IVF or investigations first?

[NavyTeal]

Hi all,

Regular poster but have NC as could be identifying.

We have been TTC unsuccessfully. At beginning of May we were seen at the local infertility clinic. They advised lap & dye due to a lifetime of severe period pain (suspected endometriosis), 6 months of clomid, then IVF. At that appt blood was taken for an AMH test.

A couple of weeks later I got a call to say my AMH had come back low for my age (4.2 and I’m age 30). They asked for it to be repeated and it came back as 5.9 the second time. The IVF criteria is a minimum of 5.4. They cancelled my lap & dye and wanted to see me in clinic.

I’ve been there today and it didn’t go too well. The consultant was dismissive about my AMH and couldn’t understand why I was worried about it now it’s within the IVF criteria.

He said I could either go straight for IVF, or still have some investigations done first. Either lap & dye or just the dye test.

Am so confused and very stressed. I don’t know whether to go ahead with the lap & dye in the hope that we may conceive naturally, or in the case that we don’t, to make sure everything is as good as it can be ready for IVF.

Or am I being short sighted not to just go straight to IVF? Would an IVF clinic want these investigations to have been done first?

Am also worried that the lap could further worsen my AMH levels.

Has anyone been in a similar situation or have words of advice please?

Thank you.

Hi @NavyTeal

So if you have suspected endometriosis I would go for the Laparoscopy. I am sure many others know a lot more about endometriosis that I do but my understanding is that patches of endometrium in the peritoneal cavity release cytokines, it inflamed everything, adhesions form, egg quality is poor as a result and the transport of an egg/embryo along the Fallopian tube can be affected.

If there are patches and they can ablate them then you will likely get better results from IVF, this is especially important if AMH is on the lower side, you want the eggs that are collected to be the best quality as possible.

I understand that you don't want to delay things because of your AMH result, there is an emphasis on getting things sorted as soon as possible with low AMH. But as far as AMH goes, there are many people that have had success with a lower AMH, so it
is likely you have some time to get this investigated.

Hi @NavyTeal

If you do find yourself with endo I think they usually refer you straight for IVF anyway?

It depends how you feel really :) how long you're prepared to wait, if you'd rather try naturally ect

Personally I went straight for IVF but we'd been trying a long time and I didn't want to wait or have any more potential Covid issues get in the way!

Thank you both for your replies. It does make sense that endometriosis can cause inflammation, and that can’t be good for conceiving.

The covid delay is a worry too - the consultant said if my level was rechecked and had gone down I’d be back to being ineligible for NHS treatment. But apparently the current result will be valid for 12 months, in theory enough time to do the investigations first and then IVF. The major hiccup to that would be if covid shuts down fertility services again.

It’s really difficult to decide. I thought the consultant would have a recommended plan rather than leaving the choice totally in my hands.