Anyone starting IVF? Join me (5)

[waitingimpatient]

I don't think anyone has started the new thread yet? Apologies if so and ignore this one if its already been done

I'm hoping by the end of this thread I'll be waiting and impatient for a new arrival fingers crossed

I hope you do not mind a gatecrasher. You all write so beautifully and honestly. I am so sorry for all recent setbacks, and so happy for all recent successes. What incredible women you all are.

I'm not sure I qualify for your group but I don't know where else might be as supportive as you all are to each other.

I have one 18 month old son, born when I was 38, natural conception, unexpected, my first ever pregnancy.

Following a miscarriage last June (wasn't ready for another then anyway), and I am now 40, I have failed to get pregnant again. I now really really want a second child. Had a few tests, AFC was very high for my age, AMH was low....what is that all about? Why might that happen?

Anyway, am now starting IVF at the Lister so I can freeze some eggs now, before I get married in June. The idea being we will transfer one or two frozen embryos (if we get any) in August (after which I will then be able to deal with the horrendous hyperesemis that I seem to suffer from). Or do a fresh round of IVF if we don't get any frozen now.

So I am currently on holiday waiting for my period to start so I get get a 'local scan' (Maldives) so I can start my VERY high dose of Gonal F. Short anatagonist cycle.

Based on today's mood I expect period to start in next few days, local scan soon after, then start with the Gonal F on Monday or Tuesday. I go back to London on Thursday and can get to Lister for scan and bloods on Friday earliest. They are happy with this plan.

I am sure my post reeks of complacency and ignorance. But any advice or warnings or ideas to maximise my chances of performing well with my crappy AMH, and getting a decent Collection of eggs? I feel like such an idiot with my stack of needles in the cupboard hoping something is going to happen. Maybe I am just too fxxking old.

I don't even know how long I might be injecting the Gonal F for and what happens over the Easter period at clinics like the Lister.

I just desperately want another baby, I am old, getting older, and hate myself for being so complacent when I got pregnant last spring. Now learning my lesson.

If my situation is not welcome on this thread don't hesitate to say so. I will return to lurking and reading quietly!!

But I trust all your judgement and experiences and while I haven't (yet) been where you are, I feel for you all so very very much.

Hello LH of course you are welcome !

Sorry that you are having a tough time of it too and find yourself here but there's loads of support and some very knowledgeable posters.
I don't know much about low AMH as I have pcos so mine is stupidly high but I think it affects my egg quality. I'm sure someone else will be along soon though who has some info

Most London clinics are quite good and open 7 days a week so I don't think Easter would be a problem although obviously I'm not sure. I've heard a lot of good things about the Lister so fingers crossed for you x

Waiting you are so very kind, not least because of your recent disappointment. I held my breath for you along with every other woman reading the latest in your story. I look forward to the next chapter which I so hope is more happy for you.

I haven't been able to even start a book here because I have been so busy reading this thread (and others) and being reminded how powerful women are.

If anyone does have any views about how someone may well have got pregnant naturally twice in last few years, but apparently has a high AFC but very low AMH...and now it is no longer working. All I can assume is that I turned 40 and it has all dropped off a cliff...? Bollox...

I have just started taking co enzyme q10 as I read the book 'it starts with the egg' which is really good. The same principles may apply to low AMH and maximising the potential of any eggs so worth looking into it. The book goes into detail about other things too ill have a look when home and see if there's anything relevant to low amh and high afc

I'm feeling a little better this evening, had a busy day, went for a long walk, ate healthily, took my supplements and I have reflexology tomorrow

Fingers crossed it will all help. I am just going to try and do everything I can to give us the best chance of it working next time. I was very tempted to just go for it again as soon as we can but from reading various things I am def of the opinion now that I need to get myself in the best possible shape so will have three months on supplements etc to maximise their effects before next cycle

Well I haven't done any supplements at all!! This is all my first time so I suspect I have so much to learn. I can totally imagine the impatience to get on with the next go must be overwhelming.

Waiting if you do what is advised when will you try again?

One more question: as I am holiday I am having a few glasses of wine every day. No more than half a bottle of wine a day, but certainly more than Lister advised.

Still no sign of my period which is due any day (will start Gonal F injections when it starts). Do you guys all avoid booze like the plague at ALL times, or do you think a few glasses of wine a day while feeling pretty relaxed and happy is not going to make the world of difference?

Excuse my ignorance if I have YEARS of catching up to do. :-(

I don't drink at all as I have a bad reaction to alcohol (face puffs up and goes red and I get hives) dh does like a drink but has now given up in anticipation of next cycle. I'm not sure if it'll help but it feels like we are doing something !

I need to take supplements for three months so would probably be dependant on my irregular cycle possibly June time

Ok Waiting - I get married in June (thus not doing any transfer now because my hyperesemis is very bad) - so if we get anything from this round of drunken ignorance, you and I will be back in tune I think. We hope to do FET in the summer. Or start all over again then....

LH I don’t know anything about the combo of low AMH and high AFC, as that sounds quite unusual given that AMH is produced by the antral follicles so normally high AFC = high AMH and vice versa. That’s really interesting, what do Lister say about it? How is your FSH?

I had desperately low AMH, horrific FSH and a dire AFC - before my first cycle my AMH was 1.5, my FSH 17.6 (bounced down to 9.5 the following month just before we started the cycle) and my AFC was just 5

My AMH consistently measured 1.5 on a subsequent 2 occasions, although I didn’t have it retested just before my 2nd cycle, when my AFC had gone up to 10

I was on short antagonist cycle both times, and did really well on it

BTW I have no idea if they made a difference, but there was a marked different in quantity and quality between the eggs and embryos on my first round and my second round:

Cycle 1: AFC 5 at baseline: 7 eggs, 6 mature, 4 fertilised and good quality at day 3 but none made it to blastocyst

Cycle 2: AFC 10 at baseline: 17 eggs, all mature, 12 fertilised, 7 made it to blastocyst - of which 1 is inside me, 4 are frozen and the remaining two weren’t sufficiently good quality to freeze

I have no idea if there is any correlation or causation but the first round I had only been taking a cocktail of egg quality supplements - incl. DHEA, CoQ10, resveratrol & high strength vitamin D - for about 6 weeks vs the second round, which seems to have had better egg and embryo quality - where I had done over 3 months of the supplements (the duration of the egg maturation process). I am sceptical but who knows!!

I can really recommend the book ‘It Starts with the Egg’ - which I found particularly useful. The author is a biochemist who went through IVF with diminished ovarian reserve, and ploughed all the research for evidence about what might help egg quality - it’s very easily digestible for the layperson, I found it made me feel like I was doing something proactive, if nothing else.

During stims, I ate LOADS of protein on my Dr’s advice, and drank water like it was going out of fashion. ARGC tell you to drink 2l of water plus 1l of milk - I didn’t manage a litre but whatever you can get down is great for those follies

Remember AMH is just a measure of quantity not quality. And it only takes one!!

Hope you’re having a fantastic hol!

It's so hard indecisive. It really does push you to breaking point. There seems to be no easy answer. If you continue with another cycle, you are stuck in the emotional whirl of IVF, but if you decide to stop, then you are still stuck in the same situation of wanting a sibling for your son. There is just no easy answer.

Very warm welcome to you LH. As banana says, the combo of high AFC and low AMH does seem unusual as AMH is produced by your antral follicles, so the more follicles, the higher your AMH. All I know from my personal experience of 11 IVF attempts is that some cycles I had 15-16 follicles, while other cycles I had 5-6. Why knows why! So if you had your AFC tested on one cycle and your AMH tested at a different point, perhaps that could be an explanation?

I only ever ended up with 3-4 eggs and figured if I couldn't increase quantity, I could improve quality. I was very reassured by the studies online you can read about high protein diet of more than 25% protein daily for two months prior to and during IVF cycle, increasing IVF success to 60%. The study further went on to say that if carbs are also reduced to below 40%, then the pregnancy rate went up to a staggering 80%. That really gave me reassurance. But I guess the most important time is during the actual cycle when the eggs are doing their most growing so better now than never.

As for the alcohol, I personally did not drink. But I think if I did, I would have just been very stressed that I was ruining my chances. Where as you sound like you don't feel that way. I think the most important thing is that you have to be able to look back at this cycle and feel like you gave it 100% as it's awful living with the 'what if...' so you just do whatever feels best for you. I hope you are having a lovely last few days of your holiday before your IVF cycle begins.

Hello to you waiting. Good on you for getting out for a nice long walk. Not much I can say. It's just going to be 3 months of waiting.

Hello to you too *banana :)

Yes, it is just going to be a long wait! I've told myself that I need to do things properly this time and do everything in my power to maximise our chances

I wish I could just go ahead next cycle but then I might get a repeat of the last year (we might anyway but at least then we know we did all we could to improve things). I also want to reduce stress levels and I think that will have an impact.
Another thing I'm doing is forgetting my timelines. I had got so obsessed with when I will have a cycle, when I might be testing and then (stupidly) counting nine months on so of course I've had my hopes dashed each time and I don't think it's a healthy way to live. So, this time I'm going to just try and get through each bit and not plan too far ahead as I honestly thought this time last year that by now I'd have a baby or be pregnant and each time I've felt heartbroken.

I feel optimistic though and if I can improve egg quality maybe I can get some blastocysts next time and be successful or some day 3 good quality embryos. I feel very determined and I'm not giving up.

I actually feel a lot healthier already from eating differently and going for a brisk walk each day

Hope you are feeling ok today indecisive x

Your husband sounds supportive waiting in giving up alcohol to maximise your chances. And taking time off work so that you can rest after the transfer. It must help that you have him as support. My husband - despite being the one with the diagnosed dud sperm issue - denied that his junk food habits had anything to do with it and it was a real source of contention.

I found myself doing the same thing of TRYING to forget timelines. It was difficult to forget what day of my cycle I was at and when I expected my period, but I do remember after the transfer of my last cycle, not daring to get my hopes up and see when the baby would be due.

You are very inspiring to watch you get right back on the horse and start walking and eating healthy as a 3 month plan. I guess the only other aspect to improve egg/embryo quality is the protocol. I was a poor responder and it led me to do research on what protocol would be best for me. It led me to this study on the estrogen priming protocol. It was interesting that the study found this protocol compared to the standard antagonist protocol showed a trend towards increased number of normally fertilised embryos and what I consider to be quite a significant increase in the percentage of good quality embryos at 51.2% versus 25% for the antagonist protocol. I realise you are not in the poor responder category, but it is interesting that it seems to show that different protocols can clearly produce different results. So I hope your clinic can tailor something specifically for you. Have you booked another appointment or are you now considering where you will go next, seeing as the follow up consultation is no longer part of the service where you went?

You are doing brilliantly waiting

Given Create special in mild and natural IVF and they stimmed you for such a dreadfully long time and you ended up being quite hyperstimulated, and given they say quantity can be at the expense of quality, presumably it would be reasonable to ask them how they would put what they promote as their selling point into practice for your next cycle. A milder dose of stims? Natural modified protocol? Quite a few women I know who've cycled with create got better embryo quality with natural modified and lighter doses of stims - given this is what Create publish all their research into and what they promote as their USP, I'd think they should have rather a lot to say about the stims protocol and ways it might be tweaked xx

My dose last time was 112.5 gonal f, which isn't high but it all seemed to be a bit hit and miss. I started on day 2 and had my first scan which was ok a few days after starting (can't remember exactly when as was a year ago!) but then another scan two days after that and they said to carry on and that I wouldn't need cetrotide yet (I think this was day 7 or 8?) but my bloods that day came back high so they told me to start cetrotide (biggest follicle was only 8mm at that point I recall) and I had a mad dash up to London to get a cetrotide as they'd said I didn't need it so I hadn't got any!

I think that was the mistake which then made me need stimms for so long-they rushed into giving me it too early. Based on the scan I didn't need it but the bloods made them change their minds and I think it was perhaps a day or two early? Then I ended up having it for so much longer than I thought. Not sure if the buserilin trigger was an issue too but I had no choice due to PCOS
I also was a bit surprised how unevenly the follicles grew. EC day some were huge (biggest 27mm I think on trigger day) and then so many of varying sizes and I think some were 'overcooked'

I don't know much about modified natural, how many eggs does that usually produce? Obviously I'd go for quality over quantity any day. They told me initially I wouldn't be able to do do natural due to PCOS but perhaps modified is a good option.
We are staying with them depending obviously on out follow up next week as I'm hopeful they can use these failed cycles etc as something to learn from and hopefully get it right next time now that they know my response

Natural modified maybe not if you don't recruit any follicle, but certainly low dose stims. Or a letrozole plus low dose Gonal-F just to goose along a few follies with Cetrotide added in later on. These are all Create protocols from women on FF who've cycled there. Also Create offer IVM which is supposed to be brilliant for PCOS women. They advertise it as such on their website!

So they should be able to talk through the different pros and cons of the stims protocol they used, what worked well and what didn't work so well, and what the different options are for the next fresh cycle, taking these learnings on board

My consultant said first cycles are often as much a diagnostic exercise as anything as you just don't know how someone will respond until you start stimming them - and it's tailoring the protocol to them and their response that gets the best results. You have some cracking learnings from last time and so they should be able to get you to a much better place next time, given what you all now know. You have lots of really great questions there and it's their job to be able to respond to them. You know all the right things to ask - they just have to answer them and come up with a plan of action xxx

Thank you so much for the educated and thoughtful assistance to my situation.

Re what Lister said about my High AFC (I think it was 14 - about 7 on each side; which consultant said was good for a 40 year old); and then my low AMH (which was 2.9) was that we should see this as a 'warning sign'. My age is starting to have an impact. My take from this was that she didn't really know, and I would try not to get too worked up about it. Remembering I have got pregnant naturally twice before - one ending in my son and one ending in early miscarriage. All the same man ( who is also my fiancé - so no changes there). His sperm is described as 'fine but not far from borderline'.

Both AFC scan and AMH bloods were done on exactly the same morning. I do not know what my FSH is. Would be keen to know though.

I have downloaded It Starts With The Egg to my Kindle to read here on holiday. Thank you so much for recommendation. I will rapidly increase protein intake from now on; keep drinking 3 litres of water a day (drinking milk grosses me out but I can try); and keep alcohol as low as I can, and completely stop when I get back to Loondon on Thursday.

I think all I can do is press on - and hopefully start the Gonal F (450) injections in next few days when period has started (still no sign - due around now). My preparation has clearly been FAR from best practice but I still want to give this a go now as I am pretrified of being a bloated mess any closer to my early June wedding.

And if this cycle is not fruitful (so nothing to freeze) then I have the Spring to follow all your advice, good eating, zero booze, and get a good 4 months of supplements going to maximise my egg quality before we start again in the summer.

Do you all get DHEA prescribed for you? Or do you order online from the US, and in what dose?

As banana says, maybe this round is a bit of a diagnosis exercise, and I would be crazy lucky if some nice results popped up too!

Thank you again....

Not had a great couple of days :( have had the worst migraine and the bleeding has now started :(
Have decided we are booking a holiday!

I do seem to ovulate sometimes as did both FET cycles unmedicated and did have a dominant follicle but then I do have some cycle where I don't ovulate

I'll look up the other cycle protocols and see if any sound suitable although reading about modified natural it sounds promising

Letrozole in a natural modified type cycle sounds a good idea perhaps. I'm going to mention this all to them as I'd rather have 2 or 3 good eggs than 16 that don't work like last time

Reading about IVM I wonder why they didn't offer me that for the three immature eggs I had last time ? It might have worked but never mind

Sorry you are feeling so bad indecisive migraines are horrible aren't they, it's probably hormone related if you are also bleeding. You must be feeling awful try to rest and just get through the next few days. I agree a holiday sounds like it could be very beneficial and will help you to relax x

LH having a higher protein diet during stimms will help too so it's not too late ! Fingers crossed for you

Ah LH interesting - the AFC and AMH seem slightly out of kilter but not massively. The AFC tbh is the more important one as it’s that which determines how many follicles are in the starting block at the start of the cycle. It varies across months, and usually not all follies will develop, although I must have had some hiding round the back as both cycles I got more eggs than the no of antral follicles I had at baseline, so go figure!!!

DHEA can’t be prescribed, it’s a dietary supplement - get the micronised kind. Although tbh I stopped mine as soon as I started stims so I wouldn’t worry about it for this cycle (and hoping you don’t need a second stims cycle!).

I bought mine from DHEA.com and took 75mg daily

Best of luck with the stims - I started on 450iu Gonal-F both times and did really well on it. Both times my dose was dropped down after a few days based on my response - the only thing I found was that on the higher doses I got massively bloated. Drink tonnes of water!

waiting all sounds eminently reasonable to ask

indecisive big hugs xx

waiting, I don't want to add more stress and confusion as banana has already given a few suggestions on her thoughts on protocol and I know that it can just lead to you doing research and getting yourself all stressed out (or at least, that was what I did!) But I do want to say this and then I shall try to keep my mouth shut and just be here for support rather than to stress you out with everyone offering their two cents to you.

I do know that I have read the first to mature follicles are often the best, which makes perfect sense as it mimics what our body does each month in a natural cycle where it starts with several follicles and selects the best egg and grows this on to ovulate. So when you say you had some at 27mm, it sounds like your strongest follicles were allowed to overmature, although I do realise that when someone like you has 30 follicles, the clinic would trigger when you have the most numbers within the mature range which rather than just waiting for the first 4 of 30 to be at 18-20mm. I guess the answer is to try and have a protocol that gets more co-ordinated follicle growth in the first place. I mentioned the estrogen priming protocol (EPP) study for poor responders and just want to share my personal experience with it. When I started IVF, I had an AFC of about 8 for my first three cycles. The first cycle I did a short protocol, just starting stims on day 2 and had only 2 mature follicles with one smaller grow. The second time I did my research and wanted the EPP but the Dr was not familiar and suggested taking the pill to shut down my ovaries so that everything grew at a similar rate. Well that had no effect and I had a similar result to round one and cancelled. He then says 'the pill doesn't work, try the spray', by which time I thought 'well if the pill doesn't work, then why the fxxk did you insist it would and waste my time with it?!?!'. By this time, I had decided that I was the one that had spent the most time researching what was best for me and I would make the decisions and I insisted on doing the EPP. This time, despite still only starting with 8 follicles, I had 5 at the 10-12mm mark on my first scan following stims. So my body worked just the way the study had promised and I got much more co-ordinated growth. I know you are not a poor responder but I mention this because I was convinced to do the EPP based on a friend in America who is not a poor responder but her clinic does this as the protocol of choice as studies show it produces co-ordinated growth for quantity as well as better quality embryos. Okay, so that's my thoughts just to add more confusion to your brain when you are trying to de-stress!

LH, that makes it even more confusing that your AFC and AMH were tested on the same day! The only logical explanation that I can see is that obviously your scan didn't lie and that you did indeed have 14 follicles. Since AMH is a hormone that each follicle produces, I can only assume that your follicles each produce a little less than average???? I've also read that AMH is produced by the smaller follicles (forgot what size they had to be under!) so perhaps this could be an explanation???? Either way, you are starting soon and will find out soon enough. It does sound encouraging that as you say, you have been pregnant twice before to the same man, so it's just a matter of finding that golden egg and I hope it is within the batch you are brewing.

Presumably if you're at risk of OHSS and have endo estrogen priming could be very deleterious? Did this come up in your studies Shell? I read up about it lots and found I had fantastic follie growth on the second cycle after the pill, which Dr Sher uses for estrogen priming in his protocols - but I'm not at risk of endo or OHSS so didn't know how it would work for a mild protocol?

Without a doubt there were a few follicles that I thought were too 'big' and obviously over mature
From the outset it seemed there were numerous follicles all at differing stages I remember them saying the measurements and it seemed to be similar to this "one at 27mm one at 22mm four at 18 four at 16 six at 12 and 20+8mm etc etc" so a huge range of sizes

I think cetrotide was started too early too-would that have made a difference if they'd held off? After that the differences seemed greater than the scan before starting it
I will look into the oestrogen priming protocol but will have to see how it is with pcos and endo. I also avoided mediated FeT so as to avoid Progynova as I suffer from hemiplegic migraine and was always told to avoid the pill and anything similar.
I'll do some research though. It all helps !

No banana, I didn't research Estrogen Priming Protocol in relation to OHSS or endo as that was not my issue. I know my friend in America who introduced me to EPP had 15 eggs collected in her EPP cycle (which failed due to male factor and 0 fertilisation rate) and the same protocol was used for her next cycle despite clearly not being a poor responder. She got more eggs in her last cycle, 3 made it to day 5 and 2 were transferred in her fresh cycle and both implanted - although one stopped growing due to genetic abnormality, and the third took in her FET cycle. I found that to be an amazing result to get 3 pregnancies/2 children from just 4 eggs. And obviously it worked for me too.

But that doesn't mean waiting that it is the best protocol for you as neither of us have endo and perhaps the pill or estrogen priming are not suitable for your body if they result in migraines for you. But I just want to put it out there as something for you to do your research for your circumstances or ask your clinic as it certainly worked for us... just to keep you busy in your three months of waiting! It's so hard to know - the pill worked wonders for banana while I had staggered follicle growth and only one or two mature after it.

I don't know the mechanics of how Cetrotide works to know if it would cause the varying follicle sizes you found on scans after it, or if it was just co-incidence and that your strongest follicles just naturally took off? I hope you get some clear answers from a competent Dr at your appointment and you can feel less stressed about all this with a clear plan for going forward.