IVF with low AMH - advice needed

[kl88]

Hi all. I'm hoping for some positive responses but more than that just keen to understand the experiences of others, positive and negative.
I'm 36 years old, non smoker, non drinker, healthy BMI. DD born start of last year, natural conception, normal pregnancy and birth.

Been ttc for 6 months with no joy (have been tracking ovulation). Attended an IVF clinic for assessment. DH results all normal. But I was told I have low AFC (7) and very low ovarian reserve, AMH (2.6pmol). So IVF recommended. I was absolutely floored by this news. I'd just assumed, having had a baby last year, that all was in order and that we were just unlucky with our timing or other factors.

I've been on the dreaded Google and for my AMH the chances of IVF success statistically look so low. We are not eligible for any of the refund programmes because of my AMH. So are facing upto the high potential of having to spend a lot of money with what looks to be a pretty non existent chance of success.

I'm wondering if there are others on here who have been in a similar condition to me, and what their experiences with IVF have been. Is it worth a try, or am I setting myself up for heartbreak?

Obviously we could look at the donor egg route. But I don't know if I could get my head around that.

Thank you to those who have read to the bottom 💕

Hi OP, sorry to hear you are going through this. First thing is to say that low AMH on its own isn’t a cause of infertility, it just means that your likely to collect less eggs than someone else your age if doing IVF and that you probably shouldn’t just leave it for years. Given you’ve already had your DD, your DH’s results were fine and you’ve only been trying 6 months you are likely very much ‘fertile’!

low AMH as a topic comes up very frequently on MN infertility, here are a few threads you might want to read through, but I’m sure there are more:

https://www.mumsnet.com/talk/infertility/5341559-low-amh-ivf-success-stories-please?utm_campaign=thread&utm_medium=share

https://www.mumsnet.com/talk/infertility/5194413-low-response-to-ivf?utm_campaign=thread&utm_medium=share

https://www.mumsnet.com/talk/infertility/5307418-low-amh-ivf

https://www.mumsnet.com/talk/infertility/5217511-low-amh-levels-32?utm_campaign=thread&utm_medium=share

Hi OP,

First of all, low AMH/AFC does not reduce your chances to conceive naturally, as you only ovulate one egg each month anyways.

People with low AMH/AFC typically do not respond as well to IVF because they produce less follicles per cycle, and in the end it’s a numbers game, so it’s common to have to do multiple egg retrievals, which is costly.

However with an AFC of 7, I wouldn’t say that your chances are non-existent.

I have a lower AFC (started 5-6 but is now 3) and still managed to fall pregnant twice with IVF. Unfortunately they ended in MMC, but I am still doing IVF with my AFC of 3, and still made an embryo during my last cycle.

Thank you for taking the time to reply. I had seen some of those threads, but not others, so it was helpful.

I'm finding it very confusing to decide how to approach. There are so many different options and being new to this and unfamiliar with it all it's very tricky to know what option is best for our circumstances. I don't know typically how many cycles someone with my medical profile might need to have before being successful for example. The clinic we have been into sent over pricing for a single cycle and all the forms to sign but without discussing with us whether a single cycle is likely to be sufficient. It feels like it won't be from what I have read.

Thank you, it's reassuring to read that someone in my position is achieving pregnancy, I'm so sorry you have been experiencing heartbreak along the way and I hope this time you get the positive outcome!
Can I ask, because of the low AMH have you chosen a clinic that specialises in that particularly? And how many eggs were retrieved and then capable of being transferred during your cycles? Sorry if I'm using the wrong language, this is all new to me. Obviously everyone is different but given our similar stats the egg retrieval process might look quite similar and that might help me to judge how many cycles we might need. Any other info or advice you have would be so useful to me 💜

Not problem at all, I am happy to help.

For my first egg collection, we retrieved 5 eggs and got 3 blastocysts. We are trying for our first child so after the MMC we decided to do another cycle and not use the 2 frozen embryos to improve our overall chances. For my second egg collection, we retrieved 6 eggs and got 1 blastocyst. After the MMC we decided to do another cycle again, to give us more chances of success, and for my third egg collection we retrieved 3 eggs and got one blastocyst.

It is worth noting that my partner has sperm issues, so you might get better results if it is not the case.

My clinic is not specialised in low AMH, I would love to find a clinic that is specialised in low AMH, but it’s really hard to find as all the clinics have good marketing!

That sounds really promising in terms of the number of blastocysts. I feel it really is a numbers game, and trying to bank yourself enough chances that the law of averages works in your favour. It's all any of us can do really.

You're right about the clinic marketing. I didn't realise there were so many clinics. It's hard to choose but think we will speak to a couple and go with our gut. But we need to get a move on. I'm waiting for some blood tests and have been told to take COQ10 which I'm stocking up on. After that sooner the better as I'm feeling more and more anxious with each day that passes.

Do you have a date for your next transfer? Fingers crossed this is the one 💜

At the moment I think I will likely have to do 1 or 2 more cycles before transferring which is hard to accept as I really wanted to transfer in September but one thing I have learnt is this process is that everything takes more time than anticipated!

Q10 is a good idea, I have also been taking it in addition to Proceive.

I hope you will find a good clinic and that you will have success!

Yes you definitely need to have a lot of patience that's for sure. Have you considered duostims? I'm leaning towards that over multicycle as sounds potentially to be a better option for those with low AMH / AFC.

Yes I've also stocked up on omega 3, selenium, Myo-Inositol and vitamin d. All good for egg quality apparently!

Thank you, I have a couple of consultations booked in the next few days so going to ask the questions I need to ask then. Hard choices when there's so many pros and cons to different approaches.

I have never tried Duostim, I think my clinics are not using it a lot, but it seems great!

Good luck to find a clinic!

If you don’t mind, please let me know which clinics you shortlist as I might want to tey another clinic in the future!

Hi OP. I’m 43 and have an AMH of 4.2.

I have undergone IVF in the UK (had 4 rounds and got 1 blast and had an unsuccessful transfer) and am now doing it in Prague (1 x duostim round = 1 blast, second duo stim = 1 blast so far, have only done first phase so second round to go). So I have 2 in the freezer and have the final phase of duo stim to go so hope to get more.

My chances of success are much lower than yours due to my age but I feel happy I am trying everything I can and am so pleased I have gone to Prague.

I highly recommend taking the supplements recommended in the book ‘It Starts with the Egg’. They tailor a plan for different circumstances (in my case endometriosis and being ancient!). The CoQ10 is a must for everyone though.

I would also recommend getting your testosterone levels checked and then take DHEA accordingly.

Vitamin D is a must also.

Everyone’s decision is personal but the reason we are in Prague/Czech Republic is threefold:

• Cost it’s about half to two thirds of the cost of ivf treatment itself
• Drugs are a quarter of the cost
• I believe it is more advanced than the UK, I have been really impressed
• Duo stim is available and affordable and it is this which has yielded our best results

I wish the money I had spent in the UK had been spent there as I know I would have got more embryos for the same or less money.

Ah OP don't despair! I could have written something very similar to this a few years ago.

DH and I tried to conceive baby number 2 for about 7 months and had 2 early miscarriages. Ended up booking a fertility MOT mainly because I wanted to have an ultrasound and was totally floored to find out my AMH was 2.5 and AFC 6 (I was 33). Totally out of the blue, first baby was 2 and had been conceived really easily. I was told to keep trying and to consider IVF if we got to the 12 month mark.

I actually got pregnant with baby number 2 the next cycle; and she's now 4. 18 months after she was born, when I thought my ovaries were well and truly empty, I got pregnant with baby 3. No idea how terrible my AMH was then!

Don't give up hope and definitely don't stop trying. Honestly after getting my results I googled everything, read so many papers and thought we probably wouldn't be able to have more kids. Now there are 3 of them. Fertility is mysterious, and the significance of AMH isn't very clear. I'm keeping everything crossed that you have the luck I did.

@WarriorsComeOutToPlayay would you mind sharing which clinic you went to in Prague?

Of course, I am with Fertility Port 😊 I am very happy with them and they are very responsive and happy to answer questions.

There is a helpful private Facebook group called IVF Support Prague where lots of people discuss their clinics and experiences. Gennet is the one most people appear to use but I didn’t feel they were the best fit for me due to my age but I’m sure they are very good.

I highly recommend Duo Stim if, like me, you have a low AMH and time is ticking.

Good luck!

Thank you! We are looking at Bourn Hall and Cambridge IVF. It'll be a journey for us as we are on the South coast but want to give it our best shot. It's been a real struggle to find many UK clinics that offer it. Happy to update on our experience here incase you need to pursue in the future, but I'm hoping that you won't and that your next transfer is the one! 💜

Thanks so much for taking the time to read my post and sharing your own experience. It's really encouraging to hear that so far, your DuoStim experience has been positive and seems to be yielding some promising results! Especially with another round to go!

I have friends who have similarly had IVF in Prague (but MF infertility, so different circumstances) and they also have had a really positive experience (1 toddler and baby no. 2 on the way). So thank you, and for sharing the details of your clinic, I will look into it. It's all so daunting with so many clinics and just thinking about the logistics, so a recommendation goes a long way and helps to short circuit the search!

I will check out that book. I've already got on the Vitamin D alongside the COQ10, omega 3, selenium, myoinositol, collagen and a general pregnancy multivitamin, practically rattling! I will definitely look into the testosterone, thanks for the tip, that hadn't flagged in my searches but I am seeing GP to arrange some bloods next week so will try to wrap up then.

Please do keep us updated on your DuoStim journey, would love to know how it all works out for you and keeping everything crossed! X

This is such an encouraging story to read. I totally relate to how you felt getting the news about your fertility. It was the same for me, having a little one already I just didn't anticipate we'd have any real issues (assumed we were just unlucky) so to be told my fertility was in the state it is has been a huge shock. I also had a scan last November and was told my ovaries were bursting with follicles so I'm struggling to understand how it's declined so rapidly. I don't smoke, I don't drink, I've been practically caffeine free for 5 years and healthy BMI with no family history of fertility issues so feel even more aggrieved that I've done everything in my power to look after my health but my body is letting me down. I'd always hoped for 4 children and realigning my expectations from how I thought my life would be to the potential new reality has been tough.

Google has been horrific. My worst mistake was trying a fertility calculator which wouldn't even give me a % likelihood of natural conception. It's true what they say about stress messing with your cycle, my LH has been all over the place this month. I'm not even sure I ovulated to be honest. It's hard to stay calm when you're given what at face value is potentially life altering news.

I'm feeling more positive now that a plan is coming together. This initial phase of being out of my depth and having to accept this is what I'm going to have to do has been overwhelming but I know once I have firmed up arrangements and know what the next steps are I'll feel more at ease.

It's incredible to know you managed two babies following your diagnosis. Anything is possible and I'm so glad it worked out for you! It certainly gives hope to us all, so a massive thank you for taking the time to share and for being so supportive 💜

@kl88 you're very welcome. When I read your OP it sounded so similar and really resonated, I couldn't not reply.

I remember the feeling so well - I too don't smoke, no previous gynae issues, regular periods, Grandma went through menopause in her mid 50s... Just no reason for it all all. Whatever I read online didn't look great but equally we seem to understand so little about the relevance of AMH.
I had a really short cycle at the time too which only seemed to add to the evidence I was going to be imminently menopausal. It's perfectly normal now, 5 years on, so who knows what was going on...

My consultation was actually at Bourn Hall in Norwich, and they were relatively positive about my chances of conceiving naturally and proceeding to IVF later on if we needed to. Didn't feel that way to me at the time though.

I'm keeping everything crossed for you

Yes I also have a short cycle (every 24 days) and always have! That's normal for me.

Great to know your experience was at Bourn Hall and it sounds like their advice was spot on in your case. I've had an initial call with them and just completing remaining tests before we can proceed to full consultation. And obviously will continue to try in the meantime and will try to keep positive!

Thanks for the support!

Hi OP. I was floored when I went to a fertility clinic at 37 a few months into TTC and found out my AMH was 7. I am now 40 and it is 11.5 and my AFC has doubled. We're embryo banking after 2 years of no pregnancies but AmH has little to do with that, we have dual Factor and significant MFI. I attribute the AMH improvements to lifestyle, diet and supplements. Fixing nutritional deficiencies and reducing stress specifically.

As others said, low AMH has nothing to do with your chances of conceiving naturally and the fact that you've done so already and you're only a few months in suggests that's still an incredibly viable option for you. You might not even need IVF, your eggs are likely still of decent quality.

From an IVF standpoint, yes I've had lower numbers but we're still making embryos and funnily enough, our best cycles were with fewer eggs retrieved. Quality over quantity.

Hi, thanks so much for the reply. Obviously I wouldn't wish this on anyone, but equally it's reassuring to know others have been in the same position and can relate to how I've been feeling. It's incredible to hear that you've been able to increase your AMH and AFC. There's so much conflicting information on this subject online so it's amazing to hear from someone who has actually managed it, it is something that can be done. Really pleased to hear that your cycles are resulting in embryos. I totally agree, quality over quantity, as everyone says, it just takes one! And I really hope you get one that sticks soon! It'll be so worth it in the end! 💜

Hi OP - my profile was similar to yours, but my AMH was lower than yours. I had 3 failed rounds of IVF ( < 4 eggs retrieved each time, none made through the PGT-A test). Although we continued to try naturally, and I got pregnant before starting the 4th round.

I echoed another comment that a low AMH doesn't necessarily mean your chances of conceiving naturally are low. You need one good egg and the right timing. If it helps, for my case, I started the supplement regimen based on the "It starts with an egg" book for 3 months and had regular sex around the ovulation date (rather than just "on" the peak ovulation date only).

Good luck!

Hi, thanks for sharing your experience and for offering advice. It's super reassuring. I will try to think positive and just keep up with the right supplements! Amazing that after IVF heartbreak you fell naturally. I have read stories of IVF almost resetting the body, perhaps that was true for you! Thank you 💜

Just jumping on to say that at 34 I was diagnosed as having a dermoid cyst on one ovary and a low amh (approx 5pmol). I had the cyst removed which resulted in most of the ovary also being removed and it was non responsive to ivf.

I never retested my amh but was told it almost certainly would have declined post op. Anyway, with an afc of 10-15 I had one failed round after retrieving 6 eggs (and was convinced that ivf was doomed to fail for me as I had an early day three transfer given the eggs all looked to be poor quality) followed by a successful round (10 eggs, only 1 blastocyst) resulting in our son. Then, 2 years later I did ivf again where I didn’t do my amh again (but it must have been a lot lower than before), but my afc had gone down to 5.
3 eggs retrieved, 1 blastocyst - and a successful pregnancy with my daughter.

so what I would say is that yes ivf is a numbers game, but you only need 1 good egg. Low amh does not mean poor egg quality.
Lots of people have high numbers of eggs retrieved but still only end up with 1 or 2 blastocysts per round.

You have age on your side and you’ve already shown that your egg quality isn’t an issue as you have a DD. Honestly, I would ignore the statistics online and stay positive - you have every chance xx