Anyone over 35 with low AMH had success on long treatment protocol IVF?

[GlummyMummy]

I am 35 and about to undergo 3rd round of ivf. Clinic wants to put me on long protocol as last time on flare protocol my lining was disappointingly thin (finally made it to 6.6 by ET) but I am worried as I have low amh and have heard that the downregging can shut ovaries down totally.
Just wondering if anyone else with low amh has conceived on this long protocol? Has anyone with lining issues found one protocol to work better over the other? I'm a bit confused!!!

Yes me! First 3 cycles short protocol( 2 bpfs-1dc, 1mc and 1 bfn), 4th and final IVF long protocol also a bfp and am now 24 weeks with twins.

My primary diagnosis is blocked tubes due to endo, however for my third cycle my Amh was retested and it was classed as low. I had no choice but to change to long protocol as my last cycle was abroad( about as far from the uk as you can get) and the clinic needed greater control of my cycle.
Physically I found it much tougher than the short protocol cycles as you are essentially being put into early menopause with all of the corresponding symptoms.

My view would be if the first 2 haven't worked I would be looking at doing things differently going into the next round.

Hi glummy , we've chatted lining on other threads, hello again!

I haven't done a long protocol cycle, but we did initially TRY to do long protocol for exactly that reason - consultant said it would enable him to have much much more control over my lining

I also had exactly the same concerns about being over suppressed, given my horrifically low AMH . However my Dr said whilst he wouldn't have risked long protocol the first time around for that very reason - now having seen my response to stims had been pretty decent, he was less concerned about that as a risk.

He said AMH was important at the outset as a predictor, to inform choice of protocol, drugs, dosage etc. But that ACTUAL response to stims was what mattered.

We ended up NOT doing LP because I didn't down regulate properly (unusual - not impossible, but just unlucky!). Rocked up to my down reg scan to see a whacking great corpus luteum. I'd bloody ovulated whilst I was on buserelin - so no way we could start stims until till my ovaries were quiet. He didn't want to risk over suppressing me by down regging any longer, so he put me on the pill for a few weeks to quiet my ovaries, and reverted to short protocol for our second crack at the whip

Realise this is deeply unhelpful as doesn't answer your question at all, as we didn't end up actually DOING long protocol

But hopefully the fact that my consultant (who I trust completely) recommended doing LP for exactly the same reason, might provide some reassurance that it's a reasonable option to consider

Good luck - do let us know how you get on! xx

Also worth adding that my lining did suffer from doing short protocol again - I got a BFP, but miscarried at 10w. Tissue testing showed the miscarriage wasn't due to chromosomal abnormalities - so the problem was with the soil, not the seed. We can't know for sure, but as every other investigation has come back clear, poor quality lining seems the most likely explanation for why the pregnancy failed

Long protocol gives the Dr WAY more control, and they can add in oestrogen much earlier in the cycle than they can with short (flare or antagonist) protocol, so it could well be a great option for you.

So this time (IVF #3), we're working on the seed (embryos) and the soil (uterine environment) separately. We've done a freeze-all stims cycle with PGS, and will hopefully be starting a FET within the next week or so. Taking the ovaries out of the equation means we can focus solely on the lining - hopefully leading to a better outcome this time

Congrats Danaust - twins, how exciting!

Our first round of treatment was successful (we have a two year old) and that was on the long protocol, but 2nd time round they wanted to try me on the short protocol as I only got 7 eggs first time and they wanted more to play with! I got 7 eggs again but had lining issues. So this time they are suggesting the long protocol again. Just a bit concerned that it might shut my system down altogether! My amh was 3 in 2012 so likely to be much lower now. The short was much easier, I remember the long protocol dragging on and on, but hoping the lining might be thicker on it.

Hi again Bananafish, how are you? i am worried as my response to stims has been rubbish both times but Dr is adamant that it won't shut things down, he says it's just like giving your ovaries a holiday and that they come back rejuvenated!?!? That's very frustrating for you with the poor lining, given that your embryos were good quality. Pom juice, hot water bottles and brazil nuts worked for me - managed to get lining from 4 to 6.6 in a day so worth a try. Still 6.6 wasn't great, lining was over 10 in my first round. Maybe just an age thing for me!

Many thanks! Congrats on your dc.

I also found that the difference in protocol made no difference to the yield in the end. It is a numbers game and your doc will work to Optimise those but it really is about egg quality.

My first 2 cycles ( 2012/2014) versus last 2 ( mid 2015/beg 2016) yielded 3x the number of eggs. Last cycle i only got 3 eggs, 2 embryos were put back in, which resulted in the twins.

As you have trialed both protocols I suspect your doc is working more on your lining issue thinking the yield won't be affected either way. Just on that have you tried acupuncture? I used it during last cycle for the first time. I did 2 lead up sessions and then on the day of transfer immediately before and immediately after. If nothing else it was really relaxing which can't hurt.

Are you doing Isci? I believe most clinics recommend this for low Amh even when there are no male factors involved.

yes Danaust - snap for me, 7 eggs both times on different protocols and drug levels. And it is totally a numbers game, though egg quality is much more of an issue for me. Both times, only one of embryos made it to blastocyst and although these were both top grade, the quality on average was poor.

So the short protocol seems to have worked better for you in terms of numbers, yet quality was better on the long one, hence your pregnancy!?!

Did you do anything differently yourself between 2012/14 and 2016? ie diet, supplements etc?

Have considered acupuncture, did you find it helpful?

We are ivf, not icsi - icsi not been offered to me, though I had also heard it can be better for low amh. My clinic not great at suggesting things, often feel I know more than them! :-)

I think the main issue difference was being 35 versus 39( almost 40 now)....which totally changed the way I responded between cycles 2 and 3. My first 2 cycles which were both successful( although second was a mc @9weeks), I didn't take any supplements just the standard low-mid level stimms etc.

For cycle 3 my stims were increased to max 450 gonal f, I did Coq10 but that's all. For cycle 4 stims were kept at 450, I did CoQ10, growth hormone(omnitrope) and acupuncture. I figured I needed to do everything I could beyond standard protocol. I loved the acupuncture and would highly recommend it.

Have you considered changing clinics? I also felt that way with the clinic on my third( and only one that failed) cycle-i was suggesting everything to them and they were annoyingly passive with any suggestions for a follow up cycle. I did my first 2 when an expat abroad, 3rd in uk and when they weren't willing to change anything or recommend anything different for a follow up cycle I started to look at other options so we ended up changing.

yes, I think age has a big part to play Danaust, I noticed a big difference between ivf at 31 and 35.

We have thought about changing clinics but it's harder this time with our little girl in tow. Logistically it's easier to do it near to home (last time I was in every two days for scans) although the clinic is frustrating! Such a lot of money to be paying too!

Hi Glummy
I'm OK thanks - just done a third fresh cycle, dying to get my AMH retested as apparently post miscarriage my ovaries became PCO again. Despite my AMH having measured 1.5 on three different occasions, in three different months, at two different labs (in July, Aug and Oct last year), we got 28 eggs at EC 2 weeks ago, on a very very mild dose of stims!! Ended up with 9 blasts suitable for PGS biopsy, plus we had 3 frosties biopsied too - got the results back on Monday and out of 12 embryos tested, 6 came back as genetically normal!!

Hoping to be able to do a FET next cycle, and generally absolutely bricking it. The tissue testing showed the embryo was chromosomally normal last time, so the PGS doesn't give me a massive amount of reassurance, as I'm terrified of miscarrying another healthy baby

As the lining was the likely reason for my miscarriage, Dr will not transfer unless he is absolutely confident in the quality of the endometrium. Amazingly, my lining grew all my itself on this fresh cycle (11mm!!) so we're hopeful that I'll actually have a proper period and the clear out I need post miscarriage, so we can wipe the slate clean and build up my lining in a FET

Dr was absolutely bang on when he said he hoped that the cumulative effect of ongoing oestrogen exposure would upregulate the oestrogen receptors in my endometrium and make my lining more responsive. The 8 weeks of progynova tablets I took from EC until the miscarriage seem to have done just that, as my lining never got above 6-7mm In my two previous fresh cycles.

It was definitely an oestrogen issue as my uterine blood flow was perfect, hence why all the aspirin, acupuncture, pomegranate, vitamin E etc did absolutely bugger all for my lining - my blood flow didn't need improving, the lining just couldn't grow unless it was able to respond to oestrogen

Oh and will be throwing the kitchen sink at the FET : oestrogen pills (& patches if needed), vitamin E, l-arginine, aspirin, acupuncture for lining; plus Lubion (injectable progesterone), Cyclogest, prednisolone and intralipids

Desperately hoping that PGS tested embryo plus super charged FET will give me the chance to become a Mum

wow bananafish - 28 eggs!!! that's fab! says me on lowly 7 eggs each time! ;-)

I wonder if the supplements have had an impact on lining - 11 is great! Did you do anything else differently to contribute to that?!?

So hope it all works for you next time round then, you are definitely doing all the right things and sounds like your clinic and Drs are excellent

Thanks Glummy - Dr is completely mystified as how I went from AMH of 1.5 and FSH of 17.6 in July (with an antral follicle count of 5 at my baseline before my first cycle), to FSH of 5 (and FSH : LH ratio of 1:5 very characteristic of PCOS) and an antral follicle count of 20+ before this cycle. I am apparently officially polycystic again!

Asked if we could retest my AMH as I'm dying to know what it is!

Lining wise, the difference was almost certainly the fact I had two months of taking progynova while I was pregnant - so two months of extended oestrogen exposure - which helped to upregulate the oestrogen receptors in my lining, thus making it responsive to all the oestrogen being produced by my follicles

Basically the continual oestrogen exposure woke up my sleepy lining and seemed to kick it into gear!

Sounds like your Dr will be learning a lot from you!

Think I have got my head around the long protocol being worth a shot again this time. This may be our last attempt as it's so expensive and emotionally/physically draining but we are really keen to put as much of our efforts as we can into trying again. Hoping the supplements I've been on, plus increased protein diet will do something!