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!

Hi @Sunshinelove8 and everyone.

Well, to my huge surprise, I am currently about 7 weeks pregnant (naturally). I daren't get excited, as it may not work out. I have an 8-week scan next week, which I'm incredibly nervous about.

The worry of it has given me a very different perspective on everything. If it doesn't work out, I'm now about 90% convinced that I don't want to go through IVF. I think all the worrying and waiting would be too much for me, and eat away at the time I have with my existing child.

But if I had to pick my preference, Natural Modified (with Create) was much more appealing than Conventional IVF. With the latter, even if we had some success, the worry I have now (about quality etc) would be even greater. I'd feel that I'd forced my body to do things it wasn't comfortable with, which is such a tough gamble. Whereas NM is gentler.

Before this latest news, we'd had consultations with three fertility doctors and all of them said that natural conception is possible with a low ovarian reserve. I guess I just didn't believe it would happen to me, even though it's only three years since my first child (when my AMH probably wasn't that much higher).

I think maybe it's different if there are other problems too. My only issue appeared to be the low egg supply, but I continued to ovulate monthly. I was fortunate that my scans showed my womb and ovaries are normal and healthy; and my progesterone levels seem to have been normal, post-ovulation.

So, I hope this is helpful for anyone else with low AMH - especially if you're younger than me.

@CC81 congratulations!! That’s great news ! I have low amh and conceived 4x so it can happen my issue seems to be just an unfussy uterus which accepts any old egg regardless of quality hence ivf needed with pgs .
I’ve read about a lot of successful pregnancies after ivf lately ! Fingers crossed you have a beautiful pregnancy ahead xxx

@CC81 that's amazing - congratulations! Fills me with a little hope! ♥️

@Sunshinelove8 I am in the process of FET so I will let you know how I get on. I'm kind of torn about natural modified I got a total of 9 eggs across 3 collections and only 1 useable embryo so I think you'd have to go in expecting do to 3 cycles. I have to say though they are throwing all they can at me to sustain a pregnancy if that happens - thyroid meds, blood thinners and steriods so that may help if you are experiencing recurrent MCs.

@ohsheglows I was advised the same back when my AMH was 5.7 and I hugely regret listening to them. It's ok if your first cycle works but what if you need to have multiple cycles. It all takes time while your AMH is dropping. Mine went from 5.7 to 2.1 in a year, then down to 1 about a year later.

Thanks! I guess time will tell (I really hate the waiting).

I wish there was some clever test you could do at 2 weeks that tells you everything...!

Sounds like you're doing the right thing for you and I'd love to hear how you get on. xxx

Congratulations @CC81 that's wonderful news! Do you mind me asking what your AMH was again? Just interesting to compare. Wishing you all the best!

@ohsheglows was this an NHS consultant? I don't personally feel the NHS takes low AMH very seriously so I would consider getting a 2nd opinion with a private clinic. I would certainly not wait another 6 months. I am 34 with AMH of 2.1, I was given the impression that IVF was the only option but told by the NHS they can't give me IVF because my AMH is below the eligibility threshold and to go private 🙄. Then I went private and turns out there are other things you can do before IVF, especially so if your under 35. I've just done 3 cycle of Clomid and now I'm doing 3 rounds of IUI. Less invasive and cheaper than IVF. When / if we do then come to IVF I will do mild.

@Dbop100 - Yes, sure - in early September, my AMH was 0.9 and my FSH was 16.5 (average of two different tests).

One of the fertility doctors said he'd known various people conceive naturally with AMH below 1.

I think if you're young and it's what you want more than anything, you should investigate and try everything.

In my case, I'm 39 and have one child already (naturally), so I'm just not sure I want it enough to go through the IVF process. But it's difficult to be certain of anything at present!

@CC81 thanks that's interesting, so pleased for you. And so nice to hear of these things happening!
Yeah we did conceive after 10months but lost it at just over 5 weeks. It's been about 6 months since then. My consultant is very confident about the IUI being a good option for us, just had my scan yesterday and have 2 mature follicles thanks to the Clomid so fingers crossed we'll that this weekend 🤞

@CC81 congratulations! What exciting news! It gives me that tiny bit of hope x

@Sunshinelove8 I am sorry to hear about your previous pregnancy. I did think that about egg quality, but she was adamant that based on my age, I should be churning out good quality eggs. I was a bit like, ok why am I not getting pregnant then. She didn't really have an answer to be honest.

@Weswoo I'm worried about timing as well, I just feel like I'm wasting time just hoping I'll conceive naturally when I should be thinking about IVF.

@Dbop100 yes, it was an NHS consultant. I asked about IUI and she said it was only good for couples where there is MFI. I also asked about Clomid but because my cycles are regular and I seem to ovulate based on my progesterone levels, she didn't want to administer this...

Any of your going through IVF have to lower your TSH levels? My levels are 2.9 and according to my GP this is entirely normal but from my understanding a lot of clinics will want this under 2?

@ohsheglows yes again the NHS level for TSH is under 4 but specifically for the purposes of conception/pregnancy it should be under 2.5. My private consultant prescribes it for me and the tablets are no more expensive than an NHS prescription anyway

@ohsheglows yes I also ovulate regularly and have normal progesterone levels, we don't have MIF either, low AMH is our only problem. As I say the NHS are a bit clueless about low AMH, they don't even recognise it as a problem, which is crazy when you think that they use it as an excuse to deny IVF funding, but that's to save them money. Are you based in London? Would recommend my private consultant if so. The Clomid wouldn't be right for someone with normal AMH but as I have less follicles it makes me get more mature eggs than I normally would, so this cycle I'm hopefully releasing 2, so double the chance of it working. There is also technically a chance it would be twins but that's low. I'd be chuffed with twins it would at least give them a sibling as we don't have any kids yet.

@Dbop100 @ohsheglows I think it depends on area but I was denied NHS funding at AMH 5.7 due to the likely success rate (5.8 was the cut off )

If it helps anyone, this is what I was doing in the months leading up to conceiving (mid-October-ish):

• Taking a conception multivitamin supplement (Proceive)
• Taking ubiquinol (200mg, either one or two a day)
• Reduced my caffeine intake (but didn't stop completely)
• Having weekly Chinese treatments - acupuncture, reflexology and massage, plus a herbal tea.

I didn't stop drinking alcohol, however. I've never been a binger, but I found that a cocktail and/or glass of wine helped me unwind a bit. It was the same with my first child - I'd had a fair bit to drink in the weeks leading up to her conception (lots of social events)!

Interestingly, this time was the first month in a while that I didn't bother with ovulation LH testing sticks. I watched out for natural signs (CM etc.) and we just made sure we DTD every day when it seemed the right time. Also, earlier in the month we'd started to decide not to do IVF, and the pressure felt lifted - which may have helped me relax and improve my chances. But really, who knows?!

The way one of the fertility doctors described it, he said that natural conception is often about timing - that even though an egg lives for about 24 hours, in some cases it may only be fertilisable for the first 12 - so if you ovulate in the middle of the night, for example, you might miss that crucial window. So you have to hope the sperm from earlier occasions has stuck around and survived. That's why it can take some people a long time.

Also, the Chinese practicioner recommended DTD three times daily when you see good CM!!! We felt that was a bit extreme, haha.

I don't know whether or not I believe in the Chinese treatments, but it made me feel better during a difficult time - and coping with the stress in that way may have made a difference. I stopped the sessions literally three days before my positive test result, as I didn't want the constant reminder (I had to take my temperature daily for her to monitor, etc. - which was becoming a slog).

I still worry about quality, though. It's such early days.

@Weswoo I'm so sorry that happened to you too. It makes me quite angry. Just because we'd get less eggs doesn't mean we're a write off, it's quality not quantity and you only need 1 good egg! It's all about money, but it's our lives not some business investment x

@Weswoo thanks, I'll look into trying to lower my TSH.

@Weswoo oops sorry sent my reply too quickly. I'll look into trying to reduce my TSH. I was also denied funding for my IVF due to AMH so we'll have to go down the self funding route.

@Dbop100 I'm in Hertfordshire - but I'm open to travelling to London if it's a really good clinic and consultant? I'm really interested in trying the clomid route first - it would be significantly cheaper if that worked out!

@ohsheglows my consultant has her own practise on Harley St and is also at Care fertility. If you go to her direct like I do your first appt would be a zoom to talk about your case, get copies of all your test results and send them over first. Then you come in about 1/2 times a cycle for scans. She is Amanda Tozer - [email protected]

@Dbop100 thank you! I'll definitely get in touch with her.

And thank you to everyone else, it's been really lovely to hear from you and your experiences, it's made me feel less lonely in the world of TTC and infertility.

Hi all, another low amh soul here. 1.1 down from 8 just over 3 years ago when I conceived my first through iui second time round. Aiming to do treatment in January but looking through the thread I'm wondering if it'll be possible... we're moving house and our most local consultant is dr reddy in Cheltenham. I hear she's good but don't know much detail on how she handles low ovarian reserve. I've been on tons of supplements and eating pretty healthily and we've managed to knock out any male factor through lifestyle and supplements.

..I'm 38 and had consultations in July, 2 of which (Create Wimbledon and serum in Greece) both saying milder forms of ivf but kings fertility who did our iui said they'd go ahead with trad ivf first. So who knows whats coming. Has anyone heard any success stories of people with low amh conceiving through treatment?

...I've also been told that I should anticipate a minimum of 2 / 3 cycles. We're paying privately.. fortunately it coincides with the sale of our flat!! Is anyone else doing treatment in jan who wants to be buddies? :)

Quick update to this thread - we had our twins a few weeks ago (natural conception).

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