Saturday, December 08, 2012

Why you may not get eggs during your egg collection

In most IVF clinics , egg collection is a routine procedure. Most patients will grow quite a few follicles and the doctor will successfully retrieve eggs from most of these follicles. However, sometimes doctors may not get any eggs at all after the egg collection; and there are five possible reasons as to why this may happen.

1.    The follicle may have ruptured prior to the egg collection. This may happen if the hCG injection is mistimed ; or if the egg collection is delayed beyond 36h of hCG administration for some reason. Under such circumstances , the follicles rupture and the extruded eggs may be lost in the follicular fluid found in the pouch of Douglas behind the uterus at the time of egg retrieval. The doctor may not be able to retrieve eggs from this because he no longer has intact follicles as targets to aim for.

2.     The doctor may experience technical problems during the egg collection . This may happen when the patient is very obese ; or if there are adhesions in the pelvic region, as a result of which the ovaries are not easily accessible (sometimes the ovaries remain hidden behind the uterus ) with the vaginal ultrasound probe. This can be a major problem when the doctor is inexperienced in performing follicle puncture ; or when the egg collection is not done under general anesthesia and the patient has a  low pain threshold , and cannot tolerate the vaginal manipulations.

3.     Sometimes in patients with few follicles , if the doctor does not use a double lumen needle for flushing each follicle scrupulously , it's possible that even though the egg is present in the follicle , he may miss this. Similarly, if the embryologist is not experienced , it is possible that even though the egg is present in the follicular fluid which the doctor retrieves from the follicle , the embryologist may not be able to identify the egg within the oocyte cumulus complex, because it is too small or too dark.

4.     Another reason for the failure to retrieve eggs from mature follicles is due to empty follicle syndrome.   You can read more about this at http://blog.drmalpani.com/2011/06/what-is-empty-follicle-syndrome-why.html


5. The final possibility is that there are no eggs in the follicles at all. Fortunately, this is not a common problem , but will occur in clinics which do not monitor patients carefully; and those who batch their patients. They may end up triggering at the wrong time ( too early or too late) because of logistic considerations
( the doctor may be available for only 2 days, and all egg collections need to be done in this window of time, whether or not the follicles are mature).

Even in good clinics, we may not find any eggs in patients with a poor ovarian response , even though we monitor follicular growth with serial ultrasound scans;  and their E2 levels rise well . It's still possible that there may not be any eggs within the follicles at all because of their diminished ovarian reserve. Unfortunately, there is no way of predicting this in advance , because estradiol ( E2) is produced by the granulose cells which line the follicle , and not by the egg itself. This is why it is particularly important for patients with a poor ovarian response who have just one or two follicles to find a skilled doctor who will do the egg collection under general anesthesia , using a double lumen needle ; who will flush each follicle scrupulously ; and will work with an experienced full-time embryologist to make sure that if there are any eggs in your ovaries, he will be able to collect them and use them for in vitro fertilization.

However , if you are doing IVF in a clinic which performs IVF in batches , the chances of your getting no eggs at all because of technical difficulties is much higher , because the doctor may not have enough time and energy to devote to your particular case . If you are a technically challenging patient you need to find the right IVF doctor who will offer you individual attention , so that the possibility of failing to collect eggs from your follicles is reduced .
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