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! 🙂

@Lebe14 Yeah! Are you aiming for a fresh transfer on Wednesday?

I know, on the one hand I wish we got daily updates but on the other... that just gives you more stress every day. I'm trying to put it in a box till Wednesday morning. And not succeeding, cos I'm posting all over mumsnet!

We can virtually hold each other's hands 🙂

Hahaha I am definitely not succeeding either!!

I'm doing a freeze all cycle (if we get any), so no transfer on Wednesday. Are you planning for a transfer on Wednesday? So exciting if you are.

We're not planning any transfers until about November / December, so it will be really hard in that if we do get an embryo, we'll have to now wait ages...... But the reason for starting early was that if we don't get any, we can do another cycle and we've not wasted time between now and November/December. X

@Lebe14 Yeah planning for transfer on Wednesday... but feeling a bit weird about that cos our first fresh transfer failed and then the frozen transfer after it worked. But maybe that's silly. I did a natural frozen transfer which my body seemed to like.

It'll be November before you know it! We did our first cycle last November and the time since has gone so fast.

Everything crossed for you. Xx

Ah how exciting @countrypunk!!!! Fingers and toes crossed tightly for you too xx

@Lebe14 if you don't mind me asking, what clinic/company are you with? I was considering a freeze all approach and then transfer at the end (if we got any of course to transfer)

@Sunflower360 I'm with LWC. I have to transfer any embryos before I can do another EC on my multi cycle package.

However - there are freeze all single packages which I looked at (the cost decreases on 2nd and 3rd go if needed but you pay for each transfer, whereas mine are included with the multi cycle package). As I'm likely to need multiple cycles I did all the calcs and went with the multi cycle one instead as ends up being more cost effective if we need 2 or more. Albeit I'll need to transfer before I can go onto another EC x

Also have you considered DHEA? I was on tbem and believe it increased the quality of my eggs.

After 2 cycles we have decided to use multi-cycle as we were given only few percent chance so thought we would need more cycles.

We were very fortunate that we've ended up pregnant after that 3rd cycle but 1st in the multi-cycle. Overall was more expensive but first of all more worthvit as it relaxed us a bit knowing we have just in case 2nd go...so for the piece of mind it was well worth it.
Due to my low AMH we were not allowed cycles where they give you money back.
As you can imagine we now say that was best spent money anyway.

Also remember it is not just your eggs...
My hubby wasn't having any hot baths, has been taking proxeed vitamins every day. Even didn't use protein powders for the gym in the last 5 years as our health care has mentioned it may have an affect on the sperm.

@Lebe14 @countrypunk How have you both got on with your embryos? Hope it is all good news

Thanks for asking @Sunflower360.

I got my day 5 update this morning and both are still at morula stage 😞 Embryologist will call again tomorrow on day 6 to see if they've reached blastocyst.....

So not really the news I wanted to hear but at least they're both still there and still a bit of hope. Been doing so much google searching to find out success rates of a morula at day 5 making blastocyst on day 6 - but loads of differing info..... just have to wait and see - nothing I can do!

Hope you've had better news @countrypunk x

@Sunflower360 Morning 🙂

I've got one blastocyst being transferred this afternoon, and two more early blastocysts that might be suitable for freezing tomorrow.

Bloody delighted to have something to transfer - was afraid we wouldn't!

Thinking of you too @Lebe14

Thanks @AlisonDanuta I was advised DHEA 25mg after our 1st cycle (without any testing for my levels), but understand Create are anti DHEA so I thought best not to for now.

If you don't mind me asking, what clinic company did you go with? And was it a fresh transfer that you did that worked?

Argh cross posted @Lebe14

I'm sorry you didn't get brilliant news, but all hope is definitely not lost. I've read stories of morula making it. I'm keeping everything crossed for you still. Xx

That is good news, @countrypunk ! So hopefully, you would have 3 embryos by the end of this cycle, that is really good. If you don't mind me asking what clinic company are you with? Good to get a view on different people's experiences

@Lebe14 Sorry to hear that, but perhaps it could still work out? I do not know much about that stage of the process, but if you are reading that it is still possible, then that is good

@Sunflower360 I'm with a small clinic in the south west that you wouldn't know unless you live here too. If you want more deets feel free to PM me 🙂

Really hope you're OK @Lebe14
Every round is different so even if you don't get to blastocyst this time, next time you absolutely could. It all seems so random. Xx

Oh and try an NMN supplement!

@Sunflower360 I was also asking about test before I used dhea but was advised testing is for people who are treating along term illness. At this point after 8 years of ttc I'd would take anything... so i believed that this must of also helped.

We've used Care for our treatment and found the transfer and EC much more professional than when we've used nhs.

Yes it was fresh transfer with 5 day blastocyst

So pleased for you @countrypunk - that's amazing news!! Hope it a went okay xx

@countrypunk hope transfer went ok and @Lebe14 hope you had some good news today about your embryos

@Sunflower360 Transfer went well thank you! Other two blastocysts made it to the freezer. Very happy today. Just got to think of some TWW distractions now...

That is good news @countrypunk fingers crossed! Can I ask, when you went through your stimulation/meds, where did you get the meds from? Just forward planning where would be best to get them from

@Sunflower360 I did actually ask my clinic if we were allowed to shop around for our meds, and they said no. They only work with one supplier because they said they trust their quality. That might have been total bullshit and they just have a very lucrative business relationship with them! I think the company that sent them was called Healthnet Homecare but the actual meds were by Ferring Pharmaceuticals.

I've read on these threads that Asda pharmacy is best because they sell IVF meds on a not for profit basis.

@Sunflower360 Meds totted up to 2.5k but I was on the highest dose of menopur, which I believe is one of the more expensive ones anyway. That includes fyremadel (stops ovulation) and 60 progesterone pessaries too.

@Sunflower360 I got mine from the Fertility Medication Centre. My clinic suggested I look around as they would be cheaper than through them. I was on highest dose of Bemfola plus Fyremadel and the trigger. Cost was around £2,300! X