Gutting fertility clinic appointment... Advice needed

[Judylamb]

I've just come back from our first fertility clinic appointment where I had an ultra sound and the consultant told us that more than likely I had low egg reserves as my scan showed two egg sacks in one ovary and none on the other. I had an AMH blood test done to confirm this, will have to wait 2 weeks for my results. Was told the best chance of conception was IVF but with a low AMH I won't be entitled to this in the NHS. I feel numb, useless and confused. I'm 39 so the success of IVF is minimal anyway... I don't know what to do 😟

[What2]

No advice but lots of sympathy

[Chattycat78]

I had IVF 2 years ago due to having low amh- so it's not the case that you don't get IVF if you have low amh (unless it varies according to area?). It worked first time too and I now have a 1 year old ds. There will be plenty of people on this board who have had IVF due to low amh.

Natural conception is not impossible either if low amh is your only fertility issue. I'm now pregnant again- naturally this time.

[Judylamb]

Thanks Chattycat78, if you don't mind me asking, how old were you when you had your IVF? Was it as bad as I'm imagining? I guess as you had a positive outcome then it overrides any bad moments! X
Thank What2 for your kind comment x

[Chattycat78]

I was 35. It really wasn't that bad in terms of the actual process. The emotional side is the hardest bit. Have they said you won't qualify for IVF due to low amh? As I said, that confuses me, because that's the reason we were told we needed IVF in the first place. Unless they have a cut off where once it gets really really low they won't let you do it. Can you (have you) try naturally too?

[Judylamb]

I don't know if it's different from one area to another maybe. As I'm 39 we'd been trying naturally for 18 months and no joy yet. I miscarried about 3 yrs ago. It might be my age as well I guess with the IVF. It is something the consultant will talk us through in two weeks I think. I guess my results may come back ok.... But not really feeling very hopeful at present.

[Chattycat78]

Well you never know. Good luck!

[bananafish81]

I wouldn't have qualified for IVF due to my ovarian reserves but that is because I had low AMH and high FSH and a low antral follicle count. The NHS funding criteria in most areas has ovarian reserve cut off but they shouldn't be able to refuse funding purely on the basis of low AMH if your FSH or AFC are OK

And I have disgustingly low AMH and I got my BFP last Sunday via IVF. So low AMH isn't the be all and end all xx

[Chattycat78]

I didn't think you were supposed to advertise on these boards?

[Judylamb]

Thanks bananafish81, it's good to hear some positives. I guess with my age and low AMH I'm worried IVF is just an unrealistic option. I've few eggs anyway, the consultant implied it would be difficult to get enough good quality eggs to do IVF. I know I'm being uber negative about it all, I guess it's just very raw.

[What2]

I've reported Kathetines spammy post. How nasty to post such crap.

[bananafish81]

Judy can you ask your consultant about DHEA? I really do think DHEA and the litany of supplements I took for egg quality made a difference, as the quantity and quality of my embryos was significantly better for my second cycle (where I’d been taking DHEA, CoQ10 etc for over 4 months, i.e. the duration of the egg maturation process - vs the first cycle where I’d only been taking them for 6 weeks)

If you google ‘CHR DHEA egg quality’ you can see lots of info from a clinic in NYC who has pioneered the use of DHEA to improve egg quality in women with severely diminished reserve, including many many women over 40

I can massively recommend the book ‘It Starts with the Egg’ for tips to improve your egg quality - if nothing else, I felt like I was doing something proactive to improve my chances

xx

[Chattycat78]

I read that book too, and took massive doses of co enzyme q10 as ubiquinol. Obviously I have no idea if it helped or not, but I doubt it hurt! I also did a lot of acupuncture in the months before and during my round of IVF.

[Judylamb]

Thanks bananafish81 I've ordered the book, like you say, at least I can feel like I'm doing something. Good to know about the questions as well, I'll look it up and ask when we next to. It's great to hear some positives as well. I'm feeling a bit calmer today, have decided that I think it's important that we at least try IVF otherwise I'll always wonder... What if?
Thanks for your reassuring words chattycat78, it does really help. Thanks also what2, I reported the post also... Like you say, how insensative?!

[ChewyGiraffe]

Judy - can I ask what day in your menstrual cycle you had the ultra sound scan that showed 2 follicles on one ovary and none on the other?

Antral follicle count is supposed to count number of visible, small follicles (2–10 mm) on cycle days 2–5. If yours was done any later/towards mid-cycle then what was seen is pretty normal for that time of the month.

I only mention it as ... lets be charitable and say due to an administrative f*ck up ... I had a fertility assessment at a supposedly cutting edge IVF clinic at mid cycle. FSH was 19 (or something similarly ludicrous) and follicle count was 3 on one side, zero on the other. Nobody seemed to notice that it wasn't, actually, baseline (i.e. cycle day 2 - 4-ish) and diagnosed me with severe DOR (diminished ovarian reserve). I didn't have the first clue about these things at the time and never twigged. Anyway, I was refused for IVF, lots of tears, but conceived DD naturally straight afterwards. It was literally years later when I was looking through an old diary, noticed the dates and (having picked up a thing or two in the meantime) thought WTF!!!

Also - number of antral follicles is supposed to correlate with ovarian response to IVF stimulation, but does NOT predict success/failure to conceive. See e.g. link

[Judylamb]

Thanks chewy. That makes interesting reading. It was later in my cycle but I ovulate late so that might make a difference?!

[goinggrey1978]

Judylamb it depends if your fhs and lh numbers are messed up, along with a low amh reading and egg count, all these factors lead to poor or low ovarian reserve from your birth, i was refused ivf on the nhs firstly due to not having a partner, despite the fact i would still need ivf anyway, after a long battle i am currently having my nhs funded cycle, so i would recommend you check the NICE guidelines for your are and the CCG guidelines for your area, this will help you to find out exactly what you are entitled too, be aware that DHEA doesn't work for every person either, go to your gp and get all the tests you can on the nhs, explain what you've had done so far, my gp has been fantastic and my journey started in 2012!

[ChewyGiraffe]

I'm no expert, but I think whether or not you ovulate late might not make a significant difference. For instance, the cycle I conceived my DD I'm pretty sure I ovulated on day 16 (going by the first positive OPK), could even have been day 17 - and yet I'd just had that damning fertility assessment.

I think that beyond day 4 or 5, your body begins to select a lead follicle and once that starts growing ahead the others start to fade away (atresia).

Fairly recently I had some cycle monitoring scans at an independent scanning service who just do fertility/early pregnancy scans. All the sonographers are ex-NHS fetal medicine/ante-natal/gynaecology etc so I believe they know their stuff. I discussed this very point with them and they said they'd seen other patients concerned about the same issue - i.e. scan at fertility clinic done at inappropriate time in cycle, looks in completely normal range when they've re-scanned on day 2-4.

[ChewyGiraffe]

Sorry - X post with goinggrey. Quite right, AFC (antral follicle count) isn't the full picture. It would be helpful for you to have an idea of your blood results for FSH and LH (on day 2 - 5, but preferably day 2 - 3), plus AMH (anytime) too.

[Judylamb]

Thanks, that's interesting. I think my FSH were all ok, when I had them done at docs I was told they were all within the 'normal' range. I've had my AMH test done and get results next week. I guess Ill know more then, it's the not knowing that's frustrating!