How long can I put off IVF?

[Thomasina76]

DH and I have been TTC since Nov 2015, so around 17 months. We have no known fertility problems other than age (I am 40, 41 in July and DH is 47) and have had a number of IUIs, all unsuccessful. Next step is IVF and consultant said not to wait too long as our chances go down every month. My AMH is 8.9.

Problem is, I can't seem to make a final decision to do IVF. I had a nurse consultant yesterday to begin the preparation month and I'm just not sure I can/want to go through it. I keep holding on hoping we will conceive naturally. DH and I each have 2 kids from previous relationships so were fertile at one point!

Should I keep putting it off until I'm certain I want to do IVF (which might never happen) or just get on with it. I feel like pushing it back a few more months to give TTC naturally one last try but that means by the time we do it I will nearly 41. How fast are my chances dropping?

Ooops, yes, is me. Forgotten I had done a name change.

Well, just got results from ovarian reserve test. Antral follicle count of 10 but my AMH has fallen from 8.9 last October to 4.6!! Massive decline in only 7 months. Clearly we need to do IVF now if we are going to do it at all. Has anyone else has such a massive drop? My periods have also been getting heavier and heavier. Wondering if I am pre-menopausal.

I had a massive drop

Without exaggeration, I was having 2 'cycles' at rhe same time because I was so fertlie my body was literally pushing eggs out 8 at a time twice a month. Some months I was bleeding whilst ovulating because my body was telling me to get a wriggle-on.

The next month I went for the planned ultrasound and the imaging was different. Bloods confirmed my AMH had dropped 0.57 OVERNIGHT. Honestly. Overnight. When I picked up the phone to take the call, the nurse told me to sit down because the news wasn't what we expected at all.

Whilst we did conceive with the one egg I produced with stims, that wasn't steong enough. We now have a DD by donor egg.

Your AMH is not that bad yet (mine was 1.5) but you have to remember that it's not only egg quantity that matters. The quality also goes down quite drastically after 40. My round of IVF/ICSI netted 3 embryos of which one was OK. If you really really want a child, I would start IVF as soon as possible.

(And IVF wasn't that bad. I got used to the needles in a couple of days, the egg retrieval was easier than I thought it would be, and the transfer was basically like an IUI procedure. Emotionally it was hard. But I'm now 33 weeks pregnant with that one good embryo.)

From what I gather, amh result can come out differently according to who does the test and where it's stored. So it's not necessarily the case that it's dropping massively in a short time. I have a friend whose amh appeared to double when she went for another test 3 years later

I do believe that you become more fertile as you come up to menopause and your body starts to push out more eggs in one go. That's why older women gave twins more Often I believe. However, this in itself doesn't make you run out of eggs quicker- you would only ovulate more of the follicles that were there each month anyway.

Ignoring that though, age is the important thing in determining ivf success so I wouldn't delay if you're going to do it.

Thanks all. Good to know it still isn't that low but it's still a bit of a kick up the bum. We are getting ourselves ready to do IVF next cycle. Really can't believe we are going to do it.

Mentally ivf is gruelling. Physically, I didn't find it too bad if I stuck to natural/mild rounds. I attempted long protocol and the down regulation drugs sent me properly loopy, so I stopped that cycle, researched lower drug options and eventually had my daughter that way.

Agree ivf is mentally gruelling as well as emtionally and financially - Esp if have repeat failures

Physically tho it was ok. You get used to injections tho I did gain weight loss thro over eating due to ivf not working

I agreed with consultant that I would do short protocol as really didn't like the idea of shutting down the system, so no down reg for me. What does the stimulation feel like? We did IUI with injectables last month and, overall, was fine but I am guessing I would be on 3 or 4 times the dose for IVF. Urggh. What causes the weigh gain? Water retention?

I barely felt anything during stims (despite being on massive doses of meds) apart from constipated and quite bloated by the time off egg collection. I actually lost weight during stims (until the later cycles where I took prednisolone during the stimulation phase).

Can anyone tell me what egg collection is like? We are due to do IVF next cycle but worried I am going to chicken out again and do another IUI with injectables. I am driving everyone mad as I cannot seem to reach a decision on this. Would IUI with injectables be a complete waste of time given that we tried this before, got 3 mature follicles, perfect lining and still nothing? The dr even said to me that I would get pregnant as everything looked so good! Must mean my egg quality is rubbish. Keep thinking though, it's the same eggs whether you do IVF or IUI. Obviously with IVF you hopefully have a lot more eggs to chose from but if there is one good egg there then you should get to it sooner or later, possibly later with IUI as it may take more gos to get to the good egg. Or is this logic totally flawed?

If you truly want the best chance of having a baby, stop messing around and do IVF. This month. Your chances of a live birth from IVF at your age are low and literally falling by the month. IVF is not that unpleasant to go through, plenty of people do multiple rounds and manage just fine. But please don't put it off again and end up looking back wondering whether if you'd just got on and done it, things might have worked out differently.

Oh and egg collection for me was uneventful! My clinic use a sedation anaesthetic which felt like having a general. I was wheeled round to the theatre and the next thing I remember I was back in my room. We went out for dinner that night I recall. I was a bit sore and bloated for a few days afterwards but was able to work and go out.

Thank you weasel, helpful. My clinic also sedate but wasn't really sure what to expect. So it's similar to a general?

Yes, felt exactly the same. I have no recollection of the procedure at all.

I had an EC with local anaesthetic and some opium based drug administered via nasal spray. I felt euphoric :)
I was watching the screen while my eggs were being collected, it took max 10 min. DH helped me to a room to lay down for a bit, I was back to normal in half an hour. I found the whole IVF process quick, easy and pain free. Considering I have almost 0% chance conceiving naturally this is as close as I can get to having a baby.

For me ec was horrendous in cycle 1&2. They don't sedate and I felt every movement /scrape and df could hear me in pain through the wall in the next room :(

3rd fresh and diff clinic was a better experience but still not pleasant but had more local drugs and though sore it was much better

Seems many clinics knock you up /general. Sadly my uk clinic didn't

If you truly want the best chance of having a baby, stop messing around and do IVF. This month. Your chances of a live birth from IVF at your age are low and literally falling by the month.

^^ This.

Your chance of getting pregnant with IUI with injectables is 6.9%, the hfea doesn't show birth rates for IUI. For IVF the chance of pregnancy is 23.1% with a live birth rate of 13.8% so significantly better.

I think your logic about if there is one good egg, you should get to it sooner or later is flawed because the quality of your eggs is declining rapidly, so by the time you get to the egg which is currently "good", it may have declined in quality and no longer be any good.

Sorry to be blunt, but your chance of success is declining rapidly so if you want the best chance of have baby, you should do IVF as soon as possible.

Egg collection really is fine. The physical side of IVF was fine for me, the emotional side is more difficult, but then so is the emotional side of infertility.

Thanks EarlGreyT, very helpful. You are right of course, especially with the logic around the eggs. Makes sense. Think the chance of a live birth at my clinic for my age range at my clinic (CRGH) is 23% which is a lot higher than the success rates with IUI so a no-brainer really. Just finding it hard to take the plunge.