Low ovarian reserve - go straight to natural IVF, or try normal IVF first?

[Kitekat81]

Hi everyone

I am 39 years old, TTC#1 for a year now (plus 6 months NTNP before that). We've had all the tests and investigations, and have found out that I have low ovarian reserve (everything else was fine). My FSH was borderline at 10.7, follicle count was 6 in January and 7 in February, and AMH was 2.2. My gut is telling me that we are unlikely to get pregnant naturally now, and I'd like to look into starting private IVF in about three months from now (the NHS waiting list is too long to be an option for us).

I am tempted by natural / natural-modified IVF, which looks to be a good option for people with low ovarian reserve. However, the nearest clinic which offers it is four hours from where we live, whereas we are an hour and a quarter from a clinic which offers normal IVF. This means that by going for natural IVF I would be reducing the stress from IVF drugs on my body, but potentially adding in a whole load of other stress trying to manage the logistics of travelling back and forth from the clinic.

I think what I need to do is book an initial consultation with both, and then go with the one that seems more confident about the possibility of success. However I was wondering if there is anyone on here who has any advice based on your experiences. Have you gone through IVF with low ovarian reserve? Or have you tried both normal IVF and natural / natural-modified IVF, and have some thoughts on how they compare and the order to try them? If so I would love to hear from you!xx

@MabelG congratulations on your pregnancy! 😊 Really pleased to hear you had a good experience with Create. Interesting to hear what you were told about dhea as well. I'm loathe to mess around with hormones as the one thing I do have going for me is that I am ovulating regularly, so don't want to do anything that might interfere with that!

@IslandStars wishing you all the luck in the world that your embryo sticks! 🤞🤞🤞 That makes perfect sense why you went with PGS, I think I would be tempted to do the same. I've booked a consultation with Create for next month, will be interesting to see if they recommend natural or mild for me.

Hi- I got pregnant at 34 just after I was told my fsh was 12- unfortunately it was a miscarriage.

Then I did ivf age 35- only retrieved 2 eggs but it worked anyway first time.

Baby was born age 36- as soon as I finished breastfeeding I thought I had better ttc immediately. I assumed it would take several years to conceive if it was indeed possible at all.

Two weeks later I was staring at a positive test.

Clearly it’s possible. My friend was in a similar boat and had her second at 41.

@Ilikeviognier so sorry about your miscarriage, but lovely to hear that you went on to have two successful pregnancies. Brilliant that you had success with your first cycle of ivf, did you do normal ivf or mild/natural ivf? I can imagine how shocked you must have been to then conceive naturally in your first month trying after your baby was born! Just goes to show how completely random everything about ttc is, it just feels like pot luck!!!

It was “regular” ivf and granted I responded really badly. So I don’t know what would have happened had I done modified or mild ivf.

And yes I was totally shocked - I was prepared for it to take years or not happen at all, so it really does just show you.

@Ilikeviognier it depends how you define a poor response, the important thing is that you got one good one and it worked, I would consider that a great success! 😊

Hi @Kitekat81 Just found your thread as I'm quite anxious about my CD2-4 test results whilst I wait to get to CD21 (ish, it'll be earlier because of my short cycles). My FSH level was 13.2, and I flew into a panic. Once I have my other results I'll have a better picture, but finding it helpful to read about others' experiences. Have you made any progress with your IVF research? x

Hi @TTCat39 where I've got to is that I've booked initial consultations with a "normal ivf" clinic and another with Create who specialise in natural/mild ivf, so I'll be having those over the next couple of weeks and can then compare the two. I'm keeping an open mind until after the appointments, but just based on research my gut feeling is we may end up going straight to natural/mild. If we lived nearer to the Create clinic it might be an easier decision, but it's 4 hours away (vs just over an hour to the "normal ivf" clinic) so that's a factor to consider. If you are just starting out and don't want to book consultations yet, most ivf clinics offer free webinars that you can join to find out more. If I were you I would try and get as many tests etc done on the nhs as you can (if you're going private for ivf you'll need to save money wherever you can!) but if you are in a hurry you could also consider getting some done privately e.g. I couldn't get amh tested on the nhs so I got that one done privately for £125, and I also did a private hycosy for £500 to see if my tubes were blocked (they weren't). Try not to panic until you've got all your results though. Having a higher FSH / low AMH doesn't necessarily mean you can't conceive naturally (though it might make it harder) but wait and see about your progesterone and also your oh's semen analysis as well. If you find out that you are having any ovulation difficulties, or that there are issues with your oh's sperm, that will also affect what help you might need and how quickly you might be wanting to consider ivf x

Thank you @Kitekat81 I hope your consultations go well and you find the right fit for you. We will of course keep trying in the meantime and hope we're lucky! x

Thanks @TTCat39 I'll keep you updated after I've had my appointments! Fingers crossed you guys will be lucky and won't need to go down this road 🤞🤞🤞

Hi @Kitekat81 I would advise you to comtect and do consults with all the clinics you are interested in. I was also interested in mild ivf but create told me at the consult they would put me on 150 bemfola which I know the clinic I was with at the time would do. So for me if wasn’t worth the move. They said I wasn’t suitable for mild protocol even though I’m a poor responder and low AMH so definitely worth talking through your options.

Really it’s all random. For example in @Mrbay it’s like that was the magic protocol as it yielded the most embryos and a pregnancy but it might not be the case. For me I thought I had found the magic protocol. After 3 rounds with no embryos, no embryos, 2 eggs and 2 blasts I changed clinic and protocol and got 13 eggs and 3 top quality blasts so thought we had cracked it. I’m doing embryo banking so we didn’t put any back and repeated the exact protocol a few months later and the round got cancelled due to poor response. So it is often random. If I had gone ahead and put back one of those 3 blasts and gotten pregnant I would also have been on here saying I’d found the right protocol for me whereas it literally was a disaster the next time!

So go with a clinic you feel happiest with. I did 4 consults and got the feel of how the consultants would treat me and despite my recent cancelled round I’m very happy with my decision.

I also wouldn’t worry about travel - I’m based in Ireland and going to London for treatment now. Flew over in lockdown too and it was totally fine!

@ForeverAintEnough12 thank you so much for your advice, it's so useful to hear about other people's experiences! It's scary how completely random this whole thing is, like you say there's just no knowing how anyone will respond to the different types of treatment, and then to get a completely different response from exactly the same protocol... I'm sorry about your cancelled cycle, but that's great that you've got those three blasts in the bank already. Was that your decision to do embryo banking, or was that recommended to you? Do you mind if I ask how old you are, and what your AMH and afc are? Which is the clinic that you've found is working well for you? Sorry that's a lot of personal questions 🙈 Do you think I should be being more ambitious and looking at clinics further afield? I haven't even looked at any of the London ones, I know there are loads there. I so desperately want to get this decision right, it's such a massive investment of time and money and hope!!!