If you had high(er) AMH or AFC, what route did you take with IVF?

[thislittlebird]

If you had high(er) AMH or AFC, what route did you take with IVF? Or which route are you planning to take, and why? Which option produced the best egg quality? What was successful for you?

I know everyone is different but I haven't seen so much discussion of the medium to higher ends of the AMH scale and IVF choices so far.

I'm just getting into researching our IVF/ICSI options (and potential costs!) at the moment. I am 37, 38 next month, my AMH is 36 and my AFC was 28 in February and I am aware of the potential for OHSS. I have been reading a bit about mild IVF with Create (and attending an upcoming webinar), and am seeing the NHS for our referral in May to hear what they suggest but we have male factor and low progesterone issues, so I'm hoping they'll be able to help us too.

I know mild and natural modified IVF is often recommended for low ovarian reserve and PCO(S) but I suppose I'm somewhere in the middle and I'd be interested to hear from anyone with similar numbers about their journeys.

A private consultant already told me I'd need short protocol after my AMH test, but I'm very open to options right now and keen to produce some quality eggs. Will be starting my supplements again this month after I finish some medication and hoping that will help the eggos out as well in the coming months as it all gets more real.

Would be happy to hear anyone's experiences, TIA!

@thislittlebird my AMH was 17.4 but my AFC a whopping 34 with 17 follicles on each ovary. I don’t have PCOS it was just really high. I had a short protocol, they scanned me at day 6 (rather than their standard day 8), by day 8 I had responded enough and was told to stop the stims ready for EC. I had 12 eggs, all mature, all fertilized, ended up with 9 blasts. No sign of OHSS. It was uncomfortable as my ovaries grew in size, I felt instant relief after EC.

Thanks for sharing! @Gardenlady543

How many days were you on stims for overall? I assume your 9 blasts were good quality too? One of my concerns is producing a ton of poor quality eggs but glad to hear short protocol went well and you had no OHSS. Was this recently or a while ago?

@thislittlebird half were 1,1’s (the best grading you can get), all except one got high embryoscope scores. I’ve had 2 unsuccessful transfers, I had the remaining embryos PGT-A tested, 1 didn’t survive the thaw which I’m told is bad luck, 5 out of the remaining 6 were euploid (I’m 35). My fresh cycle was in November. I only needed 8 days of stims in total. Do you have PCOS? as that might be a different situation, I’ve seen lots of people get huge amounts of eggs but few are mature and they can end up with a small amount of embryos.

Oh that’s great @Gardenlady543! I need to google some of these terms I’m not familiar with yet. But looks like we’ll likely be going through the private route soon because the nhs are mucking us around.

I’ve never been told I have PCOS, the last consultant I spoke to didn’t seem to think I had it. She said maybe borderline but my test results have all been normal bar low progesterone and I don’t have any “signs” of PCOS, but my concerns remain you know? That I’ll just produce a ton of poor quality ones. But then you had more follicles than me and didn’t.

Can I ask if it worked out or are you still going through it all etc? I don’t like to be nosy but I’m interested from people who have been through it all.

@thislittlebird you probably don’t have PCOS then, while a high AFC is part of the diagnosis you need to have at least one of:

• Clinical Hyperandrogenism / Biochemical Hyperandrogenism (Elevated Total/Free Testosterone)
• Less Than 6-9 Menses per Year

Me and DH went private from the start we are with Access fertility 2 cycle package that works out really well if you get lots of embryos. I would recommend you have a look at their packages as well as any packages your clinic might do.

I developed a rash in my fresh cycle which was later diagnosed as progesterone hypersensitivity. It meant my worst embryo was transferred rather than the best one in the fresh cycle (still a very good embryo). This was unsuccessful, I had a FET and this time the best embryo was transferred, again unsuccessful. I have known there is something wrong the whole time, in most people that problem is the embryo... I then got the embryos tested and when the results came back, my specialist was on the same page as me. I have never had a BFP yet me and DH produce high amounts of high quality euploid blastocytes. Normally you have to have 3-4 transfers of good embryos before they start considering recurrent implantation failure tests, but given my embryo results, we’ve brought these forward. I had tests for autoantibodies (no issues) and a thrombophilia screen (only one abnormal gene found which means I’ve been put on aspirin and will go on heparin, but it doesn’t really explain things), they’ve also found a common folic acid metabolism enzyme mutation. When reviewing everything my specialist told me my lining was thin in a natural cycle 9dpo (this was missed originally) I seem to respond to estradiol but they are worried my lining shrinks once I start progesterone.

At this moment I’m having an ERA EMMA ALICE, I’m on all the medications of a FET and I’m having a endometrial biopsy on Thursday, this will provide information on receptivity and good and bad bacterial.

What has your journey been so far? How long have you been TTC? Have you ever had a BFP? And when you say low progesterone- what result did you get?

@Gardenlady543 Yeah, I have fairy regular cycles, every month give or take a few days in length (26-36 days, mostly about 29). Progesterone was 17.5nmol in July and then 10nmol in Feb.

I don't have a clinic yet, we've just started looking around (I did use one for private AMH/AFC tests but didn't love the admin staff there) because the NHS are dragging their feet and I'm 38 next month. I'm keen to get cracking now, good to hear Access do a 2 cycle package, that would be interesting to me, rather than committing to 3 at the same place. I take it their storage fees are good?

Amazing how many curveballs this can throw you, I have never heard of progesterone hypersensitivity. Why was the worst one transferred? Sorry if that's obvious and I missed it.

Your journey sounds complex, it must be very frustrating not to be able to get to the bottom of it. We started officially "trying" in October 2019 (although we weren't using contraception before that really), I was 36 then and now I'm nearly 38, it goes so fast.

We got tests done on the NHS last July but they didn't tell us we had problems (my low progesterone, and his low motility). Only six months later when we still hadn't had a BFP (and never have had) did I ask for the breakdown and realised they were not in fact "fine" but that we both had signs of sub fertility. Eventually re-run the tests early this year and got referred after both our problems were worse. I have been waiting on that appointment for months now and today they have cancelled it, I'm pretty furious but I think it's a sign that I just need to dive into private.

How long did you have to wait for Access to start treatment? I have been on medication for 6 weeks and finish next week (for eczema) and need to restart my supplements. I want to try to take my ubiquinol and vitamin c etc for three months before we start I suppose, rather than feel like I've wasted a cycle if I get poor egg quality and haven't at least tried with supplements.

@thislittlebird

You know I went into IVF thinking it would be the thing that works straight away, but as I’ve learned on these threads, it is rarely ever easy. I seemed to be doing really well, my specialist said I had the best rates of embryos she’d seen and the embryologist said it was so rare to deal with such a lot of high quality embryos. But it’s only half the equation, if they never implant, then I’m still childless.

That progesterone is a bit on the low side but that can be dealt with through IVF.

Access Fertility is a finance company, have a google, they partner with clinics throughout the UK. The prices vary depending on age and if Icsi is required. At age 35 with no need for ICSI my 2 cycle package was £7,300 it allows for 2 egg collections and unlimited FETs until I either run out of embryos or get a live birth. It has already worked out cheaper than paying the clinic, and financially I don’t need to worry. There is no storage fee, they pay for the embryos to be stored until the package ends, it’s then up to you to pay the clinics storage fees. They also throw in things like the embryoscope. They don’t cover additional tests though. With my package I didn’t need to send them any medical stuff, I just paid and told them the clinic I was with and it got acted on the next day. They do refund packages too, this takes about 2 weeks to go through, you send them all the medical documents.

The worst embryo was transferred as my specialist felt I was having an allergic reaction to progesterone, so she didn’t want to transfer the best embryo as I could need to stop the progesterone and the embryo would have definitely died.

How frustrating for you to find out tests weren’t normal after so long! I felt like this when I was suddenly presented with a thin lining issue, that was missed 6 months ago! It was only picked up because I said I wanted a natural FET.

I’ve seen so many people have these delays with the NHS, if you can afford it go private, most clinics don’t have waiting lists.

Hi there
Just wanted to share my story with you. We have just done first round IVF/ICSI. Partner is 34, I am 25. He has MFI and I have pcos. My AMH is 72.8, so I was told I may over respond.
They put me on a short protocol and started me on a low dose. The low dose didn't do much for 5 days so they increased it quite a bit. Then the follicles started to grow. They kept me on stims for 13 days! I honestly thought it was too long and it fell over Easter weekend and they weren't open then. I had my EC last Wednesday.
I got 17 eggs, 15 mature, 7 fertilised. 2 blasts 1 not great quality (words of the embryologist) and one really good top quality. I had a 5 day transfer on Monday and currently in the tww.
I honestly expected to get more blasts but I've realised I think my eggs may have been post mature or even poor quality because I was on the stims so long not sure?
Just wanted to say it's not always the amount of eggs you get in the first place and quality is really important . If we were to do ivf again I think we would go with a completely different protocol.
Anyway about 4 days after EC I did develop OHSS which gradually got worse and worse. The day after the transfer I got admitted to hospital. I wasn't there too long thank god but they gave me anti sickness meds and blood thinners as my bloods suggested ohss and I was very swollen. Got to take the blood thinners for 10 days.
I can tell you now at this point I wasn't bothered if I was pregnant or not I just wanted to feel well again. It's the most sick I've ever felt in my life. Luckily I'm feeling much better and seemed to have made a quick recovery.
My advice would be do this as risk free as you can, with the aim of getting good quality eggs.
I thought we were sorted getting 17 eggs I was so pleased. To end up with 1 blast (I am 100% grateful for as this could be our baby) but it's still a big drop off!
Good luck. I hope this was helpful in some way. Sorry it's long x

Gosh @swirls3468 I’m sorry to hear you’ve been unwell, that sounds like an awful experience, I hope you’re feeling better now. Best of luck for the rest of the two week wait.

@Gardenlady543 yeah, it must be frustrating if you know you have good embryos too.

With the progesterone, do you think (from your experience with IVF) it's a non-issue for them when it comes to IVF? I keep thinking we've got too much going against us, but I know they can probably deal with it.

I got some quotes from Access today and it's so expensive . I think I'm having regrets leaving it until I'm nearly 38. If I'd started already I'd have so many more package options but we've spent all this time waiting and waiting for appointments and tests, it's annoying, and I'm 38 next month so will lose all the extra options imminently. Is the unlimited FET option unusual? There's a 2 cycle option but it's not a refund package, and it's more expensive for ICSI which just bumps up everything. It was 19,200 for ICSI x 3. I need to do a lot more reading to understand what I'm getting from each place for the money, it's useful to hear from people who have experience already, like yourself.

I don't know if we'll need ICSI or not yet, I need to speak to some clinics and see what they say but I thought it was best to look at those costs in case we do need it.

That's really interesting, thanks for sharing @swirls3468. I'm glad you're feeling better but that's not a nice thing to go through.

Stories like yours are why I think I might speak to Create and see what they suggest as well because I do worry about having a similar outcome. In my head, I would like to try the free NHS round and then see how I respond and choose my private option (assuming round one fails and is a test run) based on how that goes. But knowing I have a fair few follicles makes me very keen to get quality ones out if I can. Did you take any supplements for egg quality at all?

Why would they suggest short protocol and then leave you on stims for 13 days? Seems crazy. What protocol options would you have to choose from do you think?

@thislittlebird they will put you on supplementary progesterone in your fresh cycle and in FET cycles, so not an issue at all for IVF.

We didn’t know whether we’d need icsi but you can pay for the access fertility package without it and if the embryologist thinks it’s needed on the day then you can either pay access fertility the extra amount or pay the clinic for it. I went with the 2 cycle non refund package. What I found helpful was to put a spreadsheet together with every cost option. And then see how much it would cost as cycles progress both through paying the clinic and with access fertility. In my case it worked out cheaper if it required any more than one cycle. On average it takes 3-4 attempts to get success so you’ll need to take that into account with finances. And also neither the clinic or access fertility include the cost of medications. You can get these cheaper by asking for a private prescription and taking it to Asda pharmacy, who will sell you them at cost price.

@Gardenlady543 that’s good to hear. I assumed they might give me a supplement.

Did you have any male factor issues at all? I am interested in the two cycle plan because handing over £20k for three cycles when I’ve never had one before feels like a huge deal. At least with two if you don’t like the experience you still have more to take elsewhere. We also don’t void our theoretical NHS one if we do two, but I need to run that by them when I see them in May.

The spreadsheet sounds like a good idea. Were there any good resources you found on all the different aspects of ivf? They list so many things that it’s a little overwhelming to know what you might or will need.

Handy Asda pharmacy tip, thanks! I don’t even know where there is one, would need to google.

@thislittlebird

That's really interesting, thanks for sharing *@swirls3468*. I'm glad you're feeling better but that's not a nice thing to go through.

Stories like yours are why I think I might speak to Create and see what they suggest as well because I do worry about having a similar outcome. In my head, I would like to try the free NHS round and then see how I respond and choose my private option (assuming round one fails and is a test run) based on how that goes. But knowing I have a fair few follicles makes me very keen to get quality ones out if I can. Did you take any supplements for egg quality at all?

Why would they suggest short protocol and then leave you on stims for 13 days? Seems crazy. What protocol options would you have to choose from do you think?

Well I was a newbie to ivf so just went on their advice tbh. But I think they left me too long as my follicles were huge before the end. Yes I took loads of supplements , I've spent £100s. For the last year I've been taking them. Vitamin D, selenium, ubiquinol, omega 3/6/9, standard pre natal vitamin, myo inositol. They also put me on metformin few months ago to help with pcos. I thought my eggs would be fine as I'm 25 and generally in good health. So it's either the protocol, the sperm or maybe I do have poor eggs because of the pcos. Hopefully I never have to do ivf ever again but if I Did I'd focus on producing less eggs that are better. Take the nhs one but I wouldn't think of it as a trial as you don't want to go through it for nothing. It can be a hard process so focus on getting that positive at the end!

I had an AFC of 34 also, although I think during stims they said they could see around 40 folicles. I was on short protocol and was also told to stop stims two days earlier as I had responded enough.

They removed from 20 folicles as they were the right size, got 17 eggs but only 11 were mature. 8 fertilised out of that and I got to 4 embryos by day 5.

I had to have a freeze all because of the high risk of OHSS due to lots of folicles. I also had fluid in my lining as it leaked from one of my folicles. It got pretty uncomfortable with having so many.
I got zero OHSS symptoms btw. Stocked up on lucozade sport and salted popcorn haha.

@swirls3468 I think it’s more I don’t expect them to get it all right for us first time/or we won’t be producing much quality. I’m just not optimistic one round (nhs or private) is going to cut it for us

I’ve started taking ubiquinol and a few other things again. It adds up fast.

How are you now?

@willithappen did tour AMH line up with your afc? Mine is higher and it makes me worry there’s more lurking in there they can’t see lol

Are those things good for OHSS? I am worried about that, I’m going to be vigilant about being monitored. What sort of quality were your embryos?

[quote thislittlebird]@swirls3468 I think it’s more I don’t expect them to get it all right for us first time/or we won’t be producing much quality. I’m just not optimistic one round (nhs or private) is going to cut it for us

I’ve started taking ubiquinol and a few other things again. It adds up fast.

How are you now?[/quote]
I don't blame you for thinking like that. I think it takes a lot of people a few rounds for it to work. I will never do a second round though as I couldn't deal with the heartbreak of not only failing again, but the loss of so much money.
I'm feeling ok physically now, ohss all gone. I did a test yesterday and it had a very faint line, today it's negative. I think this round has failed. I'm so upset because It was our only chance. I suppose we will move forward and look into adoption. But not yet, probably in a few years. X

@thislittlebird I actually never got an AMH test, or if I did they never told me the results :/ so I'm not sure

For the lucozade and salt - again think it's more wives takes but lucozade helps replenish thirst quickly (the sport version) which is good for keeping liquids up (obviously water is too haha) and salt is meant to help

I had four that got to be frozen (and will be thawed tomorrow ahhh) but on the call I asked they didn't tell me the grades because I'm doing an FET and knew I would just over think all of it up until testing, so personally would rather not know the grades. Doctor said they wouldn't freeze anything that wasn't good anyway so that was a good sign :)

@willithappen oh, I wonder why they didn’t test your AMH? seems unusual.

I think that makes sense if it’ll make you anxious and that doc sounds sensible. I hope it’s all going ok!

@thislittlebird just wondering how you've got on since this post

Hey @MoonlightDreamer. Not a lot to report, sadly. I've been able to retrieve eggs (three collections, 10-15 eggs each time) and we've made good embryos, at face value. I've done regular IVF but with modified natural transfers. But nothing has stuck after six transfers, so I'm in a minority of a minority who IVF fails, it seems. We're still trying, transferring this month, but I'm fairly sure I'm not especially representative, might still consider low-dose IVF with create yet.

Are you just starting out with ivf? If your AMH is in good shape then that's a good start, and most people do have success.

Oh, and officially I've not had OHSS but I'm fairly sure I do get a touch of it after egg collection, I have breathing issues every time.

Hi @swirls3468 - I hope you are doing well. I hope you don't mind me asking but what dose were you on? I think I've been put on a low dose but just trying to gauge!! Thanks

@marshk I think originally I was put on 75 menopur and then it was increased to 150. Don't quote me on that.
I had one good embryo from the round and he's a gorgeous little boy who is now 20 months old.