Mild ICSI/IVF with low AMH?

[cluecu]

Hello,

I lurk here a lot (although have purposely taken a break recently) and wondered if someone could help advise me? I have created two threads, one is in miscarriages as I have two main questions.

Me and DH have been trying to conceive for 4 years and now have 3 failed ICSI cycles behind us. The last one did result in a BFP but the early scan showed that the two embryos had stopped developing at around 4-5 weeks.

These cycles were funded by the NHS so as lucky as we were to have them, I know there will be lots of things that may not have been investigated. We are now looking to have one final cycle privately.

One of the things I'm wondering is if anyone has low AMH levels and has been advised on natural/mild treatment. My last AMH levels were measured at 4.48 (I am 36). The best results in terms of follicles I've had were 8 at egg collection and this was on Menopur. However I've only ever had 2 get to 3 cell stage for transfer.

My worst was with Bemfola when I got 1 from egg collection.

I don't know if I should be going for mild treatment or stick to as high as possible. And also, surely any clinic I ask will want me to go with them. For example, Create in Manchester tell me how their mild process is better. But they would say that wouldn't they?

Just feel a bit/very confused and I guess the trauma of the process so far is still at the forefront of my mind. The costs etc as well mean I really only want to do this once more.

Thank you for any insight.

Well, with less stims you’re likely to only have 1 or 2 eggs. Whilst that might feel less harsh on the body, I’d try to get as many as poss - 8 sounds like a solid number. And it seems to me that in top private clinics ladies do get more eggs, more high quality embies and obviously higher success rates.

Thank JoJo, yes I am thinking to lean towards the higher stimulation as opposed to the mild/natural way. The clinic that offer the mild way is the one offering a cheaper first consultation but then if I'm not going with them anyway, perhaps I should cancel the appointment. Argh it's so different to the NHS as well with wondering about prices, ulterior motives and a lot of the tests they want me to pay for are also available on the NHS. Going round in circles!

My amh is 2.9 and I’m 34 we are going for icsi with 300 gonal f which may increase to 450 depending on how I respond.

My consultant initially said iui before my amh results came back and we are now going straight to icsi-we also have mfi.

I’d be more keen to understand the egg quality vs quantity in your situation. Any reasons the first 2 cycles didn’t work?

If your tests have been done by nhs they wouldn’t necessarily need repeated. My consultant ( we are 100% private ) didn’t repeat the ones my gp had done initially.

Try and research the consultants and clinics, you need to feel confident in who you are with especially when spending so much cash. I think we will be 7k a cycle nearly!! 😳😳😳😳 but we are happy with clinic and consultant. Good luck x

I don't know why they didn't work beyond that they didn't really. I guess with NHS there isn't much of a post-investigation. I was on the maximum (450) dosage of the stims all three cycles.

Thank you, have made some headway today and this has really helped!

After three failed cycles, I’d definitely suggest having further tests for blood clotting and immune causes, even though this won’t overcome any egg quality issues. Did you have long protocol or short protocol? I’d be interested in how a protocol could be adapted to help improve quality. I would meet with a couple of clinics - try and get in on open days and get free or reduced consultations. Additional tests changed everything for me, so I’m influenced by my experiences, but I’d definitely shop around to find somewhere that really focuses on you as an individual. Good luck.

I wouldn't get too paranoid about alterior motives. I think private clinics are just thorough. Is it on the back that ridiculous Panorama programme by any chance? It was utter rubbish. I was quickly convinced by the fact that these clinics often have almost double the success rates of others - not because they're grabby but because they're just that good.

However, ARGH is extra thorough and they do test all the time. If you find that a little much, you could try one of the other successful clinics like the Lister, Zita West or CRGH.

I agree with tiger

Although, also wondered what your clinic’s thoughts on this are?However I've only ever had 2 get to 3 cell stage for transfer.. As I’m taking this and your other comment (about both having stopped developing) to mean you’ve only had one cycle with any embryos to transfer? I can understand with the cycle where there was only one egg why there wasn’t anything to transfer, but what about the other 2 cycles? Why do your clinic think the embryos have stopped progressing? I think that’s possibly the most important bit to understand.

I do agree with the others though, if you’ve had up to 8 eggs from a cycle, higher dose stims with the possibility of getting reasonable egg numbers is the approach most likely to be successful.

Well the 1st cycle we put two embryos back but had a bfn and bleed 2 weeks after transfer. The 3rd we got the bfp but ended up having to have the surgical miscarriage option. As it's all been on the NHS it's not been investigated it's just one of those things. I have an appointment with the nhs recurrent miscarriage clinic next month but i can't imagine it will reveal much (I'm not bashing the nhs btw we are very grateful to have had the treatment we've had so far).

So much of it feels like a mystery and guesswork. I spoke to CARE Manchester and got a much better feel from them so they will be the clinic i choose as the reviews and ratings seem good.

Thanks to everyone so far it's meant a lot being able to get input from you xxx