28 but with low AMH - should we move clinics for more blastos?

[Smiler88]

Hello Mumsnetters,

I've been reading these threads for ages now and I really value your opinions so I was hoping someone on here could help me! I'm 28 years old, and in Feb I was told my NHS consultant that my AMH is so low (3.4) that I need to try to conceive now or have IVF, because in as little as 6 months I may not be able to have a baby of my own.

I've always wanted a family but wasn't expecting to have one yet, so the news came as a bit of a shock! Luckily my boyfriend has agreed to conceive with me, he's 25 so we thought our chance of getting several embryos from an IVF cycle would be quite high. (We've been told low AMH just signals egg reserve rather than quality and due our ages our's should be good.)

So we went to the Lister clinic and although everyone was very lovely we got 6 mature eggs, 5 of which fertilised but only 1 made it to a grade 4AC blastocyst on day 6 (rather than day 5 as it should) . We've frozen this one and want to try naturally or use IVF to conceive in the future.

I figure if only one blastocyst was created with medicine, its unlikely we will get pregnant naturally, although we are trying. The embryologist has said my boyf should do a DNA fragmentation test to check his sperm, and we may need to do ICSI in the future. I'm very aware time is of the essence I want to do IVF again asap to give me the best chance of conceiving!

So: has any one in a similar situation (Low AMH) has much better success doing ICSI rather than IVF? And should I leave the clinic to go to somewhere like the ARGC or another clinic? From my emails since the IVF I get the vibe they wouldn't change my dosage it would be the same again, which I'm not convinced would be best- has anyone has a similar experience and gone to another clinic and had more blastocysts as a result? I'm aware Lister isn't the most successful but it did come recommended - I'm so confused!

I'm so sad and panicked as I don't have much time - and not sure what to do :(. I would be so, so, so, so, so, so, grateful for any one with a similar experience or any advice! xx

Tbh I don't agree that you can't get pregnant on your own. Low amh just means you have less eggs and are unlikely to respond well to the ivf drugs. your egg quality is likely to be very good at your age. However you are right that time probably isn't on your side in the same way it would have been if you had higher amh. I don't think they can really quantify if though and tell you you only have 5 months left to try!

I had amh of 2.8 age 34. I got pregnant naturally as soon as I got this news, miscarried, then did ivf. The ivf worked. Once our ds was 9 months and I stopped breastfeeding we tried again. We got pregnant straight away. This was 2 years after the amh test was done. I now have 2 little boys.

If you have no other issues I can't see why you couldn't get pregnant on your own. Ivf just speeds things up, and with people with low amh, it doesn't always work that well just because you don't respond well and get that many eggs. It CAN work though!

Also- I think it's expected that the number of embryos from an ivf cycle drop off as the days progress. There will always be a front runner or runners which is stronger than others and also weaker ones. I don't think your logic follows though about not being able to create an embryo naturally. Your body is only supposed to create one at a time, and in natural conception your body picks the best egg to ovulate to create the strongest embryo.

Thank you so much for your reply Chattycat78, i find it very heartening! I very much hope you're right! Do you mind if I ask which clinic that you went to for your IVF with your low AMH?

I'm in the north- so a clinic in Leeds. There isn't as much choice here as in London!

Hello Smiler. I would definitely see if they can up the dosage slightly, IVF is trial and error and what doesn't work on the previous cycle should be adjusted for the next cycle.
I agree with Chattycat that really you could be getting pregnant on your own but it's taking a risk to stop treatment and try naturally. Each year your eggs age with you so you don't want your egg quality going against you as well your quantity.
I'm 28 and my AMH is considered low at 14 and I'm not getting pregnant, they cant find any other reason by im not getting pregnant, ive been trying for over 3 years in total. I would definitely push for a higher dosage or I would want a detailed explanation as to why not to. If they won't budge, I would get a second opinion at another clinic.

I'm not suggesting giving up ivf- do both. BUT I would say don't rule out natural conception!

What Chattycat78 said, there will always be a drop off from no of eggs to no of blasts, that's to be expected.

Also, AMH isn't just on a downward trajectory - I started with an AMH of 13 (ok for my age) which then dropped to 3.5 in the space of 15 months. Cue massive panic.

I took DHEA and CoQ10 for about 6 months and my AMH went up again to 6.2. Did the Lister recommend you took these supplements too?

I was also with the Lister, my first cycle was successful (3yr old DD) and I subsequently did an elective freeze-all embryo banking cycle.

Do you mind if I ask why the Lister took your embryos to blast stage if you were planning to freeze-all? They were quite insistent that mine should be stored at 2pn stage (straight after fertilisation) as the thaw survival rates are a lot better for embryos frozen at 2pn, rather than blast.

...ICSI is usually recommended for male factors, rather than low AMH.

5 out of 6 eggs fertilising without ICSI is pretty good going, I'd have to question what value they think ICSI will add to the process?

It will add the best part of £1400 to your overall bill though!

By the sound of it, they are worried about your BF's sperm quality if they suggested the DNA fragmentation test. Also, from what I've heard embryos developing to day 5 can depend a lot on your nutrition. Are you both super healthy (oily fish, nuts, lots of fruit and veg, wholegrains, no junk or sweets, balanced blood sugar etc) + no smoking or drinking (not to mention drugs) + supplements? If not, then in your position I'd probably be trying naturally for another 3 months whilst being extremely healthy and taking supplements so that you can start another cycle in 3-4 months if nothing happens (sperms take 2.5 months to develop and eggs take 3 to grow). That way you'll give yourself the best possible chance. However, if you have been super healthy and using supplements, then I would potentially consider another clinic or stay with the current one for another cycle and go with what they say re ICSI.