Higher vs Lower Stim IVF in 40+ladies. Help!

[MrsGAT]

Hi there
I'm very confused. I'm 41 (just!), DH is 32. After one silent miscarriage 18 months ago, and after usual agonising process of tests ( all negative for anything obvious, my AMH is 5.2, my FSH is 6.7, DH tests all fine), we were advised to go for IVF because of my age.

I did lots of research and met some consultants, we had to go privately as our NHS won't provide past 40, and went with Dr Simone Rofena (under Dr George) at Zita West as we felt we connected with him really well, he was incredibly understanding and all staff were great.
Moreover, he was very convincing re the argument for reasonably high stimulation for me (450iu FSH), as his philosophy was always - "if you want to win the lottery, you buy more tickets". He said that in his and Dr George's experience, this produced better results.

We also met with Gita Nargund at Create, who although absolutely lovely and persuasive in her argument for the exact opposite - ie smaller number of eggs in older women produces better results as egg quality is better - we didn't go with them, as we felt overall the clinic organisation was very haphazard and disorganised, a few staff were quite rude and I also had a really bad experience with an internal scan there.

Anyway, with the "normal" IVF at Zita West, I produced 10 eggs, 7 of which were retrieved as viable, 5 of which fertilised, 3 of which went to Day 3, 2 of which were put back (one lost along the way), both high Grade 2 - all of which I thought was great at the time (!) but sadly, BFN.

The biggest shock to me of all of this since then, and I feel so stupid for not knowing this before, is that the grading of embryos by the embryologist bears little or no relation to their quality. Having had a good, if fairly brutally honest, follow-up appt with Dr Simone, I feel now much more realistic about our chances (1 in 10 eggs being viable/good enough quality to go to full term pregnancy).
As the protocol produced exactly what he'd expected, and as he's explained to us, his feeling was we didn't really need to hugely change anything protocol-wise, going forward to a 2nd attempt, as he felt he'd rather stick with what worked, which makes sense to me. The only thing is he said he might do is up the dose of FSH to 600iu for the first few days, in the hope of me producing one or two more eggs (and also wanted to add melatonin into the mix during stims)
(just FYI, we also did immunity tests recently, which Dr George is an expert in, which showed slightly high NK assay cells in me, so are having that treated with them, as another box ticked hopefully!).

BUT, now I'm really confused. Especially as we really only have money, just, for one more go, which is slightly killing me in the pressure of it all. Having talked it all over with DH he is keen we go one more time with Dr Simone at ZW, on the basis that, bar actually getting pregnant (I know that sounds mad, but you know what I mean!), everything else went exactly as he'd predicted (number of eggs produced, my response etc) and also that we had such a positive experience there generally. I was pretty much in agreement.
However, the more research I do, the more I keep coming back to the philosophy of "less is more" in older women, it seems to be mainly along the lines of, that the quality is better on lower numbers of eggs as the body does it's own sort of self selection.

So sorry if this a long-winded way of asking - I just wondered what other ladies over 40's experiences were? And whether you had any advice as to what works best? (I am heartened slightly by my lowish FSH, although v aware my AMH not great!).
I'd be so grateful for any thoughts.
Thank you SO much ladies - sorry for long post
xxxx

[gcerron]

Hi Gat I am doing my first cycle of mild ivf at create, I am 42 and I got 5 follicles, on Sunday I had EC they got 4 eggs and by today all of fertilised, the road is still long all I am doing is keep positive, keep my mind busy but also eating healthy as I can and I am doing acupuncture, tomorrow it's my third session before the ET on Wed, I can't give you that much advice more than prepare your body and your keep your mind positive, in my case I think your spirit is also important and I keep praying a lot, I will let you know how I am doing, but each case is different unfortunately, all the posts are just a reference, good luck and all the best!!