IVF 2nd time after having daughter 1st time round, low AMH, but different protocol this time

[GlummyMummy]

I am shortly going to be starting my second round of ivf after having conceived my daughter on our first attempt two years ago. We were so lucky for it to work first time round, especially as I have low ovarian reserve (3.8) so was told by doctors my chances of it working were very slim. Last time I felt fine during the treatment and it all happened very easily! I was on the lowest level of drugs and the long protocol (nasal sprays & injections)

This time around, the doctors want to up me to the highest level of drugs and the short protocol. Their reason is my age (35) and that my AMH level will only have got lower in the two years since last time. I had naively assumed that they would just repeat the same treatment as last time given that it was successful and they were really pleased with how I responded.

Has anyone else been in a similar situation? Worried that I might not feel great this time around on higher drugs, and having a toddler to look after this time will mean my chances of resting are somewhat slim! Would be great to hear from other Mums who have had success with IVF more than once. Also, can anyone help to clarify whether it's the low AMH which is causing our unexplained infertility as none of the doctors have been able to answer my queries or explain what low AMH actually means!!

[Chattycat78]

Hi- not Exavtly the same situation, but I did IVF in April 2014 because I also have low amh. Mine was 2.8 in 2014, so pretty low. IVF worked first time for me too- unbelievably lucky as the clinic had suggested my chances were low.

I haven't repeated IVF- however I am 18.5 weeks pregnant. This time naturally! As soon as I finished breastfeeding when my baby was 8 months old we started trying as I had been given the impression that it might be difficult/take a long time/might need IVF again etc. However, what happened instead is that I got a bfp first month of trying! I have no idea if this is pure fluke or what, but that's what happened to me.

As an aside, my friend was told her amh was 2.7, 3 years ago. She just had it re measured and it's now 6! Maybe the amh test is not as reliable as people think?

As for what it "really" means, I was given the impression that they assume that because you have less eggs, the ones you have are likely to be worse quality, therefore less chance of conception. I'm not totally convinced this is right. I think you can have low amh but still have some decent ones in there! Are you trying naturally too? I would if low amh is your only issue.

[GlummyMummy]

Hi Chattycat78! Thanks for getting back on this. Wow, that's great you have conceived naturally, congratulations! Lovely that you don't have to go through IVF again. How long did you try to get pregnant first time round before you went down ivf route? Just shows it's true what they say about having a baby increasing your fertility. We've been trying for several months this time, so it's looking like ivf might be the best bet, particularly as I'm 35 now.

I've read online a lot of people saying amh test wasn't reliable, but my hospital aren't keen to repeat the test for some reason!

Very confused on the amh thing - I kind of thought that it meant I was "wasting" more eggs each month than the next woman, but that the quality wasn't affected. My doctor doesnt seem able to explain it clearly!

Hope you are keeping well in your pregnancy and getting time to rest (if that's possible with a wee one!)

[Chattycat78]

Hi- no low amh doesn't mean you waste more eggs. Just that you have less than average for your age. You may have been born with less for example. Doctors seem to think that this gives you less chance of getting pregnant in general as they assume the ones you have left are likely to be crapper quality and therefore less likely to lead to fertilisation. However, there is no test available for egg quality so they are just guessing, plus from what I've read, egg quality is linked more with age. I think your biggest issue with low amh is time- the idea is that we have less time left than other people to conceive just because we have less eggs left, and I suppose you don't know when you're going to actually run out!

Last time we tried for 4 months, got pregnant but had a miscarriage. Then we tried for another 5 months without success before doing the IVF. We were told to do IVF atvthat time because my amh test came back low so I was given the impression that I was running out of time.

Did you only do IVF last time due to the low amh or did you have other reasons too?

[GlummyMummy]

We tried for two years before going down the ivf route. Our infertility has been classed as unexplained and I was told that the low amh isn't the reason, it's just one small factor. I only found out what my Amh level was a month before we were due to start our Ivf cycle. Do you mind me asking your age, and what protocol you were put on first time round?

From what you are saying, it implies that people with low Amh are going to have an early menopause then? The doctor I saw last week said absolutely not, that there was no actual evidence to suggest I would go through the menopause any sooner than any other lady. It is worrying that time is ticking, as ordinarily I would rather wait til my daughter is a bit older before trying again for another child. Though I think I know too much about ivf now so I've convinced myself it isn't going to be successful again-I mean surely we couldn't be that lucky!

[Chattycat78]

I just turned 37 so am older than u! I was 35 when IVF worked for me previously. It was the short protocol. I think that works better for people with low egg reserve.

I don't think it means an early menopause, but i do think it potentially means an earlier than average menopause possibly. Eg if the average is 51, it might happen at 48 for example. That's what I'm expecting to happen to me- and my understanding is that your eggs are no good approximately 10 or so years before menopause.

It's interesting that the clinic told you that the low amh was only "one small factor" in your not getting pregnant! Mine said it was the whole and entire reason we needed IVF! We had no other infertility issues but were definitively told we needed IVF because of the low amh. It sounds to me like clinics across the country really don't know what it means if anything!

[GlummyMummy]

You've been really lucky then!!!

I would have thought an earlier than average menopause too but the doctor at my clinic said only if it was in the family, nothing to do with amh!

That is really interesting what your clinic said! Mind you, you've managed to get pregnant twice naturally so proves the low amh isn't making you infertile. And you're over 35 which I was told was when fertility takes a significant drop anyway

I'll be on the short protocol this time, was the standard one last time and I felt really well on it so I'm worried I might feel rubbish this time. How did you find the whole process?

[Chattycat78]

No- if anything the long protocol would make you feel worse- they give you more drugs on the long protocol because they send you into a state of menopause with the down regging. You don't have to do any of that with the short protocol.

As for the fertility drop at 35, I think there's some truth in it, but I don't think you turn 35 and then suddenly it falls off a cliff. It's more like a gradual thing- so it gets less as you get older. It's Not like you turn 35 and then it's game over! Ive got pregnant at 34,35 and 36. I was aware that I needed to try to do it asap to be in with the best possible chance, and I suspect that if had been trying at 39 it would have been a different story.

So at 35 I'm not sure you need to panic just yet.

[GlummyMummy]

Thanks for your encouragement. I'm on the short protocol this time, but higher level of drugs so hoping I'll keep well, especially with a toddler to run around after! No feet up for me this time!

Thanks for the advice and all the best for baby number two!

[bananafish81]

Glummy just to chime in, I am a desperately low AMH-er and I’m another example of low AMH not being the whole story. My AMH measured 1.5 on three separate occasions, with FSH that measured as high as 17.6 one month. Ugh.

However, my consultant was very encouraging and said that AMH is just a measure of quantity, and that the best test for quality is age. In my case having such high FSH may have compromised quality, but he said age was by far the biggest determinant and that at 34 I had age on my side

Egg quality really goes downhill most sharply at 38 - the reason the clinic stats look so different between

[Chattycat78]

Banana! That's amazing! When did you get a bfp? Congratulations!!!!!

[bananafish81]

Thanks chatty! My gob is well and truly smacked

Sneakily tested early last Sunday @ 8dp5dt (intended as a BFN practice run so I could break myself in gently for OTD on Thu) but got a blazing BFP line on a FRER. First beta on Tues was 299 and then on Thu was 509 - apparently as long as it doubles within 72h it's on track. Third beta on Monday eek!!

Hope you and your dynamic duo are well? X

[Chattycat78]

Good news- fantastic for you. I'm ok- although thanks for remembering it was twins but unfortunately one of the babies didn't make it. We were told at the 12 week scan that it had fatal anomalies but it was risking the entire pregnancy to allow things to continue, so we had to unfortunately terminate the sick baby. It was horrible but we really had no choice. The other baby is doing well though so we're hoping for a happy outcome from a sad situTion. I didn't mention this further up the thread as it wasn't relevant to the topic.

Good news again for you!

[bananafish81]

Chatty I'm so very very sorry - my sincerest condolences to you and your partner, I can only imagine how devastating a loss this must be. I hope your little fighter continues to bloom and grow, and that the coming months fly by until he or she is safely in your arms. Thinking of you and sending much love and strength xx

[Chattycat78]

Thanks. I appreciate that.

[GlummyMummy]

Hi bananafish81!! thanks for this, really useful! Can I check, it sounds like you got your amh tested before you decided to embark on ivf? We didnt get ours tested until after we had been trying for 2 years and had been attending the infertility clinic for 6 months! Might have been helpful to us if we had known about my low amh before all this as we might not have wasted two years trying naturally!

17 eggs is amazing though!! I did the long protocol last time and got 7 eggs, all fertilised, two made it to blastocyst and we chose to put one back which resulted in my daughter!! Short protocol this time as I said above.

I've started taking CoQ10 though I'm wishing I had started it earlier as our treatment is later this month, did you find it made you struggle to sleep though?

Reading your post again, can you clarify about your high fsh please? Is high fsh and low amh combo a bad thing? Sorry to sound so ignorant, but my clinic really haven't explained anything to me. I still really have no idea what low amh really means! Have got more info from here than my clinic though, definitely!

That's great you got a BFP though, congratulations and fingers crossed for everything!

Chattycat78 - what a shame, you've been in a difficult situation, that must have been awful! :-(

[bananafish81]

AMH is a measure of ovarian reserve - ie how many eggs do you have left. Lots of eggs = high AMH, few eggs = low AMH. High FSH is also an indication of diminished ovarian reserve - it rises the closer you get to menopause. So high FSH and low AMH means stock levels are running low and the clock is ticking. 

I first had my AMH tested years before I started TTC, as I took myself off for a 'fertility MoT' when I was 28, as I had the suspicion I might have issues, because I'd never really had proper periods when I wasn't on the pill. We discovered I had high AMH and PCOS. When I came off the pill to start TTC I took myself off for another fertility MoT  so I could see how polycystic my ovaries still were - and had the shock of my life when we saw my antral follicle count had dried up and all my eggs had vanished. My AMH had gone from 28 in 2010 to 1.5 in 2015 - so it had declined 93% between the ages of 28 and 33. FUCK. My follicle count had gone from 42 to 5.  And then my FSH subsequently turned out to be horrific. So I had gone from PCOS to severely diminished ovarian reserve in a matter of years. 

My antral follicle count doubled between my first and second cycles, and we don't really understand how I got 7 eggs from a baseline of 5 in my first cycle, and 17 eggs from a baseline of 10 in my second. So my consultant has said of me that 'something doesn't stack up' and 'I'm stumped - and I'm not usually stumped'. He also said to my husband after EC 'I wish I knew what was going on with her AMH as it's throwing everything off'. But also went on to say there was so much about the human body we don't understand. We don't know how or why my eggs all dried up and then how they seemed to come back. So basically, I am a medical freakshow marvel 

Low AMH means you're not likely to get many eggs with IVF - it's a quantity issue not a quality issue per se (hence why the 17 eggs from someone with barely detectable AMH doesn't make any sense). But sounds like you did great on your last cycle - congrats on your DD!

I haven't found any issues with sleep on CoQ10 but I did read this could be a side effect so maybe take earlier in the day?

[GlummyMummy]

Just shows the supplements and vitamins you've been on must have done some good. That's really exciting you're pregnant now, you've been very lucky too! Sounds like you've been through such a lot to get to this point! It's so unfair isn't it that some people just have to look at their other halves and fall pregnant!

Maybe you can answer my query as to why we have less eggs, were we born with less or just wasting more each month?

[bananafish81]

Thanks glummy - the NHS would have written me off completely with my ovarian reserves and many private clinics would have given me the donor egg speech. So it feels like a big middle finger to them!!

There's quite a few reasons for premature ovarian aging - some women just burn through their eggs at a faster rate than others, some have autoimmune conditions (often undiagnosed) where anti ovarian antibodies deplete reserves, some have genetic issues (the suspicion is that's what I have, a particular genetic variant that's found in women with slim PCOS who transition to a state of diminished ovarian reserve at a young age - we don't know for certain but it fits)

I do think the DHEA made a difference insofar as the difference between when my testosterone levels were undetectable vs when they were in normal range is pretty stark. But who knows?!!