The morning after

So I had to get up at 5 this morning to pee, should be happy it is getting later each day, and after 1.5hrs have given up on being able to fall back to sleep.

I have come to a few conclusions.  I believe my cycle failed due to the trigger not working properly.  If it wasn't for all those empty follicles I should have at least some embryos make it.  Of course there is also the question on why my embryo quality sucks so bad for a 33 yo.  2/4 fertilization is normal, but it is not normal to have embryos die at 1 day old and our only 2 did.   A similar thing happened with my previous cycles, though we had more embryos so 2 good ones at least made it past this point.  I mean there are women that only get 1 or 2 eggs and make it to ET and some even get a baby out of that.  At least with most people their embryos don't arrest until after day 2.  Mine don't even make it that far.
I don't know why and it is hard to find information out there since it is so rare for embryos to arrest that early, like I said most arrest between day 3-5.  I did find a couple of posts from some women who had arrested at the day 2 stage, but never the day 1 stage - I mean this means my embryos didn't even cleave once.   The only thing I can find says that before day 3 it is an egg problem since the egg should make an embryo to the 8 cell stage and then the embryo's genome is turned on.  I don't know how true this is, but it sucks because we originally started ivf for mfi only, all my tests were good.

Anyways I have decided a few things for next time.
1. I believe taking menopur from the start was wrong.  Though most doctors believe LH is needed most do not believe it should be given in the first few days of stims.  In a natural cycle, only FSH is secreted which helps recurit that cycles follicles to grow.  Once the follicles start growing, LH is also released in tiny amounts until the egg is mature when it surges quickly to cause the final maturation.
There have been reports that LH given early can cause bad quality and now that I think about it might also be a reason why the trigger wasn't effective.  Since the LH surge can not happen in ivf they use hcg to minmic LH to cause this final maturation that is needed.  Maybe my eggs didn't respond too well to the hcg because they have been exposed to low amounts of LH from the start.
My first cyle I was on LH (repronex) but it was started on day 5, while my 2nd cycle I was not on any LH at all, just gonal-f which is purely FSH, of course that cycle I didn't start the anatgonist until my lead was 17 and my LH was starting to rise so I was exposed to a bit of LH -it was just in the natural form. 

I am going to ask my doctor about this point and have decided that either way I am going to avoid menopur for the first few days of stims.   So if she says to be on 450 gonal-f and 150 menopur again I will take 600 gonal-f only for the first 5 days and then after the first u/s and bw go down to 450 and add in the menopur.  This way I will be getting the 600 units of FSH that I need, but avoiding the additional 150 units of LH at the start of the cycle.  I will also save myself $30 because I wouldn't have to buy more menopur since I have 24 left over vials from last time and stimming this way I will only need to use 16.  Also I have more than enough gonal-f to do this as well.

2. I believe my biggest problem with my last cycle was because of the empty follicles.  Now I don't know if this was a trigger problem or just a really poor egg quality problem.  I also don't know how aggressive the RE doing the ER that day was with trying to get the eggs.  Normally eggs are removed from the follicle by aspiration, however if that is unsuccessful than sometimes they will try repeatly flushing the follicle.  I don't know if this was done with me or not.  I would guess that they didn't spend a lot of time since they are probably on a strict time limit on how long to do ER for (which shows by my ER happening right at 9am).   A 15 min ER slot may work for most women, but when there are complications like in my case I would expect them to spend longer to try and get those eggs than just give up.  Like I said I don't know what was actually attempted here, but will be one of the questions I will want to ask my RE to prevent this from happening again. 

Another theory is maybe I need more time for the trigger shot to work.  I don't know if this theory holds true for me because I didn't have this problem with my first two ER.  Anyways normally ER is done at 36 hours, but there have been recommendations to hold off a couple more hours to get the trigger more time to work.  Of course with this you run the risk of ovulating before ER, though everything I read says ovulation happens 38 hours or later from the time the trigger is given, so maybe this isn't that much of a concern.

I will be asking what to do differently about the trigger though.  Should I double the dose of the trigger, should I give it somewhere else in my body (there is a theory that obese women should use their arms instead of their stomach - not sure if this will work with me though because my arms are big too. I do have a belly, but not as large as you would expect at 226lb, however when I triggered my first two cycles I had a flat stomach and weighed 40lb less)?  And lastly I use another drug to trigger instead of hcg. Lupron can be used to trigger if using the anatgonist proctocal because it reverses the action on the anatgonist that is blocking the LH surge.  It is usually given to women with very high estrogen and when the risk of OHSS if given hcg.  However it is another option I can use to see if that is more effective instead of the hcg.