Clinic and advice with Low AMH

[mountaingirl123]

Hello,
This is my first post on here so apologies so sorry if this has already been extensively covered.
I would be really interested in your advice on highly recommended clinics in the Bristol, London, Oxford or around.
I'm a healthy 35 year old and live with a partner and we have been ttc for 8 months. I have had tests I have been told I have low AHM 1.9 and high FSH 15-19.
Really worried but I was told we were likely to conceive naturally however, I want to give it the best chance possible. So advice would be great on this front.
Also I would like to know if I should go straight into having eggs frozen and IVF sooner rather than later.
Many thanks in advance for any clinic or general advice.
Happy New Year and let it be a happy one for everyone!

I am quite surprised that they told you that you could expect to conceive naturally. Perhaps at 35 they expect egg quality would still be good, even though projected quantity is low.

Personally, with AMH at that level, although it's not the full picture, I wouldn't really want to wait too much longer and if it were me, I'd be looking to move to IVF sooner rather than later to maximise your chances with your own eggs, if that's what you are hoping for.

Best of luck with the next steps!

Also to add, I don't see the benefit of getting your eggs frozen.

If you did need to delay a pregnancy for any reason, you'd be better freezing embryos rather than eggs.

Hi @mountaingirl123 - I agree with @Botanica. Those results would indicate to me to go straight to IVF. I think there are several clinics in london that specialise in low AMH - there should be some threads on here if you search.

The good news is your egg quality is likely to be pretty good as you are only 35, but as IVF is a numbers game and you are low on reserve, sounds to me very much like you need to crack on ASAP. This is the advice my sister was given with similar results and age to you.

Hi @mountaingirl123 I also agree with the other posts, my AMH was 2.1 and I was told to move straight to IVF by 2 separate clinics as low AMH means that response to IVF drugs is likely to be poor. I was expected to produce "1 or 2" eggs. As it happens I produced 4. The AMH test is not an exact science and needs to be looked at in conjunction with AFC (and of course the only way to know how well you will respond is to actually have a round of IVF!). Unfortunately I'm not in any of the areas you list but I'm sure someone will be along with some recommendations. Best of luck to you xx

Many thanks for you message @Botanica.
Yes I'm pretty nervous about just waiting and seeing what happens without a second or third opinion.
looking to getting things moving forward as soon as possible.

Hi @Wesstywoo Thanks for your message and yes your right its not an exact science all came as quite a shock though that I'm still reeling from. I think I better look into IVF have no idea what it is really and getting the right place. Good luck with it all if you are still on this journey x

Yes looking into the London Low AMH level clinics here is the shortlist so far will probably choose say two to have a follow up consultation:
Lister in Chelsea.
Zita West
Dr Venkat at Harley street fertility clinic (www.hsfc.org.uk/)
argc
Create centre bristol
BCRM

@79andnotout Thanks for your thoughts on this, best wishes

OP- I disagree that it was a mistake to tell you that you will conceive naturally.

I had an amh of 2.8 and fsh of 12 at 34. I got pregnant 3 times following this result- twice naturally and once with ivf.

This result shows you that you need to crack on- yes- but not that your eggs are no good. Amh only tells you about numbers- you only need one good egg to conceive.

Ivf is a good idea- but continue to try naturally also.

OP- read this:

www.google.co.uk/amp/s/www.vox.com/platform/amp/science-and-health/2017/10/11/16453714/ovarian-reserve-test-science-results-fertility

I definitely agree you should continue to try naturally, and age is the most important factor. But as you have been trying for 8 months already with no pregnancy, and assuming you have been timing things right and there's nothing wrong with your partner, then getting your ducks in a row for IVF is important to give you another option. AMH isn't a great marker for fertility, but is a key marker in IVF success, and also a good predictor of menopause, and time seems to be running out for you. But hopefully you will be like the previous poster and won't need it.

Hi @mountaingirl123, I was in a similar boat as you, up to last month when I finally had an op to confirm infertility... now I'm just waiting for my IVF treatment planning appointment... then hopefully set to start!
With IVF clinics, it's a really good idea to consider how near they are (you'll need to do the journey a lot!) and how comfortable you are with the staff, in addition to the stats. Most have an open evening that you can pop along to (with no explanation) and just scope it out. They explain the process, show you the rooms and treat you kindly (after all you're a prospective private patient!)
Best of luck for 2019!

Hi guys, thanks again for the advice. Sorry for the slow reply. So have found it useful to get some more advice from other clinics and not just listen to one clinic to get a more rounded picture. I was left feeling like pretty down after the first consultation where she gave me all the bad news with seemingly no good news. Opting for the Lister who were more reassuring and positive with treatment starting in a month, ready for the long haul and still possiblily to conceiving naturally. But I’m the meantime eating well, cutting the stress, getting body prepped but getting on with life.

@mountaingirl123 - good to hear you've found a good clinic and are taking positive steps with both natural and assisted. Best of luck!

Hi @mountaingirl123 I know this is an old thread but just wondering how you got on at the Lister? I have low AMH and have a consultation with them next week. Did you have success with them?

Hi @Misty84 I am with the Lister and I find them very good. Very nice staff and nurses and I really like my consultant - I feel he really listens to me and is proactive and happy to try different things. We have low AMH , poor response to ivf meds and male factor issues so we’re a complicated case.

Lister are my 3rd clinic and the best so far and I am not biased in that as unfortunately I’m still not pregnant. I will say however that I have learnt regardless of clinic you do need to advocate for yourself and keep on top of things (ie if you want a particular technique done to make sure to double check it’s happening, if you’re mid cycle and haven’t received a call from the nurses with next steps ring them to check if that’s correct and they haven’t forgotten about you). Hope your consult goes well.

Ah @ForeverAintEnough12 thank you so much! It’s such a minefield of knowing where to choose! That’s brilliant to have a recommendation for the Lister! May I ask what were your two previous clinics?

My other two clinics were in Ireland! Before going to U.K. I did 3 online consults with 3 clinics I liked the look of before deciding on Lister. So if you’re only starting out it could be worth doing a few before making your decision. I know they are expensive but they’re a lot less expensive than failed rounds of ivf if you are paying privately!

Hi @Misty84 thanks for your message. So I’m over the moon to be 21weeks pregnant and all going well. Lister was very competent but in the end we had the least good results there of 5 subsequent IVF rounds at other places. I don’t think they do anything particularly different from other IVF clinics. But the sinographer was good and docs probably all fine. Large waiting rooms full of women, doesn’t feel like a particularly personalised approach. I actually always had the feeling that something else was going on and it wasn’t the the AMH level and was frustrated that the local well recognised IVF clinic didn’t really look too much further than the obvious. Argc did the trick in the end but it’s not for the faint hearted and probably worth going elsewhere first if it seems like it’s going to be straightforward. The fees are generally about 30k all in as they do so many tests, and monitoring. This is not transparent and one of the large costs being ‘immunology’ treatment which a large amount of their patients end up using. It’s highly medicated but they do have high success rates too. I’m quite up to date with IVF clinics and procedures so let me know if I can help at all.

Hi @mountaingirl123 did you figure out what the issue was? I’ve just finished 3 rounds with lister and I have 2 untested embryos and 2 embryos with inconclusive PGS results frozen - low AMH and male issues. We are doing some transfers this summer but I was also considering maybe just going to ARGC. We do have the money and I could take time off from my job but I would have to move to the U.K. for it from Ireland which would be a big deal (and leave my puppy ) how long would I need to be over there for do you know and what did they do differently to lister?

Also huge congrats on your pregnancy! I’ve done 5 rounds of ivf so so happy to hear of someone who got there after so many rounds too.

@ForeverAintEnough12 wow that's good going then that you have four possibles. I probably would give argc a go if you have the time, resources and know what you want out of it.
The difference for me was probably mainly the immunology part of it (btw this is the major cost probably 15K of the 30K) . I took Humira first (this is strong) before starting, then had IVIG before and after conceiving and up until 20 weeks. Every three weeks. You would want to be in London for two weeks to a month probably and then arrange for blood tests/scans near your home. The concept is that the body is rejecting the embryo early on as it treats it as a foreign body. The IVIG keeps it busy will you are growing it. I was sceptical, it is big money making business but also had knew of three people who had had success there first time round.
The other smaller differences where only starting cycle with a low FSH which did actually happen at that point.
I did karyotyping before to check that wasn't an issue
Urine sample showed urea plasma this was treated with antibiotics
Hysteroscopy (they check out where the egg will be placed) also cyst removed at this point
An absolute cocktail of drugs administered before collection. This didn't however miraculously result in more eggs though and we didn't actually have a better outcome really when it came to the five day progress of eggs in lab. But we did have a good solid HCG level post conceiving which might even have been twins.
Blood tests virtually everyday to check level etc and that centritide in the blood so you wouldn't ovulate early.
Then additional monitoring during the two week wait.
Suggested lots of scans afterwards.
It is ALOT of work, takes months to start to get all the tests etc lined up.
Happy to chat if you need some more advice on logistics of how to get it to work for you.

@mountaingirl123 and @ForeverAintEnough12 Thank you for your replies! We had our consultation with the Lister and plan to begin IVF in July/august. We can’t afford ARGC (and I’m a bit afraid of how intense it is!) so will see how this round goes first as I have no idea how I’ll respond to the meds. Find the whole thing very daunting.

Hi @Misty84 I think it makes sense not to need all the bells and whistles initially as I would have been wandering with Argc if it was really all necessary if I went there first time. I think Lister are professional about it all. It’s not so bad once you get going. Good luck!