Cancelling cycle?

[starsareblazing]

I was wondering if I could get any thoughts or advice or our current situation. Feeling a bit lost.

I'm 28, my husband is 28, we've been TTC 1st baby for 2 years. Found out in the summer that my AMH was 3.2, FSH was 19, so I don't meet the criteria for NHS IVF in my area due to low ovarian reserve. We decided to go ahead with private IVF and remortgaged our house to do this, as we were advised by our consultant that time was of the essence due to the results.

I've been put on a short protocol. Baseline scan last Thurs showed 4 follicles on one side and 5 follicles on the other. I started menopur 112.5 and gonal f 175 last Wednesday, also started cetrotide 250 on Monday morning.

I went for my first scan to assess progress this morning and only 1 follicle is at the expected growth. There are 4 more follicles which the nurse said are below the expected growth but a couple of which could be potential recruits, there is another which is tiny.

They've recommended upping my dose of menopur to 262.50, continuing on gonal f as is. I have a scan on Thursday to see whether the other 4 follicles are joining or not. I've changed my appt around so a consultant will be around to discuss results afterwards in case they recommend cancelling cycle.

I guess I just wanted to know if anyone has been in this position? We've pre-paid for 2 cycles and a cycle counts from egg collection. We have no other funds for further cycles.

I'm just wondering is it worth cancelling cycle anyway? Then at least the next round they could put me on a higher dose of meds from the start and we might have more of a chance. I wasn't expecting only 1 follicle to be at the expected growth today, so feel a bit confused by it all and it feels a bit bleak. Just don't want to waste a cycle if the odds are so against us.

Thanks so much

I would. We only had one egg and the pressure during the 5 days wait was too much and it wasn't a viable embryo in the end.

I would cancel at this point?
I would also look to see if you can swap onto natural IVF (create do it) as that's designed and pioneered for women with very low AMH - they collect the one egg that month naturally - no stims etc forcing your body to do something it isn't designed to do. It's also a lot lot cheaper x

Thanks both of you, I'm leaning towards cancelling I think, just a lot to get our head around. And the clinic team are lovely but not very good at explaining things so I don't feel that I really know where we stand, so maybe looking into other clinics is a good idea x

Which clinic are you using OP? Is it abroad? We are doing it abroad, just got news yesterday that it failed :-( ivf is such a roller coaster.

@starsareblazing I have a low AMH too. I'm doing mild IVF with Create and paid for three cycles up front. In my first cycle, I only had two follicles, but in the next two cycles, I had more. I would cancel this cycle, and try for your next cycle, every cycle is different.

We're using a clinic in east Anglia just because it's closeby, but listening to everyone's experiences, maybe abroad or create might be a better option.

@MaButterface I'm so sorry to hear your news, it is a total rollercoaster.

@HJF84 thank you, I think cancelling and reassessing is the way forward. how have create been?

Hello! Sound a tough time. I was a poor responder to drugs for ivf. We now have five weeks before baby from donor eggs arrives! Happy to chat if you're thinking about less stressful alternatives x

Hi @Angliski thank you so much for responding. How many cycles of own egg IVF did you go through before moving onto donor eggs? Part of me feels that moving onto donor eggs may be the way forward sooner rather than later. Did you do donor egg cycles in the UK? And what were the costs? How have you found it? X

Hi @starsareblazing - I am currently on my 3rd cycle, 1st cycle MMC at 10wks, 2nd cycle poor response and only one follicle - immature egg. This cycle I currently have 7 follicles, I'm obviously not there but I just wanted to say I know the despair and worry you must be feeling. In my 2nd cycle my clinic said I may never do better than 1 follicle, so I carried on, if I was there again I would cancel. This cycle has really given me hope that we can still get there as I've got the most follicles I've ever had. X (ps sorry for babbling).

@starsareblazing Create have been wonderful. The staff there are so lovely, very empathetic. I hope one day to be able to recommend people to them based on how lovely they are and that it resulted in a successful pregnancy 🤞🏼 I wanted to find a clinic that could fit appts round my work schedule.

I chose Create because of their experience with low AMH and recommendations from friends of friends

I'm also with Create and found them to be incredibly compassionate and seem genuinely passionate about getting you pregnant and don't make you feel like a walking credit card

@HJF84 @itwasalovelydreamwhileitlasted it's great to hear both of your experiences of create, thank you so much. If we do cancel this cycle I will definitely look into moving across to them!

@WorriedButterfly that's so interesting to see the variations between cycles! Are you at the same clinic? And have they drastically changed your meds? Congratulations on your 7 follicles, that's so brilliant! Whereabouts are you in the cycle?

I stayed with the same clinic, for my first two we did a 2 cycle package but have just paid for the 3rd separately. They have put my menopur up to 450 (for my 2nd I started on 375 and upped it on day 4 to 450), they've also introduced dexamethasone which helps the ovaries absorb the stims. I'll also have to have more progesterone (intramuscular injections as well as pessaries) if I get that far. 🤞🏼 I should have said my AMH was 3.9 in February it is now 1.3.

@starsareblazing
You should think about it. It seems quite a low dose of stims for that Amh and fsh combination. Your age is really on side but ideally you want to get a few more follicles.
My amh was 5.4 at 32 and on my first cycle I started with 300 of gonal f and stayed at that level for 12 ish days. That cycle didn’t work (went to a different clinic where i started on 225 of menopor) but a FET from second one did work.
Now you know more about the response you could ask them to stop and then start again with higher dose of meds in a month or 2.

@WorriedButterfly thank you for sharing, it's great they've found something that works. How long are you on stims for? This is a silly question but does your AMH ever fluctuate up and down or is it usually on a downward trend?

@Waterdropsdown yeah that's what I'm thinking, they started on too low a dose, we know that now, so let's start fresh with more meds from the start. I worry they will be reluctant to cancel the cycle though.

As an aside I'm slightly confused about the options for mild and natural IVF for low amh. Are there differing opinions on this in clinics? Some clinics seem to encourage loads of agressive stims and others mild or natural? They just seem to be such polar opposite views! I guess it's more of a just see what works for each person?

@starsareblazing
AMH tends to only go down really unless you have PCOS then it tends to go up but that still
Isn't a good thing

Most ivf clinics push for aggressive treatment because it's a numbers game - most number of follicles equals most number of blasts and of course then as many transfers as possible.
If you go with mild ivf or natural then you need to know you're only going to get a couple of blasts or just 1 but actually the science shows they are better quality (the body isn't designed to mature 10+ follicles in the same ovulation)

I've done mild and I actually got more follicles and blasts than my friends on aggressive long protocol......

@itwasalovelydreamwhileitlasted that's really interesting, thank you so much for explaining! It's just such a massive amount to try to understand and take in, a whole world that so few people seem to be aware of.

@starsareblazing
Be your own advocate and if you feel it’s the correct thing to do then do it. I felt through all this that I really had to spend time educating myself about all the processes/meds/timings and it really helped me being in the know. Some will feel the complete opposite.

That's such brilliant advice, I definitely need to. I feel exactly the same, knowledge is power!

This is another silly question, but if I had 9 follicles on the antral follicle count, is it usual that all of those would respond to treatment? Or do you usually lose a few along the way? My AFC a couple of months ago was 11, this time 9, does this fluctuate up and down?

Thanks so much for all of the advice, it's been incredibly helpful

@starsareblazing I'm in agreement with @Waterdropsdown and @itwasalovelydreamwhileitlasted and go with what feels right for you and do your research. I chose Mild IVF because I didn't want to feel as if I was using all my eggs, plus I worry about putting too many chemicals in my body, I'm so sensitive to these things.

@starsareblazing Yes it goes up and down, it did for me anyway! On some cycles I've had 12, then I had 4 then I had 11.

@starsareblazing
AFC does fluctuate month on month
It's usually a good indicator of how many follicles you might get in a stimulated cycle however no one can predict whether they will all respond to the medication and mature enough to give you a good quality egg

Thank you so much for the responses, it's so helpful to know that these things can fluctuate so much and makes me feel a lot more positive.

Just as an update, the scan today went better, 3 follicles are now growing as should, there are a couple of others which are not growing as well but are growing. Saw the consultant and they feel very confident that with a few more days and another increase in meds things could improve further so am being scanned again on Monday and then we will decide whether to continue or cancel the cycle.

Thank you all for being so supportive and helping me feel so much better informed :) x