundation rate and the embrio evolution rate corrects? - Do I have to worry about anything? I start the FIV with a lot of hope but after the recovery I was very sad and upset. Thank you very much
Answer Hello Laura,
Where are you writing from?
I don't think that you had "empty follicle syndrome" because by definition, no eggs (oocytes) are retrieved. It is not know why this happens in some patients, but in general, it is thought that this was due to bad or inadequate HCG (Ovitrelle). You don't say what the dose was but some doctors under-dose the HCG. Without the HCG, the eggs don't go through their final maturation stage and don't release from the follicle wall. Therefore, none are retrieved. The fact that you had mature eggs retrieved indicates that you did not have EFS. What may have occurred is that the majority of your follicles were not mature enough, and therefore, did not release their eggs, or that there was some kind of problem with the retrieval and the eggs were lost. Premature ovulation is also another possibility. At this point it is difficult to know exactly what happened. At least you had embryos to transfer.
One thing you need to keep in mind with IVF is that it is a method to assist natural conception. That is, your body still needs to go through some of the its own natural processes to get pregnant, and women don't get pregnant every time they try even when trying on their own. That means that you need to keep trying. The majority of patients will get pregnant by 3 attempts. In our clinic, only 50% get pregnant on their first attempt. By three attempts 86% are pregnant.
In addition, it is well known that people respond differently with each IVF cycle. It is very possible that you will do much better the next time. I just had a patient that had 8 eggs retrieved on her first cycle. In this cycle, the second, she only had 1. She didn't stimulate well this cycle, despite a higher medication regimen.
So keep trying. It will eventually work. If it doesn't work in your local clinic, then you can always try in a different one, like here in Monterey with me. We might have better luck.
Sincerely,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
