Poor response with normal AMH / ovarian function

[BewilderedBee]

Has anyone had average AMH levels but poor response to IVF and therefore concerns around ovarian function. I’m 32, AMH was 21 in January and 18 in June. We cancelled our first cycle as it was expected we should respond better on a second cycle. No guarantees though. We’re now on cycle 2 with a higher dose of Bemfola (225). I had a day 6 scan yesterday and my follicles aren’t growing on my left ovary, some growth on the right. Both cycles we’ve started with 8 follicles.

Clinic have told me the AFC doesn’t marry up with my age and AMH. We hoped the first was just a bad cycle and we’d get a better response this time, but that really isn’t the case. I have a history of ovarian cysts - never needing surgery. We saw a gynaecologist with Nuffield who told us they are corpus luteum cysts, and they come and go regularly. After our first cancelled cycle, I went on the pill - which prevented cysts growing and ensured the follicles are growing in sync.

But it doesn’t seem this cycle is any better, if anything it’s worse with no growth on the left. The clinic say it’s probably a problem with my ovarian function. Which will never improve. I asked about egg quality and they said it’s likely that my eggs would be poor quality. I left the clinic devastated.

Has anyone any experience of something similar? I really don’t get how my AMH doesn’t represent my AFC and what the clinic are telling me.

Hi @BewilderedBee I’m amazed to find someone else in the same situation as me! I was 32 with AMH of 25ish and we were doing ivf as my DH sperm count was very low. I was put on 150 of gonal f but only got 4 eggs and they were on verge of cancelling the cycle. All our eggs fertilised and embryos made it to day 3 then collapsed so they said male issues and I probably just needed more Stims than they thought.

A year later on our 2nd cycle my AMH had dropped to 17 and they upped my Stims to 225 gonal f 75 menopur. I responded equally badly and again got 4 eggs all fertilised but all gone before day 3.

At this point they said same to me - AMH didn’t match my response and I am a Poor responder with egg quality issues.

Next AMH had dropped to 9.9. I was put on max Stims of 450 Menopur. I went on DHEA as my testosterone was virtually 0 and did alot of work on diet etc. We had our worst egg collection yet with only 2 mature normal eggs which again both fertilised. Somehow both made it to day 6 blast and currently in TWW with one frozen.

Doctors don’t know why I don’t respond well. I wonder if it’s as my AMH has dropped quite rapidly each time I test it so maybe I’m losing fertility rapidly? No history of cysts and no issues with fertility or early menopause in my family.

I do also know one girl who was in similar situation to me - initial IVF for male factor but poor egg quality and couldn’t make blasts. They just had a baby via donor eggs.

@Racinglikeapronow thank you so much for getting me. It's reassuring to know of others in a similar situation. I really hope you get a BFP at the end of the TWW. Which clinic are you with? We're with ABC, I look back to Friday now and feel quite angry that I didn't have a more balanced response, as I know their sister company create specialise in people with low egg reserve. I'm hoping our scan on Monday will give me a more positive update. I kind of wish we'd never cancelled our last cycle now - they told us at best we'd expect 5/6 eggs. We chose not to go ahead thinking we'd get a better response though. I'm not even sure how many I had growing on my right.... the appointment is a bit of a blur now.

Have the clinic said anything about your AMH dropping so quickly. I've just looked back at my notes and my first test was 23 and not 21!! But I think I'm wrong in saying it was Jan, I think it was more like October last year.

It's come as such a shock as we've been treated as unexplained this entire time. All the while professionals telling me my age, AMH is good. I don't think there any history of early menopause in my family either, do you think it is early menopause? Or do you think if we were young and in our twenties the quality of the eggs would still be the same? I'm so confused by it.

Thanks so much for responding on this thread xxx

hi ladies, hopefully this is a good positive story
i was 31 with AMH of 21 had my 1st short cycle. i was a very poor responder only 2 follicles , cycle cancelled before egg collection.

2nd attempt also short cycle 5 follicles, 4 eggs collected only 1 fertilised, 2 day transfer. BFN. also had a large cyst drained in egg collection
both these cycles were with menopur.

3rd attempt different clinic age 32,
AMH now 16.2
they put me on long protocol with meriofert ( i really think the change in drugs helped) also took ubiquinol.
17 eggs collected, 12 mature. only 2 fertilised, MFI issues.
1 made it to blast and she has just turned 1 :-)
really wish you both all luck. x

Hi @smith1986 I had heard meriofert is good. I asked my clinic to put me on only menopur for my latest round as they don’t do meriofert and I have heard they’re similar. we are very similar - really hope I also get lucky with this round.

@BewilderedBee I am not in Uk my clinic are fine but if this round doesn’t work we are going to go to Uk and considering Lister ARGC or maybe serum in Athens. I think with poor response there is no point cancelling cycles as you’re never going to respond brilliantly so bear that in mind and consider going ahead and hoping one of the few make it. If you’re unexplained you are probably in with a good chance for any eggs you do get as you’ve no male issues whereas we’re battling on the sperm front too.

My clinic have pretty much dismissed the AMh thing but I will be looking for stronger opinions of any of the above clinics if we go to them. I don’t know re menopause I was just thinking myself if it’s dropping so quickly maybe it’s a sign menopause is coming quicker too. That’s just speculation on my part.

I guess what I would do if I were you And this round doesn’t work is look into Other factors:

• consider moving clinic and ask around if you’re paying privately for who will help with poor response
• ask for meriofert / menopur only and max dose of Stims
• get testosterone tested mine was v low and I think the 3 months of DHEA helped with this round
• I also took melatonin to help with sleep and meant to maybe help egg quality
• I gave up sugar, dairy, gluten and most carbs and ate a high protein diet. I also fasted 15/9 and didn’t snack 3 meals only per day - did this for 3 months alongside standard no alcohol or caffeine (disclaimer broke it for prob 6 days in total during the 3 months)
• I ate 50-70g of protein every day during Stims and no carbs or snacks.
• I ate 2 servings of fruit (not banana or anything - berries / apple) per day and 8 different types of veg per day. Had 4 at lunch and 4 at dinner.

I don’t know which made the difference but they’re all things that apparently help with egg quality and this does seem to have worked for us as it was our best round embryo wise although worse egg collection wise.

Hope this helps.

Hi @Racinglikeapronow @smith1986 thanks so much for your replies. @smith1986 thanks for your success story! It really does help to hear about people's success stories. @Racinglikeapronow how's the TWW going? Sending you lots of luck and best wishes.

I'm responding better now this cycle. It is drawn out though, only one follicle ready for egg collection so we'll be stimming longer. Aiming for collection either weds or Friday. Will know more about egg quality after collection. Keeping my fingers crossed.

Hi there, came across this thread as I'm currently going through the same issues as a number of you above. Very varied IVF cycles, poor response and no natural pregnancy (normal AMH). Wondering if anyone has an update in here in terms of new things they've tried?

Hi all, I was @Racinglikeapronow on this thread. I ended up moving to Lister. I was put on 450 menopur plus letrozole for 5 days. I did 3 rounds of embryo banking with them. I got 13 eggs on 1st round and 3 blasts. 2nd cancelled due to poor response, 3rd 12 eggs 1 blast now nearly 17 weeks from that blast.

Thank you @DrivelandNonsense for getting back to me so quickly. What do you think has made the difference in getting you blasts? Meds / diet or just random given the variability in the 3 next rounds?

For context, I'm now on my 4th IVF round:

First (age 33) - at Lister. 13 eggs / 8 mature / 5 fertilised / 2 blasts - one frozen (3BB) and one didn't impact (4AA)

Second (age 33) - at Lister. 14 eggs, 5 mature, none fertilised

Third (now in US, age 34) - 4 eggs, 0 mature

Currently on the 4th which doesn't seem to be going well

I genuinely have no idea what's going on and we have a great doctor working with us. Any insight on what's changed for you would be much appreciated thank you x

Also are you still taking DHEA?

It’s so hard to know what made the difference. I did take DHEA but my testosterone was low at 0.1 - what is yours? I do think adding letrozole helped some follicles along and the max dose of Stims was probably also needed. I did vary a lot though in my cycles. I had no blasts for my first two rounds.

Would you transfer your 3BB?

I did also overhaul my diet. I worked with a fertility dietician so that could be worth doing.I did intolerance testing and eliminated foods o was intolerant to as well.

I would transfer it but now I'm just really worried I can't make blasts anymore and if the 3BB doesn't work I won't get over it. Doctor also says it's better to try and bank some embryos before trying to put it in.

My testosterone is normal - on paper I look very normal the doc is saying which is why there must be something wrong with the eggs. Even in the first round my maturity ratio was low so there's clearly something going on there.

Can I get the details of your dietician?

Have you discussed some of the newer things like HGH as part of Stims or PRP ovarian rejuvenation?

melaniebrownnutrition.com/

@annastone Hey in case it helps in similar. I did an egg collection at 31, normal AMH of around 18. I responded poorly - 4 eggs collected only 2 mature. Got a 5AA and 4AA blast. 5AA transferred fresh and AF came only 4/5 days after transfer. The 4AA was transferred in a FET and ended in a chemical pregnancy.

Clinic redid my AMH which had rocketed to 32 I think (something like that). We changed stims, they let my follicles grow larger and we did a delayed egg retrieval (longer time between trigger and egg collection) for second try. I changed diet and tried accupunture as well. That time we got 6 eggs all mature, all made it to day 5 but only 3 suitable for freezing (5AA, 3BB, 3BC). I'm now 10 weeks pregnant from a FET with the 5AA.

We're currently exploring my (female) partner doing an egg collection and freezing embryos this year for a sibling in the future, as I dont really want to do an egg collection again, and there is no guarantee our remaining embryos would stick in the future. It's still early in the conversation but I'm hoping even though she is older.she might get a better response to stims than I ever did

@DrivelandNonsense - tried HCG as part of a new (4th round), lets see what happens. Thank you for the recommendation for nutrition

@2mumlife thank you for sharing your experience and very happy for you that you're pregnant. What was the change in Stims between first and second round?

@annastone First cycle I did a long agonist cycle - so down regulation with Prostap, then was taking Menapur (400iu first 2 days then 200iu a day), with an Ovitrelle trigger. Second cycle we did a short antagonist cycle, so I did a short (8 days I think?) of Norethisterone, after bleed I started Ovaleap (550iu first 2 days then 275iu a day - one of the consultants actually originally wanted to push me up to 300iu but because my repeat AMH came back high another consultant at the clinic refused saying it was too risky for OHSS to go that high...). I then had Fyremadel injections added in from day 4 until trigger. We did a double trigger (Busserelin and Ovitrelle). To be honest I think the main difference once they left my follicules to grow larger the second time - both times I had lots of follicules, but I seemed to always still had lead follicules. A lot of my follicules resulted in no egg when aspirated - my consultant doesn't believe in 'empty follicule' syndrome and suggested there were eggs in the follicules, just that they were still immature so wouldn't come away from the follicule wall.

Just hope to reassure that even with low numbers of eggs, you CAN get pregnant x

Thank for for all the replies here - honestly it means the world that people are responding. So I did another IVF cycle (a back-to-back duo stim after the Third one and managed to get better results.

6 eggs collected, 5 mature, 3 blasts and 2 of them genetically normal!

The doctor has said it's wise to keep going given my cycle variation is so weird and try to get more embryos before implantation.

We did a different protocol on this one - used a dual-trigger ovulation shot and also introduced HGH. Who knows what made the difference but sending this out in case anyone else is reading this channel and wants more information.

@DrivelandNonsense just delighted for you hun, we crossed paths a few times on other threads. I have my baby too. I know how tough your journey was , enjoy the rest of your pregnancy! Congratulations