Yea, IMO, I think that's what the RE's from large clinics aim for in the general population... donor or yourself! I guess RE's figure they are doing pretty good if they get a handful of eggs since a lot of infertile women respond very poorly and get less than 5 eggs and a few of those 5 eggs are probably immature. I was disappointed too to hear this when we went to CA for a 5th IVF because my RE here in our state had always gotten 10-15 eggs with my FSH under 3 and a fairly low dose of 1-2 amps of FSH meds. I think aiming for 5-10 eggs is lame considering the expense we are going through and there is not likely to be frozen if all eggs aren't mature and if all eggs don't fertilize.
The difference, IMO, is that the larger IVF clinics have a standard protocol and they just give that standard dose of 2 amps of Gonal-F and 1 amp of Pergonal or Repronex to everyone... whether donor or you. I had reams of records with the dose of what med I had taken for each cycle and it was generally the same with a bit of tweaking of the dose, had my E2, my progesterone, my linings, and all the records for the previous 4 IVF cycles with my RE. I don't think the other RE with the big clinic out of state took 1 look at any of the records for the cycles!!!
The RE did what he always does with every patient and the 5th IVF he only retrieved 5 eggs and just 3 were mature so we only had 3 embryos to transfer to our SM. What a bummer and it was the poorest cycle I ever had so I went back to our hometown RE!!! The next cycle with the hometown RE he retrieved 20+ eggs. He knew how high my E2 could get without the Progesterone affecting the egg quality and he tweaked the dose and trying to get the most amount of follicles and having them all be a mature size.... like "baking a cake"... trying to get the best darn cake he could and not going by the book-LOL!
I was really surpised when we did egg donor and our "proven egg donor" at the clinic in CA was put on 3 amps... just like I had the "standard" protocol with my awful cycle! The 2nd egg donor who was "not proven" and had no records of how she responded was put on 2 amps since she was young but then they upped it a bit mid-cycle. I have done about the same or better in terms of quality and quantity than both egg donors, but I had no pregnancies with me and it was 2 years before a pregnancy with a SM using our gametes, so that was part of the reason to do egg donor... to change a variable... and perhaps change the success rate.
The RE in CA put me on different meds and I questioned why since I had such good results with my previous retrievals in terms of number and quality on a certain med and a certain dose. He said they found that these certain meds produced better quality eggs than just doing plain FSH like Gonal-F.
RE also did a short stim cycle of 9 days and I had always done meds at least 12 days before HCG so I don't understand why he changed that either. He explained that their research showed longer stim cycles could affect egg quality. (I think it's different for each woman.) If that RE bothered to look at my records he would have SEEN that longer stim cycles for me resulted in a nice quantity of eggs and a nice quality. This may not hold true for everyone, so the RE's gotta look at the records. My eggs fertilized great too.
Also that other RE's clinic seemed to have a cut-off E2 level... not wanting it to get above a certain number...1500 comes to mind. My E2 with my hometown RE averaged 3,000 to an all time high of 6,000 before HCG and directly correlated to the amount of follicles I had and the size and maturity.
The other RE didn't want follicles over 18 mm. With my hometown RE I had follicles that were all 18 mm (considered mature follicle) and then some were of course much bigger at 20+ and a few at 30+. The CA RE explained that if the follicles were too big in size the eggs inside could become "overipe". I thought eggs were either mature or immature....
My hometown RE did lots of ultrasounds and tweaked the dosage going from 3 amps in the beginning to 2 amps, then 1 amp, sometimes coasting. The other RE just kept things at 3 amps so it was like he was using this "standard" recipe for baking a cake instead of adding more flour if the dough was sticky or baking things longer if the cake wasn't done, KWIM?
Another thing is that when we did surrogacy my E2 didn't really matter because getting pregnant in itself can cause OHSS so since I was just going through the egg retrieval and our surrogate was going through the transfer and hopefully getting pregnant, it was not a big risk for ME to get the E2 high. So, IMO it is not a big risk for egg donors to have a high E2. I NEVER had to go in the hospital or anything like that with those high E2/s ranging from 3,000 to 6,000. Sure I felt a bit bloated, had to hydrate myslef, got a little dizzy, but nothing major.
Also the amount of follicles you start out with is the amount you'll have in the end. So it is better to start with a higher does of meds in the beginning and you can always taper off.
I am rambling but having been through so many IVF's and in different states with different RE's, I've learned a lot. Hope I haven't confused you.
Emily- 3/02
- Alexander David and 
