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! 🙂

That's great @countrypunk on your frosties!!

I got my day 6 update and both made blastocyst stage yay!!! Really wasn't expecting any to reach this stage, let alone both of them. They're the only 2 (out of 4) that fertilised so we had no further drop off. They aren't great quality - 3BC and 2BC however the embryologist said they're 'average' and clearly they're good enough to be frozen. They're going to leave them be for today to see if the 2 grows a little more and then freeze end of day. Even with the quality not being great, at least we have 2 chances!! X

Thanks @countrypunk @Lebe14 was that both on short protocols? Mild or natural modified IVF may be a bit less, suppose I'll find out soon enough though!

Short protocol 😊 and yes lower dose meds will be cheaper! X

@Sunflower360 but just to note that cost for me was only for stims for EC as I did a freeze all cycle x

@Sunflower360 Short protocol for me too this round! Got pretty different results from my first round. Not sure if that's because we did so many things differently or if it's just where my body was this month...

@Lebe14 Congratulations again 🥳 Bet you're over the moon. Xx

Thanks @countrypunk what was done differently if you don't mind me asking?

Thanks @Lebe14 with Create I understand it is frozen and then any embryos are transferred by picking the nest after the multi cycle package

@Sunflower360

First round:

Long protocol
Provera, Buserelin, 225 Ovaleap
10 eggs
2 blastocysts

Second round:

Short protocol
450 menopur, fyremadel
6 eggs
3 blastocysts

It's so hard to say if the change in protocol made a difference. I was happier on it - I found the buserelin really hard. Horrible mood swings. I did get pregnant from transfer 2 on round 1 but miscarried. TBA on this round! We didn't do PGT-A on either round.

Thanks for sharing @countrypunk I am really stuck on what IVF to go for...it will definitely be short protocol with Create but really on the fence between mild and natural modified. When it comes to the consultation the Consultant may just advise one way or the other but I would like to make an informed decision myself too...we only got 2 mature eggs, albeit the other 2 were immature, and that was with high stims so am questioning if mild would even be worth it

Congratulations @Lebe14 that is really positive! Will you get them tested?

@Sunflower360 I know, it's impossible to know how your body's going to respond.

I think if your high stims round failed, it's worth trying mild. I know a woman from another thread who had unsuccessful 'normal' IVF, then did Create's low stims 3 cycle package and now has several embryos in storage. IIRC on one of her normal rounds she got no eggs at all. I think she's 35. And I've read several similar stories.

Thank you both.

@Sunflower360 we haven't been recommended to get them tested but we have a follow up consultation now booked for 21st July, so will see what they say. I also managed to get the Timelapse video of both embryos growing - it's amazing! X

Just an update from me....had my AMH results... 4.3 pmol so they have dropped from 6 pmol about 6 months ago. So natural modified has been suggested for 3 cycles from end of August with them being back to back cycles. Thyroid and Prolactin was all good.

If anyone has any positive stories please share, I'm 37 going on 38... a bit nervous about that too as I know age can affect egg quality etc

Hello @Sunflower360

Don't be disheartened! My AMH is 3.6 and I'm 39. I'm nearly 6 weeks pregnant from my latest embryo transfer. Of course it's very very early days and without wanting to be negative I did miscarry my last pregnancy. So I'm trying to be cautious.

What I mean to say is there's no reason why you can't make blastocysts with a low AMH. You can! All it means is that you'll probably make fewer than someone with a high AMH because you'll have fewer eggs to begin with. But saying that I got 3 embryos from this latest round. I was delighted with that.

Stay hopeful, stay active, eat well (not restrictively!), take a good quality prenatal supplement and ask your clinic about other supplements - they usually recommend CoQ10. (Sorry, you probably know all of this already!)

You can absolutely get there! Good luck and let us know how you get on.

Thank you @countrypunk that is reassuring and congratulations on your BFP!

If you don't mind me asking, was AMH your main challenge? What type of IVF did you do/what were the outcomes of each cycle? It has been suggested for us to have natural modified with my AMH being under 5 pmol.

Thanks!

@countrypunk just remembered you mentioned all that in the thread!

Natural modified may not get as many eggs, 1 or 2 at the most....Create's approach is more quality over quantity, and having tried high stims, it just did not work out well for me, unfortunately.

@Sunflower360 It's actually all written out a few posts down!

My plan was always to try mild/natural modified if this round doesn't work out.

Oops name change fail there.

Yeah, I got 3 embryos but they might all be rubbish. Just trying to take it one day at a time and not think too far ahead, but also have a plan in mind if things don't work out.

Thanks @countrypunk Did you make any dietary changes at all? Supplements? I have made some changes with diet...getting as much healthy stuff, mediterranean diet, less refined carbs, more water etc etc and and standard supplements plus 600 mg Ubuiquinone

@Sunflower360 I'm not great on the diet 😬 I eat lots of veg but I also eat quite a lot of sugar and carbs. Not great. I do drink a disgusting green powder to try to counteract that slightly. And I'm not overweight - from what I've read that can really have an impact on chances of success. Also I had a few holidays in the 3 months leading up to the latest round and drank like a fish. Not ideal.

I took a supplement called FH PRO for women which is horribly expensive but contains lots of the stuff in It Starts With The Egg, including ubiquinol. I also took 1000mg vitamin C, magnesium, calcium and something called NMN which has been shown to improve egg quality in old mice! It's a substance our bodies make naturally but less of as we age.

Obviously no idea if any of it made a difference. It's nice to feel like you're doing something, even if you're not!

@Sunflower360

PS I'm not sure if you have a male partner but if so get him on the supplements too! Mine takes the Wild Nutrition supplement for blokes and vitamin C and ubiquinol. The pressure shouldn't all be on your shoulders 💜

Also - and sorry in advance about this - but men should have a masturbation schedule to ensure sperm is top quality. I think it's every 2 days but google it, I can't quite remember.

If only it was that easy for us eh

Thanks @countrypunk that is really helpful! My DH is also on supplements too and thanks for the other tip lol

@countrypunk how are you getting on? Hope all is going ok