Low AMH (1.1) - Trad IVF or Mild?

[Ellsiedodah]

Hi all, I've just learned the nearest consultant for miles where I'm about to move only does traditional IVF. However 2 out of 3 consultants I spoke to in July said to do mild IVF with my AMH being so low. I'm at a total loss of what to do... apart from anything, I can potentially be in London for Dec and Jan but thereafter it's going to be a lot more difficult, so if I were to go with the trad IVF and it didn't work, then changing tack would be difficult owing to location. So I'm wondering whether to attempt to give mild IVF a go immediately here in London. Has anyone read any research which indicate one is conclusively better than the other for very low AMH? Has anyone with low AMH had success (or heard of) success doing traditional IVF?

There are so many factors at play that it's difficult to compare two people's experience with low AMH. Mine was below average abs I first did mild then dropped down a level further to natural modified abs had my best results the less drugs I took. The good thing with both those protocols is that the whole process over in less than 2 weeks so very quick compared to traditional IVF and might fit with your timescale to be in the London area

@Ellsiedodah do you know what your AFC is? If it is ok you might still get a reasonable response despite the low AMH

Thanks for getting in touch @TTCIVF. I think they counted 6 at the scan. Is this okay? I've been doing further research this morning and I'm really wondering if I want to put my body through long protocol IVF... seems so full on. Hope your journey is so far so good?

@Ellsiedodah sorry hadn't realised you meant traditional to be long protocol! Quite unlikely they would recommended long protocol for you as that involves down regulation (shutting down the ovaries) which they don't usually do when you have low AMH/AFC. They'd do short protocol instead which for me was putting me on the pill instead of down regulation and then starting with a high dose of stimulation drugs.

I think mild IVF is similar to short protocol. There is also natural modified. I've done short and natural modified. Had a marginally better response egg numbers wise on natural modified but overall embryo numbers were better on short protocol. No successful pregnancies yet though.

Ah... interesting! Thank you! It's very confusing... the clinics outside London (well, Oxford and satellite) class 'mild IVF' as I've understood it from descriptions on London clinic websites as what London clinics call Natural IVF. I had forgotten about natural modified as yet another option. Did you do 'mild' and 'natural modified' at the same clinic or could it just be different terminology used by different clinics? Sorry to hear you haven't yet had success.

@Ellsiedodah I did them at different clinics and they are not the same thing. Short protocol was high doses of drugs from day 2 of your period, whereas natural modified piggy backs your natural cycle using much lower doses of (different) drugs from day 5 in my case.

To confuse matters further natural IVF is something else as well - no drugs and collecting the one egg your body has naturally selected that month!

Ah thanks for explaining. Would you mind sharing if you're happy with your current consultant and who they are? Im really vacillating between who to go with... whether to go for the -what will be- local option, another month, even 2 down the line, where they don't do mild ivf either, whether to go for the best clinic in London (crgh) and do whatever they suggest... but our finances may not stretch to as many cycles as I prob need, or whether to go with Create st Paul's and probably do mild with both the slightly minimised chances of not doing full ivf and with the inconvenience of having to return to London 3 months running, albeit for far fewer days than I might do with the expensive clinic. And I have a 2.5 yo and house move to co tend with. Argh...! Sorry, brain dump :)

@Ellsiedodah I understand it is hard to know what to do for the best because ultimately until you try one or the other you don't know how you will respond as an individual! I am with Create St Pauls and overall I have been happy with my care - they monitor each cycle closely. No specific consultant - care is consultant led so you always see a doctor

Thanks so much for sharing. Dare I ask just 2 more questions?! Have you done both types of treatment with them? And are you doing the egg collections back to back (eg consecutive months?)? I promise to trouble you no more!

@Ellsiedodah I have only done natural modified with them. You can indeed do it back to back but I was unable to due to having to fit it around other commitments. They will take your history/scan you and advise which type of IVF is best for your situation

OK... thanks very much :) best of luck with it all. Thanks for your time

Good luck

I did short protocol and natural modified with Create (Birmingham) but also some scans/egg collection/PGS with St. Paul's as I work in London (or did!) a lot

Thanks @ivfbeenbusy. Can I ask why did you choose Create...? I really liked the consultant at Create (Wimbledon) but the issue for me is that it'll be major upheaval for my family to be in London for treatment. So I'm thinking maybe I should just go for the local option. She does seem to have very positive feedback online. Do you know if women with v low amh are ever put on long protocol?

I chose them because I specifically didn't want to do long protocol traditional IVF. I'd had 4 Miscarriages by that point and nearly died from an ectopic - I have one DD and I felt that I couldn't put my body through too much more plus I was concerned of the effect being on hormones/drugs for weeks at a time wouldn't be fair on DD

I also got a better "feel" for them than I did other clinics (priory, care etc). They were more relaxed and friendly and I didn't feel like a walking cheque book, they didn't try to sell add ons and actually talked me out of a lot of things I'd read about

I have heard of low AMH women doing Long protocol but not very many as most of those clinics have a limit below which they won't treat whereas Create doesn't? But i think it has depended how they responded to their first cycle so they probably didn't do it for their first try but maybe their second or third round?

Can you travel into London by train? You don't need the entire family there and your partner only really needed on egg collection day

Thanks ivfbeenbusy. I'm so sorry you went through such a dreadful time with an ectopic.

Birmingham will only be an hour away by train so I could potentially do that instead of London St Paul's (and their wimbledon branch is near my in laws who i'd have to stay with whilst down there), but st paul's has such better results. Do you know why by any chance?

Unfortunately it could be hard leaving my toddler with my husband because he's the only breadwinner and struggling as it is. But we'll have to review the situation I think... Thanks again. I hope your journey ended okay?

By 'okay' I mean a happy ending? x

@Ellsiedodah

Yes thankyou! I'm 27 weeks with twins now after another miscarriage and then another ectopic losing my final tube. So I'm very lucky to be having my happy ending

I'd imagine St Paul's rate is higher purely because it's a bigger clinic - but I've heard that Wimbledon is a lot more personable/relaxed. When I went to St Paul's it was always very busy and I much preferred Birmingham x

Amazing! So so happy for you! What a journey you've been on. I looked at Birmingham yesterday and was impressed with their success rates... might go there instead!