Secondary infertility - accept it, or wipe out savings on IVF?

[CC81]

Hey all, I've contributed to various threads on here in recent times, but my situation and thinking have now moved on. I'm keen to hear from others who are struggling with the same current dilemma.

I've had tests at a private clinic and also NHS. I'm still ovulating and am physically fine, as is my husband - but I have a low ovarian reserve (AMH is 0.9, AFC is 5 and FSH is around 16.5). I'm nearly 39.

It's been a shock, as we conceived our first child naturally (immediately) only three years ago. We're extremely fortunate to have her - and this process has made me realise that even more.

However, we'd dearly love to give her a sibling. If we can't, I know it'll be an awful struggle seeing people around us have second and third children. We also worry about her being lonely - but I'm aware this is a stereotype of single children, and probably the result of stupid social pressure and expectation. It's hard to shake it off, though.

IVF is an option for us, but it's very unlikely to work. We're wary of wiping out our savings on a stressful, unpleasant process when we could be concentrating on the child we have; and investing in our future instead.

There's a lot of appeal in the idea of not bothering with IVF and accepting what we have... BUT I don't want to regret not trying, for the rest of my life.

Natural conception is still possible, though also unlikely, as my egg quality may have declined along with the numbers. I'm doing acupuncture and taking various supplements.

My feelings are confused, as I'm also reeling from the idea that my egg supply is so crap for my age. While I'm relieved that I'm internally 'normal' (womb, ovaries, etc.) and my blood results show I'm fine, I worry about what it means for my general health. Maybe nothing.

If this was our first child, there'd be no question of trying IVF - and we'd also look into adoption. But as it's second time around, it makes the decision so much more complicated. And finally, I feel guilty for feeling upset when some people are going through hell to conceive their first, or fighting other health issues.

Hi @CC81 I can totally relate to all of that. We have a naturally conceived little boy who’s just turned 5 an only took 9 months to conceive. I wanted another straight away so that’s how long we’ve been trying. In 2018 we decided to go for IVF as my partner has male factor. We spent about 13k on tests an Ivf and it has resulted in 3 miscarriages. Since then, we suspect the issue may have been to do with my partners crohns meds an we complained to the clinic to which they admitted negligence and we have just started another cycle which the clinic have kindly offered for free. I am not hopeful in the slightest but just going through the motions and the quicker it’s done with the better as then I plan to get some closure on it all. It’s so difficult and I can totally understand what you’ve said in your post, I feel exactly the same. We do have a lot of debt and a lot of pain but we are definitely stronger and very very appreciative of our little boy xx

I can hear the distress in your post - I'm so sorry. I'm not in the same situation, as I don't have child no 1 yet! But I do have a low AMH for my age (6.3 at 31) so we're starting IVF at the end of Oct. I can empathise with the shock of this news.

I suppose the only thing I would say, whilst not wanting to be insensitive at all, is that with an AMH of 0.9 you are extremely unlikely to conceive naturally, so your choice is most likely IVF or settling with your current situation. It sounds like you are desperate to have a sibling, so if you have the finance available, would it be the worst thing to use this on IVF? You would have to go into it knowing there are no guarantees, but perhaps knowing you've tried may help. It might be helpful to discuss with a specialist counsellor? I'm sure your feelings are not unusual.

Definitely don't feel guilty - whilst one child is great, if it's not the family you had envisaged secondary infertility must be very distressing. Be gentle on yourself, and don't worry too much what others think! Good luck 🙂

Hi, I'm in pretty much exactly the same position although haven't had my AFC and AMH checked since 2016 so no idea what my numbers looks like.

I'm 40 and TTC #2 for a year, we've had 1 MMC and 1 CP in that time. I have a DD who is 3. DP is happy to try a round of IVF but I can't work if it's just a £8K gamble? I'll be more distressed if I spend that money to end up with another stark white test strip at end of month when I can do that myself every month for free.

I completely agree that if I was trying for my first, the money and stress of IVF would be irrelevant, but it's more complicated when you already have one. And the distress of TTC every month without success is actively hindering my time with my DD (I'm miserable a lot of the time) and this doesn't seem to make emotional sense to me - I'm spending hours fixating on not having another as my beautiful little girl is getting lost a bit in my constant fug of disappointment. Surely I'll regret this but can't seem to shake my chronic sorrow at not being to get and stay pregnant.

No real answers but I feel you OP. I think deep down IVF won't be for me and I need to work hard to get to the acceptance stage of my grief around not having another, but that doesn't mean IVF isn't right for you. The annoying thing about this is no one can tell you what to do.

Thanks so much for your replies, @Mctm123, @MGee123 and @porger80.

I think uncertainty is the worst part of the process! There are so many differing opinions out there.

Take AMH/FSH, for example. A US study a few years ago concluded that poor test results do NOT necessarily impact the ability to conceive naturally. It defined 'normal' AMH as anything above 0.7 - see here:
www.nhs.uk/news/pregnancy-and-child/hormonal-fertility-tests-waste-time-and-money/

But at the same time, logic suggests that anyone in their late 30s onwards may not have great-quality eggs... so the risk of problems is much greater.

That's another thing, I guess... having had a positive relationship with pregnancy in the past (only once - with no problems), I'm not sure if I want to run the risk of miscarriage or chromosomal abnormalities.

IVF-wise, I'm starting to lean in the direction of Natural Modified, as Create clinics bank embryos over three cycles and study quality, before moving onto transfer (rather than doing one cycle at a time).

It's cheaper and certainly sounds less hard-going, for someone in my situation. Fewer drugs and fewer procedures. Hmmm.

I know that standard IVF is the first recommendation by most clinics, but as it's unlikely to work for me based on my candidate profile (i.e. I probably won't produce loads of eggs), the results may be similar.

Of course, we may get no embryos at all... but at least we'd have tried, so it might feel easier to move on.

@CC81 The US measure AMH in different units so 0.7ng/ml is equivalent 5.0 pmol/L in the UK.

I am not in quite the same situation as you as I'm still TTC no 1 but the thing that stood out for me in your post is that you would regret not trying. You may even respond better than expected, after all AMH etc can only give you an idea of how you might respond.

@MabelG - Thanks for your reply. Yes, I've often found the AMH scores confusing for that very reason! Our consultant said that they'd prefer mine to be between 1 and 3, so 0.9 isn't miles away - it's in the 'low' category (whereas 'very low' is under 0.5).

Also, it's interesting that my desire to try IVF stands out (among the ramble!). My GP said the same thing about indications... that the tests don't provide a cast-iron guarantee of how anyone will respond, so the only way to know is to try.

It's really useful to be getting others' opinions on what I've said. For example, @MGee123 - it's not insensitive at all to point out my low natural chances. I need to face up to these things in order to accept my situation and move forward :)

It's just such a ton of stuff to get our heads around, isn't it?!

I did wipe our savings, reMortgaged and also took out a bank loan in the pursuit of giving DD a sibling after terrible secondary infertility, recurrent miscarriages and losing both tubes to ruptured ectopics

We did 5 rounds at Create and Am now 18 weeks with twins. Obviously I can say now I have no regrets (and that's probably easy for me to say given I'm pregnant) . DD is 4 and has been asking for a sibling for a long time now and is very excited about having two on the way and so the money was 100% worth it just seeing her tell my bump she loves them and talk about all the things she's going to do with them

Even if it hadn't worked at least I could say We tried - DH and I agreed that was our main aim - not to have regrets that there was something we could have done or tried but didn't or wake up in a few years time wishing we'd done something only to find we are definitely too old.

We spent £35k - I don't miss the money now. And in 4 years the IVF loan will be paid off. Yes we sacrificed things - no holidays, no big expenditures, cheaper car - but it's only money - DH said we can't take it with us when we go

Hi @ivfbeenbusy - Congratulations! :) I think I've seen you on another thread. x

Do you mind me asking your age and test results when you started IVF? What made you go for Create over other clinics/options?

I'm thinking Natural Modified may be best for us, but is it right that only one egg can be collected each time? I'm a bit confused by what I've read! I've looked at the 3-cycle package.

Hi CC81 I think we talked on another thread as I'm in a very similar position. DD is 7 years old and my dream is to give her a sibling. I know I have a low chance of conceiving naturally now...apparently 85% get pregnant within a year and out of the remaining 15% half of them will get pregnant in the second year (according to my fertility consultant). We've been trying to conceive for two years now so I feel we've given it enough time BUT I'm so scared of IVF...I'm scared I won't know when to stop and it will take over my life, I'm scared I won't enjoy DD because I will become so obsessed with trying to conceive a sibling and that I will miss out on her childhood years in a desperate attempt to pursue this dream. I almost wish a consultant would tell me I have no chance so I can move on.

But on the other hand like you, I can't let go of this and not give it a proper chance. If I don't do IVF I think I'll feel like I didn't try when I was able to and regret it for the rest of my life. That feels harder to deal with.

I think I might get counselling to deal with the process, I know myself and I know if I fail it's going to hit me really hard, I don't want that to ruin the good times with my DH and DD, my DH keeps saying he loves our family and is happy as we are even though he would love a second, he says he doesn't want to destroy our happy family with the pain of this process....I really feel I will need to learn to segment this part of my life and not let it spill out into everything else. I've already told friends that I am no longer trying to conceive which is a major weight off me...as I don't have to update them anymore. But now I need to deal with my own inner dialogue.

Sometimes when DD is playing on her own I get this sinking feeling that I waited so long to try to conceive and that I ruined my chances to give her a sibling to play with, I end up not enjoying the moment of her happily laughing and playing with her toys, the thought there is not a sibling sitting with her playing takes up so much space in my head. I really feel I need counselling on how to deal with the fact she may never have a sibling and the process of IVF.

@CC81

Yes I've been around for a while - changed user name a few times though! 🤣

I'm 37 but started IVF when I was 36 my AMH I think was about 12 before I started I think

I chose Create because I'd gone to a few open evenings and got the best "feeling" about them - not so corporate and glitzy, staff very friendly, didn't feel like I was a walking cheque book to them. I had had several miscarriages before and also lost a tube to a ruptured ectopic. Having nearly died from the ectopic I wanted a more gentle approach to IVF and I wanted to cycle quicker and take less drugs to minimise the impact on DD. With short protocol mild IVF the whole process is over in less than 2 weeks. We originally said we would only do IVF for a year because we felt it was unfair to be taking much more focus off DD as our secondary infertility had been going on a while at that point.

Unfortunately the first 2 cycles showed rubbish egg quality and we also PGS tested a couple of embryos and didn't get any normals which was a surprise at my age to have so many chromosome issues. I did manage 3 transfers from those cycles with average quality blastocysts but 2 were BFN and 1 ended in another ruptured ectopic and I lost my final tube

We then decided to change to natural modified IVF to focus more on quality over quantity and signed up to a 3 cycle package. We could also cycle back to back so do all 3 egg collections in 3 month (and would have done if it wasn't for covid!) and then call it a day and move on with our lives

Yes there is a risk of getting much fewer eggs but it really depends on what's going on with your hormones that month - 1 month I had 2 follicles the next I had 7 (my friend doing natural modified also had 7 and got 5 blastocysts).

For me natural modified is the best decision we made

Over 2 cycles of normal IVF I got a total of 28 eggs but less than 30% fertilised and 4 average blastocysts

Over 2 cycles of natural modified I got 9 eggs but 100% fertilised and 4 top quality blastocysts - 2 are my current twins with the other 2 still frozen. So for me the statistics speak for themselves x

ivfbeenbusy Congratulations on your pregnancy, you are an inspiration. I don't mean to hijack the thread, but please can you offer any advice on how to stay strong during IVF and infertility in general?

My AMH is around yours and Create was willing to try, CRG refused. We reviewed all and decided to go for donor eggs ivf and this was a personal decision. But I have friends who conceived naturally with such low AMH through insemination or naturally do it happens. During the past year I started all the supplements mentioned in it starts with an egg and I got naturally pregnant first time ever. Wasn’t successful in the end but I had not gotten that far before so it can happen as the doctors said but needs more rigorous precision and takes time but then it’s the egg quality. It’s all unknown so you need to make a decision that works for you. I wish you all the best.

@FieldsAndSun

Thankyou! I think if anyone had told me 5 years ago I'd survive 5 miscarriages 2 ruptured ectopics nearly dying twice and 5 rounds of IVF I would have said they were mad and probably wouldn't have even attempted TTC. I'm definitely a different person to who I was - my family may even say not for the better - I am stronger but I do have lower tolerance for people's bull shit now and maybe I'm harder than I was? I don't think anyone goes on this journey though and arrives at the destination unscathed

Not going to lie there were tears - a lot of them and days where I felt I couldn't carry on. But I found a few things helped

• agree what "no regrets" means to you - write a list you tick off - is it a maximum number of cycles, or a maximum budget. We started out with both those things but in the end we came to realise "no regrets" to us was trying different protocols. I knew after I did short protocol that I would have regretted not trying natural modified and actually when I thought this cycle hadn't worked I looked into long protocol as it was the last thing I hadn't tried. After that I was done. The only things we categorically wouldn't have done was egg or sperm donation or surrogacy

• research research research. Knowledge is power. I'm not medically trained at all but would spend hours reading latest research and would then discuss it with the consultant or embryologist. I went armed with questions and ticked them off. It probably didn't make a difference to the success of my cycles but it helped me feel like I had some control as that is one of the main things I struggled with mentally about infertility is not having any control over anything

• I have a book in which I write down little quotes or thoughts about miscarriage/Infertility etc . When I'm feeling low I'll take it out and read it have a good cry and put it away again. I Maybe to remind myself how far I've come from the memory each post represents but also so that I didn't let it take over my life - I had to learn to put infertility away at times like a book and only get it out occasionally

• find closure naturally don't force it. if you have the opportunity - because my ectopics were lost in a hospital the hospital arranged a full funeral service - which whilst harrowing with a hearse, coffin and baby garden where they spread the ashes it was the closure I needed and I'd recommend anyone elect to have it done if they get the option. It was after the second ectopic funeral that I realised I'd naturally reached a point where infertility and IVF didn't possess me the way it had done before and I felt much lighter. I went into the next cycle with an attitude of "if it works it works. If it doesn't I'll be ok"

• look after yourself don't worry about others. I came to realise my family and friends weren't that interested in what I was going through. At first that hurt. But I didn't have the energy to continually worry about it. At the end of the day they could never understand what your going through so don't feel obliged to help them understand. Join some good online support groups (some are better than others) - I talk to a friend I met on one several times a week and we've seen each other through a lot

• don't be afraid of what the future looks like - lockdown helped me see that if we were only ever going to be a family of 3 then we'd be more than ok.

• don't beat yourself up over diets, lifestyle, supplements etc. My twins are actually from the egg collection we did in the new year after weeks of booze and gluttony and general bad lifestyle. Infertility and IVF is shit enough without cutting out the little things which make life more bearable

• don't compare your journey to others. I'm the only one out of my IVF friendship groups who needed 5 rounds - all the others had success in their first cycle and first transfer.

Hope that helps in some way - I know I've written a lot there! Xx

Thank you ivfbeenbusy That was incredibly honest and helpful. You've given me a lot to think about, I am at the start of my journey with IVF and being given this kind of advice is invaluable. Congratulations again on your twins. I hope you have an easy pregnancy and birth. :)

@ivfbeenbusy congratulations on your twins. I also have seen you ‘around’ . What a story and what a beautiful outcome. You’re also very good with words and expressing yourself. Your posts are always very helpful and you have time for people. Thank you for sharing.

@FieldsAndSun - I have very similar fears about IVF, especially as I know it's very unlikely to work for me, based on my low egg reserve. I don't want it to dominate my life and control my happiness.

I'm definitely going to get counselling. My feelings about the subject are very complicated and I need to sort through them to figure out what I really want (and how much).

I have exactly the same thoughts when my toddler is playing. She's not yet asking for a sibling, but I know the time will come. She doesn't lack for company, as we have a great close family life (we both work from home and have a lot of flexibility). But my brother was a HUGE part of my daily existence as a child and I'm struggling to understand how different her childhood may be, as a result. I try to remember that not all siblings like each other - and some prefer being with friends, especially after primary school age!

@ivfbeenbusy - Thanks SO MUCH for the insights... I'm going to be studying your comments in detail over the next few weeks!

I love what you've said about not beating ourselves up about lifestyle issues. I want to focus on taking as much enjoyment from life as possible, as I think feeling happy and relaxed will be more helpful to me, rather than turning into an IVF-obsessed misery.

My antral follicle scan only showed 5, so I know I'm unlikely to get many eggs by either method. So quality is definitely the key for me. I like the idea of Create's method of 'banking' embryos (if we get any) across three cycles, before dealing with the next stage (or not).

A possible advantage is that we know our egg and sperm have worked well together in the past, naturally (only three years ago).

@Leala20 - So your AMH was as low as mine? (Just checking in case you're replying to one of the others!)

It's always encouraging to hear that others have defied the odds. I find the numbers and statistical probabilities hard to ignore, but am trying not to assume too much.

Are you still proceeding with donor eggs?

I think you 'just' need to decide if you'll regret it if you don't try.

We have a 4 year old dd (conceived naturally after 9 months) and have been trying for a sibling for coming up to three years now. I have other problems not low amh. We've had three ivf/icsi transfers, all negative. I don't want to give up yet. My dh tried to talk to me about when we'd give up and I told him I just wasn't ready to even talk about that. I said I might talk about it when I'm 40 (in 2 years).

I am a pretty shit mum at times. I hate having to tell my daughter to be careful of my tummy as she tends to then ask if there's a baby in there with a really excited face on her! I also hate what a stroppy cow i have become and that she sometimes sees me crying. But ultimately I desperately want her to have a sibling so I'm going to keep fighting, for now.

@seven201 - Thanks for your reply. Really sorry to hear you're having a tough time.

I think it's likely that we'll try something next year. But not sure which option it'll be, or how much.

The pro of conventional IVF is the potential for more eggs, thus higher statistical chance of success - but with low egg supply, this may not be the case for me.

While the pros of natural modified IVF include lower drug costs and less messing about with my body. So it might be a generally kinder process. My cycles are still regular, so it seems daft to wait too long (in case this changes).

But we don't know about either, until we give one or both a go. Either way, we've agreed we'll probably restrict it to one year, then move forward as we are.

@CC81 I’m 41, almost 42 with AMH 0.5 FSH 7.4 and AFC 8. Daughter born in 2016. It was the 2nd pregnancy after a missed miscarriage in 2015. 3rd pregnancy ended in early miscarriage in Feb 2019 after not long trying. And then nothing for 18 months.

So went for investigations. I have always used the clear blue advanced fertility monitor and was told to take my basal temperature and see if matched. It did. They also said to widen the window. So 2 days before first OPK peak. Peak + 2, Peak + 4. We managed the last 3 and it has worked. So far. I’m 10 weeks and very anxious of another miscarriage.

If it hadn’t of worked and I had the funds I would have tried IVF if there was a chance. Cut off for treatment where I live (non UK) is 43 so we would have tried for a year and see what came of it. I think the end date here brought the idea of not trying more final and that changed my thoughts on fears of needles etc. I also have a lot of siblings so felt sad that my daughter would not.

But then the other side is that she is almost 5. We are over the hard part. We do really nice things with her. She has friends. If it doesn’t work then we tried and will move on, focusing on her.

Good luck with your decision.

@Ana567 - Thanks for your reply and I really hope this pregnancy works out for you.

It sounds like your FSH is much better than mine! I think unfortunately low egg supply is what's standing in my way.

BUT I've been feeling much better about the prospect of staying as we are (as a family of three). I think that'll help me manage the stress of the IVF process, as it won't feel quite so 'all or nothing'.

Hi all, how are you all doing?

Just a little update from me. I've talked things over with my husband a LOT in recent weeks... and we're definitely coming around to the idea of NOT getting on the IVF train. I'd say we're about 80% there.

It's mainly because we've realised that our desire to have a second increased when we discovered it's unlikely to happen (around the time I started this thread).

Before that, our attitude was very much "we're super-lucky to have our daughter - and we'll just see what happens with a second". In the couple of years after she was born, we were pretty much 50/50 about it.

It probably puts us in a different category to those who are truly DETERMINED to have a second child (or a first child, for those unable to conceive naturally at all). The bottom line is that with OR without IVF, our chance of having a second child is statistically less than 90%, so we have to get used to that idea and make peace with it.

The uncertainty is still there, of course - we haven't ruled out IVF. We're going to think about it for the next couple of months. Then either give it a try in 2021... OR simply carry on as we are and focus on enjoying life with our daughter.

The thought of the latter option, simply moving forward, makes me feel happy and excited - especially when compared to a year of IVF, which even if successful would be followed by pregnancy and newborn time... all of which will take our attention away from our daughter when she's at a pivotal age (3 to 5).

I've started seeing a specialist fertility counsellor, to help me weigh everything up and make peace with whatever we decide.

*less than 10%

Thanks for the update, you are echoing a lot of my thoughts. I read a quote on an old thread where a woman said she wanted to 'win the game of getting pregnant' which has always resonated with me. I already have a DD and I enjoy giving her all my attention, and I actually enjoy the ease of being a '3'. I don't need to have another, I'm just pissed that I'm being essentially told I can't. It seems madness to pursue IVF when I don't really want to do it, I just don't.
The real 'moving on' action would be for me to go back on BC but I'm not ready for that yet. I just need to get better at coping better every month when there's the inevitable disappointment. I'm working really hard on that bit.
Good luck with everything