Low AMH - Natural Modified or Mild IVF?

[Sunflower360]

Hi 👋 I was hoping for some advice. I am about to recommence IVF soon after a failed high stimulation short protocol.

My circumstances are:

• Age 37 (38 not too far off....)
• AMH 6
• AFC 4-6
• 1 x failed high stimulation IVF cycle (which led to 4 eggs, only 2 were mature, 1 failed to fertilise at all and the other abnormally fertilised with 3PN due to 2 sperm entering, so ICSI advised for next time)
• OH has lower morphology (but not worryingly low. Hence, IVF and no ICSI suggested the first time around), otherwise, all other parameters are good

Question is what have people's experiences been with natural modified and/or mild IVF?

I am reading a lot about natural modified being better for those with low AMH, if I only got 2 mature eggs in a high stimulation cycle, is it better to just go with natural modified? Would mild be that much different from the high stimulation cycle?

I am gauging with IVF consultants each have their own approach/ideas, so I would like to go into my next consultation with questions and to ensure we ourself make the best decision for us following the advice given.

Be good to hear different experiences. Natural modified is also a more cost-effective option, I am trying to gauge whether mild IVF would even be worth the extra cost in my circumstances. That cost difference could perhaps be used for more natural modified cycles and focus on quality with lower numbers (I would never get double digit eggs anyway)?

Shared experiences would be appreciated.

Thank you in advance! 🙂

I'm afraid I don't have any advice but definitely want to follow the thread.

I also have low AMH (4.4) and low count. Had my first EC yesterday and got 4 eggs, of which 2 have fertilised through ICSI. I too was on a high dose protocol - 450 Bemfola. Be really interesting to hear any success stories of low dose / natural IVF with low ovarian reserve!

X

I also have no advice but also want to follow! I'm in a similar position - AMH 3.6, did a high stims round on 450 menopur and got 6 eggs at egg collection yesterday.

I'm very interested in mild IVF but I can't find any actual science backing it up. Have either of you seen any research that supports it or otherwise? I think we will probably try it next time because I've read loads of anecdotal reports and we want to try something different.

@countrypunk 6 eggs is great - well done! X

@Lebe14 The weird thing is that on my first cycle I was on 225 ovaleap (so half the dose of this round) and got 10! That was 6 months ago. Got 2 blastocysts, first transfer failed and then miscarried the second.

It's so hard to know where to go next isn't it.

Sorry to hear about your first cycle and you miscarriage @countrypunk 😔

Interesting that you got more eggs with lower stims. There are just so many different factors aren't there. And I guess even if we did exactly the same each cycle the outcomes will always be different x

@countrypunk 6 eggs is really good as is 4 @Lebe14
Hopefully you will not need a further cycle if that all works out, after all it only takes one. Please do keep the thread updated on how you both get on and if natural modified or mild is needed at all.

Reading wise I found this study which was interesting and explained that a 3 cycle natural modified cycle can lead to success for those with low AMH.... www.ncbi.nlm.nih.gov/pmc/articles/PMC6822952/

I am gauging a slow and steady approach, can lead to better quality, albeit lower in numbers. Suppose the question is why spend more on stims if egg numbers will be the same regardless ...but then would egg numbers not be less with a lower stimulation?

Happy to keep this thread updated and if there is anyone out there with experiences of natural modified or mild IVF with low AMH please do share, be good to understand more.

Another article, more recent...

journals.sagepub.com/doi/full/10.1177/26334941211062026

I suppose lower doses protects the endometrial lining and aims to get better success that way, with the focus being on egg quality. It would definitely need multiple cycles 3 or more from my understanding

@Sunflower360 Thank you for sharing that study, it's very interesting.

As @Lebe14 says every round is different so there's no reason why this one shouldn't be successful. I just like to have a plan in place for the next steps. I started planning what we were gonna do next as soon as I knew the pregnancy wasn't developing as expected, and it really helped me.

Will definitely keep you posted. And both of you please!

Really interesting @Sunflower360 - it's so tricky isn't it. There are so many factors.

I'll be interested to hear what protocol my consultant suggests if this cycle isn't successful. She did say we were going to start 'aggressively' with high stims etc. But I'm not going to think about that for now - will wait and see what Wednesday brings x

Hi ladies, just to share a positive story!
3 ivfs icsi
1st 3 eggs (225 meriofert)- 2 fertilised but no embryos
2nd 6 eggs didn't produce any good embryos. (225 meriofert) 1 poor quality failed
3rd the highest dose 450 meriofert and 7 eggs - 1 very good quality embryo
Currently 17 weeks pregnant!!! And one frozen!

As they say you do only need 1!

Don't lose hope as when we started 5 years ago my amh was 8 and on the 3rd cycle it was only 1.8 !!!
Good luck

@AlisonDanuta that is really interesting, thank you for sharing and congratulations! Were they all short protocol and standard IVF (not Mild)?

@Lebe14 does your clinic do mild protocols should you decide that path or would you go elsewhere (if needed of course)?

Really interesting @AlisonDanuta and massive congrats!! Thanks so much for sharing. So high stims defo worked for you. I wonder whether it depends from person to person. It really is trial and error isn't it? And really interesting that the cycle which worked you had the lowest AMH. It's honestly such a minefield.

@Sunflower360 I'm actually not sure what my clinic will suggest, and if they even do natural IVF, if this round doesn't produce any embryos at day 5. I suppose it might depend on the reason. I'm on a multi cycle so will try again with the same clinic and see what they suggest. But really hoping we get 1 good embryo on Wednesday and I don't need to. But not being too positive as this is only the first cycle. X

That is good @Lebe14 well hopefully this round works out for you, please keep us updated!

Another positive story. Low amh -(2.8) did Ivf age 35. 2 eggs retrieved, 1 fertilised. Assumed it was pointless.

instead, 1 embryo and 1 bfp who is now 8!

it was the first and only time I did ivf, so it can work with low numbers. I didn’t believe it, but it did. Doctors had already written Us off before we’d started with the chat about “low chance of it working”.

i then got pregnant spontaneously 8 months after the ivf baby was born after trying for just 1 month. So clearly all is not lost either way.

Thanks for sharing @Ilikeviognier that is really positive to hear. When you did the IVF cycle what protocol was that?

Not mild. It was the standard protocol with high stims (450ml). It’s quite a while back so I can’t really remember.

Mine was all short protocols... we were told that this the matter of adjustment and best to keep the same protocol just tweak things. Apparently it is all practice as everyone is different so to see what works best for you!
Also we've had Zaymot to select the best sperm as morphology was lower.
Good luck

@Lebe14 @countrypunk hope you're both doing ok. Any news on how your embryos are doing? Hope their still developing well

@Sunflower360 Morning! 4 were still going yesterday but it was only day 2 so I'm massively trying not to get my hopes up. Last time we went from 8 on day 2 to 2 blastocysts on day 5.

I've read some interesting stuff about a supplement called NMN so I've been taking that in the hope it might improve my egg quality. We'll see!

That is good that have 4 though @countrypunk Hopefully they keep developing. What is NMN?

@Sunflower360 Read this study: www.ncbi.nlm.nih.gov/pmc/articles/PMC7063679/

It's helps increase the amount of NAD in our bodies, which is a naturally occurring substance which depletes as we get older. It's involved in all sorts of important cell functions. That study on mice saw much improved egg quality in older mice when they were supplemented with NMN.

I think they're doing human studies now.

That's great you've still got 4 out of 6!! I don't get an update on Day 2 😭 only the day after and then day 5. Wonder if the embryologist looks at them between now and them and if not going well, they will call earlier. Or do they literally just leave them and only check again on Day 5??? X

NMN sounds interesting... even just in general to help with ageing. I'd never heard of it....!

@countrypunk I've also just realised we're on exactly the same timeline with having our ECs on Friday! X