For all of you runners, cyclists, and swimmers out there, you know how good it feels to exercise in the pack. There’s definitely comfort in numbers—the energy and the spirit can pull you through even the steepest of hills or the roughest of currents. Drafting off the guy or girl in front of you is also pretty nice! Follicles (a.k.a. eggs) also like the group mentality. Growing in concert or an evenly sized cohort is ideal. It increases the chances that many, if not most, will achieve maturity simultaneously. Mature eggs are the ones that get fertilized, and fertilized eggs = usable embryos!
When a follicle takes the lead, we’re not standing on the sidelines applauding and screaming, “Go, follicle, go!” We’re actually pretty bummed and do everything we can to hold it back and let the others catch up. No, we’re not believers in the “Everyone gets a trophy no matter what place you come in” phenomenon, but lead follicles can negatively affect the outcome of an IVF cycle. They can force you into scheduling the retrieval a bit early to avoid compromising the bigger ones. This can result in a bunch of eggs that are uneven in development and therefore uneven in maturity.
Additionally, if one follicle is putting the pedal to the metal while the others are strolling in the pack, there is dis-synchrony in the hormones secreted. The leader has enough juice to get him or her across the finish line. However, the fumes the leader is releasing can be toxic to the smaller follicles. Hence, it can impair their growth, development, and quality.
When an egg retrieval is performed, there will always be something of a Goldilocks story. Some eggs will be post-mature (too hot), some will be immature (too cold), and some will be mature (just right)! It’s very hard to complete 100% maturity (and probably not normal). When a lead follicle pops up, it can throw the balance off even more. To avoid the leader of the pack, we have many tricks up our sleeve, a.k.a. the birth control pill, estrogen patches, and luteal antagonists, to name a few. The purpose of pre-stimulation medications is to level the playing field and make sure everyone starts the race when the gun goes off (and not a minute before).
If a dominant should arise, we can either chose to cancel the cycle or ignore it. By ignoring it, you can recruit what’s called the secondary cohort. While this can work, it can also compromise the quality of the follicles on the B team. In this case, it becomes a pluses and minuses and pros and cons-type of situation that you and your physician need to have.
Synchrony’s a big deal in ovarian stimulation. It’s what we strive for, what we train for, and what we aim for. We know when it isn’t happening and know how to try and make it happen. When we can’t get it to happen, no matter what we pull out of our hats, it’s a sign of poor egg quality.
Follicles, just like females, like to travel in groups. We can chat, we can bond, and we can share experiences. Going out on your own can throw off the balance of everything else, and it can be lonely! If your follicles appear to be growing unevenly, have a sidebar with your doctor and talk about calling a time out. Even if you do it again and have a lower number that’s more even, that’s probably a better race to run. Think about how much you and your friends can cover if you do it together!