Low AMH and IVF

[Naomi270]

Hi everyone,

I’m 37 and after having a fertility check recently have an AMH of 3.5, which is very low for my age. I’ve been advised to start IVF straight away. We’ve been trying to have a baby for a year and no success yet.

We’re based in East London and are currently trying to find a suitable clinic. Unfortunately as I need to start straight away I don’t think NHS will be possible.

Does anyone have any clinic recommendations for London? Currently we’re looking at the following but reviews and success rates seem to be very mixed. Any advise would be super helpful. It’s all a bit overwhelming at the moment!

• London Womens Clinic
• ARGC
• Harley Street Fertility Clinic

Ive been told I’m likely to need up to 3 cycles and only have a 20% chance of conceiving. We’re looking for a place with transparent costs, good customer care (I’ve heard ARGC isn’t great with that) and good success rates.

Thanks!

Naomi

Hi Naomi,

I don’t have any experience with those clinics - I am with the lister. 1 failed round at Guys (NHS, but wouldn’t go private with them) and 1 successful round with the lister. Am currently back at the lister trying to conceive a second child. Overall they seem to have good results and specialise in low ovarian reserve but I have found some consultants better than others and horribly long waiting times when you go for an appointment (often spend 2 hours there for a 15 min appointment!!)

my experience is limited but I would say the key things to be looking for in a clinic are a) a good embryology lab (the embryologists make all the difference esp if choosing sperm for icsi etc) and b) somewhere that does good monitoring during the cycle (I’ve found this round with the lister to be frustrating for this - they do monitor closely but despite that I triggered late and lost the biggest follicle).

In terms of costs transparency, most clinics will say how much ivf/icsi is - but the ‘add ons’ all add up - medication - which would be pretty much the same cost anywhere - and then often blood tests charged additionally. At the lister you have to have a blood test at every appointment and this round i spent an extra £1k on blood tests which I’m not sure actually told us anything valuable about the cycle at all.

Finally, I also have low ovarian reserve (we also have male factor infertility) and found that amh tells you how high the drug dose needs to be, but how many eggs you get is more dictated by follicle count than amh. Obviously the more follicles, the more eggs.

i wish you all the best with your ivf - it’s a shit journey and I’m sorry you have to go through it, but low amh doesn’t affect the quality of your eggs and you have every chance xxx

Thank you so much for your reply - really appreciate it. Really useful to hear about your experiences and that’s great that you’ve had a baby! I’ll have a look into the Lister as could be a good option for us. I’m going to have a chat with my GP tomorrow as well to see what options there are through the NHS. That’s really useful to know that AMH doesn’t correspond to egg quality - that’s what I’ve been worried about.

Fingers crossed I can start my first cycle soon 😊 xxx

@Naomi270 hi there! I am 34 (almost 35) with a low AMH (I think 2.1 when last tested) with an average follicle count of around 4-6. Have been TTC coming up for 3 years.

We did 2 NHS cycles in Scotland earlier this year, where I was on maximum stimulation drugs with rubbish results. 1 egg first cycle which fertilised but didn't make it to transfer and then no eggs at all second cycle.

We have since went private with Create Fertility in Manchester. We are doing a 3 cycle package with ICSI. They specialise in mild and natural IVF. With mild it's not as high dose medication where they are aiming for quality over quantity. There is lots of info on their website and they have a few clinics in and around London. I was on a much lower dose of medication, monitored very closely and had 4 eggs retrieved, a day 3 embryo frozen and a further 2 frozen on day 5. We are absolutely thrilled to have had these results. We go back down in January for our second cycle and have asked to do a transfer after cycle 2 rather than do the 3 than a transfer. All the communication with the clinic and my patient coordinator has been brilliant. We had our first appointment in October, followed by a Dr consultation and then started the very next month.

My experience with them so far has been great and I am so glad we have went and tried again with my own eggs after NHS telling us it had to be donor. Any questions just ask! Xx

@HJen22
thanks so much for your message! This really gives me hope 😊 I’m so pleased for you that you’ve had good results on your cycle with Create! We’ve been looking into them as well and joined an open evening with them to learn more. The reviews online for the London Create clinics were very mixed, some good reviews and then some really bad ones and so we’d been a bit put off, but I think it probably varies a bit from clinic to clinic. That’s great that you’ve had a really positive experience with them. We’ll have another look into them as we have a clinic close to us and the costs seem quite transparent.

I was concerned that taking fewer drugs may lead to a lower success rate but it seems to have worked better for you and great to not have to take so many drugs. Also great to hear that they do really regular monitoring.

I hope your second cycle goes really well with them! I’ll probably have some questions when I look into them a bit further so will message you if I do if that’s ok 😊 xx

Hello 👋 Did they check your AFC as well as your AMH? This is often a better indicator of ovarian reserve. I was diagnosed with a low AMH and AFC in 2020 age 31 (AMH 6 and AFC 6). We had a private round of IVF with Kings Fertility and we're lucky to conceive first transfer. We didn't have any other embryos though so will be looking to start again next year to try for a sibling. We will go back to Kings without hesitation - they were great, are very reasonably priced and put profit back into fertility research.

@MGee123
Thanks a lot for your message. They counted 4 follicles in each ovary (I presume that’s the AFC?). I understand that that’s quite a low count unfortunately. Thanks for the Kings Fertility recommendation - we’ll definitely look into this as well! Amazing that they put the profit back into research 😊

@Naomi270 you're very welcome ❤️ I know how overwhelming it can be trying to research and find a clinic. It's a big and expensive decision!

Yeah sometimes reading reviews be a good and a bad thing. I tried to not read too many and go into the consultation with an open mind, and see how we felt afterwards. I may have been very lucky with the patient coordinator I have, but I can't fault her so far. They are helpful explaining costs, payment options etc. And they do quite a few different protocols depending on your case. It feels much less of a "one size fits all" and I really felt like an important patient and not just a number.

I think because I'd been on maximum dose, we just thought let's try something completely different to really be able to say we have tried everything. Compared to my NHS cycles (which to be fair I can't fault as the staff were all lovely but of course they are more restricted than private) I had the first scan on day 5 rather than day 9, and then had scans day 8,9 and 10 with bloods taken each time too to check hormone levels. They also don't require you to have a minimum number of follicles to get to egg collection. So that took a bit of the stress out of it as my second cycle I didn't have 3 follicles the correct size when I was expected to, stimmed longer then somehow came out from collection heartbroken with no eggs.

Thank you so much ☺️ at a normal time of year we'd likely have went straight into the next cycle but what with Christmas we decided to just do the one and then wait until January for the next. Of course, please do ask any questions I am more than happy to help ❤️ xxx

AFC is your total number of follicles, so yours would be 8. A good example of where my AMH was higher than yours but your AFC is better! Yours is a bit on the low side for your age, but not significantly. Also worth noting AFC varies a bit month to month and as pp said, AMH and AFC are not indicative of egg quality.

Were your tests done on the NHS? It might be worth exploring that route as the wait might not be as long as you think. At 37 it probably is worth getting on with things fairly quickly, but waiting a few months for NHS treatment is unlikely to affect your outcome. I am slightly surprised by what you were told - saying you need to start straight away and that you will need multiple rounds sounds a bit like a heavy sales pitch if it was a private clinic telling you this?! Definitely worth having a bit of a think before you make a decision about what to do.

@MGee123 Thanks, that’s really useful. I have a call with my GP today so will definitely look into NHS options. I did panic a bit as it sounded from the private clinic like I needed to kick off treatment this side of Christmas but you’re right, much better to think things through properly and then get started. Fingers crossed the wait with the NHS isn’t too long and we can go down that route 😊

Yes for sure don't feel pressured into anything, that isn't how it should be. I had the option for 1 or 3 cycles and they didn't push the 3 as they of course don't know patients financial situation. They also didn't push me to do my next cycle right away. We were limited to our choice being in Scotland and therefore had to go further afield but it sounds like you have many options down London area. I got a spreadsheet and put in all the info from the 2 clinics I looked at to compare. It's such a hard and big decision and definitely speak to your GP and local NHS clinic to find out waiting times before you do go private too xx

Hey- I also have low AMH/AFC and have gone to Kings. I recommend looking into them if they are easy enough for you to get to. I started with them when I was just turning 36. I had 1 round on the NHS with them and the fresh transfer did not work. I then went straight into a package with them privately as I liked them. They offer a 3 cycle package which takes a bit of the stress off as you know you have 3 rounds to get the best embryos you can. Seemed to be reasonably priced (not cheap but less than some other clinics).
I have low AMH and an AFC of 2 on my first scan which is pretty dire. I only got 1 egg fertilised on my second round with them and put it back in on day 3. Expectations were low but it worked and I have a 1 year old son. In Jan I am going back for a FET with an embryo from my first round with them. If that doesn't work I will be starting another fresh round. I am 38 next week.

The last thing I want to do is put any pressure on you (I know how stressful the whole process can be with low AMH) but I recommend looking into the NHS wait time if you can. If it is going to be long and money isn't a big issue then I would recommend paying to go private. Age is the most important factor when it comes to egg quality. 37 is a decent age in the world of IVF but I would definitely recommend starting early 2023 if you can. If you want more than one child I would also recommend looking into a 3 cycle package to bank some embryos if possible as if the first round works and you do have a child it will be a couple of years before you can do another fresh round (depending on when you give birth and if you breastfeed etc). I hope that isn't too overwhelming.

I wouldn't worry too much about your 20% odds of success. I never asked for any percentages as I knew it would not help my mental state but I am sure if I was given a number it would be very low considering I have barely any follicles on my scans. And I had success on my second round with what was called an average quality embryo.

I'd also advise you to be wary of clinic success rates. Sometimes they are not comparing like for like. Some clinics also have lower rates as they accept people with lower chances of success. I have heard that some clinics won't take patients with very low AMH as it affects their success rates.

Sorry for waffling on. Sending you all the luck! x

Hi - I had AFC 8 and AMH 6 I'm 36.
I Had been trying for 4 years.
One failed round with the NHS which resulted in one follicle that didn't contain an egg.

We then decided to go private and researched clinics for low amh and went with Create fertility St Paul's.
I had a really positive experience compared to my NHS round.

I had 3 egg collections before my transfer and results below:
1st EC - 6 eggs collected with 1 day 3 and 1 day 5 frozen
2nd EC - 4 eggs collected 1 day 3 frozen
3rd EC - 2 eggs collected 1 day 3 transfered fresh and 1 day 5 frozen
Consistently my egg collections produced fewer eggs. But I am now 20 weeks pregnant.
That was my first ever transfer and still can't believe it worked after all those years. Especially as create gave me 10% chance of success!
One thing i will say is the location of the clinic was a plus as it wss close to work and eliminated stress when going to appointments as there are a lot of them.

Wishing you lots of luck xxxx

Hi op, I remember the absolute minefield of choosing a clinic. I got so stressed , I drew comparison tables and read for hours.
i had terrible amh 2 I think and 4 follicles total! At 40 I conceived a baby and got Frosties as well.
I cycled with Argc, they are expensive and intense but I feel they got the best results for me.
I also thought crgh looked good but never cycled with them in the end as was successful with Argc.
I did consider create but found them very sales like and my consultant said with low amh it’s a numbers game so push for as many eggs as you can get not the soft approach. Who knows? It seems to work for lots of women though
Good luck!

Also you can look up clinics on here to compare www.hfea.gov.uk/choose-a-clinic/clinic-search/

Thank you everyone for all of your responses. It’s been really reassuring to know that there are lots of other people who have had similar AMH levels and had success with ivf. I spoke with my GP yesterday and need to have more blood tests before she’ll refer me. My private fertility check results don’t seem to be enough. I spoke with Homerton, which is my local NHS clinic and if I go via the NHS the earliest I would start is March 2024!! I was expecting a wait time but not quite this long. It looks like private may be my only option as there’s no way I want to wait another year and a bit with low egg reserve.

@Jane1284 thanks for your recommendation of Kings. I’ll have a look into that and add it to my list of potentials. Also very useful re. the success rates. Some clinics I’ve looked into will only take people with a good egg reserve and now I know why!

@Scarlett868 thanks very much as well - will keep looking into create. Great that you’ve had a good experience there. I think you’re right - I’ll need to find somewhere close to go to to make things a bit easier with loads of appointments

@Rumpelstiltskinsmum thanks also very much for your recommendation of ARGC. Also on my list of potentials - I’ll have another look at pricing!

It’s hard as the initial consultations seem to cost over £200 so you basically need to have decided on the clinic before the consultation but all of this advice has really helped and us really appreciated so that you everyone! I will look to get a consultation booked in and hopefully start in January 😊

xxx

@Naomi270 I had my NHS round at Homerton and it was horrific.
They shut the clinic down in April when i was due to have my 2nd round so we had to go private. The whole thing was an awful experience. So do go private if you can!
Funny enough I am with Homerton for my antenatal care and they have been amazing at that.
Really hope it all works out for you! Lots of luck xxxx

Hi everyone, I’ve been reading this thread with interest as I’ve also got low AMH and have decided to start IVF in the new year. Im 35 and have a 2.5 year old who was conceived naturally after 2 years and varicocele repair surgery for my hubby. Had 2 miscarriages this year and some private investigations showed up my low AMH. Probably a silly question, and shows my lack of knowledge in general re IVF, but why do some people choose to do multiple cycles in a row before transfers? Is it to bank and freeze more embryos? Because of age etc? Thanks in advance!😊

Hi - yes the advice is to bank embryos as you produce so few eggs in relation to someone with a higher ovarian reserve and AMH. :) xxx

Thanks @Scarlett868 that makes sense! Xx

@RCP87 so sorry to hear about your miscarriages. Are you having any investigations into this? It doesn't sound like your AMH is the issue, even if it is low? AMH is one measure of ovarian reserve and if low means you usually struggle to get pregnant. It is not a reflection of egg quality. It seems you can get pregnant, so the AMH could be a red herring regarding the difficulties you're having? Just a thought.

Hi @MGee123 thanks for your message. We had some private investigations after the second miscarriage which found that my AMH was low and some of hubbys results suboptimal. The Prof thought that my low AMH was the likely cause of the miscarriages and he explained that with a lower ovarian reserve often the eggs are a worse quality. He said that IVF/ ICSI with genetic testing could try to prevent another MC. We tried for a few more cycles without luck so that’s why we’re planning to start treatment in the new year. Part of me is wondering whether we’re jumping the gun given that we have been able to conceive this year, but I’m also worried about my low supply now. I’m also quite unsure about the genetic testing; I know it’s rated red on the HFEA website and I worry that if we don’t get many embryos one that could work may be discarded because the testing isn’t completely accurate. I’m speaking to an embryologist about it this afternoon so it’ll be interesting to see what they say.

good luck to everyone else! Let’s hope 2023 will be a good year!

Hi, I am with CRGH I saw another poster mention them. I was in East London and initially referred to Barts...I did not enjoy it. I had my initial tests woth them and the delivered what was the worst news of my life in the worst possible way telling me it would be impossible with low AMH, high FSH, 1 inaccessible ovary and 3 folicles only in that inaccessible ovary. They only gave me options of egg donation or adoption...then they called 1 week later and said they would give me 1 cycle. That cycle resulted in 1 folicle but a premature ovulation. It then took the 3 months...3 months to call me back after a failed IUI. In this 3 months (I was calling and emailing every day!) I decided to go private. Other have had good experiences with Barts there is a thread on it but for me I couldn't leave something so important with them based on my experience.

We looked at ARGC, CRGH and Create, it was the success rates for my age group that got us to CRGH, I was 39 at the time.

In the year I have been with them batching I have had 8 cycles start and 3 got to egg collection, 4 blasts and am now on transfer stage.

Someone on a forum mentioned Care as they offer duostim whcih I hadn't heard about before, but it's 2 collections in 1 cycle targeted at low ovarian reserve patients. If I was still swimming would absolutely look into this further.

Hope that helps 😊

@Naomi270 hiya just seen you mentioned the cost of the initial consults. I know it's a cost but it's worth it for making sure you are happy before you spend the thousands. We had tests and consultations at 3 clinics before we chose. The way they delivered my results and what they proposed as a treatment plan...and the way they proposed it was the deciding factor. One clinic I won't name refused flat out to do normal IVF they wanted me to do ICSI even though there was no known issues with partners sperms and we had never had IVF cycle to know if this was an issue. That was a problem for me as I didn't feel listened to, so that discounted them.

It's important you are happy with the clinic because once you start you won't want to be looking at moving. But if it just isn't right absolutely move clinic x

@SPR40 thanks very much for your post. That’s really useful - we’re still compiling a list of clinics to work out which one to go for but you’re right, we’ll definitely go for more than one consultation if a clinic doesn’t feel right x

Hi everyone, I’ve been researching Create more and looking into the natural ivf and natural modified ivf. It seems that for the modified ivf you only take a small amount of medication for 5-7 days. With the natural ivf you don’t take any medication. It says that both are really good for low amh / low egg reserve. It’s so completely different from the advice from most other clinics where I’ve read you’re taking drugs for most of your cycle to give you the best chance. It almost seems too good to be true. Does anyone know much about modified ivf? It’s hard to know whether to go for something like this which is cheaper but unsure if it will have the same results.

Thanks,

Naomi