Low response to IVF

[Olivepearl]

Hi everyone, I’m looking for some help on how to cope with a low response to IVF. I am on my first NHS funded round, short protocol and highest dose. I have a low ovarian reserve (4.2) and my husband has low motility and morphology. On Monday I had 6 follicles, 3 on each side. The right side has two over 10 and one at 13. The left side, 3 all under 10. I had a scan yesterday and I now only have one large follicle. I had no idea they would disappear, it was a huge shock. They are going ahead with egg collection because they aren’t willing to fund a second round because of my low response. I am completely devastated and overwhelmed, I have no idea what to do next. I am praying this one follicle has an egg and is the follicle that could succeed but chance are so low. I’m 37 and struggling to cope with the idea I’ve just left it to late to have a baby. Sorry for the long post, my question is, does anyone have any success stories? I am in desperate need of some hope.

I'm so sorry to hear what you are going through. I don't have any encouraging stories to share, but didn't want to read and run.

What explanation did they offer as to why 5 follicles disappeared? There must be some explanation. It's so sad they are going ahead with egg collection despite this just to save money. Is this your only NHS funded round? If so, I would not rest until they have fully explained everything.

Also, I don't want to raise your hopes, but I have read time and again here on MN how people had only and or two eggs and both went to the blastocysts stage and had success. It's rare, but not impossible. In IVF, it's always the quality over quantity.

Wishing you all the best 🍀

hi @Olivepearl sorry to hear your going through this, it is so horrible. Just to flag that there really can be a huge variation in what you get each cycle, I’m 34, I haven’t tested my AMH in a couple of years now but it was measured at 3.3pmol, 5.3pmol and then 2.4pmol when I was 31-32 years old. I’ve been freezing the last couple of years and we have MFI as well (1-2% morphology). To show the variation, for me this has looked like:

Round 1 - started with 9 follicles, 5 eggs collected, ICSI 1 embryo made it to freeze

Round 2 - start 8 follicles, 5 eggs collected, ICSI & PIMSI, 1 embryo made it to freeze

Round 3 - start 7 follicles, cancelled cycle, poor response, looked like max 1-2 eggs would make it if any.

-changed protocols to slightly different drugs -

Round 4 - start 18 follicles, 12 eggs collected, ICSI, 5 embryos made it to freeze.

Round 5 - start 9 follicles, cancelled cycle, same issue as round 3 despite new protocol.

moved on to frozen transfers:

• x1 on board, BFP MMC at 8+5, growth was behind from 6 weeks
• x1 on board, BFN
• x1 on board, BFP, now 14 weeks pregnant and all looks great!

it’s a long road and I’d advise freezing asap is best with a low AMH, but just one cycle doesn’t tell a whole story, different people react to different protocols and each cycle is different. If you took my third or fifth cycle in isolation it’d look pretty stark without the wider context.

Wishing you the best!

I would challenge this decision, I had short protocol first round on NHS and got 8 eggs but none made it to day 5.

Second round I had long Protocol and got 21 eggs x

Out of those 21 18 fertilised and 3 made it to day 5- my DD is 17 months and 2 in the freezer.

I have also now got pregnant naturally and am 20 weeks pregnant x

I was in a similar situation to you. I responded terribly to treatment!

First round I did short protocol and while I had about 5 follicles growing only three were big enough - of the three eggs collected I got one successful blastocyst which was transferred but BFN.

Second cycle, we tried long protocol changed medication, took maximum dose, but I only ever got 1/2 follicles looking big enough on the scans. We went to egg collection anyways and I got only one egg. It miraculously made it through to blastocyst and fresh transfer resulted in BFP. I’m now 25 weeks pregnant from that one egg! I know that’s very lucky, but when I was in your position I needed to hear these stories. I was also 40 when doing IVF with rapidly declining AMH so you’re in a better position than I was.

Wishing you the best for this round.

I’m really surprised they’re forcing you to go ahead. When I responded poorly to my first NHS round, they encouraged me to abandon the cycle as if I did so before egg collection I would get another round funded and they’d try something different. I would definitely look into what you’re entitled to and challenge them. Keep asking questions until you’re satisfied they are acting in your best interests.

@Olivepearl Oh lovely - I’m really sorry this cycle isn’t working out great. I’m quite shocked that they are carrying on with collection as most clinics want you to have at least 2 or 3 eggs to do it. Have you read your local area guidelines - you can find them online.
If it helps - I had almost exactly the same issues as you, AMH 3.9, low morphology and motility. My scan showed 7 eggs and then when I had collection I got 3, one of which was too small. The other two fertilised and one made it all the way through and I got pregnant first time. I do genuinely think it was that one golden egg that was bigger the whole cycle and that I would have ovulated anyway that worked. So all is not lost with very low numbers BUT I would check your district and clinic guidelines and push them
for a second cycle. It might be on stone on a lower dose for longer may work for you. You’ll never have many eggs retrieved, but it doesn’t mean you can’t get pregnant, it just might take longer (or like me, maybe it won’t and your one egg is perfect and is all you need).
Big hugs and good luck! Xx

I had an amh of 6.1 at 30. My first round was short protocol maximum stims and I only got one poor quality blast and a BFN. I took some time out before next cycle (long than I initially intended due to COVID) and made some supplementation changes. My vitamin D and TSH were both borderline. So I was put on levothyroxine by my clinic and took higher strength vit D. I also took DHEA supplements. My next round 11 months later I ended up with 5 good quality blasts. 1st was a chemical, 2nd is my DD and 3 in the freezer. So one round in isolation isn't enough to call it quits. Although my consultant did give us a less than 10% chance of it working after the poor response to the first round. Have a read around DHEA.
And I agree with others. Push your clinic on why they want to go ahead

Thank you all for your replies. I had my appointment yesterday and they have said that because they don’t think I will get a better response, if I cancel this cycle then that’s it. They would offer another round of stims if they thought I could get a different response. So basically this is my only chance with the NHS to have my own baby.

im really encouraged to hear some of your stories, I am praying this one follicle has a a good egg and by some miracle this works. But if not, we will try private clinics to see if we get a different response.

@Mseddy thank you for the supplement advice, I’ve booked to get my vitamin D tested. I’m already taking the supplement, but a finger prick test came out saying I am deficient so worth looking into. I took DHEA but between march and September my thyroid went up from 3 to 4 so I stopped. congratulations on your DD, I’m really glad that it worked for you.

@HopefulllHolly thanks so much for your reply, it’s really given me some hope for this round , the nurse was really positive yesterday about quality over quantity and she said it’s a ‘good follicle’.

@AnnieStar12 congratulations on your pregnancy, that is such lovely news. Thanks for your reply, it’s really helped me feel a bit more positive about my situation.

@PMAmostofthetime congratulations on your pregnancy, that’s wonderful news. Thank you for sharing your experience, it’s really helped me. I was very much feeling like there is no point in trying privately after speaking with the nurses at my clinic. But there’s such a different response each time. Thank you!

@Zypig congratulations on your pregnancy :) itabso lovely to hear it worked for you, thank you for sharing your experience, again it gives me hope for more treatment of this round doesn’t work.

@Olivepearl I think it’s really unreasonable of them to say that you won’t respond to anything else better when they don’t know. Unfortunately the first round is often treated as a bit of a test, and I think if you went private that they’d be willing to try another round with a changed protocol. It’s rubbish they are being so pessimistic with you. I’m sorry they’ve treated you that way as it’s not how you want to go in to an egg retrieval. Will keep my fingers crossed for you, one egg is better than no egg after all! Good luck! I hope it works for you, and if not then find a new clinic if you can and see what they can learn from this round. Xx