London IVF Recommendations - Low AMH

[Iwouldlikesomecake]

Hi all,

We were turned down for NHS funding just before Christmas and all we were told was my AMH is low (4.3 I think she said) and I should take Coenzyme Q10 and DHEA (no doses given) and maybe try the blood test again in 3 months. I called to chase up my results at work and got a nurse on the phone who told me that - and that's that apparently. It would have been nice to be able to speak to someone properly!

Anyway I have read that you can improve AMH and also that you absolutely can't. The doctor said my scan was good with lots of follicles. Husband has poor morphology and we are likely to need ICSI, but if I'm honest I don't know where to start.

Do I just pay £200 a pop to find a clinic by having initial consultations to find one we like and can afford? Some places publish costs and some don't... we can probably afford IVF but it all seems really overwhelming.

I'm 41 and don't have a lot of time to do it if we go for it, unfortunately.

Does anyone have any recommendations or where to even start?

I was with Lister. I also have low AMH (7) and we have severe male factor. I did consultations with Create, ARGC and Lister and I felt Lister were more about tailoring the treatment to my case history ( I’d already done 3 rounds with 2 different clinics at this time). So for example, they suggested adding in Letrozole on top of max dose of Stims to try improve response. They were open to do a low dose stim natural IVF if I didn’t feel like high stim was getting anywhere - similar to what create do and they recommended embryo banking. I felt ARGC and Create were more ‘we would do X protocol’ and it was the same as what I’d heard others say they do for different reasons. Lister also do IMSI which is a more magnified version of ICSI.

I’ve also heard CRGH are good. ARGC do get good results as they throw all meds at you but they are very very expensive.

Re the advice you were given above, it’s ridiculous. With low AMH and your age I would be trying to start IVF in 3 months time not just re doing a blood test and seeing how things are. The good thing is with a private clinic you can usually start quickly.

Re DHEA you need to get a testosterone test. It should be between 1.5-2. If it’s very low you could benefit from DHEA. Mine was 0.1 and I was on 75mg of DHEA (taking it 3 times a day) for 3 months initially to get my levels up. I was having monthly blood tests to make sure my levels didn’t go above the recommended 1.5-2 as this can have a negative impact on egg quality so it’s really important you monitor it.

I saw a fertility dietician who said myself and DH should take the following if you want to get started on vitamins now and obviously no caffeine, alcohol, smoking or drugs is a given.

Me:
Proceive women
NAC x2 daily
Biocare 500 vitamin c x2 daily (important dose and spacing for absorption)
Mor DHA (not EPA) x2 daily
WHC Uno Cardio & Vitamin D x1 daily
Melatonin x1 per day (to help with sleep which anecdotally can improve egg quality)
DHEA 75mg per day in 3 doses (monitored)

DH:
Proceive max men
Biocare 500 Vitamin x2 daily
WHC Uno Cardio & Vitamin D x1 daily
Mor DHA x2 daily
Ubiquinol 200 x1 daily

The Mor DHA and Uno Cardio are high dose omega 3 which is important.

Hello, I went with Create Fertility Wimbledon. They were very good.i now have a beautiful 6 month old DS.
Good luck hun

I'd also speak to Create - the price list is very transparent - just email them for a copy.

They also specialise in treating women with very low AMH that other clinics won't take on

Thanks. I'm a healthcare professional myself and literally the first thing I read when I looked at DHEA was 'don't just TAKE it, it needs monitoring' so I was like hmmmm don't think I will be taking that willy nilly!! I also know I'm pretty affected by hormones - so I am reluctant to try it when I am not really certain of its benefit. I am going to keep on with my high dose Vit D and start on ubiquinol, and put my DH on Impryl which is what we were recommended by the actual doctor.

I also was of the mind that we should be starting IVF in 3 months; I think the nurse was more thinking that if we can sort out the AMH to an acceptable level we would then qualify for a funded round which we currently don't. Which is a good point.

It seems astronomically expensive. You're putting a lot of trust in people who are taking a lot of money off you :/

I got the Create price list and I quite like the look of their website. Also they would be one of the closest.

In terms of raising your AMH level it is possible but it's rare and it isn't consistent and at 41 I'm going to say unlikely you'd be able to get it to the required level in time. Isn't the NHS cut off for funded IVF age 40? Most places are even 36 now. You've probably got a 2 year window until age 43 when chance of success with IVF really does plummet and then becomes no more likely than conceiving naturally. Sorry if that's harsh but I just want to brutally honest here that over 40 you've not got the time really

I did a 3 cycle package of natural modified IVF with ICSI and that cost £13k (significantly cheaper than the previous 2 rounds I did which cost over £20k) - I had twins from natural modified x

Our borough was nil funded then they opened it up to age limit 42. I have zero inclination to still be trying at 43 regardless of if we have been successful or not by then.

I am aware re the time factor hence asking for clinic recommendations. I should have been clearer, I am aware it’s shit advice to wait three months, hence why I want to start with ivf but we have already done initial tests so I don’t want to have to start at the beginning and pay £500 for tests we’ve already done but ‘initial consultations’ all seem to come at a ridiculous price. We know what the issues are. I just don’t know where to start with looking for a clinic that isn’t just making a lot of money off vulnerable people (like the Lister’s price list shows a COVID swab will be £85… it doesn’t cost £85 to do a COVID swab and there’s no need to charge that much).

I do also feel a bit shit with the inference that is I’ve left it too long. I married my husband in late 2019 then we started trying and then it was the pandemic. I’m frontline NHS and he’s forces, we’ve worked so hard. I’m sorry I am such a failure to have met and married my husband so late :( and then we couldn’t start anything, it took us months to even get referrals done through the GP, because of the pandemic. It’s been shit and it’s circumstance and not my fault :(

I'd not rule out Lister based just on the Covid test price. I assume other clinics will charge similar- it may be a turn-around time thing, Lister gives PCR in a few hours results and private same-day tests in London I've gotten PCR is far more expensive than £85. There's a tight time window to know test negative and going ahead with egg collection, and I don't think any clinics take lateral flow?

No one is inferring you left it too late. It’s just age is one of the most important factors determining whether ivf will be successful or not. So it’s relevant in that regard.

I don’t think a clinic that is affordable and doesn’t try make money off people exists! I’ve been with 3 clinics in 2 different countries and all were pretty much the same prices. It is completely extortionate. Prague is cheaper as it’s a cheaper country but then you’ve travel costs and uncertainty re covid and quarantine but it could be an option for you? Gennet & Reprofit are the two main ones there.

I think you need to sit down with your DH and come up with the absolute max you’re willing to spend on IVF and then accept you’re going to give those thousands of pounds to a clinic and that you may get nothing in return - or you might get a baby. Also be aware any add on the clinic might suggest is going to be minimum an extra £200 - same with some additional bloods - my clinic recommended some that were £500 for example. It doesn’t matter what it costs in the GP etc. unfortunately they charge what they like and we pay it out of desperation. That’s the reality of private IVF.

I’ve heard ABC are one of the cheaper clinics though? But it’ll still be thousands and I don’t know how good their reputation is. Someone else might have more info.

Also re initial consultation. If you have your tests done recently you shouldn’t have to redo them. You can email the info email for the clinic, say you have your test results and want to arrange a consultation then send on the results in advance. I think it cost around £150 for this at Lister and ARGC. Create were a lot more expensive as they insist you get some scan which I couldn’t do as I was in a different country but they charged me for it anyway.

No none is inferring you left it too late but there does need to be certain acceptance that age and fertility does matter and there is a time limit for us as women

It's entirely feasible since you've only been trying since 2020 really that you could still fall pregnant naturally but presumably you want to speed the process up by using IVF?

ABC are much cheaper but have very strict age criteria - you have to be under 37

Nearly all clinics will charge for Covid tests so don’t let you put that off. Virtually all will charge for an initial consultation. The costs don’t change hugely from clinic to clinic.

Your priority should be who can get you pregnant fastest rather than cost. You want a clinic who focuses on egg quality given age - this isn’t a criticism, this is just working with the reality of being 41.

CRGH and Evewell both have a strong focus on egg quality. The latter does a free mini consult before you get stuck into the merry go round and I know they will accept previous test results if fairly recent & presented to HFEA standard (ie lab name stated on the results sheet - this requirement won’t change clinic to clinic).

On morphology, my husband was banned from laptops on laps (bought him a tray for the sofa), hot baths and tight underwear. We also put him on Impryl and Proxeed Plus on advice of consultant. All helped a lot.

Many (most?) clinics should take initial tests from other clinics (allowing you to not pay for another AMH/baseline scan before treatment cycle), but there will be no getting around an initial consult fee I wouldn't think. It's a drop in the bucket to the overall cost I'm afraid. For example you don't do a package (like with Access), bloods monitoring is charged separately, so even just your consultants deciding you need one extra blood test is £150+. Or extending one extra day of stims, depending on your dosage, £100-£200. It's very hard to predict exact costs but just pointing out the consultation isn't going to end up being much against the total when its all said and done (unfortunately).

I'd not punish Lister for being transparent with their costs. As I understand it all clinics will charge for a Covid test, its just that some haven't put it on their pricelist. As I mentioned, private same day PCRs are a lot more than £85 in London, and sometimes hard to schedule. At least a clinic's test doesn't involve an extra visit some place or an added variable in a stressful time a day or two before egg collection.

Oh I know that’s what they charge you. But I also know it doesn’t COST them that. That’s what’s so shit. The markup is astronomical.

Also yes I want a baby but (and this will probably offend some people) not at any cost. You can’t really say ‘we won’t spend more than X’ till you know what ballpark you’re looking in though.

I think that I’m well aware of the effect of age given that I’m a midwife (!) and I’ve had people telling me for years that I’ve left it too late. But I didn’t want donor sperm ivf as a single woman so what could I do?

I am on my knees with work and knowing that I don’t have any time to wait to see how things pan out but it’s my moral duty to work in a pandemic and it’s possibly fucked any chance we have of having a family because first nothing was open and now I don’t have the headspace to get my head round the minefield that is working out where to go for treatment.

Sorry. A lot of the replies are really helpful. But I’ve been being told how I’ve left it too late, etc, for so long- and I literally work in an area where this is a huge part of my work so I’m well aware of that but what nobody realises is that nobody tells you what you are supposed to do to go down the assisted conception route- we just see people once they’ve been through all that and got pregnant. So yes I’ve some idea but not of how to access any of it. Or how to make good choices as the HFEA just say they’re all as good as each other if they are rated as ok by them.

Irony is that if I get pregnant I’m super well informed!

The mark up is crazy but you’re not going to be able to do anything about that. You said yourself you are short on headspace so forget about it. It costs what it costs. People have recommended good clinics here - Create, Lister, Evewell, CRGH. Maybe just pick one and go for it if you don’t want to pay for multiple consultations. Many women on these threads have had success at all of these clinics with low AMH.

I don’t think anyone would be offended by saying not at any cost. Most women here have either an emotional, physical or financial threshold for how much they can do. Roughly a round of IVF costs between 5-7k give or take - it’s impossible to get an exact cost as it’s dependent on your own case, response etc meaning there may be extra costs in the middle of the treatment so again not worth wasting your headspace on. Work out with your DH can you afford however many rounds based on the 7k figure so you have an idea of what flexibility you have for treatment.

There is also no point in worrying about your situation of meeting your DH late. I met my DH at 28 and I started TTC at 30 when I got married so completely normal age. I still had fertility problems.

I think you sound overwhelmed, exhausted and angry at the circumstances. Very common feelings when facing into IVF and realising a nice miracle isn’t coming your way. It’s important though especially with your age to just take the plunge and start treatment. I think you will feel better getting the ball rolling and hopefully it’ll all work out for you.

but what nobody realises is that nobody tells you what you are supposed to do to go down the assisted conception route

Trust me, everyone on this board knows this. We’ve all been thrown in the deep end after an infertility diagnosis. that’s why boards like this are so useful. I asked so many questions when I started and got loads of useful information. None of us want to be here but here we are all the same. I think try remember this is not a space where anyone judges. We’re all trying our best and trying to help each other.

People here only mention age in relation to chance of success which is statistics and nothing to do with saying you’ve left it too late.

There is a thread here on doing IVF at 40+ that might be worth getting involved in!

www.mumsnet.com/Talk/infertility/4327731-Anyone-doing-IVF-at-40-pt-2

Thank you xx you’re right. I have literally nobody to talk about this to in real life. Nobody apart from my totally clueless husband. I can’t tell family or friends. I’ve alluded to it to a couple of people. I’m helping look after a sick family member, dealing with pandemic etc and it all just is what it is- and it’s like someone saying ‘here’s the most stressful time of your life and you need to also now sort out IVF or you will lose your chance’ and part of me is ambivalent because I’m so tired. But if I don’t do it now we will lose our chance.

Thank you for all the suggestions. Also £5-7k is sort of what I was thinking would be acceptable, so hearing that’s a possible amount is reassuring that people have had it for that. I know people who’ve gone abroad but I am nervous about that. Although we would do it if we had to.

I will see who contacts me back after the weekend. Also I’ve put my husband on impryl he’s not one for tablets or supplements but I am asking him to do literally nothing else so…

That sounds so tough @Iwouldlikesomecake no wonder you are finding it difficult to focus on selecting a clinic with all the other stresses in your life. I totally get why you’re feeling ambivalent. It’s a lot to take in on top of the rest.

As I said above, all of those clinics are good and I know they’ve dealt with low AMH. Maybe focus on the decision of whether you want to go down mild or standard ivf and that will help your decision - if mild then Create, if standard then I’d personally pick either Lister or CRGH.

You will find plenty of support on these boards. Definitely get your DH to commit to taking his supplements and cutting out or right down in alcohol and caffeine.

I do think once you get in the system it’ll help you. There will be a certain amount of propelling you along I.e ring on this date to book a scan, come in for bloods on Y date etc and you just do what you’re told.

Wishing you the very best of luck!

Many of us don't have anyone to talk to about IVF in real life, so you've come to the right place!

I don't know anywhere in London you could do a round for 5k with all treatment and meds, other than by going with a package or ABC IVF (but have to be under 37 for ABC) But not aware of anywhere that you can pay as go and have it be that low? Does anyone want to chime in if they have recently done egg collection + transfer for less than 7k including meds?

My cost of first round collection-only for all treatment and meds was 7k (not including frozen semen/semen storage/semen shipping or PGTA). That was just to do one freeze-all, no transfers. The cost of one transfer was 2k. So 9k just to get through one collection and one transfer, which would have been a bit less if I did a fresh transfer rather than freeze-all, but not dramatically.

After failed first cycle (chemical pregnancy) I am going with Access Fertility package as can't afford any more out of package- wish had just gone with one in the first place as would have saved me thousands but I was overly optimistic I suppose!

@tulipsandsnow I was thinking more of the likes of a a 3 cycle package with create which if I remember correctly from having a consult with them is around 13-15k so works out around 5k per round.

I'm at concept fertility in sw London. The first cycle cost us £3,500, plus £1300 for meds - I was on a fairly high dose of stims and the cost for meds was towards the higher end of what they quote as estimated cost. I'm now doing a three cycle package with them for £7,800, (not including meds)

We didn't do ICSI which adds a lot more to the cost. From what I've read here they are on the cheaper side for London and in my experience pretty transparent with the costs - they are all on their website including info on what is and isn't included in the cost of a cycle. They ask for a negative PCR before egg collection and you can arrange it through them for a fee or arrange it yourself

They don't offer a lot of the extras that the other clinics mentioned here do, which keeps the costs down, but could arguably hurt chances of success. I haven't had success with them yet and am thinking of moving to one of the clinics mentioned here, who seem to offer a bit more of a tailored service, but at a price

@Iwouldlikesomecake, seen your post that I have similar question as you, looking for a clinic and don't know which one should choose. I am age over 43, and I tried Create 3 years ago, generally they are good, but every time when I went there, see a different doctor and they missed my egg date so IVF treatment with them didn't go further; Now I am thing to try IVF again and know they have another branch near where I live, not sure if I should go back to Create or try another clinic can have more tailor services with my age.

Hi, anyone here have experience with CRGH? and can recommend which doctor is better with patient?