Low ovarian reserve and IVF... better to go for natural modified?

[CC81]

I've just had tests at a private clinic. Won't get my AMH result until our consultation in late Sep, but they also did an internal ultrasound.

The antral follicle count was low (5 total) - which probably means a low egg supply. Not entirely unexpected at my age (nearly 39), but still a little disappointing.

We need to see what the doctor says, but we're preparing to have to make a decision about treatment. With low egg supply, I may not be an ideal candidate for IVF - so we're wondering about natural modified, as it focuses on quality rather than quantity. I've seen a few positive stories on these forums. But I don't want to waste time on the wrong thing!

I'd love to hear from anyone else out there who's been in a similar situation!

On the bright side, as long as I'm still ovulating each month, apparently it's possible to conceive naturally. My periods are pretty regular.

And the scan showed that everything else is normal - womb fine, no cysts, no fibroids, no polyps, a 'very neat' c-section scar from child #1 three years ago (!); and two functioning ovaries (it showed recent ovulation).

It makes me wonder if we should try naturally for a couple more months, as we've only tried for about 8 months so far.

I've started taking supplements and also a course of Chinese treatment (acupuncture etc), so it might be good to give those a few months to improve my overall health? So many things to think about!

Hey I’m only at the beginning of this ivf journey and same age , I have 7 follicles - well that was last year so who knows now! My consultant said it’s of course better to have more but he said people with a lot can produce few eggs and others with less number can react well and produce an okay number . What he basically told us is they don’t really know for sure until they take me through ivf how my body will react and how many eggs are possible. He also said it only takes one good one . I would probably have kept going naturally but have had 3 mmc and 1 cp the last year so think a large number of eggs are likely bad , I’m going to do pgs to test for any abnormal eggs ( if any of mine get to day 5 ) as I’d rather avoid any further mc .
I think it’s a good idea to talk to your clinic and get their advice as they are the experts and can judge whether it’s worth going ivf or natural modified route . If mind had told me not to bother with ivf I wouldn’t have but they have suggested to do it , so will try x

Hope that made sense I was being harassed by dd while typing and read it back and was a bit garbled lol !

I am 31 - low AFC (7 in total) and AMH of 6.3. Unexpected at my age, but we are where we are! We have been TTC for 12 months with no success so they recommended starting IVF. Reasoning given was the success rate of IVF starts to decline once you're over 30, then more rapidly once you're over 35, so the sooner we start the better (we would like to have more than one child and will likely have to do this all again, if we get past hurdle 1!).

In your situation, and from what I've read, I personally probably wouldn't spend too much longer trying naturally - your chances of success through IVF will be lower due to your age unfortunately. Great that everything else looks good though! They said the same to me too. And egg quality is important - it only takes 1 good one. I am a bit sceptical about some of the books around, but the advice from 'It Starts With The Egg' re the benefits of ubiquinol for egg quality are quite widely reported, so it may be worth starting to take that. I think vitamin D is also a good one take for egg quality as well, and folic acid in general of course. Our Consultant didn't advise anything else in particular in terms of vitamins/diet etc. Other than a normal healthy diet high in antioxidants. We have already cut out caffeine and alcohol which are also worth giving up if you can.

Very best of luck 😊

Thanks @Sunshinelove8 and @MGee123 - it really helps to hear from others.

Have you considered natural modified IVF, or only traditional IVF? Just interested to know how you chose between them (or if your consultant advised either way). That's my potential dilemma.

Our clinic offers both types - and natural modified IVF is meant to be better for low egg reserves, so I'm wondering about it.

(We conceived our first child three years ago on our first month trying, so we never had any tests - for all we know, I may have had a low supply then, too! I was 36 when she was born.)

PS - I've been taking ubiquinol and vit B6 alongside a conception supplement in the last couple of months; and also started doing some Chinese treatments (acupuncture etc).

@CC81 I have very low AMH and I've done both short protocol (max dose of 450 menopur) and natural modified (low dose of 150 bemfola) and to my amazement I got more eggs on natural modified

@Weswoo I’m just hearing this in another thread on this site . I also think the quality of the eggs ( although you get fewer) can be higher . I spoke to my clinic this morning and they said they decide whether to do full or mild ivf based on initial reactions to drugs etc so they will tell me which one is best as we begin the process .
@MGee123 although your results are similar to mine at 31 your egg quality is likely to be a lot better ! So good chance for you I’m sure x

@Sunshinelove8 that is very good advice from the clinic - it is all a bit of a gamble because really the best test of how you will respond to the drugs is to actually do a cycle of IVF and what works for me may not work for you and vice versa. I decided to move to natural modified because normal short protocol wasn't working for me so I felt I needed to try something completely different

@Weswoo I read that mild ivf is for those with normal or good ovarian reserve , I don’t have that and you said you had low amh too? Is mild ivf what you are talking about ? Xx

@Sunshinelove8 no, mild is different to natural modified although I am not sure how mild differs to short protocol. With natural modified you don't start the injections until day 5 of your cycle (and only take them for around 5 days) whereas with short protocol you have different drugs and you start them on day 2

My AMH is 1.0

Mine is 5 but I think it might be 0.5 I’m sure I’m reading it wrong ! Ah right , it’s confusing having such similar names where are you with your cycle - you got lots of eggs , have you had any transferred? Xx

@Sunshinelove8 I'm banking embryos over 3 cycles before we transfer any - one top grade in the freezer at the moment! But I got 5 eggs on one cycle of natural modified compared to 1 egg on short protocol IVF

Thanks @Weswoo can you keep me updated on your success hopefully 🤞 always lovely to hear happy stories ! My clinic doesn’t do banking - who are you with ? X

I'm 29 and my AMH is 2.8. I had a cycle at the end of last year of short protocol IVF with my local IVF clinic. I think my AFC was 7.

I personally found the short protocol very stressful. The cycle kept almost getting cancelled due to poor response (which was totally unsurprising due to my ovarian reserve, but the clinic weren't very aware or confident in managing it and just kept upping my meds). It ended up being so expensive because of the amount of meds I was on, and I had horrible side effects.

From the short protocol we ended up actually getting 5 eggs which was brilliant but only 2 fertilised and 1 progressed past day 1 so we had a day 2 transfer which we sadly had a MMC with at 8 weeks.

It's taken a while to be ready to restart more cycles with Covid etc but we are changing clinic and starting natural modified IVF doing 3 cycles and banking anything we get to give us the best possible chance. I definitely now feel that quality rather than quantity is key .

We did get a pregnancy from the first cycle so I definitely don't regret trying it, it's definitely a trial and error to see how you respond. I think the quality of my eggs were poor I wonder perhaps in part due to the overstimulation, which I think didn't help the fertilisation rate and ended with the MMC.

After a lot of research I definitely feel that going for the natural modified is the best option for me personally, but I don't regret the 1st cycle, I just wouldn't do it again knowing how my body responds.

In your circumstances I would wait to see what your AMH is and research clinics that do natural modified (if your clinic doesn't) and consider booking in a consultation with them. They may not recommend natural for you, they may suggest mild instead or standard IVF if your AMH is normal.

In hindsight the only thing I wish I'd have done is paused and taken the time to have a couple of consultations at different clinics before starting IVF to make sure I got the best fit for me

Sorry that was so long!

@starsareblazing I agree, no regrets as you don't know until you try but I realised that I'm never going to get loads of eggs so I may as well try and make sure the ones I do get are the best they can be

Would you guys ever consider pgs on the embryos from the medicated cycles . Reason I ask is that I seem to produce initially viable embryos - I’ve had three pregnancies in the last year , all reaching 8-9 weeks with heartbeats / good growth etc . If I did any form of ivf I’ll probably get decent looking embryos . I don’t want anymore miscarriages though . I am pretty convinced to do pgs on any I get .
@starsareblazing and @Weswoo are you both at create ? What are you thinking ? Do they do pgs? X

And thanks for the information @starsareblazing it’s hard not to rush things when you feel the tick clocking eh . I’m the same . I’m looking at argc for short protocol as have such great results but don’t know if they do with my low amh etc or create and do medicated but stats look lower for success rates . It’s hard where to place all your £££ although you guys are convincing me medicated might be a better option especially when egg quality is the issue x

Hi ladies :) I'm 30 with a low AMH of 4 and anttal follicle count of 2 on each ovary. No other problems I'm aware of. My friend is doing the natural approach with CREATE. Her AMH is lower than mine and she is in her 40s. My clinic seemed to recommend not doing that...

Is it the natural ivf or natural medicated ivf she’s doing as natural you need normal amh whereas medicated is for low . Perhaps your clinic thinks it’s natural ivf?

@Sunshinelove8 yes I am with Create and I find them very good. I wouldn't PGS my embryos - I have also had CPs and MCs but I am not convinced by the science of PGS and as I'm never going to have huge numbers to choose from I'd rather just transfer and see what happens

@Weswoo yep I totally agree! No regrets! Good luck for your cycles

@Sunshinelove8 I'm so sorry to hear of your miscarriages. I haven't considered PGS testing at this point because my numbers are so few anyway, but definitely worthwhile discussing with your clinic as every circumstance is so different. Yep it's incredibly difficult not to feel the urgency to rush and make decisions quickly! In a way all the covid delays helped as had no choice but to think. I'm also with create.

My worry is with low quantity can come low quality and at older age especially something like 80% can have chromosome issues - I seem to be showing that through recurrent mcs . It’s tough , if I hadn’t had mcs I’d probably skip the pgs and hope for the best but I can’t knowingly not weed out ones that have obvious defects . Which might be all of them ! So hard :/ can you keep me updated on how you both get on ??? Good luck 🤞🤞🤞

Hey everyone, just wanted to say thanks so much for all your responses on this thread.

@Vea1601 - As you're young, even with low AMH you have a better chance with traditional IVF, as your egg quality should be more reliable.

@starsareblazing - Really helpful to hear about your experiences. I'm 10 years older than you, so egg quality is definitely a big issue for me.

I had my first child at 36 (no problems at all), but we may simply have been lucky with the egg on that cycle. It's the only time I've ever been pregnant, so my experience is very limited.