High stims due to low AMH - success stories?

[Eventide85]

Hi everyone. My husband and I are due to start our second round of IVF in October. Our first round earlier this year led to a MMC at 9 weeks and a BFN. We have MFI so are having ICSI but I also have low AMH (8). I am 38. For our last cycle I was on a dose of 300 stims but our consultant wants to put me on the highest stimulation dose of 450 this time. I am worried high stims might reduce egg quality - I think I've read that somewhere - but when I mentioned that to our consultant he said it's a myth. There seems to be so much on mumsnet about mild or natural IVF, I feel like hardly anyone has traditional IVF with high stims and gets good outcomes! That might just be my perception, though! Has anyone had a successful pregnancy from a high stims cycle? Or a successful outcome in terms of embryo quality? Hopefully I'm wrong to be concerned and just over-thinking things...as usual!

High stims can go up to 600IU, I'm with ARGC and they prescribe up to that dose. I have low AMH 1.2 and they've suggested they'll probably put me on the max dose.

From my experience low stimulation results in worse quality eggs. My first cycle I had 300IU, retrieved 5 mature eggs, 3 fertilised and ended up with one poor quality embryo, then BFN. Second cycle I had 225IU, retrieved 3 mature eggs and all 3 got necrosis soon after ICSI.

Also my friend had a similar experience, 150IU resulted in poor quality eggs, 300IU gave her 8 high quality blasts and she's now pregnant with twins.

So I agree with the clinic, you need a higher dose to get better quality eggs.

It's a tricky balance of quality vs quantity. The mild/natural approach is usually adopted for older people undergoing IVF as egg quality is generally likely to be poorer. But it is also a numbers game in that of x number of eggs a high number won't make viable embryos regardless of what you do. I would follow your clinics advice. I had high doses of stims due to low AMH and have a daughter as a result (only viable embryo). We have subsequently had a further fresh and FET for a sibling which both failed but I'm not convinced that's anything to do with the protocol - just bad luck. Robert Winston's essential fertility guide is excellent for dispelling the many many myths that get good press on mumsnet!

Hi @Eventide85 sorry to hear about your MMC and BFN.

I had a mix of 375 and 450IU for my second round, and it gave us our son and 2 frosties from 6 eggs (AMH approx 5). Our first round I was on 300IU we had got more eggs, but we had only 1 viable embryo on Day 5, which was only an early blast.

So, although I think our issue was more to do with sperm quality than egg quality the first time round (only from what I read, as we're unexplained), the higher dose definitely didn't negatively impact the quality! It;s hard to know what's best but, as the PPs have said, I would go with what the clinic recommends.

Thank you so much @ButterscotchBabe @SErunner and @beachbum85 for your super helpful replies. Your stories of high stims leading to good outcomes (number / quality of embryos and even children - congratulations!) are very reassuring. @SErunner you make a good point about some myths getting good press on mumsnet - I'll be sure to look up Professor Robert Winston! But yes to the balance between quality and quantity when planning a protocol...
You're all absolutely right about trusting my clinic, though.

If you're still reading this then - on the subject of trying to get high quality eggs - do you believe diet / nutrition makes a difference? I'm a healthy eater anyway but should I really push myself to very high protein, low carb, no refined sugar, masses of fruit and veg etc? Do you believe this makes a difference? Regardless of stims dosage, I think I'm unlikely to get more than one or two embryos so I'll do anything I can to try and make sure the quality is as good as possible! I'd appreciate any views / anecdotes you've got about diet on the run up to and during IVF cycles.
Thank you all very much!

Not really, beyond generally eating a well balanced diet and having a bmi in normal range. Even giving up caffeine/alcohol, which are adopted by a large number of people having fertility treatment, are not well evidenced. I personally choose not to drink alcohol or caffeine except for rare occasions. I do eat dark chocolate regularly though which contains some caffeine. I eat a well balanced, low processed diet but don't deprive myself of treats. I keep my weight stable and exercise regularly.

Again, with supplements, most of the things people state help are not backed up by scientific study. 'It starts with the egg' gets a lot of press but it's been well picked apart by leading fertility experts and I wouldn't waste your money on either the book or the extortionate supplement regime it recommends! Prof Winston's book covers all of this - it's £8 well spent if you want the realistic and pragmatic view of what research actually shows. I follow a vegan diet so I do take a vegan supplement and some additional vitamin d. I also take ubiquinol which crops up the most when it comes to egg quality, but partly because my hair and skin is great on it and I feel more energised! I take it knowing in reality it probably makes no difference.

In many ways I find it incredibly reassuring knowing there is little I can do to influence the outcome. We will probably do one more fresh cycle and transfer any embryos from that, then call it a day if we have no success. Prof Winston (and national guidance) recommends three fresh cycles give the best chance of success, failure before then could just be bad luck.

@Eventide85 thanks! And you're most welcome!

I can't say whether diet/nutrition made any difference in my case, but I was more than happy to make some changes just in case 😅

From approx 3 months before the cycle I cut out caffeine, alcohol and soy, reduced refined sugars, and tried to follow a mediterranean diet. During down regulation and stims, I tried to consume at least 30% of my daily intake as protein, and then I switched to high fibre (plant-based as far as possible) after egg collection. All throughout the cycle, I drank at least 2l. of water daily, had some bone broth daily, and drank pomegranate juice, and after transfer I ate pineapple core and drank beetroot, watermelon and ginger juice, although those things were not for egg quality really...

With hindsight, this was a bit over the top but I was at the point where I was willing to try anything. I'll never know whether any of it made a difference, or it was the higher dose of stims, or it was the things my partner did, or it was just luck that cycle... but I think if I had to do another full round, I'd do the same because it had worked for us and, quite honestly, the psychological benefit of having control over something throughout all that uncertainty was worth the effort for me.

1st round - lower dose stims 1 5day 3BB - Chemical. (Age 37)
2nd round - average dose stims 1 3day Good Quality - BFN and 1 5day 4AA - BFN. (Age 38)
3 round - 450 max dose stims 1 5day 3AA and 1 6day 4BB (Age 40) - both not transferred yet.

I had better results in terms of embryo number and embryo quality on higher doses. They were not tested so I can't rule out the genetic issues being the reason of BFNs.

I am not a big believer in supplements, I think "It starts with an egg" is overrated and although I did take some of the supplements during my second rounds, it didn't improve the quality of my eggs - my eggs are a bit rubbish as my embryologist noticed.

I eat a balanced diet, I don't smoke or drink, but I do drink coffee and I haven't stopped throughout my 5 years of TTC. I think moderation is the key and the fact that I haven't been successful doesn't have anything to do with my diet, but more with the fact that we are unexplained - we tested EVERYTHING - immunology, karyotype, hormones, uterine cavity, sperm and dna defragmentation tests etc and everything came back normal.

Thank you @SErunner for sharing your thoughts and tips. I’m also on ubiquinol and feeling some nice hair / skin / energy benefits! I haven’t read It Starts With The Egg. To be honest, I’m scared to read it because I fear I could get obsessed with some of the strict rules it recommends! I eat a broadly mediterranean diet because I enjoy fish, nuts, fruit and veg but I suppose I always wonder whether there’s anything more I could be doing. If only it was that simple, right?! I might check out Robert Winston’s book if it’s more thoroughly informed by scientific research. Thank you for all your tips and all the best for your next steps.

Thank you for this helpful reply, @Mistymist. Interesting (and reassuring!) that for you higher stims meant better quality and quantity of embryos. Thanks for sharing your thoughts on supplements and diet too. It sounds like you’ve had quite a journey so far and I wish you all the best for any upcoming transfer / next steps.

Thank you so much for replying with all this, @beachbum85. I’m with you 100% on the psychological benefit of having control over something whilst going through fertility struggles. I lean toward a mediterranean diet anyway because I love fish, nuts, fruit and veg. I think I’ll add more chicken breast, eggs, full fat milk and full fat Greek yoghurt into the mix for further protein. I’ve not yet tried bone broth (where do you buy that?!) but might give it a whirl along with the pomegranate juice, beetroot juice post-transfer. In case you can’t tell, I’m also at the stage when I’m willing to try anything! But you’re right that, with so many variables involved in the whole IVF process, who can really say what makes it work or not! You’ve been really helpful which I appreciate lots.

You're very welcome @Eventide85 ! I'll admit I didn't actually like drinking bone broth, but you can buy it from most big supermarkets, and we used to find it at our local organic produce shop too. Or you can make it too!
Sounds like you're already starting off on the right foot with your diet. Very best of luck with your cycle and keep us posted xxx

@Eventide85 thank you and good luck with your cycle! xxx