Poor response to IVF age 39. Is there any hope?

[Annabel82]

Hi all,

Wondered if anyone had any experience of this? We had our first round of IVF a couple of months ago. We weren't successful. However, the embryologists were positive and said it had been a good round. Although we had a 4AA embryo, we only got three eggs. One developed slowly but was not good enough to freeze by day 6. The other didn't fertilize normally.

Having got a 4AA embryo, we felt relatively positive and assumed it could just be a case of keeping going (despite low egg numbers) until we found our golden egg. However, when we had our consultant review she seemed very disappointed with my poor response. She is willing to up my dosage to 450 meriofert for a second round but didn't seem very hopeful about our prognosis overall.

I'm feeling very defeated. Is it worth continuing? My AMH was 6 when tested over a year ago and my afc is 10 but according to a sonographer 'some of them aren't doing much.' I've had two miscarriages over last two years.

Any words of advice would be much appreciated,

TIA

Before you do another round I would have your testosterone checked. If it’s low this could impact on your response - it can take 3 months for it to increase to a normal level via DHEA. I would agree to go up to 450 of meriofert and I would also ask about adding letrozole in for the first five days to stimulate response.

overall though I would probably consider moving to a different consultant as yours sounds so defeatist after only one round! First round is often a trial run.

also consider a high protein low carb diet, cut right down on/cut out sugar and no snacking during Stims.

@Dochas12111 ill look into the testosterone and other bits- thanks. Yep, I was really surprised by her response. She made it sound like 450 was a really unusual dose as well .. I’m aware it’s high but don’t think it’s unheard of !?!

Well it’s generally that max they will go but I was on that dose and a good few others I know too so I don’t think it’s that unusual!

I got much better results using Pergoveris and Gonal F than I did from Meriofert. Plus growth hormone and steroids. Your Dr sounds quite defeatist, round 1 is basically a test run!

@Dochas12111 @Phrenologistsfinger
That makes a feel a bit better! Maybe a change of drugs would be good too. She’s made me feel that IVF at my age is pretty much hopeless. I feel that even with 3 eggs it’s worth keeping going since we got a good embryo. Who knows!?!

Wishing you both good luck x

I'm in a similar position to you except my clinic and consultant say it's too early to give up on using my own eggs. I'm about to do my 5th egg collection and here are my results so far, aged 38, AMH 6.

Cycle 1 - NHS, short cycle, 300iu Meriofert, 9 eggs, 5 mature, 1 blast 3BB, BFN.
Cycle 2 - Private clinic, long cycle, 350iu Overleap, 4 eggs, 0 mature, 0 blasts. We decided long cycles were not for me, reverted back to short.
Cycle 3 - Same private clinic, short cycle, 375iu Meriofert and upped to 450iu Meriofert on day 8; 6 eggs, 4 mature, 2 blasts, one 2AB transfer BFN, 1 5AB hatching blast in the freezer. Best cycle.

Opted to do 3 embryo banking collections given low AMH and age.

Cycle 4 - short cycle, 450iu Meriofert, 4 eggs collected, 0 blasts. Conclusion with the consultant was that the high dose of Meriofert although sparked my follicles on my day 5 scan it impacted quality. I was on track for 6-8 eggs to be collected based on follicular graph but only 4 collected and poor quality, only 1 8 cell embryo at day 3.

Cycle 5 - short cycle, 375iu Meriofert upped to 450 iu for the last 3 days. Collection Friday. Based on follicular graph I'm hopefully of 3-5 eggs being collected.

The key thing I've learned is to not expect lots of eggs or follicles with a low AMH. I want to see three large (over 15mm) on my final scan to feel like I'm in with a chance. I aim for 3-5 eggs to get collected and hope for 1 blast per cycle. This helps with my motivation as I'm not being unrealistic.

I was interested to see recommendations for Pergoveris and Gonal F as if this cycle ends in 0 blasts I'm going to be asking to swtich meds as my body is getting too used to Meriofert.

I wish you all the best on your journey and you getting your golden egg.

I'm not giving up yet - I don't think you should either if you can emotionally and financially keep going!

I was with the NHS so never got the details of my medication (or I can't remember) but wanted to comment. I hope this gives you hope rather than feeling like it's everyone but you.

My first round I also only got three eggs that fertilised, but by day 3 only one remained (I didn't get a grade) so that was transferred then. This didn't work.

For my second round they increased the dose a bit - sorry I can't remember specifics - and I responded a bit better so more eggs were collected. Four made it to day 5, though not as blastocysts yet, so two were transferred (I was 39, we were given the choice of single or double transfer though with the risks of double transfer emphasised), one didn't make it to blastocyst, and one did by day 6 so was frozen. From the transfer one worked and I've now got a 7 month old daughter.

So in our case we still had success with few eggs (we had to go IVF because of issues with sperm originally, but after covid delays my age obviously become a larger factor). I wish you all luck in the future, it's such a hard experience.

After just one round, it’s definitely too early to give up hope and I’d echo the previous advice about considering changing consultant or clinic. 450iu is not out of the ordinary. I’ve had 4 cycles and been on 450iu for all or part of 3 of them. I’ve never had more than 4 mature eggs or one embryo per cycle but I will be going again. I don’t blindly believe it will happen for me, I’m aware that my chances are limited but while there is a chance and I’m physically, mentally and financially able to do it again then I will because I’d hate to look back in years to come and feel I gave up too easily.

@4F99S1 glad to hear others are on a dose of 450. Do you mind me asking how old you are? My consultant has made me feel old for the first time in my life!!!

@MollyVanDer fingers crossed for your egg collection x

@OM82 thanks so much for your message - has given me hope x

I’m 36 but with low AMH so my consultant very delicately told me that my ovaries are older than the rest of me!

@4F99S1 I’ve heard of lots of people of your age having success. Fingers crossed x

I was the opposite to @Phrenologistsfinger I did better on all meriofert so it shows you should switch up the meds too @Annabel82

My history (can’t remember exact number of eggs but below is fairly close):
1st round: 150 gonal f , 7 eggs, no blasts
2nd round: 225 gonal f, 100 meriofert, 4 eggs, no blasts
found out testosterone was v low, took a break to take DHEA, strict fertility diet plus sorting sperm issues on DH side
3rd round: 450 menopur, 2 eggs, 2 AA blasts, 1 frozen , 1 BFN
4th round: 450 menopur plus letrozole, 13 eggs, 3 blasts all AA - sent for PGS testing. 1 abnormal, 1 inconclusive, 1 no DNA detected. None normal.
5th round: 450 menopur plus letrozole, cancelled day of trigger due to poor response
6th round: 450 menopur plus letrozole, 11 eggs, 1 BB blast - currently 37 weeks pregnant and did NIPT testing at 10 weeks and all came back fine.

@Dochas12111 thanks so much for your post .. so encouraging! Do you mind me asking how old you are? X

@Dochas12111 definitely worth looking into testosterone then x

@Dochas12111 and I’m so sorry I didn’t say massive congratulations on your pregnancy. Such wonderful news xxxx

@Annabel82 I’m 36. And yes definitely look at testosterone. It’s a simple blood test so morning to lose by looking. Our consultants were broaching donor eggs without even checking if it was off and once fixed we started making blasts despite still having poor numbers. My testosterone was 0.1 and it should be 1.5-2. My DH does have sperm issues though so if your embryos were dropping off after day 3 it’s also worth having him investigated properly via a urologist. It’s unfortunately possible to be a poor responder and have male issues too hence how we needed so many rounds. Everyone has their own limits for how much they can do but I definitely wouldn’t stop after one round. Like I said in my initial post if you’re not happy with your consultant get a new one. I was with 3 different clinics in the end in two different countries.

For info, I was the same age as you when I started a short protocol on Gonal F 200 with 10 follicles at baseline. Only 5 of these follicles responded despite increasing the dose to 250. I was advised to cancel the cycle and start over as it felt this was a poor response and could be greatly improved.

We then tried a long protocol with Menopur 375. From this I somehow amazingly got 19 eggs, 14 of which were mature and 10 of which fertilised, resulting in 5 high quality blastocysts. All the staff commented on what a great cycle it was and what a good thing we’d cancelled the last one (until the embryos all tested aneuploid but that’s another story).

Hopefully that makes you feel a bit more optimistic that another round could see big improvements if it’s a case of follicles being there but not responding. As others on this thread have said, I would expect your team to be looking at a change of drug and protocol at this point rather than just increasing dosage. Perhaps look elsewhere for a second opinion if that’s an option?

@TwinkleInMyEye123 thanks- yep, with follicles being there I’m hopeful for a better response next time. I raised the issue of cancelling cycle when I only had three follicles but was told nothing more could be expected at my age and amh of 6. We’ve been given a lot of conflicting messages. I’m going to see how next round goes and then maybe think about moving to another clinic

How are you getting on now? Wishing you all the best of luck x

@Annabel82 have you considered natural modified IVF? I started with regular IVF using 450 menopur and my response was similar to yours. I switched to natural modified and was put on 150 bemfola and actually responded much better

@MabelG I have thought about that too. Do you mind me asking how old you are and how you responded to the natural modified ivf? Feel free to tell me to mind my own business!

@Annabel82 yes I'm also late 30s and went from having 3 follicles with normal IVF to 7 with natural modified . I was shocked given the difference in doses (it is slightly different in that they start you on stims later than with normal IVF). My original consultant was also not optimistic but I sought a second opinion, went with natural modified and am very lucky because it worked.

@MabelG Thats great news. Massive congratulations! I’ve thought of looking into Create. We’re currently with Care x

Care London?