Ivf at 40. Waste of time? Opinions ? Mild vs high stims?

[VioIetMoon]

About me, Im turning 40 this year, PCOS and partner has low morphology. We tried for about 12 years naturally and medicated before moving to ivf ( icsi) for our nhs round. We waited a further 6 years before we got our nhs round and were very very blessed our first round worked and we have our little miracle who's turning 1 soon . We desperately want to give him a sibling but I'm turning 40 this year. Wait time for private is few months aswell.

We've started the process of ivf again. We're waiting on our first consultation. I'm so conscious time is ticking on and worry its too late. We didn't get any embryos to freeze from our first round which was really heartbreaking for me.
Our first round We had 2 embryos but they were poor grade 5cb and 3cc, one being our son. The other they wouldnt freeze so we did a double but that one didn't take.
Does this sound normal ? I know i should be grateful but My amh at the time was 62. I couldnt help but feel really disappointed that we only got 4 eggs from that meanwhile I see women with much lower amhs boasting the got 20+eggs. I didn't know if my body failed me or it wasn't the right protocol or if this was what they wanted as that wasn't communicated.
I think its due to the fact they stimmed me very gently. This means with nothing left over we have to start again , a process that realistically, this is our only shot. We can't afford another round if this fails. The clinic we booked with, they are advocates of mild stimulation. Has anyone had experience with both? Does mild stim really produce better quality? Or should we try to get as many as we can? I should also mention my left ovary is a non responder and only my right works. I feel pressured into picking the clinic due to age and would appreciate feedback. Should we stick with the gentle stims or move clinic . Given all I've mentioned, what do you think would grant us the best chance at getting embryos

Being 40 is not a write off situation - go for it. Around 35-40% of embryos are on average still chromosomally normal - it is not too late.

Attrition is very often high with PCOS. If your AMH has now lowered from 62 that could actually potentially be beneficial - some women have improved egg quality when ovarian reserve lowers and with it androgen levels/ insulin resistance/ high AMH. Reducing BMI where applicable can also assist things.

Do you know your latest results for AMH, AFC, FSH and testosterone? I think this information will partly guide whether you should go for standard or gentle IVF. Get your partner on the antioxidant supplements!

The waiting time for a private clinic should btw be weeks not months - which are you with?

And do you mean that you only had 4 eggs retrieved in total or was it 4 that were mature and fertilised? If you can share your protocol and results from last time with your new clinic they should be able to use the information to inform the course going forward. It sounds like you may have either had an issue with egg maturity/ eggs not growing as a cohort. Or did you have a low fertilisation rate because of male factor?

@sirensong Thnaks so much for your reply. We do have male factor issues aswell so it was Icsi we had with nhs but we had a pretty good fertilisation rate with that 3 fertilised. The fourth egg wasn't suitable for fertilisation. Im assuming not mature enough. Out of those 3 two made day 5 blasts. The other they disposed of on day 6. During the scans I did have 7 follicles growing and mid stims they contemplated upping the dose but ultimately decided against this. This round was with nhs.
That's interesting to hear about quality improving with reduced amh, despite age
Makes sense as I have heard with pcos that as you get older androgens reduce it and it can regulate periods.
I'm currently waiting to get my amh levels. The clinic thinks it shouldn't have reduced too much, but my levels were last tested 3 years ago, surely there's bound to he a noticeable change. I'm in Northern ireland and there's not alot of clinic options here , just two. The clinic I've booked in with are advocates of mild stimulation, which is similar to my nhs round and I can't help but wonder if I should switch clinics. I've read conflicting information regarding mild stims and quality. Some studies have shown it doesn't actually result in better outcome compared to regular stims and that regular still has higher pregnancy rates due to yielding more eggs. I know not every egg will be mature or good but if we can harvest more eggs I wonder if that would give us a better chance at getting some more embryos. I'd hate to go through the process again only to achieve a few eggs if there's potential to have more. The clinic also batch but apparently have more modern technology than the other which im hoping would be beneficial as they claim it improves outcome but its just the knowing the clinic have told me they prefer to mildly stimulate women. It's so hard to know what to do. It's a risk really isn't it. We could go full steam ahead with higher stims and perhaps it might comprise quality or it could end up being worthwhile and obtaining more eggs to work with.
If money wasn't an option then we'd just give both a go but unfortunately it's not feasible for us. I'm not look for mass amount of eggs. Ultimately our goal would be to have an embryo left over to freeze for future use incase the next wouldnt work but i know ill probably obtain a similar amount or less next time as its 3 years ago. On our first round we did get 2 but it was basically either transfer the second embryo or dispose of it as it wasn't freezeable grade .

Your fertilisation and blast rates were good but it does seem strange that only 7 follicles were developing given your AMH level, even considering gentle stimulation and only one ovary playing ball.

I'd personally try slightly higher stimulation. Or at least whatever protocol will get everything growing as a cohort so that the reduced number are all mature and have a chance.

I am also turning 40 and trying to have another baby. I just did an ivf cycle and it was a complete failure. We are going to try one more round and depending on those results I don't think I would go again. My doctor said that this first cycle was a trial run so we could work out how my body would respond as my last full stim cycle was over 4 yrs ago and since then I have started premenopaus. My doctor says he has high hopes for getting us another baby and my age isn't even considered to be too old, he says technically everything is still working as I get a period and I still ovulate and if I am still doing those things then there is something for him to work with. I'm sceptical because I don't exactly make the best embryos and now being much older and going through hormonal changes I feel I might have reached my baby making limits. But I try to have hope because my desire for another baby is higher then my doubts right now so I'm going to trust my doctor and see where it all leads me. So I say to you that you should go for it, if you don't try you won't know and when you do try sometimes beautiful things happen.

@Miraclemuma03 really sorry about your round - very tough after all the hard work.

Women with PCOS usually go through perimenpause and full menopause a few years later so the same issues may not be in play for OP but the common feature is hormone imbalance.

Is perimenopause manifesting through symptoms and blood test results?