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Any success after cycle(s) with dominant follicles? What was changed?

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  1. #1
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    Any success after cycle(s) with dominant follicles? What was changed?

    So it looks like another cycle with a dominant follicle. Has anyone gone from dominant follicle cycle(s) to retrieving multiple eggs? If so what changed?

    My current MDL protocol:
    BC- 2 weeks
    Lupron- Started 2 days after discontinuing BC; 20 units which is 2 mg per injection done morning and night for a total of 4 mg per day (20 units per injection of 40 mg in .2 mL)

    Menopur- 300 units (FSH and LH)

    Follistim- 300 units (FSH)

    My last protocol was the same, but with 150 units of Menopur and 450 units of Follistim.

    I am wrestling with feeling hopeful that we at least have one egg versus feeling so disappointed that I’ve turned into a dominant follicle machine… and living with the slim hope that my other follicles will decide to grow and my U/S tomorrow will show multiple follicles above 10.
    Last edited by GreenIvy; 09-18-2011 at 09:36 AM.
    Me: 39, DOR DH: 33, MF
    TTC: 4 yrs
    IVF#1: cancelled
    IVF#2: dominant folly- converted to IUI
    IVF#3: 2 eggs, 1 egg fert and arrested
    IVF#4: 2 eggs, but no fert
    IUI due to X-mas clinic closing- chemical
    IUI due to new job- BFN
    IVF#5: ovulated so IUI - BFN
    IVF#6: 4 eggs, 3 fertilized & x-ferred- BFN
    IUI due to summr clinic closing- BFN
    IUI-BFP- MC @ 11 wk
    chemical on ntrl cycle rt aftr D&C

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  3. #2
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    Birth control pills have nearly always left me with a dominant follicle...they just don't suppress me well enough. (I am 46, 10 IVF cycles).

    You're an older patient, too. Try a low dose cycle....start suppression on CD2 (ganirelex) and see if that doesn't help?

    Last cycle I did, I stimmed for 5 days at 150iu a day and was ready to trigger. They only got 2 eggs from me as they waited until CD6 (!) to suppress me (I warned them too!).


    2 IUI, 10 IVFs, 1 FET. In all, 30 embryos transferred, not a single BFP.
    Stage 4 endo, fallopian tubes destroyed/removed.
    MTHFR hetero, elevated NKs, NKUs, cytokines.
    Moving onto GS using my own eggs in 2011/2012.

  4. #3
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    greenivy - how much bigger is your dominant follicle than the others? what CD are you on and what do your e2 levels look like right now? i just did my first IVF cycle, and also had some issues with a dominant follicle. i'm in a slightly different situation than you - i have functional amenorrhea and a very high antral follicle count, so i'm an overresponder - but the other follicles ended up catching up for me and i was able to go forward with the retrieval and got 25 eggs (the transfer was canceled because of very high E2 levels and risk of OHSS, but that's another story).

    here's my information, in case it's at all helpful to you:
    long protocol (suppression with BCPs and 10 units lupron)
    day 8: largest follicle was 14 mm, others were mostly 7-10 mm, E2 = 1745
    day 9: largest follicle was 17 mm, others were mostly 9-11 mm, E2 = 2778
    day 10: largest follicle was 19 mm, others were mostly 9-13 mm, E2 = 3407
    day 11: largest follicle was 19 mm, others were mostly 9-15 mm, E2 = 4320
    day 12: largest follicle was 22 mm, others were mostly 12-16 mm, E2 = 6138 (!)
    day 14: 25 eggs retrieved, 16 fertilized, having to freeze all embryos because E2 is too high for transfer

    there are a couple of issues with a dominant follicle:
    1. the dominant follicle can suppress the growth of the others. if this is the case, your E2 levels will be pretty low and not rising very fast, the rest of the follicles will not be getting bigger between scans, and you're unlikely to get multiple eggs at retrieval. if this isn't the case - you can see that the rest of the follicles are actually growing between scans and your E2 is rising faster than you'd expect for a single follicle - it's possible for them to sacrifice the dominant follicle mature and let it get too large and wait for the others to catch up.
    2. the dominant follicle can begin to luteinize. this doesn't affect the quality of the other eggs, but it can lead to premature production of progesterone that can compromise lining quality and reduce your chances of successful implantation. one way to get around this is to freeze all embryos, but you want to make sure you have enough that you're likely to get some to freeze.

    i think that 20 units of lupron is already relatively high, so it's doubtful that they'd give you more next time. another possibility could be that they could increase your starting dose - my RE seems to say that the initial dose is the most important for determining the number of follicles that are recruited - i'm not sure if that's possible for you? another option might be to switch protocols to an antagonist protocol - some people on other boards suggested that they'd switched between protocols to avoid this problem, but i don't know much about that.

    good luck - i really hope that your other follicles catch up. i was definitely freaking out about the dominant follicle issue and was lucky to have it resolve - i hope it happens to you. please keep us posted!
    Me - 37, hypothalamic amenorrhea
    DH - 31, TTC since 7/10.
    2 clomid cycles: BFN; IUI #1-4 (2/11-5/11): BFN
    IVF #1 (9/11): no transfer (OHSS). 25 eggs, froze 6 day 3; IVF #2 (11/11): no transfer (abdominal bleeding & OHSS). 22 eggs, froze 5 day 3.
    FET #1 (2/22): ET 2 8 cell day 3 embryos
    Beta #1 (12dp3dt):227; Beta #2 (14dp3dt): 548; Beta #3 (23dp3dt): 20661
    U/S (3/23): 2 heartbeats!

  5. #4
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    I had a dominate follical group with my first IVF (after having a functional cyst the month prior) and I wasn't on BCP at all with either of my cycles. I agree that your on a VERY high dose of lupron. I am surprised you can even produce anything on that! I was on 10 units that dropped to 5 with my first cycle and 5 units the whole time with my second. It could be that your dominate follie is feeding off the lupron too. That is what happened to me once before I started stims. Stop the lupron and my cyst that was functional went away.

    It might be worth it to consult with a different RE just to get a fresh pair of eyes on your case. Sounds like you could be tricky. Good luck!
    Jennifer (36) - Final try FET Nov. 12, 2012. You can follow my story at: www.OurUnplannedLife.com (Caution child, child loss, and cancer mentioned in blog)

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