Infertility/Fertility/Fertility ivf cycle


Hi!  I had my first ivf cycle about 4 months ago and it failed. Very low does of stim meds (menopure and follistem) because i am small, 5'1" and 110 pounds and only got 5 follicles, 2 eggs and both desinegrated during Icsi wash. I felt they delayed the retrieval and the eggs were just too "ripe".  I am only 28 and have cystic fibrosis and have been trying for 3 years.  I also have a dermiod cyst on right ovary.  The upped my dose of all meds this time and gave me estrogen priming patches along with 4 days of ganirelix shots before the next round.  Would you suggest something different? Or does this all sound right?  I am just trying to figure out how to respond better since I am so young and all my levels came back normal.  And I have to pay for all treatments, insurance won't cover any.  Thanks for your thoughts!

Hello Jeny from the U.S. (California),

I can't answer this question because it is a "protocol" question.  There are no absolutes in terms of protocols and many different ways to accomplish the same thing.  The way I would approach you could be completely different than another doctor but that does not necessarily make my way right and the other doctor's wrong.  However, let me offer the following suggestions:

Your body size does not influence how much medication you should take.  Your ovarian response does.  In this case, you say you used a very low stimulation dose and as a result you had a low yield.  There is a protocol that some IVF clinics advertise called a "low stim protocol", the purpose of which is to reduce the amount, and cost, of medication a patient uses.  Is that what you did?  The answer to your response, which I find to be below what I would have accepted, is to increase the amount of medication.  The additional Estrogen or Ganerelix will not make a difference.  The follistim and/or Menopur need to be increased to increase the number of follicles you develop and therefore, the number of eggs retrieved.  My goal is to try to get at least 12-15 follicles because I know that there will be a decrease in numbers at each stage of the IVF process: Follicles > retrieved eggs > mature eggs to fertilize > fertilized eggs > embryos > good quality embryos to transfer.  If you look at my Blog, I wrote a series about IVF that explains the strategy more in detail.

In terms of your eggs "disintegrating" at ICSI, there are several possible explanations for this including egg quality, egg maturity and ICSI technique.  Unfortunately there is no way to know what the culprit was.  You might want to re-evaluate the quality of your IVF clinic in light of these "failures".  This is why there are differences between doctors and clinics and variations of pregnancy rates.

Good Luck,

Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program

Monterey, California, U.S.A.

for additional information check out my blog at check me out on twitter with me at @montereybayivf and facebook @montereybayivf.  Skype and internet comprehensive consultations now available via my website for those who want a more extensive evaluation that this site can accommodate  


All Answers

Answers by Expert:

Ask Experts


Edward Joseph Ramirez, MD, FACOG


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.


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 19 years.

American College of OB/GYN, American Board of Obstetrics and Gynecology, American Society of Reproductive Medicine, California Medical Association, American Association of Gynecologic Laparoscopists, Fellow of The American College of Obstetricians & Gynecologists

American Journal of Obstetrics and Gynecology, Wall Street Journal, Monterey Herald, SERMO, Women's Health and Fertility Blog

Medical Degree from Stanford University, Residency at Tripler Army Medical Center, Reproductive Training at Pacific Fertility Center, San Francisco

©2017 All rights reserved.