AMH/Embryo quality/Clinic advise

[IVFninja]

Hoping some of you lovely lot could offer a bit of advice. This is all very new to me!!

I’m 35 with low AMH (12.5) and going through ivf with icsi due to male factor. My fresh cycle got cancelled as I was quite unwell so all of my embryos were frozen. 9 eggs retrieved, 5 fertilised and 2 made it to blast stage and both are considered average/good rather than excellent.

I’ve started meds for my FET but given the grading of my blasts I’m not confident and I’m someone who likes to be prepared so starting to read around in case I need to start a fresh cycle elsewhere (not happy at all with my current clinic). I spoke to a lady on here yday who had a positive outcome, but has anyone else had experience of an average embryo resulting in a pregnancy?

I’m also looking for any recommendations for a clinic in London. CRGH keeps popping up but heard there are a ton of add on?

One other thing I read on a different thread is that if a blast struggles at day 5 it could be down to sperm quality. Does anyone know of anything on the treatment that could help with this or that I could request?

One final question - I read that human growth hormone can assist with improving egg quality. Anyone had experience of this? Paranoid in a big way about AMH and worried I don’t have much time on my side so want to ensure I do everything to give this process the best chance.

Thanks in advance x

don't know much about growth hormone but I am 32 and have an AMH of 6.5 (no idea why - i have zero risk factors and we only found out when went for checks at the start of this process. we have never tried to conceive naturally). We did ICSI as my husband's sperm count is very low and his normal forms are less than 1% thanks to childhood cancer.

I only got 6 eggs retrieved but out of those five fertilised and all five made is to blast at excellent/good level despite my husband's very poor sperm quality.

What supplements are you taking - I highly recommend getting your Vitamin D and CoQ10 (make sure its ubiquol not ubiquone) and if you're not happy with the clinic deff change as the most important thing is for you to be happy and comfy. A lot of clinics charge for lots of add ons etc so don't be too drawn in by cheap deals as they usually end up more expensive.

Good luck

Hi @IVFninja I’m sorry to hear you were unwell during your fresh cycle and hope you’re better now. I’m also really sorry to hear that you’ve had a bad experience with the clinic, this process is hard enough without extra worries.

I wouldn’t say your AMH is worrying, I’m your age and mine is 17.3 and I was really happy with that, I have friends who have AMHs of 1-2 (using the same scale you’ve given) which is far more worrying. AMH needs to be interpreted alongside the AFC and if you’ve had 9 eggs retrieved then I presume your AFC is likely around 9, I have a really high AFC of 34 and got 12 eggs, so I’d see 9 as a good result. A lot of people say that the egg quality gets the embryo to day 3 and then it’s more to do with the sperm after that, I don’t know much about what can be done to improve sperm quality, I’m sure others will though. I know there are tests like DNA fragmentation.

I’m not sure the grading of blasts means much, I’ve heard they don’t grade at all in the USA. My embryos were in a embryoscope, that uses previous data to provide a score that corresponds to how likely it is that there will be a live birth from the embryo, based on how it grows and moves etc. my worst graded embryo 2,3 got a score of 8/10 whereas I had a 2,2 which only got 5/10. One of the most important factors for success is whether it is euploid, and the grading provides no information to help with that. So I would say try not to get too worried about the grading.

I’m not sure if evidence for human growth hormone. People mention the book it starts with an egg, as that gives recommendations to improve egg quality, so many have a read of that.

I think you might be worrying unnecessarily about your AMH. at this point I would say focus on your FET, I hope you’ll get a good outcome!

My AMH was 12.9 age 35 too and we also initially started IVF due to a combination of male factor issues plus recurrent miscarriage plus one tube down due to ectopic

I had very similar results in terms of eggs and fertilisation and my blastocysts (2 from each cycle) were all average (3BBs x2, 5BCx1. I had 2 failed transfers with this batch and a ruptured ectopic

Like you I was a planner and had my eye on the next cycle as helped me cope to plan ahead.
I ended up then doing a 3 cycle package of natural modified IVF with Create - I got 4 blastocysts- 2 are 5AA so top quality and then I had a 5BA and a day 6 4BB. I elected to transfer the two "lowest" graded ones first and both stuck and I had twins last month.
I know loads of problem for whom their AA grades didn't stick but their average/low graded ones did

@ivfbeenbusy Thank you so much for sharing and what spookily similarities! Hopefully I get the outcome you did, huge congratulations ☺️ What an amazing conclusion for a very stressful and uncertain situation

If you don’t mind me asking, what does natural modified IVF entail? Which cycle from the package was it you found out you were expecting? Is there a consultant you’d recommend? X

@Bells3032 thank you, I’ve ordered the supplements you’ve recommended. I’m so ignorant to all of this! Every little thing helps x

@Gardenlady543 thank you also for sharing and such detailed advice, it’s very reassuring to know I shouldn’t dwell too much on my AMH level and embryo quality. I’ll try to focus on this FET in more positive light than writing it off needlessly x

@IVFninja

Natural modified IVF is basically just really
Low dose medication - Tamoxifen tablets which have a similar affect to clomid and stims only every other day - the idea being that you just give a couple of follicles you already had that month a nudge to grow rather than forcing hour body to produce follicles or never would have selected itself

I did 2 cycles of short protocol IVF with 4 transfers (2 BFN and 1 ectopic) and then the 3 cycle package of natural modified - with the 3 cycle package you don't transfer until you've done all 3 egg collections so I fell Pregnant with my twins once we'd done the blastocyst banking and had a few to choose from

I used GH on my second cycle and I had very similar numbers of d5 blastocysts but instead of 1/4 hatching quality as first time (1 baby, 3 failed FET) I have 3/5 hatching this time and the fresh transfer successful so far. All over great quality or clear fails. No inbetween quality embies. So possibly helped me. The theory is that also - it should improve embryo developmental competence, not numbers.

As I was paying all private I looked at lots of papers on GH and they seem especially positive for low ovarian reserve. All relatively lowgrade evidence. Some animal studies had amazing results. Some papers have evidence of no improvement. ..So the evidence is either no benefit or some benefit. As no papers demonstrated harm, I went for it. Along with chugging huge quantities of ubiquinol for 2 months beforehand.

@indub thank you, where did you get GH from? Did your clinic write a prescription?

My fertility discussed it and prescribed it. You will need a doctor to agree. We did a protocol with 6mg on day 21 of preceding cycle then days 2, 6, 8, 10. I had a short protocol and sufficient big follicles at d11 collection. I think some clinics do differently. I read the first paper had a lower dose.