Dear team of experts, I recently described our story. We would like to try this last subsidized attempt in Germany and if it turns out to be negative again, we would like to switch abroad and take advantage of the numerous additional options there. However, I now have another question about our current attempt. My wife has had 3 ICSIS so far - according to our original doctor, she suspects endometriosis, which is probably why her egg quality is reduced and our blastocyst rate is significantly lower than expected. I myself have a restricted spermiogram, but this should no longer have a major impact thanks to the zymot chamber and ICSI.
1st ICSI 2024 AMH 4.5: with 100 I.U. Pergoveris and Ogralutran for 16 days and triggering Ovitrell - of 20 follicles 16 punctured eggs, 15 mature, 11 fertilized - 2 blastocysts day 5 4AA and day 6 5AA --> birth of our son
2nd ICSI 2026 AMH 2.55: with 125 I.U Pergoveris and Ogralutran for 9 days triggering with Triptofem 2x - of 19 follicles, 8 punctured eggs all mature, 7 fertilized - 2 blastos: 1BB, 5BB
3 ICSI 2026 AMH 2.55: with 150 I.U. Pergoveris and Orgalutran for 9 days Release with Ovitrell - 19 follicles - 11 punctured eggs, 10 mature - 6 fertilized - 1 blasto: 3BC
Now to my question, we wanted to try the long protocol due to the assumed endometriosis - but the new doctor said that the cost-benefit ratio would not work, as I would first need an artificial cycle for ovulation in the pre-cycle, because I don't have a cycle myself, and then the actual stimulation cycle with downregulation. I understand his argument, but I would have liked to change something as our yields seem to be getting worse and worse, as is my egg quality, but he insists that I do the same protocol again this time with 175 I.U. pergoveris orgalutran and then Ovitrell - now I'm terrified that we'll see even worse results because I'm afraid that my egg quality will suffer from the dose. Am I thinking completely wrong? Could I ask to stimulate again with 100 IU despite the lower AHM or do I risk getting too few eggs? The doctor is focusing on quantity - which I partly understand, I would also like to have as many eggs as possible, but also with GOOD quality so that they don't all have too little energy for further development into blastocysts and stop between day 1 and 4. Do you have any suggestions as to which triggers might help to ensure that not so many follicles remain empty? I also didn't quite understand that 19 follicles always mature relatively well in size, but then so few can be punctured? Where do these empty follicles come from? incorrect maturation? Wrong protocol? Wrong trigger? or are these cysts that contain no eggs at all?
I apologize for my long question, but I would like to go into the consultation and the next attempt as well prepared as possible, especially because I feel very uncomfortable with the current doctor and not in good hands at all... He only ever talks about rotten eggs and cost-benefit and always says just keep going without thinking about the strategy behind it. maybe you can help me here! It's about SO MUCH MORE than money and I want to do everything I can to be lucky enough to become a mom again!!!! THANK YOU SO MUCH
