Worth trying IUI / mild IVF before full IVF?

[CC81]

Hi all, I'm new here. Would really appreciate your advice/insights.

Has anyone with a low ovarian reserve tried IUI and/or natural IVF, before moving onto conventional IVF?

Just wondering if the less invasive options would be a good start. I'm scared of 'losing time' trying naturally, if we go for full IVF straight away.

I'm massively panicking after an FSH result of 15.9 on a day 2 blood test by my GP. Will be testing AMH/AFC next, but I'm not very optimistic! Preparing myself for the worst.

I'll be 39 in October and all my other results were normal (including day 21 progesterone). I have reasonably normal cycles, apparently with ovulation.

I would go full ivf at your age. It might still take 3 transfers or more to get pregnant and many clinics have rules about when you start, like before 41st birthday etc.

@LouiseTrees - Thank you. Do you know how long the other treatments tend to take?

I was thinking a delay of just a few months might be okay - but would the milder options take longer than that?

Depends if you are going private or not and how long your local area waiting list is and if they are even open and doing those procedures for new entrants improper who weren’t on the waiting list pre Covid. I would suggest you phone a few private clinics up and see.

I went the opposite way - started with full IVF but rubbish egg quality led us to the natural modified IVF and the results were so much better and I'm now 12 weeks with twins

@ivfdreaming - That's wonderful - congratulations. It's encouraging to know you did it that way around. Do you mind me asking which clinic and what they told you about natural IVF, in terms of chances? Did you have good quantity of eggs (if not quality)?

@LouiseTrees - I've got appointments booked already at a local clinic (Manchester) for tests and consultation. Apparently their waiting times are not particularly long.

While I wait for the consultation, to stop myself going mad, I'm keen to hear about others' experiences :)

I wouldn’t go for IUI at 39. We were offered IUI first but declined and went straight to IVF. I was told for IUI you should try at least 3 cycles with a month break in between in order to give it a good chance of success. I was almost 36 and didn’t want to lose 6 months if it didn’t work. The statistics the clinic gave us showed that IVF had a better chance of success. We’re not in the UK and IUI was covered under our insurance but IVF was not so it was a hard decision but ultimately age was the biggest factor.

@Betsyboo87 - That's good to know, thank you.

I have elevated FSH, so I'm not sure yet what will be most suitable for me (I guess I'll find out when I get my AMH/AFC results - nervous wait ahead!).

We have one child already - conceived naturally and immediately when I was 35 - so I don't know if that has a bearing on things (i.e. we know we're well-matched in that respect).

@CC81

I'm with Create

I did 2 cycles of short protocol last year with ICSI and got a total of 28 eggs but less than 30% fertilised and 4 average quality blastocysts

I then changed to natural modified IVF - over 2 cycles I got 9 eggs 100% fertilised and 4 top quality blastocysts (2 are still frozen and the other 2 are cooking in my tummy!)

Create specialise in natural and natural
Modified IVF so their success rates are pretty good. It is a risk as you are only targeting a couple of eggs each time but we were prepared to take the risk since with good numbers of eggs the quality was rubbish so things could only get better!

I would advise a 3 cycle package though to bank blastocysts (although a friend of mine also did natural modified the same time as me and she got 5 blastocysts on a single cycle!)

@ivfdreaming - That's very reassuring, thank you.

The clinic that's doing our tests in September offers both full IVF and natural modified IVF (among other things), so it'll be interesting to see what they recommend. We also have a Create clinic near us.

Do you mind me asking your age; and what your pre-treatment test results were like? I'm mega-worried by my recent FSH test (15.9).

@CC81 I have done normal short protocol on maximum dose drugs followed by natural modified. To my surprise I responded better (more follicles and eggs) on natural modified (I have very low AMH). I think perhaps it depends which drugs you respond to better to as an individual.

@Weswoo - Thank you. That's good to know. Do you mind me asking your age? Just wondering how similar we are!

I haven't had my AMH test yet (it's booked for September) but my FSH result has got me really worried.

@CC81

I was 36 when I did normal IVF and just turning 37 when I did short protocol - I can't remember my FSH results but I did end up having OHSS even with relatively low level stims on my first IVF cycle

@CC81 38 with an AMH of 1.0. FSH isn't as reliable, mine has jumped around between 10 and 17

@Weswoo - Ah, so very similar to me. The FSH really freaked me out! I'd be interested to see a retest, but also scared in case it's the same or worse (and I know they always look at the worst anyway).

Has the clinic said much to you about probabilities/prognosis?

They said around 10% which was largely based on age but these statistics are really only a guide IMO. I've had wildly inaccurate predictions on how many eggs/embryos I'd get in the past so no one really knows if you are going to get a viable embryo until you try!

Hi there, I'm in the same quandry but suffering secondary infertility. We conceived my son 2 years ago when I had AMH of 8, now I have 1.1. My husband also has poor morphology. I've spoken to a harley street nutritionist then to a Kings Fertility consultant (we have to go private) and both suggested to try 2 rounds of IUI BECAUSE we have successfully conceived that way... but if neither works, then IVF. I'm 38 and feel my fertility may fall off a cliff any day but I'm equally nervous about the issue of not having my eggs and our sperm in top shape for treatment. We're seriously considering going abroad because of the horrific prices we face here. Best of luck with your choices. Actually, the more I htink about it all I think we ought to skip the IUI and go straight into ICSI as has been recommended.

@Weswoo - Thank you - that's good to bear in mind.

@Ellsiedodah - Same age! :) But I'll be 39 in October. Also, this is secondary for me, too - we conceived our first child when I was 35 (she'll be 3 in November). It happened the first cycle we tried, so I never got to the point of doing any tests.

It's amazing how fast things can change. We weren't ready for a second child earlier than this year, but I do wish I'd investigated a bit more, during 2018-19.

Glad you have managed to have one already @CC81, though I know the pain in thinking that they might be the only. Stupid / idealistic I don't know, but I always said 2 or none... so silly of me but I madly want a sibling for my son. I think I may not ovulate some cycles too so think I'm in pretty poor baby making shape! I spoke to Kings about mild / natural ivf as had been looking at Create, but their pov is stimulated first then mild as they want as many eggs to choose from as possible. Good luck!

@Ellsiedodah - Yes, it's so frustrating. I feel extremely fortunate to have a child already, but I feel strongly about giving her a sibling. Rather naively, we thought that because I was fine at 35, I'd probably be okay at 38, so didn't rush.

I've now seen quite a few people say that they did conventional IVF first, followed by natural modified - there does seem to be a logic to it. I wouldn't want to bash away endlessly at full IVF if it didn't seem to be working for us, due to stress and cost.

My biggest fear is that my September AMH result will be horrendous and they'll tell us it's all hopeless. At present my cycles seem pretty normal, but the stress of this situation will probably cause problems there too. I've never been so conscious of time!!! I'm starting acupuncture next week in a bid to manage it better.

@CC81 how are you doing? X

Hi @Sunshinelove8, thanks for asking - I've seen your responses on my other (newer) thread about natural modified IVF!

I started a new one because my situation has moved on a bit (and I'm now a bit more informed about different treatments).

I now know that my AFC is currently 5, which matches my FSH of 15.9 - neither are completely terrible, but they're not ideal for traditional IVF.

Need to see what the doctor says when I get the AMH result later this month. But based on what I've read so far on the subject, I'm leaning towards the view that natural modified IVF may be more suitable for me. At the age of 38, I think I have to focus on quality over quantity!

Quick update to this thread - I ended up getting pregnant naturally, despite my blood results (got pregnant a few months after). Hope it's useful for others to read.

Story here: www.mumsnet.com/Talk/infertility/4290062-Update-Low-AMH-success-story-hope-it-helps