Follicles not responded to stims

[CatSimp]

I’ve posted this on the pregnancy thread but hoping I get a response here too, so I’m sorry for the long post.

I am 38, have an AMH of 2.1, all other test results are in normal range and my BMI is 32 which is something I’m working on. My periods are irregular, my last 3 periods have been medically induced.

Mid June I had my IVF baseline scan. Due to an enlarged follicle and the size of my uterus lining we could not start meds. We were moved onto the long protocol.

On 6 July I started suprecur. And on 17 July I started stims. Had my tracking scan today and my body is not responding. I have 5 follicles, 4 of these have not responded to stims (they only measured 5mm) and the 5th follicle measured 12mm.

Our consultant has said my options are:

1- Continue on this cycle but it is high risk, only 50/50 chance of the follicle having an egg and it is unlikely the other follicles will “wake up”. Plus we run the risk of the follicle rupturing.
2- Stop this cycle. Go back to day 1 and try a longer, lower dose of stims. In the hopes the follicles wake up. But again there is a high chance this won’t work, I might not even get one follicle and it will cost us all of our scans/meds again.

It is awful but the cost does play a factor because we can’t afford infinite attempts. The extra cost is significant to us and we’re not sure it’s something we can actually afford again.

We’ve considered a 3rd option ourselves.

3- Stop/cancel this cycle due to the minimal likelihood of success and consider it failed. Have a partial refund. Continue to work on lowering my BMI to try again but on the NHS, if we’re lucky to do so.

Can anyone offer any guidance or clarity on what to do?

Hi @CatSimp sorry that the cycle is not going to plan. If you were to continue with the cycle - how long ( many more days of stims) will you have left?

also - out of curiosity, where did you get your meds from? I’m on day 10 and my response is so much slower than past (unfortunately unsuccessful) cycles.

Sorry to hear this.

What was the original issue with your lining? Long protocol was very unsuccessful for me, totally shut down my ovaries and they needed a lot of waking up!

I have never been a fantastic responder to stims but with such a low AMH I think either short protocol or some would suggest mild IVF.

Thank you for the responses. I've completed 8 days of stims (later today will be day 9). We ordered our meds through a company called Stork, that was the only option provided to us by the clinic.

At my first baseline scan they weren't happy with the thickness of my lining. I did query at the start whether long protocol was appropriate because of my low AMH and was told by my consultant it is. The more research we've done, the more we feel mild IVF might have been better in our circumstances which is frustrating.

At the moment I have to decide whether to just try with one follicle or start a mild IVF cycle and run the risk of having no follicles. The chance of success isn't higher on mild IVF so I'm not sure why I should stoo the current cycle, it's what my consultant recommends. I'm not dismissing their expertise but it just doesn't seem best 🤦‍♀️

Hi, I'm really sorry that you're having a stressful first attempt. This journey is hard!

I'm in a similar boat - I'm 39, but my AMH is lower than yours. I've been trying natural modified x 1 and mild x 1 cycle. I don't know which clinic you're at, but I'm at Create and they scan you and do bloods over the course of a get days to determine whether or not it's a good cycle and whether they advise to proceed in any given cycle. Their ethos is very much to go for the "golden egg" unlike conventional ivf. However, in women with low egg reserve, a conventional approach is unlikely to yield much more. It sounds like mild would be a great approach for you, where you'd start lower dose stims on Day 2/3 compared to natural modified which would be even lower dose starting on day 5/6.

It's worth getting your TSH levels checked to see if you need any thyroid medication, and obviously taking a good prenatal supplement, as well as DHEA and CoQ10.

As for nhs, if your AMH is below 10-15, they will not offer you ivf. They might offer ovulation induction, but I'd check with your GP or secondary care provider to manage your expectations. I waited over a year to be told they'd only offer me a hycosy.

Wishing you all the best xx

A bit like @GingerRCD I did a lot of cycles where I wasn’t sure if it would proceed, but always conventional IVF (so started stims if antral follicle count was okay then depending on response decided whether to go to egg collection).

Regarding the NHS different areas have very different rules about eligibility based on age, length of time trying, BMI, previous children for either party and yes AMH is one of them but I had NHS IVF with an AMH of 4 so check what the criteria are for your own area.

Hi, a bit late, but curious what you decided to to?

I started at 38 with excatly the same AMH level as you. Currently completed my second round of standard IVF.

Reach out if you wish.

Hi, thanks so much to everyone who have replied. So a lot has changed since my post.

We waited for our next scan which showed some more follicles started to respond. So we chose to continue.

A week later it turned out the initial large follicle that responded on its own was outside of the ovary. We like to joke it was a decoy to give the others time to catch up!

We stayed on stims for longer than usual. Eventually went for egg collection and had 3 eggs, 2 of these fertilised.

Then had a 5 day blastocyst implanted (grade 4ab - which I'm hoping is good). I'm currently on day 9 and due to test in 2 days time.

I've been getting pretty bad cramps this whole wait and convinced myself it hasn't worked. Because of this I chose to test earlier today using a CB digital test and the result was positive 1-2 weeks. I know it was silly of me test but I think I just needed to see the negative (that backfired). Now I'm super cautious that it could be a false positive and trying to keep my hopes neutral 😬

Sorry for the rant and brain dump. Hope you're doing ok on your journeys wherever you are in them xx

How are you getting on? Have they confirmed your positive result 🙏

Hi,

I'm so overwhelmed typing this, yes we've had a BFP!!!

It's still very early days but after all the worry about cancelling the cycle it has been successful. We're cautiously happy as we realise it's only been 5 weeks.

I hope everyone else is doing well and thank you again for your replies/checking in xx

Omg!! Congratulations 🥳 so happy for you 👏

Congratulations @CatSimp 🥹 I had exactly the same results as you - 3 eggs, 2 mature, both fertilised one made it to blast and I’m now almost 20 weeks! I really do think less eggs is sometimes better. So pleased it worked for you 🥹🥹😍😍🥰🥰

Thank you so much both of you!
@HopefulllHolly congratulations, lovely to hear good news stories from people in similar situations 🥰