How many follicles is too many for IVF?

4 fertility expert(s) answered this question

Answer from: Raúl Olivares, MD

Gynaecologist, Medical Director & Owner
Barcelona IVF

We don’t believe that having too many follicles is a concern when considering IVF. However, it’s crucial to be cautious when stimulating patients with numerous follicles to avoid the risk of ovarian hyperstimulation syndrome. Additionally, due to ethical reasons, we should also avoid creating an excessive number of embryos that exceed the reproductive goals of the couple. Therefore, when we anticipate that the number of follicles will be too high, we recommend not stimulating the patient as much. If we were to determine a suitable number of eggs, it would typically fall between 10 and 15 mature eggs.



Answer from: Patricio Calamera, MD, MSc, ObGyn

Gynaecologist, Specialist in Reproductive Medicine

There is no such thing as too many eggs for IVF. Sometimes, in PCOS patients, the more we can get the better because as we see the quality of those eggs and high amount of eggs , we can get those that are of a good enough quality to produce good embryos. So a high number of follicles or a high number of oocytes, does not affect the IVF outcome at all. It is about the quality of those eggs so if we get good quality embryos out of a few oocytes – it is good. If we need many eggs in order to get a good quality embryo, it is the same, it is all about getting a good quality embryo.

Answer from: Guillermo Quea Campos

Gynaecologist, Specialist in Reproductive Medicine
Pronatal Fertility Clinics

Above 15 follicles we will speak about a hyper response to the stimulation. Can a high number of follicles affect the outcome? No, a high number of follicles will force us to carry out a strategy to prevent hyperstimulation and the appearance of hyperstimulation syndrome.

Answer from: Scott Nelson, Professor

Gynaecologist, Muirhead Professor of Obstetrics and Gynaecology at Glasgow Royal Fertility Clinic and Medical Director at Access Fertility

In terms of having more follicles, you’re going to have more eggs and therefore more embryos and therefore, better embryos potentially to transfer. The problem was as you create those follicles you can also release progesterone and you can get what’s called a premature rise in progesterone and we know that if progesterone levels are increased, the fresh embryo transfer success rates go down. Although you actually may have more embryos and a better chance overall to transfer those embryos in the fresh cycle might be detrimental you might end up with a reduced success rate or that fresh embryo transfer. What we should be doing there is freezing all the embryos and then putting them back in the future as you know it’s a frozen embryo transfer to maximize that success rate. There’s a kind of complex relationship between what kind of more is better and I say but if you are aiming for a stress transfer that is the sweet spot of about 11 eggs.

About this question:

Can high number of follicles affect the overall IVF outcome?

Number of antral follicle count indicates the potential outcome of stimulation and therefore can be a key predictor in success for the IVF. It also suggests which protocol or medication should be used in the treatment.

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