Bad ovarian response to IVF - should I consider IUI?

[foxlife]

Hi. Im 38 years old, with an AMH of 4.5, and I just had a failed IVF round on the NHS. I am now trying to weigh up my options.

I was on a long protocol (Protocol-9), taking 600 of Gonal-F for the first two days, and then 375 Gonal-F for another 10 days, as well as Luveris every day.

One of my ovaries didn't respond at all and I had four follicles on the other. Only one egg was collected, which fertilised and turned into an 8c 4/4 embryo for a day 3 transfer, which didn't make the 2-week wait.

I live in Scotland where technically you get three rounds on NHS, but not if you get three or less eggs. I haven't been offered a follow up appointment until 18 Feb 2026, so I will have to start planning before then and I assume I will have to self fund from here.

I'm honestly absolutely devastated that I've been waiting since 2022 for the NHS and feel now that I'm exactly where I was over three years ago, just much older. I've heard that people who have poor ovarian response to high stims sometimes respond better to less aggressive treatments like IUI. Does anyone else near my age/amh have a similar experience of not responding to high stims but having luck in other ways?

Any/all advice really appreciated.

I was on the exact same protocol with NHS (Scotland), same age and AMH, and as you say anything under 3 eggs collected and you’re not eligible to use your own eggs with them, they will tell you that you can use your other 2 rounds with donor eggs, then tell you the waitlist is so long you won’t make the top of the list before you’re 40 (which is their cut off for donor eggs provided through NHS) but you can bring your own donor if you want. Ridiculous if you ask me and here’s why…

I moved to GCRM for private treatment, it’s about £1000 more than self funded at GRI but the wait times are much better (I was seen by the consultant within 2 weeks, the nurse 2weeks after that and started treatment 3 weeks later). They put me on the Flare Protocol, so totally different from Protocol 9, different meds (less dosage) and down reg was different. I had 3 eggs collected and fertilised and 2 made it to day 5, currently 23weeks pregnant.

it’s my firm belief that the NHS should try a different protocol if the first one doesn’t produce enough eggs, not punt us away with a “donor egg is your only hope” message! Typical NHS.

Sorry, a bit of a tangent there. To answer your question, I’ve never tried IUI but I did try a different protocol and it was successful. I know some people have also tried Natural and Modified Natural IVF with stats similar to ours and they have also been successful. I think the big take away is more meds is not always the answer.

good luck on your next round ✨

Hey @KayEmmSquared and @foxlife , funny that I “know” you both from here. As you both know, exactly the same scenario, same low reserve, protocol 9, same poor response and same donor egg but too old for the list punt. (Was at GRI).

Ive mentioned on the other thread foxlife, that I had mild ivf and got 5 eggs, then 4eggs which was much better numbers but no blasts, then “natural modified” (150 menopur for only 4 days) and got one egg, that made a high quality blast that’s currently an 8 week pregnancy.

i considered IUI because we do have mfi (2% morphology) in tandem with my age, but considering I’ve been ttc 4 years with only two spontaneous pregnancies (that didn’t take) I felt that ivf with icsi still gave me the highest chance statistically. But that decision probably depends on your circumstances/partner’s health if they’re male.

As KM said, good luck with your next round whatever you choose!

Hey both, wow thanks so much for your replies! (@Nosejug I know you wrote a lot in the other thread 💛).

Firstly, I'm just so happy for you guys that right now it's working out. It really is special, and I wish you both the best with your journeys! (but sensible to be cautious too though - that makes sense).

I'm still waiting for my letter and actually didn't know that's what the NHS offer in our case - I think I'm glad I found it out from you first. That seems crazy that they would instantly go to donor eggs like that! I asked for a debrief consultation and I don't get it until 18 February. The whole thing makes me sad because in theory I'm a big believer in the NHS but it just feels like a massive waste of time in this case.

I've never heard of flare protocol but it sounds really interesting and kind of perfect.

Can I ask you both about your experiences with the clinics you've been to? Literally anything useful (the wait time from GCRM is really good to know), how flexible they are, tests etc? I will need to look into all options now.

At this stage, I have no substantial savings (could potentially afford one IUI round), but it's possible that my partners parents might be able to help. If they can help, they might only be able to offer one round of IVF/ICSI. I'm trying to weigh up the balance of wanting to move as quickly as possible because of time, with the fact that we have to ask parents, I don't know how much of a rest I should give my body between rounds, and the wait time for clinics. There is also the possibility that we stand a better chance in the spring onwards (my partners workload is much less, and I struggle with winters).

Can I also ask you if you did/do chart your cycles, and if so whether that helped at all? I used to do ovulation tests, and occasionally BBT but got complacent in the run up to IVF. I thought I was just bad at doing them regularly or at the right time of day, but I could have probably figured one of my ovaries wasn't working if I had analysed it properly. I'll start doing both again, maybe with a wearable, and checking on mucus too.

I honestly feel like I get clearer advice from you two than anyone professional 😂

Hey @foxlife , so my experience was entangled with my partners work. We were investigating clinics, and create kept coming up as an option for low responders. They’re only in England though. DP (self employed) was offered a year’s employment in London with good pay, so we decided to do ivf there while he worked there, and they had a 3 cycle package that worked out around 5k a cycle (they have financing plans and we took a 10k loan). They definitely had to earn my trust as I’m deeply sceptical of private healthcare, and we had a couple of wobbles, but overall I am pleased with the quality of care. I felt way more in touch with the Dr than with GRI, and felt I trusted him. But it was a massive upheaval and huge time commitment (as any ivf is) which has meant me not working this year (also self employed).

cycle tracking yes definitely! I couldn’t do bbt reliably and was deeply sceptical about the accuracy of the thermometer anyway. But OPKs show the body’s attempt to ovulate which is good enough for me. I also have a poor responding left ovary, sometimes producing nothing, or oddly shaped follicles under stims. Did you know your right ovary might just be doing all the work though? It might just be dominating most months in your natural cycles (I always thought it was turn about but no).

oh and in terms of resting between cycles, I was told it wouldn’t make a difference physiologically, but it was about my emotional reserves. I did around 5 back to back stimmed cycles (with collection taking place in 3). The last one produced the best/only blast.

am I right in thinking that you’re currently with embryo though? If you are I certainly hope that all this will be background and not needed ♥️

There’s some small print in some leaflet you’re supposed to be given that tells you about the “under 3 on first round then donor only going forward” rule but I was never given such a leaflet 🤷🏼‍♀️

I asked, immediately after my failed round and being told about the donor only rule, to see the consultant to start self funded with my own eggs and was told I would go back to the bottom of the waiting list, so 6months to see the consultant etc. of course I was fuming and asked for my records/test results to go elsewhere. I had to put in a Subject Access Request but I was able to get my records within the statutory month. If you do this, be specific that you want your partners sperm analysis results too or have him put in his own SAR for this, this will save you a lot of money on tests and cut out a couple of weeks waiting time to get going.

I went to GCRM as it was the closest clinic to me, but @Nosejug had told me about Create and the Natural route and we considered this too, had their been a clinic closer to home we would’ve probably went down that route first.

I definitely cycle tracked with OPKs but I was never able to get the hang of BBT tracking, I’m up at different times each day and pee a lot during the night so my results never seemed accurate enough to chart from.

I didn’t rest between cycles, my NHS cycle started in Jan, failed in March and my GCRM cycle started in May. I didn’t want to waste time and my head space was very much focused on the end goal and not wanting to waste any more time with the ever reducing AMH guillotine constantly in my head.

Hi Both,

So sorry I didn't reply at the time to your messages. All the information you gave is infinitely valuable and has stuck with me over the months.

I am finally at a stage where we can finance self funded, and I am trying to pick a clinic.

At the moment I'm trying to decide between TFP GCRM and Create, and I have also been looking into some London ones - IVF London, AGRC London.

Trying to weigh up travel/relocation nightmare with clinics is tricky. My partner works in Nottingham regularly, which has a Create clinic, so we could rent down there, but all the operations are based in Birmingham anyway. My mum lives in London so I could go and stay with her, but she has a one bedroom tiny dirty flat, so it might not be the best place to get into the fertility zone!

I do really like the idea of these duo/triple cycle options, especially as I feel I only really have until this autumn to give it a good bash. Other than that though TFP GCRM is definitely the most convenient.

Create fertility seems to be coming in more like 20 grand for three cycles now (or that's what it looks like on the website). How much did GCRM come to? The cost of relocating would be huge too so something to consider.

How are both of your pregnancy journeys going??

Thanks again for all your advice - I cannot express how useful your experiences have been to me in this wild journey!

Lots of love xxx

Hey! Yes the living in two places (between London and Scotland) was tricky logistically and paying for a second accommodation. Plus it was all temp accom so also a bit grotty at times. I did get to know the very outskirts of London though and have lovely memories of long walks through fields in borehamwood in the heat of summer with crickets singing and the smell of scorched grass — not something you get in Scotland haha. The main issue was fridge quality, ancient ones that freeze things at the back—two trigger shots had to be re-bought after getting below 0 degrees. Something to consider if you do do it outside of home.

21 weeks :) cautious as I’m high risk for preterm delivery but starting to hope it’ll be later than sooner as I approach the first 24 week viability hurdle, finally!