# Dose of pregnyl for trigger shot, what is your experience please?



## one sweet day (Oct 17, 2015)

Hello ladies, 

Hoping you can help!  I have had 3 failed IVF cycles, and out of all of them only got 2 fair quality embryos.  I'm trying the long agonist protocol again (was on that protocol when I got the 2 embryos).  On that cycle, even though I had over 20 follicles, they only collected 11 eggs, and only 2 fertilised normally.  That time the trigger was 250iu Ovidrel, which I worry was too weak to mature all those eggs properly.  The other two cycles my trigger was 10 000iu pregnyl, which I thought was the standard dose.  On this proposed 4th cycle they have told me it will be 5 000iu pregnyl, and once again I am worried that this wont be enough to mature all the eggs properly.  I know for some ladies 'it only takes one', but for me I really need to get as many as possible because our normal fertilisation rates are so terrible (first cycle 0/8, second 2/11, third 0/3).

We have male factor infertility (v bad morph), I'm 32 and although my hormone levels are all in the 'normal' range, my FSH is almost 3 times higher than my LH (5.7:1.9) and not in the normal 1:1 ratio.  This is normally indicative of a poor responder, and as such maybe the reason why I have had such bad fertilisation rates.  We have always used ICSI.  

I know ladies with PCOS are sometimes given less than normal trigger shot dose to try and prevent OHSS, but I don't have PCOS.  

So I was hoping you could tell me:  whether or not you have PCOS, the trigger shot you used, the number of follicles of a 'good' size ie expecting to provide an egg, the number mature (MII if you know) eggs retrieved and the number of eggs that fertilised.  

Sorry - I know this is asking a lot!    

And help or input would be greatly appreciated, I'm so desperate for this to work and don't want to waste another cycle on a protocol that isn't ideal.  

Many thanks  xx


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## ~Sapphire~ (Apr 14, 2008)

Hi,

I would suggest you ask them why they are proposing to lower the dose this time.  My last fresh cycle I only had 5,000in pregnyl but that was a last minute decision because my levels were high (although I do not have PCOS). Sorry you have experience poor fertilisation I know not getting to transfer is horrible  

Good luck

S xx


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## one sweet day (Oct 17, 2015)

Hi S, 

Thanks for your reply   

It will be my first cycle with this new clinic.  Apparently the 5 000 iu dose is their 'standard' dose.  I've been with 2 other clinics previously.  I'm also concerned that none of my cycles ever involved e2 level testing during the cycle, only one ultrasound scan per cycle.  First two cycles were at NHS local clinic, 3rd was in Prague, this 4th possibly in Brno.  

Were most of your eggs mature?  

x


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## ~Sapphire~ (Apr 14, 2008)

It seems strange to me that you haven't been monitored better with blood tests and scans. I have heard excellent things about the Brno clinic though.

I had 19 eggs and 16 were mature and 14 fertilised xx


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## one sweet day (Oct 17, 2015)

Thank you 

Yes - I think I'm going to ask to have my levels monitored, even if it means spending more time in Brno.  I'd rather they base the trigger dose on that rather than number of follicles or anything else.

Thanks for all your help  x


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## ladybug8410 (Jan 12, 2015)

Hi, I am also interested in the same.
My short protocol cycle, I triggered with 10 , 000 units and got 6 eggs with 4 mature. 
My subsequent long protocol, I triggered with 5000 units and got 14 eggs but only 2 mature.  My oestradiol level was 16,000 at trigger which made them worried abt OHSS but I'm convinced this led to so many being immature. 

Having said that,  there is a question abt my overall egg quality so trigger may not be the only culprit. Interestingly my FSH is also more than twice my LH  (both under 10) and I never knew that was a predictor for poor responder.

Keep us posted if you get any further feedback.


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## Ali_123 (Mar 13, 2014)

Hi One Sweet Day

My clinic in Belgium use 5000 but I pushed for 10000 Pregnyl as had previously had a low maturity rate with Ovidrel 250. They let me have it. Having said that, 5000 is enough for most ladies. 

If you don't mind me asking, have you ever looked into assisted oocyte activation? I assume that ICSI was used in your previous cycles? We had 2 cycles of zero/extremely low fertilisation after ICSI but were finally able to overcome the issue when we went to Ghent where they specialise in this issue. I really think you could benefit from contacting Ghent, if of course you have not done so already. More info in my diary (link below) and there is also a thread on AOA/zero fertilisation under the ICSI section of this website. Feel free to join us! 

Any questions please give me a shout and best of luck! xx


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## Cloudy (Jan 26, 2012)

I have PCOS and triggered with busereline because of OHSS. I got 15 eggs, of which 14 were mature and 13 fertilised with ICSI creating 9 good d2 embies (with 4 good ones left by day 5/6). I had lots and lots of follies, but 15 from about 18 or so "ready" follies. I don't think my trigger (or lack of) affected my outcome at all (especially considering I have a chromosome issue, that's probably what led to drop-off/outcomes more than anything).

Xxx


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## cosmopolitan4112008 (Oct 18, 2013)

My dr uses 10 000 iu.


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## cosmopolitan4112008 (Oct 18, 2013)

For ladies who have OHSS problem, my dr uses Lupron as a trigger shot.


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## sarahsuperdork (Mar 12, 2013)

I can't remember how much pregnyl I triggered with now, probably the standard dose with it being an NHS cycle. I had 11 eggs (I think 8 or 9 mature) and 7 of those fertilised. On day 7 of stimms I had a collection of maybe 3-4 follicles around the 16mm mark and one at 17mm so I triggered after 9 days.


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## one sweet day (Oct 17, 2015)

Thank you everyone for your replies!

*Lady* it was only after my most recent failed cycle that I found out about the FSH:LH ratio issue. I can't believe neither of my clinics had picked this up, and I'm so glad I've started to take things into my own hands instead of blindly following what a clinic says because they are 'the experts'. I have read so many research papers on this issue and the only thing I gleaned was that a long agonist was the best stimulation protocol for ladies with this issue. The other overall thing that I have learnt is that clinics are too quick to blame the quality of the eggs! A big factor in egg quality is down to the protocol and trigger that you use: find the right protocol, get better quality eggs! The problem is that so many clinics want to move you on to a donor cycle as soon as they can so that your failing cycles don't negatively effect their result stats! (Sorry about all the exclamation marks - as you can tell this issue riles me - I was told after each of my cycles that i would have to use donor eggs if I ever wanted to get pregnant, like they weren't even going to try and help me.)

*Ali!* Oh my word I know so much of what you have been through! I found out about AOA but my NHS clinic said they didn't do it (and were quick to tell me that wasn't the issue, anyway). My second clinic where I had my 3rd cycle used IMSI and MACS or something, and afterwards told me they used AOA as well. I was so disappointed with myself as at the follicle scan there were only 3 good size follicles and 5 smaller ones that I feared would never catch up, yet instead of cancelling the cycle (which I should have done, because given our fertilisation rates, we needed a good number of eggs to give ourselves a chance) they told me to trigger, and lo and behold, they only got 3 eggs. 1 did not fertilise, 1 fertilised but didn't divide, and the other fertilised and started to divide and they told me to have a day 2 transfer. It was a 6 cell on day 2 (and being advanced isn't a good thing) and they told me it probably won't work but that they may as well put it back in. It was when I was having the transfer done that the doctor lady doing the transfer was telling me I needed to use donor eggs, and when I told her I wan't ready to consider that, she told me that 'time is ticking'! Needless to say I was in tears from that point on. Anyway, this clinc also did time lapse imaging, and when we got back to the UK i was able to watch the video off the USB stick they gave me. I was so shocked to see that this embryo had gone through 'direct cleavage' and had divided from 1 cell, to 3, to 6! It was a tri ponuclear embryo and would never have resulted in a viable pregnancy and I have no idea why they even considered putting it back in  Anyway on my previous cycles a few of my embryos that had fertilised but had done so abnormally had 0, 1 or 3 pro nuclei. So I am hoping a better protocol with a good trigger will help, I have a theory that sperm DNA frag may be an issue (it's the only sperm issue I know of that can cause embryo issues before day 3) and I am looking into Ghent NOW!!! Crickey, sorry for all this info.

*Cloudy* and *Cosmo* thanks for the info 

*Sarah* I also have always done my trigger on day 9 - wish my fertilisation rates were as good as yours, though 

Thanks all, and any more info from anyone else would be great!! Maybe I look into things too much - but I have got some answers, at least  x


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## Ali_123 (Mar 13, 2014)

One Sweet Day, we had some abnormal fertilisation a as well. 3 1pns in our first 2 ICSI cycles plus what I guess would be a 4pn concieved naturally (it looked like 3 sperm fertilised the egg). These abnormal fertilisation a can be related to activation issues. 

I was told that my eggs were beyond repair by our UK clinic but when we went to Belgium they did further testing on the sperm (mouse oocyte activation test) and it is then that it became apparent that it was a sperm issue not an egg issue. 

We tried AOA in the UK and it didn't do anything for us. They use a different and much more robust approach in Belgium and we were able to finally achieve a normal fertilisation rate as well as a pregnancy. Let me know if you need any contact details. We're your first 2 cycles IVF or ICSI? Xx


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## one sweet day (Oct 17, 2015)

Thanks Ali, 

Yep first two were ICSI cycles as well.  I got your PM's - thanks for all the info!  I will email Bjorn as soon as I can    xx


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