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!

One thing that I found really reassuring and helpful when making my decision was watching a webinar that fertility network UK did with Geeta Nargund who is the founder of create about mild and natural IVF, she explains the evidence behind it brilliantly. It's on YouTube and I'll try and link:

Hope that helps someone, I found it really useful good luck with your upcoming appts!

Thank you all for sharing your stories - I'm finding this thread really interesting. We are not going down the natural IVF route - our consultant recommended a standard protocol. I am happy to have confidence in his decision making for the time being, as from what I've read I don't think there is a conclusive argument for either option. I am sure other consultants would advise differently though!

Is anyone looking to start soon? We have our consent appointments in October and are hoping to start early November (depending on what my cycle does).

@MGee123 - We have an appointment on 22 Sep (to discuss test results / options) and there's no waiting list at the clinic, so potentially we could start treatment quite soon.

I think because you're young, the probable quality of your eggs makes traditional IVF much more likely to work.

It's confusing, because there's mild or natural IVF, which I think is gentler but aimed at those with good test results (but unexplained infertility).

Then there's natural modified IVF, which is apparently better for those whose test results and/or age aren't ideal candidates for traditional IVF (or mild or natural).

I didn't know any of this a month ago!

Hi - I am 35, AFC of 5 and AMH of 8.2. I was put on short protocol IVF. Natural modified wasn’t even discussed. I produced 8 eggs, 5 fertilised 2 made it to 5 day blastocyst. I transfered one embryo resulting in BFP - currently 12 weeks and one is in the freezer. I also did acupuncture and followed as much advice as possible from It Starts with the Egg.

I have heard from several people that you just don't know how you will respond until you have a go, which is why the first round of IVF is sometimes treated more like an investigation as to what you actually need. But understand that it gets expensive and it is a lot to go through to treat it almost like a trial.

The main thing I want to say is I was feeling really pessimistic after being told my AFC was 5 but it is possible!

Hey guys , me again ! I’m doing a lot of reading and finding most places saying there’s no evidence natural medicated equals better quality and you get less eggs so less chance etc . Now totally confused 🙄

Kinda summarised on this site

extendfertility.com/mini-ivf/

@BabySweet85 congrats ! I wish I could get lucky like you ❤️ I’m 40 though and those 5 years seem to make a difference hence my many mcs . I hope I’m wrong ! X

@Sunshinelove8 thank you. I will keep my fingers crossed for you! I would say I worked really hard on my quality through diet and not using perfumes etc - it really only takes one good one ❤️

@Sunshinelove8 so if I'm following correctly this will be your first IVF cycle, you have an AFC of 7 and AMH of 5 (with an AFC of 7 I suspect it is 5 rather than 0.5!). As I mentioned I've done both normal IVF and natural modified. With your numbers I'd be inclined try normal IVF first and see how you get on, you could always try natural modified afterwards if unsuccessful. Either way the first cycle is always a bit of an experiment!

Thanks @Weswoo I think you’re right . I’m a bit scared of ivf , is it as scary as some people make out ?? My bf said she found it fine (short protocol) but she could’ve been lying to me lol . Everyone is so helpful on here ❤️❤️❤️

@Sunshinelove8 I don't find it physically hard ie the injections and other medication, for me that part is ok. The hardest part for me is all the waiting - finding out how many eggs they get, then you have to wait until the next day to find out how many fertilised, then another wait for the day 3 update, then day 5 if you get that far, then the tww.

Just take each day at a time and there's always an active thread for the month you are cycling - those are a great source of support

Thanks @Weswoo that gives me comfort . I understand that waiting must be super hard . I won’t look forward to that bit. Please keep me updated on your journey 💓

Hi @BabySweet85 - Thanks for sharing - that's brilliant and does give me hope. We have the same AFC! I'm 3-4 years older, so I do worry about quality - but as you say, until we try we won't know.

Has anyone looked into funding packages? Our clinic does a 50% refund if you're aged 38-39 and don't have a baby after three cycles of IVF. I don't know yet whether that would mean you could mix-and-match - i.e. try standard for the first cycle, then if it's unsuitable move onto natural modified for the second cycle, etc.

@Weswoo - With you on the waiting. I HATE it. It makes me more stressed than anything else (and I'm nowhere near even starting IVF yet!).

@Sunshinelove8 - It's definitely worth reading around the subject. I think like everything else in science, different experts have different views (and interpret results differently).

I think the logic is that traditional IVF falsely produces more eggs that might otherwise have not developed (due to quality), whereas NM lets the body lead the way a little more. But I don't know, to be honest!

@CC81 yeah I can’t find any data supporting the fact on quality though . Im on a call with create tomorrow and will ask them . If you get less eggs and they’re the same quality as standard ivf where you get more 🤷‍♀️ I really thought this would be totally clear ! Why is everything fertility a mystery grr x

@Sunshinelove8 - I would be very interested to hear Create's answer to that question! As obviously they specialise in natural IVF and those with low egg reserve. I think it's probably something that isn't set in stone - it's more of a hypothesis.

We're doing our initial consultation with a different clinic (which offers both), but we do have a Create clinic quite close by, so we may well consider them as an alternative.

My GP (who has been through IVF herself) said that fertility is unfortunately filled with uncertainties - there are lots of things that even the best doctors don't know. Some people have perfect test results and yet can never get pregnant, whereas others have challenges and yet manage to overcome them. She said that tests are only ever an indication (they don't give certainties).

Hi all,

@Sunshinelove8 - How did you get on with Create? I recently talked to them too!

I posted an update on another thread which you may find useful/interesting (latest post):
www.mumsnet.com/Talk/infertility/4020561-IVF-or-Natural-Natural-Modified?pg=2

Basically, I've now had consultations with two private clinics - one about conventional IVF and one about natural modified (Create).

If we do anything at all, the latter currently appeals more...

I had four rounds of traditional high dose ivf and got 0-1 poor quality embryos. then went with the create 3 cycle natural modified ended up with one top grade 3 day and two blasts never had a blast before. One blast is now my two year old. It wasn't easy as cycle one was bust with no embryos but overall I feel the response was similar to traditional ivf but with better quality embryos. My theory not medically trained but based on my experience is that I was losing my dominant follicle with traditional ivf as it was overcooking where a Create focused on the dominant and that was the aim of the cycle. Given that the dominant follicle is the one that nature would have selected it makes sense that this is the follicle that's going to make a baby. My amh was 1.8 at last measure but was probs lower at time of cycling I also found create a much better experience as they are geared towards low amh.

I had a similar experience

I did 2 rounds of short protocol first with create - even with ICSI had awful egg quality and less than 30% fertilisation. Got 4 average quality blastocysts - PGS tested 2 and neither came back normal. I did 3 transfers; 2 BFN and an ectopic

I then pushed to change to natural modified with Create - did a 3 cycle package with ICSI - fertilisation rate jumped to 100% and in total 4 top quality blastocysts- now pregnant 24 weeks with twins with 2 more frozen

@Misty999 and @ivfbeenbusy - Thanks very much. I think I've seen you on other threads and it's really encouraging to hear your experiences with Create.

My concern with conventional is that as I have a low ovarian reserve, I'd be putting my body under a lot of stress without much chance of collecting many eggs anyway.

And in our consultation, Create were more focused on how they'd tailor things to us, rather than give us a load of stats about the chance of a fixed approach (which is what the conventional clinic seemed to offer).

@MGee123 hey. Was wondering how you were getting on. I have very similar figures to you (I'm 32 with AMH of 6.5 and intitial follicle count of 9) we also have extreme MFI.

We were going to start in Nove but hoping to move house soon so figured we'd start in January once things are calmer.

@Weswoo @CC81 just checking in on how you’re doing ? I’m nearly at the end of my sp ivf , response is very average as expected but won’t know true picture until egg collection / after. I’m still thinking about natural modified if this doesn’t work out and wanted to see how you were getting on ? X

Hello, I hope you don't mind me jumping into this thread. I have very similar results to you all. I'm 31, with an AMH of 3.3 and AFC of 7. I've been trying for a year. The consultant recommended that I continue trying naturally for another 6 months to a year, were any of you told the same? It seems that most people on mumsnet were told to go straight to some form of IVF? Also she mentioned that as long as I have an LH surge every month, it should be a good quality egg I'm releasing - this doesn't sound right as surely you can release poorer quality eggs too?

Thanks all for any help you are able to give

@ohsheglows I get pregnant okay but never maintain passed 8 weeks . I also got told to keep trying naturally . I just feel I wasted time . You are young and I would go for ivf , I wish I’d started earlier ! It’s nonsense about Lh surge and egg quality ! If that were true no one would have any pregnancy issues or miscarriage. Xx