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People often talk about how physically and emotionally taxing IVF is — as they should. The whole process is so intense and so completely consuming. But there’s one aspect that people don’t really touch on when they talk about the experience of IVF, and that's the mental load of it all.
When you undergo any fertility treatment, the sheer amount of information that gets thrown your way is incredibly overwhelming. As you embark on the process, you learn details of your reproductive system and health you were almost certainly never taught before. And you have to quickly learn this information and use it as you make decisions (with guidance from your provider) about how to approach family-building.
While it’s really empowering to learn about your body in this way, it’s also an incredibly challenging aspect of the process, which is already so hard in so many other ways.
With all this information comes the need for patients to make decisions — one of these decisions comes down to whether to undergo conventional IVF or a minimal stimulation cycle instead. Your follicle count, which is something you’ve probably never considered or even heard of, plays a huge role here.
Confused? That’s normal. These are terms you’ve probably never heard before beginning the IVF process, and to simplify them, we’ve asked Srini Reddy, MD, a fertility specialist at Spring Fertility, to explain the role follicles play in the process and how they influence a patient’s decision to go with conventional IVF or a minimal stimulation cycle.
But first: What are follicles, and what role do they play within the context of IVF?
Dr. Reddy: “Follicles are fluid-filled sacs; inside each follicle is an egg. Eggs are microscopic and not visible on ultrasound. We measure the size of the follicle as a surrogate marker for the maturity of the egg inside. When follicles are small, we assume the egg inside is immature. When follicles grow big, we assume the egg inside is mature. We monitor the growth of follicles on ultrasound in response to hormone medication to determine the appropriate time to do a patient's egg retrieval and maximize the number of mature eggs obtained.”
What happens to follicles during IVF?
Dr. Reddy: “During IVF, we give patients hormone medication to stimulate the growth of follicles and the maturity of eggs. Follicles will grow in size as the egg inside them matures. We monitor the growth of follicles on ultrasound in response to hormone medication to determine the appropriate time to do a patient's egg retrieval and maximize the number of mature eggs obtained.”
How many follicles do reproductive endocrinologists want to see during a patient's IVF cycle?
Dr. Reddy: “There's no set number we want to see. Every patient is different. We ultrasound each patient at their initial visit to get an idea of that specific patient's baseline follicle count. We use this to guide our counseling of patients and set expectations for a realistic egg yield from a single IVF cycle. We expect 50-80% of that initial follicle count to yield mature eggs from a retrieval.”
Does a higher count of mature follicles mean a greater chance of success in an IVF round?
Dr. Reddy: “The percentage of mature eggs retrieved in an IVF cycle that develop into high quality embryos available for transfer depends largely on female age.”
What can follicle count tell you about a patient's reproductive health?
Dr. Reddy: “Follicle count correlates with ovarian reserve and gives us an idea of how many eggs we can expect to obtain from a single IVF cycle. However, follicle count does not correlate with potential fertility. A patient is not more or less likely to get pregnant (if they have never tried to conceive) because their follicle count is high or low, respectively. How many follicles a patient produces mainly comes down to genetics. Conditions like PCOS can cause someone to have an abnormally high follicle count.”
Should people with less than ideal follicle count remain optimistic about the IVF process?
Dr. Reddy: “Age is the biggest predictor of successful IVF outcomes. Even if someone has a low follicle count, younger age will often overcome that barrier. It is also possible to overcome that barrier through multiple cycles of egg retrieval to increase the number of eggs you are able to fertilize in the lab.”
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Is it possible to produce too many follicles?
Dr. Reddy: “If someone going through IVF has a very high follicle count, they can be at risk for ovarian hyperstimulation syndrome (OHSS). We will modify your protocol and medications to mitigate the development of OHSS in high-risk patients.”
That brings us to the question of conventional IVF vs. minimal stimulation. When might a provider recommend minimal stimulation to a patient as a treatment protocol?
Dr. Reddy: “Minimal stimulation is an IVF protocol we offer to patients with low ovarian reserve, typically antral follicle count <5 or AMH <0.5. It involves a combination of oral and injection medications with lower total injection medications used. Data shows that in those with a low follicle count, lower doses of medications will result in the same number of eggs retrieved as doses of medications, i.e. conventional IVF. A minimal stimulation protocol saves the patient money on the cost of medications, blood draws, and ultrasounds, as well as the physical and mental toll multiple daily injections takes.”
So, how do you know if conventional IVF or mini-stim IVF is right for you?
To start, find a fertility clinic, like Spring Fertility, that offers both options and recognizes that different protocols and approaches may be necessary to help you achieve your family-building goals. Every fertility journey is different; what matters most is that you are seen as an individual, not a number, and feel like your unique needs are being met throughout the process.
Zara Hanawalt is a freelance journalist and mom of twins. She's written for outlets like Parents, MarieClaire, Elle, Cosmopolitan, Motherly, and many others. In her (admittedly limited!) free time, she enjoys cooking, reading, trying new restaurants, and traveling with her family.