Antral follicle count of 3 - choosing IVF and maximizing chances of success?

[RhubarbRocks]

I'm new on mumsnet today. I am 39 and TTC. I had an ultrasound this morning which showed 2 antral follicles on the left and 1 on the right ovary. The doctor said I should start with IVF not IUI.

A year ago when last tested my AMH was 9, FSH 3.5, LH 4.3 and oestradiol 402pmol/L. My boyfriend wasn't ready then.

I had my AMH tested again today - results next Monday. Dr seemed surprised by result last year given count today.

Does anyone else have experience of antral follicle count this low that they can share?

I'd really like to know thoughts on choosing mild IVF (which this clinic offers) v full treatment. And anything else I can do to boost my chances (I've given up alcohol, reduced caffeine, eat healthily - what else helps?) Any books that explain all this also appreciated as I don't really understand the significance of all these tests and what they mean for the choices I need to make.

I'm feeling pretty overwhelmed and down about it all right now.

Hi Rhubarb. I am so sorry you've had this news, it is a very gut wrenchingly awful thing to hear. I had an antral follicle count of 2 this time last year and I won't ever forget that day. I'd love to write that all turned out fine for me but short protocol ivf only produced one follicle which naughtily ovulated too early. I made a very hard decision to move directly to donor egg in December and attempted my first de cycle this summer only to find my donor produced no follies either! Back to the drawing board for me.

I am 37 and my fsh is consistently 9-10 so it really was a shock. I knew it was borderline but didn't expect only two. I choose not to know my amh as it seems a bit irrelevant and would no doubt depress. For this donor round I was on buserelin to suppress my ovaries and to my amazement had nine small follicles when my lining was scanned. I also had a few more with my own ivf but one follicle took the lead. If funds were unlimited, if I lived in London, if I wasn't taken by the far higher chances of conception with donor or if I was more attached to my own genes - I'd be doing consecutive rounds of mini ivf now. But that's because I know I'm a very poor responder to high doses of Menopur. You may find that you DO respond better to the meds, I don't think it's a given. I think you need to be happy with your clinic and go for what they suggest. At worst it gives a diagnostic of where to go next and donor is no way the only route, it's just the one I've chosen. Keep chatting if you have questions and a big hug to you. Life is shitty sometimes but this isn't the end, just something to be grappled with.

Oh and look at fertility friends, very helpful. If it helps I'm a yoga health freak and it happened to me. Don't beat yourself up about anything you're doing in moderation is my view.

Hi Fox
Thank you so much for your message. My friends and family are being hugely supportive and encouraging but it is nice to know someone understands what a shock it is to get the news. Gut wrenching awfulness is exactly it.
I'll keep you posted on progress. Feeling a lot more positive today and trying to focus on staying healthy and optimistic (yoga last night helped too!) Good luck with your journey and thank you again.

Hi Fox
Thank you so much for your message. My friends and family are being hugely supportive and encouraging but it is nice to know someone understands what a shock it is to get the news. Gut wrenching awfulness is exactly it.
I'll keep you posted on progress. Feeling a lot more positive today and trying to focus on staying healthy and optimistic (yoga last night helped too!) Good luck with your journey and thank you again.

Love to you rhubarb, take solace in love from your family and know that this is not your fault, just crappy crappy luck. It doesn't mean you can't have a family, it just means the path to that family may be longer and I always think I'll have a particular appreciation of my baby that I don't personally think I would have had if I'd conceived straight away, if that makes sense. I will always feel bloody bloody lucky. I'm sure many people feel that way anyway but I was a little bit ambivalent about becoming a mum and now I know for sure that it is what I want! A private consultation can be two hundred pounds very well spent for different opinions etc.

Hi Rhubarb
I've got almost the same stats as you; I'm 39 and had my antral follicle count in December last year and they found 3 follicles. FSH was 14.6 and AMH 1.6 (extremely low). The NHS agreed to do a natural cycle of IVF for me, which I should be starting in a week or so.

I tried a cycle of stimulated IVF earlier this year which was short protocol and with very high levels of stimulating drugs; I responded very quickly to the stimming, but only produced 2 follicles; of which 1 egg was not mature and didn't fertilise. The one that did fertilise was a grade 1 and was transferred at 2 days, but unfortunately didn't stick. I spend about £1000 on the stimulating drugs and basically only ended up with what the one egg I would have got in a natural cycle, so I'd be inclined not to try that again. The consultant suggested we could try again on long protocol with a lower level of stimulant if the natural cycle didn't work; she thought downregging and a lower dose of stimms might help me respond more slowly and evenly and might result in them getting more eggs.

Since the first IVF I've had 2 polyps removed too, which might have stopped implantation the first time around, so I'm trying to remain optimistic for the natural cycle.

Its a bit of a long winded post, but my advice is not to give up. It does only take 1 egg. If I were you I'd try the mild or natural cycle. A low count can mean poor quality eggs but nobody can be really sure. I've cut out caffeine and alcohol prior to this upcoming IVF cycle. Before my first IVF I was taking DHEA as well as folic acid, pregnacare vits, and coenzyme q10. This time I'm not taking DHEA and hope I won't regret it!

Like fox (Hi Fox!) I'm also a yoga nut and have never been much of a drinker. I think it's just bad luck. But try and work with what you've got and don't give up!

A book I liked was "It Starts with the Egg: How the Science of Egg Quality Can Help You Get Pregnant Naturally, Prevent Miscarriage..." by Rebecca Fett.

If you've got other questions feel free to post and I'll answer what I can.

Kuma that is really interesting. The nhs never presented natural ivf to me as an option, just donor, but the nine follies lined up after my de downregging suggested this would have been a better route for me than aggressive short protocol which fits in with this theory. Good luck to you - will you keep us posted?

Thanks Kuma. I just ordered the book.
Have you tried acupuncture at all? I'm wondering if that is also worth a try.
Best of luck with your next cycle.

I've just finished my first month of acupuncture it seems to have been good, no spotting this month and cycle seems to be a bit longer. So it's probably worth a try. I'll definitely continue it during my IVF cycle which will start as soon as AF arrives.

I hope you're feeling a bit better now; it's so horrible to get that news.

Hi Rhubarb,

I too know that kicked-in-the-guts feeling. At age 32 a scan showed two antral follicles on one ovary, and the other ovary completely taken over by a cyst. I was devastated - thought it was all hopeless - but my clinic encouraged me to continue and next cycle I had 3 on one and 2 on the other. I went straight for IVF on long protocol with a high dosage of stimms, and I had 7 eggs collected and 5 fertilised. I was on gonal-f but the clinic talked about possibly switching the drug combo/ altering dosages for future rounds - they can do a lot with tweaks to protocols etc.

I took co-q 10 and ate a high protein diet (along with all the other clean-living stuff) - no idea if it helped, but made me feel like I was doing something! Sadly I'm still waiting for my bfp, as I have unrelated lining issues.

Wishing you the best of luck. Any kind of fertility problems can be hell on earth to deal with but it sounds like you have solid family and friends - and a small group of mumsnetters! - who are rooting for you.

Fizzy.

Thanks for your encouragement. These messages have made a huge difference to me this week - things don't seem as bleak as they did a week ago. So thank you so much for taking the time to post.

I'm getting my AMH results tomorrow and have spent today trying to read up on clinics so I can make a decision with the hope of starting in October. It's between Create (and mild ivf) and the Lister. I liked Zita West but it is much more difficult for me to get to. So hopefully after tomorrow things will move to the next stage.

Wishing you the best of luck too. Hope that it works out well for you very soon.

Hello again Rhu! I hope your results were OK.

I did my first round of IVF with Lister, they are happy to take on high FSH/low AMH patients. They were very professional and organised and I was pretty much able to get an initial consultation then start a cycle right away. After my first cycle failed they offered me some alternatives for a second cycle to take into account how my first cycle went; I felt that they could have considered some of the changes before the first cycle. Although I think if I had made more suggestions of what I wanted or pressed for more tests before the first cycle they would have been very happy to provide them. I couldn't fault their customer service or efficiency though and they made the whole process very stress free for me.

I can see why you might want to try a cycle with Create first though, If I'd had my time again, I would have tried a mild or natural cycle first - I was just too impatient to wait for my NHS natural cycle to come around.

If you've got any questions, feel free to ask!