To think I can get pregnant in peri menopause? (late 30s?)

[Rosiestraws]

I posted a version of this a few weeks ago but only got 1 or 2 responses so I'm hoping there'll be a few more on here.

The summary of my question is - have you got pregnant when in peri menopause or had successful IVF? (In late 30s as I guess age might also be relevant!)

The long version is:

I'm 38, with extremely low egg reserve. My AMH was 1.4pmol at 31 and 0.8pmol at 34.. I haven't bothered testing again as I know it'll be bad!

Did some egg freezing cycles at age 35-36 which usually only got 1-2 eggs per cycle but as far as I understand, these eggs are just as good as any other eggs from a 35/36 year old - the DOR doesnt affect egg quality.

Got pregnant at 35 and then had an miscarriage - the first/only month I tried naturally (with a previous partner)

I am now hoping to create/bank some fresh embryos with my current partner and of course try to implant if/when we get have a good one after 3 cycles. (If fresh cycles don't work then ofc we'll try my frozen eggs but I'd rather they be a last resort)

However, during a few incredibly stressful periods last year, my cycle stopped for 50-60 days (twice) and I was having night sweats. I had my FSH tested and it was sky high (I think 48ish one month and 69ish another).

But, my cycles have largely come back to normal (irregular, but normal for me) and no obvious meno symptoms anymore.

Waiting for day 3 blood results now as my clinic wants to see what my hormones are doing now before deciding if we can pursue fresh cycles again. Dr seemed to imply that if my FSH is high it would affect the cycle etc and I might not respond to IVF meds. She also mentioned I might not be ovulating every month.

But surely if I do pick a month where I am growing an egg and blood tests etc indicate there's likely to be an egg, if we went ahead there'd be just as much chance as someone else 38?

Grateful for thoughts/experiences.. esp if you had actually begun experiencing peri menopause symptoms at the time of IVF/getting pregnant..

No advice, but bumping for you

I think you need to push your clinic to talk this through with you properly. If they are treating you, they must think you have some chance. They really ought to test your AMH or antral follicle count and tell you the results. I think it is unethical not to talk it through with you.

To the best of my knowledge, if your AMH is low for your age then your chances are lower than average. There's a really huge range - some people at 38 might have 15 or more eggs collected in a cycle and end up with several embryos; others will end up cancelling the cycle because there's just not a good enough response.

It is brutal, and I am sorry.

The fertility board is a better place for this.

You will have poor rates with egg collections with low follicle counts to the point where I would doubt the professionalism of a specialist charging to collect 2-3 eggs... Have plenty of sex and talk to a specialist about exploring all potentially beneficial options of e.g. metformin; growth hormone etc. Good luck though - it's a rough journey

I feel for you, I feel I am in the same situation..I am 40. Being trying for years and one loss very early on. Nothing since. Regular periods but I am having loads of peri symptoms and despite constant messages to my doctor they seem reluctant to test me for peri. I feel I need to ask lots of times before things get done, and time isn’t something I have. I can’t even seem to get IVF one private clinic was very honest and said with me being 40, my husband 49 this year and with my symptoms - don’t waste your money. It’s a harsh reality. Maybe if I wasn’t peri (sure I am) my chances would be better but they seemed to think now it’s very low to unlikely. I ovulate but it’s for 24hours at its best then nothing. We’re waiting on a sperm test for my husband. You have a few years on me so i
would say keep trying and asking questions/ do whatever you can…if it doesn’t end up happening at least you can say you did your best…I think that’s how I feel…if I do all I can then it’s nature deciding for me…and I will have to deal with that but at least I tried all I could…I wish you all the best as I know how disappointing it can be each month x

I did - one baby at 39 after the first attempt at IUI, one at 41 naturally conceived using ovulation tracking. Fingers crossed for you.

That rang alarm bells for me too. I am 40, and I've just done IVF with one of the London Women's Clinics, and they were very upfront about what they considered ethical and what they didn't. They would not have continued with an IVF cycle if there were too few follicles and they explained this from the start.

I don't know about your chances with natural conception, but unfortunately I would really be managing your expectations with IVF - the attrition rate is brutal, and whilst it's always possible, having fewer eggs does make it harder

You say you did some cycles ages 35-36, with 1-2 eggs. How many eggs did you get? If you start with say 8, roughly speaking, you'd expect 6 might survive the thaw, 4 might fertilise, 2 might make it to blastocyst and one would be normal which would give you around 66% chance. I've put the study below to show where I got these numbers from. Obviously if you've got quite a few more than 8, it does change things

a 66% chance is pretty good, but you only have to be slightly worse than average to have nothing. In the study I linked, the average number of eggs retrieved was 12, and 38% of women whose eggs were retrieved when they were under 38 had a live birth.

You mention 3 cycles for a good one. Most women in their late 30s probably wouldn't get a euploid in just 3 cycles if they only get one or two eggs per retrieval. You might be lucky, but I would be expecting to use your frozen eggs.

https://pmc.ncbi.nlm.nih.gov/articles/PMC10342811/

Thank you for the replies.

@SarahAndQuack My antra follicle count on last scan (a few weeks ago) was 4. Which is high for me tbf! They did mention testing my AMH again but I didn't really see the point as we know it'll be very low and what new information does that give us? Dr agreed with that point if I wasn't keen to re-test.

Re ethical comments re not going ahead if only 1-2 eggs etc each cycle - I'm with a clinic which specialises in the natural modified approach where they do minimal stims and aim to get only a few eggs per cycle anyway. I did my egg freezing with them (after a failed attempt on max stims at London Womens Clinic which I do not recommend) and I'm ok with that approach. I've read some info (years ago now, so I'm afraid can't link) where there is some argument to say that the reason there is a such a drop off rate with eggs collected from ivf to fertilised embryo is because ultimately your body would have naturally only selected that one good egg to release and the other ones which are collected from other follicles during IVF are less good quality so theoretically me only getting that one or two "good eggs" that my body was selecting to ovulate naturally might be good enough? Who knows...

Re trying naturally, we'd ideally like to go via IVF to be able to test the embryo (if we got that far) rather than possibly wasting a few months/another miscarriage on an embryo that would not survive if we got pregnant naturally. There are also possible sperm issues so might need ICSI too!

I appreciate the IVF side of thing is more complex but I was just pondering the natural pregnancy route and people's experience of that. There are so many women getting pregnant naturally up until early 40s and I'm just wondering how many of them may have been experiencing peri menopause symptoms? (As opposed to those who were still regular period/no symptoms and managed to get pregnant). When I was experiencing the symptoms last year my GP did say that I would still be fertile for whenever I was ovulating etc and didn't say that the hormones would affect anything.. but I feel like they might not actually know that for a fact!!

@MinPinSins I have 12 eggs frozen but I really feel like they're a last resort for when I know my fresh eggs aren't good.. I appreciate that time might be now though! Thanks for linking the study - I have read similar stats before too.. I think it's between 53-76% of one child from them.. but that's also (presumably!) assuming no male factor?

https://springfertility.com/eggcalc/