Good AMH but poor response - help??

[Maestro7]

Hi all, I’ve just finished my 2nd cycle of ICSI. I just turned 34 and have an AMH of 18, AFC of 15. We have severe male issues but all my tests have come back good and normal.

Our 1st round was long protocol, 150 of gonal f. Poor response - 4 eggs collected 4 mature and fertilised, nothing by Day 5.

2nd round was short protocol, 225 of gonal f, 75 of menopur upped to 300 of gonal f for last 4 days due to poor response again. 6 eggs collected, 4 mature and 4 fertilised so exactly the same as last time.

Does anyone know what might be going on or what I could do to improve my chances for next round? Doctor says I have no issues but clearly I do if my response is similar to someone with low ovarian reserve?? What tests might show up my issues or how can I try increase number of eggs?

Feeling so down today to have the same outcome from a totally different protocol.

That sounds very disheartening. 💐

Can I ask how things were looking when you started your stimulation medication?
Did you have lots of follicles and they just didn't respond, or were the follicles not there to begin with?
I have low AMH but antral follicle count varies so before starting stims I have a baseline scan to decide whether or not to go for it that cycle, if the follicle number is very low the plan is to wait for the next opportunity.

In any case hoping that the difference this time around is that you do have something by day 5.

My AMH is a fair bit lower than yours and I’m a couple of years older. I had an excellent response for my first round (Meriofert) with 16 eggs (sadly no BFP in the end though) and then for my second round we went private and Gonal F was used. I barely responded at all to the extent they nearly cancelled the cycle (they didn’t in the end, the cynic in me suggests that’s because they would have had to refund us) and they only got 4 eggs and none of the embryos made it to blast so there was nothing to transfer.

Sadly we then went into the lockdown so we haven’t had any kind of a follow up with our consultant, but when we do the drug choice is going to be top of the list.

Perhaps worth a discussion with your doctor about moving away from Gonal F as it seems some people just don’t respond to it?

How many embryos did you get to day 3? Out of all the fertilised ones did they drop off between day 3 and 5 or before then? because that's obviously a male factor issue (sperm quality takes over day 3 and dictates whether you get a blastocyst)

Your first cycle I'm surprised at the low dose - I'm on 150ml stims on natural modified IVF with an AMH of 12.9.

I had a couple of cycles (the one I'm on at the moment included) where follicles have been slow to grow and they added in Luveris (so I was on 75ml Bemfola and 75ml luveris) and they did grow in the end but I'm only targeting very few follicles due to poor egg quality

Have you ever kept track of follicles growth? Do you know what size they were when you triggered? I'm a control freak and kept notes on all my cycles - anything 14mm and above on day trigger yielded a mature egg for me - I had one cycle where I only got 2 eggs as the rest really were stubborn but I was on a natural IVF protocol and stimming only every other day.

I have to say though that it seemed like the first two cycles I did last year were like practice runs for the clinic so they could establish a pattern of how my body reacts (I know that's tough to hear and some people really are lucky to get a perfect first cycle that works for them first time) - my cycles have for more successful each time (currently on 5th) as clinic tweaks the drugs each time

Also how much monitoring did you get? Did you have scans and blood tests every other day? Is this with an NHS clinic? It's important as regular blood tests mean that the drugs can be tweaked each time to get the best result. Eg what were your e2 blood levels like if you have an AFC of 15 but only got 6 to grow?

I wasn’t monitored with bloods at all on either cycles!!

Never knew that about lack of blastocysts Pointing to male factor?!

@youngatheart00

Yeah maternal DNA is the overriding factor in days 1-3 and then days 3-5 paternal DNA has a bigger role.

Everyone I know who has male factor lost a lot more embryos from day 3 onwards than those that egg quality issues

@Maestro7

my 1st cycle at 30 i had AMH of 21, 1st cycle cancelled with poor response. 2nd go wasn't much better had 4 eggs only one fertilised BFN. both of them were short cycles with menopur also MFI issues.
3rd go at 32, AMH now 16, had long protocol with different clinic and used meriofert, 17 eggs collected, 12 mature. BFP she is now 10 months old :-)
my opinion the change of drugs was the key. Good luck hun x

Thank you all so much for taking the time to respond! I was in the pit of despair this morning. I will take all your advice to the doctor - definitely going to ask for change of drug type and about the Antral follicle count and will also how many showed up at the start of each cycle and whether they weren’t there or just didn’t respond. And about scans as I didn’t have one until day 7 which was probably too late. Thank you all so much for taking the time xx

Maestro get a copy of your notes, when you go for scans they usually plot the follicle sizes.
With my current clinic I usually have a scan on cycle day 2 (could be day 1 but it has never worked out that I could fit in a scan on day 1) and then confirm to start stims that day, then scans on stim days 5, 7, 9 and usually day 9 of stims get the go ahead for trigger that evening (but they could decide then to do another day or more of stims if needed) . Blood tests have been as and when, can't remember exactly which days, not as many blood tests as scans.

Am I right in thinking though that you had egg collection yesterday, in which case there is still hope for this cycle?

@Youngatheart00 sorry to hear about your last cycle. I would also recommend requesting your notes, it's unfortunate but you need to understand what's there to be able to ask questions, no one is more invested in your treatment working than you.

Thanks everyone for your responses. I’ve made notes of them to bring to my consultation. Unfortunately none of the embryos made it past 10 cells so nothing to transfer. Our last cycle we had a day 5 morula so things seem to have gotten worse unfortunately

Oh @Maestro7 sorry to hear that sad update. Hope you and your partner can take some time to let this sink in, although you may each process it differently.

Good luck with the consultation.
I guess apart from finding out what the issues were you'd want to know what they would recommend in future (if you decide to continue of course, don't want to assume either way). 💐

Thanks @jenebaguetterien we are going again as soon as we can. Just afraid now if we go into consultant he will say there’s no point after two bad rounds. Eating all of the chocolate today.

Definitely eat the chocolate today... and tomorrow.
See what the consultant says - are you committed to this clinic for future cycles?
Either way definitely get your full debrief on the treatment so far and any possible reasons.
You mentioned severe male factor issues, have you sought any specific help for that?
Dr Jonathan Ramsay is one of the leading doctors it might be worth a consultation.

The answers to some of your questions will help decide the way forward for treatment.
You may also want a consultation with another clinic once you've had your debrief.

@Maestro7 you have my every sympathy, I remember feeling so crushed when there was nothing to transfer too. Chocolate and a large glass of wine (if that’s your thing) tonight and be kind to yourself. None of this is your fault!!

I am going to raise the point re Gonal F again, I’m no doctor but can only go from my own experience. On Meriofert I had 12 antral follicles, 15 eggs. 3 months later, on Gonal F, 15 antral follicles and only 5 eggs.