AFC varying

[MsWonky]

Hi everyone

I’ve been lurking for a while now and as I am about to embark on an IVF journey I was hoping someone may have some advice about AFC. I had a scan a few months ago around day 7 of my cycle and the doctor counted approximately 13 total follicles, I had a scan with a different doctor yesterday on day 22 of my cycle and they only counted 6-7 total follicles.

I am waiting for my AMH and FSH results but in the meantime I am having a total meltdown about having too few follicles. I’m 37 and have been TTC for 18ms. Physically I’m in good shape but to be totally honest, mentally this has all taken a big toll so I know I’m worrying about every tiny thing.

N.B.: the recent scan wasn’t planned for day 22, it was just our first appointment with the clinic and they do an initial scan during that.

Thanks in advance for any advice!

Anyone? 🥺

Hi @MsWonky, I am no expert but I would say maybe don’t read too much into the scans since they were done at different times of the month because I’m not sure how useful a luteal phase scan will be, they usually recommend doing it early in your cycle. One was in your luteal phase, the other in your follicular phase. All of my scans have been done in my follicular phase and even these varied. I’ve had 28 (day 14ish), 23 (day 12) and 38 (day 1) follicles on the three cycles I’ve been scanned so far. I’m 38 and probably have PCO so I’m possibly a poor comparison but there’s a big variation in numbers from my 23 to 38 follicle cycles for example, which were a couple of months apart.

Check this study out, you can see some of the observations they make on afc variability academic.oup.com/humrep/article/25/1/221/697219

And as you mentioned, wait to see what the FSH and AMH say, they might be better indicators. It’s very stressful, I’ve definitely read into all of this way too much myself over the last two years.

@thislittlebird thank you so much! I’m definitely struggling to find the balance between being well informed and obsessing over everything - that article is really interesting 👍🏻

@MsWonky it’s really hard, I know I obsess but I think it’s tough to turn that off when you’re late 30s and time feels like it’s not on your side. Everything feels so slow and stressful. What’s your plans now for ttc? We’re likely heading the ivf route unless there’s a very lucky conception during the next couple of cycles

@thislittlebird We are going to start IVF this month hopefully - it’s actually been so difficult for me to accept this because I just feel like a total total failure. Everyone decided to start trying for babies over lockdown and we know 10 couples who are either now pregnant or have already given birth. It’s pretty much destroyed me and I am struggling to ever imagine being a mum. We had some sperm issues (varicocele, successful embolisation and SA is all good now) and aside from what I am currently stressing over being an INCREDIBLY low follicle count there are no problems my side. Ok that was all depressing as fuck 🤣, apologies!! I can’t talk to anyone about it so that was a crazy big vent.

I really hope you do have a lucky cycle!! Have you tried anything else up to now or just regular old DTD?

Oh yeah this is almost the same as us. We started trying when I was 36, before lockdown actually, in October 2019. Then all my other childless friends just had babies during lockdown because it’s just that easy! Now here we are still waiting for ivf.

I relate to that a lot. It’s been two years now, with a few cycles off for health and MMR doses. It’s very depressing. We have sperm issues, normal count but very poor motility (no significant varicocele issue to be fixed so we will need ICSI) and I don’t seem to ovulate normally and have some bordeline PCO thing going on (they all seem unsure because I don’t have classic symptoms). Yep, I also feel like such a failure, my body doesn’t work like other people’s and right now I’m on progesterone suppositories and my body still isn’t reacting like other people say there’s does . It’s really awful, and no one I know gets it or has been through it. It’s nice to have mn at least, it’s the only place where people are going through the same stuff.

We’ve had a fight to get funded ivf, they told us to sling our hook initially. I got second opinions from private docs and now we’re finally on the waiting list. Starting in 2-3 months so I will assume Nov/Dec. In the meantime we’re trying ovulation induction with a private clinic because DH’s sperm has improved a bit and hopefully I’ll ovulate if I’m doing a medicated cycle or two.

@thislittlebird I’ve read such a lot about PCO on here and there seem to be loads of positive outcomes, it’s so frustrating to feel like your body is working against you on all of this. We know some couples who, quite frankly have no business getting pregnant (drink loads, overweight, blokes who cycle constantly) but somehow they just pop em out no problems.

The ovulation induction sounds like a good plan! What kind of medication will that be? We’ve gone private for IVF and our Dr suggested doing a round of that first but we’ve had some real performance issues (the stress of it all has nuked my husband’s sex drive!) so we decided to swerve that as it just feels like another month lost for us.

@MsWonky yeah the PCOS “good” side is potentially having a good egg reserve, all being well. But who know the quality will be like at my age, I’ll find out fairly soon I guess 😐. Oh yeah, I know those people too, and I’m related to some which is infuriating tbh.

I had 5 days of Letrozole, at the start of this cycle, then a few scans and a trigger shot last Friday. Feels a bit like a mini ivf practice run lol. DH had to do an injection for the first time without any warning or teaching which was fun (thanks to YouTube for the tutorials!). We know the odds are slim because of his sperm motility but thought it was worth a shot while we wait.

I’m very lucky my husband doesn’t have that issue but nonetheless the ttc sex is pretty horrendous two years in. We’ve got the speed factor down to a fine art, so I guess there’s that

We were pursuing private with the clinic I’m doing OI with, planned to start this month, but it took so long to get anywhere with me not having rubella immunity that the nhs funding suddenly came through, so we thought we’d wait a couple of months and do our first (and only funded) round with the nhs and then go private if that one doesn’t work. I relate to those lost months. It’s so hard and I wanted to have started already but the 2-3 month delay seemed manageable, but we started the investigations process in July 2020 so it’s been very slow to get to this stage.

@thislittlebird “got the speed factor down” 🤣 - this made me chuckle because it’s so true!

That does sound like a good dress rehearsal for IVF (and fingers crossed it’ll mean the real thing isn’t necessary)! How have you found the Letrozole?

I’m also really worried about egg quality, we’re going to do PGT - I’m going to just talk like they will definitely get some eggs and that some will definitely be fertilised to save spiralling into another panic!

@MsWonky honestly, thank god it’s speedy, don’t even know how we’d manage it otherwise 😐

The Letrozole has been fine, as was the trigger and now the progesterone too. Zero symptoms whatsoever, which makes me think it’s not working because I only ever hear about people having all these symptoms on these meds. Fingers crossed I’m just being paranoid and I did ovulate and my progesterone is a bit higher than it normally is on the suppositories, it’s usually very low.

Yeah, I have the same fears, you aren’t alone. Or I hope my eggs will be mature, or that they’ll fertilise and on. What was your thinking behind doing pgt?

@thislittlebird oooh so you’re in the tww at the moment? What a fucking awful time of the month 🤣. I didn’t know it was possible to be so hyper aware of every tiny twinge in your body until we starting this ‘journey’.

I’ve been going to Acupunture for about 6ms and the guy I see suggested pgt as he had another client who went through three failed transfers largely because the clinic didn’t test the embryos and they were never viable. I’m also quite insanely worried about birth defects because of age etc (juuuust another little panic to add the pile 👍🏻).

@MsWonky ugh, yeah the tww can sod off. I’m somewhat numb to them now, they never result in a positive, just another period 🥴. I’m fairly good at not symptom spotting (this month there’s none to spot 🙃) but the hardest part by far for me is the testing. I don’t test these days, I just wait it out. But the clinic are making me test twice, starting this coming Friday. I’m scarred by those stupid piss sticks, they stress me out. I’m tempted to do one every day for a few days over the weekend to try to desensitise myself to them/bfns.

Yeah the number of months I’ve been convinced it’s worked because a different symptom happened. What a clown.

I’ve been going to acupuncture too, since around February. I think it sorted my periods out, they had gone really light and short for a few months from around august 2020 (stress, probably, my friends were all pregnant and I was failing to be) and after the acupuncture they went back to normal. Maybe it was a coincidence but I’ll take it.

I have those fears. I’m so scared of anything going wrong after all this effort. I would consider pgt on a private round, especially if we get a number of fertilised eggs. I’m not sure the nhs offer it without reason, they’re us one collection and three transfers. If it works, which it likely won’t if they’re unviable, I’ll get extra testing done privately. I think it’s called NIPT. If I’m honest I can’t see is having more than one child at this stage. I’ll be 39 in May, I certainly won’t have had number one by then, if I can at all.

I may well also need a freeze all which will drag us to around January for any chance of ivf success.

@thislittlebird I am exactly the same when it comes to testing and have also stopped. They absolutely destroyed me every time I did one, I’ve never even had one that had an indent etc - now I know that’s not a bad thing but it somehow felt like they were as negative as it was possible to be. Felt like a punch in the face. I know I’ll have to do them with IVF so I’m actually psyching myself up for that more than the injections

My Acupunture guy is great, he knows a huge amount about fertility but is more concerned with treating you as a whole person rather than as one issue. He’s given me some perspective on things which has really helped (in 20 odd years he’s seen very very few people just simply never have a child). I get incredibly down worrying whether this all means I’m not supposed to be a mum etc etc - he just says this is nonsense, if I’d started trying at 20 I’d have 5 kids by now and it’s better to have waited for Mr Right. Sounds a bit trite but it helps me to stop thinking the gods have cursed me!

When you talk about freezing them do you mean so that you have some for the future? I would like to do that but know if I get just the one viable embryo I won’t be able to not transfer it

@MsWonky I was never big into testing because I really don't see the point in the trend of 7/8/9/10/11/12/13/14dpo testing but on the odd occasion I thought it might have worked because AF was late or I had a weird symptom I did test and it was nothing but a stark white space. I did have one of those annoying indents once. Not looking forward to the IVF testing at all, there's so much pressure with IVF especially.

I like what that acupuncture guy is saying. I also get down about whether it's a sign telling me not to go down this route. I had a weird upbringing and have an unfortunate family, including bad sibling relationships and absent parents. I worry I'm going to be my mother, it's scary. I keep thinking that maybe I'm better off without kids, maybe I'll end up having a bad relationship with them and so on. It's daunting. But I would like the chance to have a good family with my husband and our child, it feels unfair all the other people in my family have tons of kids. I definitely would not have wanted kids with my exes in my 20s, but I do regret us not starting trying earlier. All my mid/late 30s friends were fine so I thought it would be too. Error.

Freeze all is when you're at risk of OHSS because you have a lot of follicles, so they freeze them all and then do a transfer in a month or two when your body is normal again, rather than a few days later. Putting an embryo in can exacerbate OHSS because the HCG keeps increasing if it implants. Obviously it relies on getting at least one lol.

@thislittlebird I’m sorry to hear that you have some difficult family relationships. I understand why that would make you worry about your tendencies as a parent but the mere fact that you have an awareness of it makes me think you wouldn’t repeat those patterns

I don’t know very much about PCOS so apologies for my stupid freezing question! You said that they hadn’t been able to confirm PCOS but you have some symptoms right?

I had my results today and they are all good - I am so insanely relieved. I’m going in for another scan at the end of the week as based on the amh levels my Dr thinks that I had a corpus luteum on one side which was hiding some other follicles and after that it looks like we’ll be starting on the meds . Weirdly I’m actually feeling excited about it now I’ve had the results back.

@MsWonky yeah, it’s just so hard not to worry when you have quite so long to think about this stuff. Most people could have had two kids and I’m still thinking about it and that’s all lol.

Honestly the PCOS thing has been annoying. I don’t have the classic symptoms at all, but I have a lot of follicles for my age and maybe some of the less common symptoms and a slight LH/FSH imbalance. I’ve seen 5 doctors, 3 private and 2 nhs. Basically they don’t seem too interested because they don’t think it’s an issue for ivf but I would like to know so I keep asking them and one has said “maybe borderline”, one said no, one was a dickhead who didn’t care and said there was nothing wrong never mind mentioning PCOS, one said I have PCOS, and one said it doesn’t matter for IVF and that was the end of that?????? 🤷‍♀️

I should probably speak to my GP and ask for an insulin resistance test, I think that makes sense. But obviously GPs are hard to access right now so I haven’t done that yet.

Great news on your results! What did they come back as? Bloody corpus luteum...did it not come out last month? 🤨 what CD are you now?

@thislittlebird You are so right about the wait making you overthink things - it really does rob you of any joy around the whole process which is fucking awful.

Oh wow, you’ve seen loads of Drs! I’ve found the difference in opinions between different one to be pretty confusing myself - one Dr even changed his tune completely from my first scan with him (LOW follicle count and non existent uterus lining to very healthy count and perfect lining - thanks pal). Given I’ve now had two low follicle counts at the end of my cycle I reckon my body just sacks a looooad off after ovulation (I know everyone’s does really but I’ve been amused by the huge drop).

Sorry you had one dickhead GP, I don’t think they understand the impact this all has on a person. I have point blank refused to go NHS because our GP told us that we would never, ever have children even with IVF as even if the sperm did miraculously get me pregnant it would end in miscarriage. This was based on my OHs first SA which she told him to abstain for 5 days prior to - it was all peachy apart from some lower than average morphology (which has now been corrected with the embolisation). As dramatic as it sounds I don’t really know how we picked ourselves up after that phone call but we decided to go private for a second opinion and they were appalled by the GPs comments. Long story short I don’t think GPs have the first fucking clue about fertility! Whereabouts are you based? Picking a clinic (and even a hospital!) seems to be such a minefield.

So my results came back as TSH 2.22, AMH 19.4 (which I didn’t think was very high but my Dr says is good for my age and after a bit of digging I’ve found that there are two ranges they use and it looks like I’m doing fine for the second one and just a bit under the first range). I’m CD2 today so could be starting the whole process in a couple of weeks

@thislittlebird sorry, just realised that you didn’t actually say the dickhead Dr was a GP - I’m clearly just very biased 🤣

@MsWonky omg yes, any possible joy is just sucked out of it. I'm miserable over all this and then even if I'm successful and get a BFP I'm going to be going out of my mind because it's taken years to get that far. Horrendous.

I have a feeling my AFC declined by a few from day 1 to day 3 this cycle, maybe some follicles just quit before they've even started.

Oh god that's not even all the doctors I've seen! Those 5 are the gynaecologists. We saw a private one in Feb for AFC/AMH tests for me (I was worried by early menopause, my mother claims hers started late 30s) but wasn't ready for IVF then. Then we saw this horrible, decrepit NHS gynaecologist in May (following our referral from GP in Feb) who didn't even mention my very low progesterone/possible PCOS/lack of ovulation, and she told us my husband's motility issue wasn't "enough" of a problem for us to get help so we had to go away and keep trying?!? His motility was 14% at this point, he's 40 in November. She was horrible and I left in floods of tears. I formally complained, not that it got me far but it might have helped me get my ivf funding approved, unsure. After that we saw two private gynaecologists at our choice of private clinic. One we saw because she was the one I wanted, then she retired in June so I had a new doc. Then finally we saw the NHS IVF clinic doctor on Aug 31. Then there was the urologist Mr Ramsay for DH, and also a dickhead GP surgery. Such fun!

You've opened up a can of doctor worms lmao, advance apologies for my rants. So my GP let us have the basic tests in July 2020, and when I called for the results I was told by the receptionist they were "fine". DH then called for his results, was also told his results were fine by the same receptionist. Being a massive noob and too trusting I took their word for it, it had only been 7 or 8 months of trying at the time so I just left it at that. We got married so a few months passed and then in December I was thinking about how it had been over a year now and that wasn't right. So I requested the results in writing and of course, they were not "fine" for either of us. Long story short (sort of), they re-run tests in Feb and then referred us. But after the experience with the GP and the gynaecologist I had had enough and changed GPs, and this hadn't been my only issue with that GP surgery. New GP was much better, he referred us direct to Guys on the back of a letters from two of the private doctors at the end of June, which was a vast improvement and a big relief.

Agree, the difference in opinion from one doctor to the next is bizarre, and they're specialists. Then the GPs are so regularly very off about fertility and I agree, the vast majority don't seem to even understand the basics of fertility, it's odd. The parameters are right there on the paper, just refer us all on if we don't have optimal results! I definitely had a dickhead GP surgery, and a dickhead gynaecologist. Very infuriating when you just want someone to help you, not keep fobbing you off.

Jfc, your GP sounds a real gem. What the hell was he (?) basing that statement on? Erm, 37 is very normal for successful pregnancies, actually, doctor . What was your husband's SA for them to come out with that? The doctor I wanted for IVF (who retired) was adamant we were entitled to NHS help and that we shouldn't have been told there was nothing much wrong so she wrote a letter and told me to fight my corner on getting the funding, which was great, but she was very surprised by our experience too. The variation in experience is not ideal.

I'm in London, there's a lot of clinics to choose from round these parts. Where are you?

Your AMH sounds fine to me, very normal from what I understand. What are the two ranges? CD2! That'll fly by!

@thislittlebird Sheeeeeesh that is a lot of Drs! I’m so sorry you’ve had a rough time with them, as if the whole process isn’t bad enough! The one who made you cry sounds horrendous, the lack of bedside manner (coupled with ZERO knowledge of fertility) is a fucking killer. I am very grateful that our dickhead GP had the ‘you’ll never ever have children’ convo with us over the phone. I think I would have collapsed in her office otherwise. She based that on higher than average sperm count, everything else in the normal ranges but morphology being 1%. We actually went to Mr Ramsay for our second opinion (we loved him, he was incredibly helpful and calming) and aside from the fact that he said it could be improved with embolisation he also confirmed that given DHs high sperm count his 1% wasn’t far off most men’s 4%.

I’m in London too! It is good for the choice but also incredibly confusing! I had a HyCsy a few months ago and basically just picked a clinic that was close and had an appointment that week - the Dr who did it was fine but after telling me that I had a potential blockage in my left tube (couldn’t be sure whether it was a spasm, mucus plug 🤢 or true blockage) just said “so you’ll need IVF”. Ok then! Pretty sure it was a mucus plug as I had some pain on that side when ovulating and that stopped after the hycsy so think it unblocked it.

How are you feeling about doing some pregnancy tests? Is it tomorrow you’re supposed to start?

This is the amh thing I found talking about two ranges (confused the fuck out of me tbh so I’m just happy to go with the Dr’s comments of ‘good levels’!) theduff.co.uk/amh-levels-ivf/

@MsWonky the worse thing about the walking out crying incident was I had to walk (run?) through a room of HUGELY pregnant women. It was horrible. The 'you'll never have children' person sounds absolutely mental tbh. Where did they even get that idea from based on those results? As you say, morphology is usually the part they worry less about and only want 4% anyway.

Oh, which part of London? I'm South East. I've ended up with a clinic that's quite far (The Lister) because I went there for a particular doctor who then retired not long after we had our consult. So that was very annoying. They have a satellite clinic at the Shard so I might ask them if I can go there this month for scans. I also had my HyCoSy with them, I had a lovely mucus plus in my cervix I think, which they flushed out . How, erm, abrupt of your clinic to announce that!

I did the stupid pregnancy test and in a massive surprise to no one it was obviously a BFN. Fuck pregnancy tests. And fuck ttc. Got to do another stupid test on Sunday. I felt very numb tbh. Like I just sort of knew it wasn't going to be positive, I prepped myself for the blank space. I cried tonight, but this morning I just felt deflated like "why can't I have two lines?". It's hard to get your head round sometimes.

Never seen that AMH thing before, I'm in the second range of optimal, I'll take that I guess.

@thislittlebird Oh fuck it fuck it fuck it. I’m so sorry, I know exactly how you feel because I hate those stupid tests. Try and look at these ones as purely part of the process and just a box that has to be ticked - they massively trigger me so I really feel for you.

I’m in North West London, we’re actually using Dr Lynne Chapman who I think works out of The Lister sometimes but we’ve gone through her private clinic - she is really lovely and we’ve been really impressed so far! I had my follow up scan this morning and they found around 15 follicles this time so I am MEGA relieved. Can just focus my worrying on the egg quality now 🤣.

Have you got any weekend plans?

@MsWonky thanks, I’m surprisingly ok compared to some negatives and I think the ivf looming might be why. I think an IVF BFN will be much, much harder to swallow. But we will try again this month, I think this is better than not trying for me ahead of ivf because it keeps me feeling like I’m doing something. Although I won’t lie, I’m not even convinced I did ovulate despite the meds. At least with ivf I’ll circumvent ovulation.

I don’t know that doctor but I googled and she looks friendly. 15 is great, what’s the next steps/timings? Have you been on any of the old supplements?

Nothing thrilling, probably good we aren’t going far since we can’t get much fuel right now lol. We decorated our spare room and built furniture the last few weekends so we need to finish clearing up and putting the rooms back together. I did buy a bike this week which is pretty hilarious, never been a cyclist, I blame ttc and infertility making me do stuff to distract myself.

Forgot to ask if you have any plans!