IVF low response AGAIN :(

[Lavendar01]

Just looking for some advise im really struggling this morning after my day4 scan being on menopur 300iu.

My previous round on menopur 187iu was abandoned due to low response: total 8 follicles, which by day12 only one grew to 14mm, nurse advised I have the option to abandon based on my AMH reserve being good (26) and start on higher dose next time,

This round I started on 300iu and my first scan today shockingly showed even poorer response only 1 follicle recruited on left side and 4 on the right side, only one measuring 10mm and all others around 5mm. I'm so devasted and confused. The nurse suggested to up the dose but said its unlikely anymore follicles will be recruited, we'll be hoping for the existing ones to develop by upping the dose, if lucky maybe one or two new ones will spring at most.

I asked if we can abort this cycle again to perhaps try new long protocol or switch medication, she said very unlikely the ICB will fund another attempt. I've been doing some AI research and its suggesting I have two options:

1. Continue to egg retrieval
2. Abort cycle as appeal under "exceptionality" argument that AMH 26 predict high response but my low response is a unique case mostly due to incorrect protocol / medication. Apparently its easier to appeal for a change of protocol as cycle is not deemed 'used' as expensive procedures have not been done yet. But the con: if this appeal is rejected I would have lost my nhs funding without egg retrieval.

Its a high stake gamble and im really overwhelmed and disheartened. Please any advice will be appreciated 🙏🏽

I'd abandon and try again unless you would forfeit the funding. Are you doing downregulation?

Thanks forcresponding, I would lose the funding if I abandon this cycle too, as ive already abandoned previous one for the same reason low response. I could then appeal for a change of medication /protocol based on the fact that my AMH is 26 meaning results should have shown a higher response as the egg reserve is there, but the protocol failed. Im on short protocol atm so no down regulation.

I was of the understanding that as soon as you start treatment, you have effectively used that funded round, but I think you might need to get some clarity on that through your clinic.

Personally I would up your dose and just continue- even a handful of mature follicles
could give you the eggs that you need to proceed. All the best to you x

AMH isn’t indicative of what you’ll get. My AMH is 1.9 but I get 6/7 eggs on collection. I think you was wrongly recommended to cancel the first cycle personally 😞

Would you mind me asking how old are you?

In my early 30s I had normal amh for age (I think around 34 or somehing can't quite remember) but I was a poor responder for both my egg collections. My consultant after my first egg collection (only 4 eggs collected, only 2 mature) said it was a low response but 'within biological variation'. AMH is not that predictive and some people just have bodies that don't respond well to stims. My second egg collection we changed protocol and I got 6 eggs, all mature.

I think you got very bad advice cancelling your first stim attempt to be honest, and if you did cancel cycle and appeal I think I'd actually put that in your grounds for appeal. I think you need to be very clear what will happen if you cancel this cycle, and I'd be tempted to go ahead if I'm honest in case you don't get another funded cycle.

And some reasurrance that you can have success with small numbers - I have 2 healthy children from my second egg collection 💛

@Lavendar01 I don't know enough about appeal difficulty. It sounds risky so perhaps continue after all (though it's the retrieval itself that is the expensive part). It's still early in your cycle so further follicles may appear.

Im 36, going onto 37 next month

Thank you everyone for responding. I got a phonecall from the nurse sharing that my day5 (sorry not day4 i calculated wrong earlier im actually on day5) blood test is showing estradiol levels at 1,300, the abandoned previous cycle first blood test was 931...apparently better indication this time round (at this stage im really not sure how much it all matters). I asked if the protocol can be switched up or stimming med changed, she said on the nhs, menopure is the only medication we offer, but if we were to go another round private, then we could consider other medication. So it seems like wouldn't be able to appeal for something that isn't even on offer yo begin with. I'm really praying for a miracle over the next upcoming days.

I'm 36, going onto 37 next month.

I was a poor responder too. But my second IVF clinic made a really good point - they were after quality not quantity. After my first cycle was abandoned, I switched clinics and although my second round produced only three follicles... two eggs were collected, both of them mature, both of them fertilized, both of them were transferred, and both of them stuck!

I've now got the most gorgeous, two year old boy twins. I genuinely cannot believe how lucky I got.

Don't lose hope. As the saying goes... It only takes one

Oh wow I can only dream of that🥹 so happy for you. May I ask if your second clinic switched protocol /med/ dose to help go after quality?

I also thought about switching clinics or getting a second medical opinion. A fresh perspective may confirm a current plan or highlight new options

So I had my day8 scan yesterday, right = 8 follicles in total and thank god all clustered together 10mm-13mm, can't see left side due to bowels in the way so annoying.

They upped my dose to 375iu menopur on the day5 scan (the day I made this thread). It seems to have worked, im hoping the follicles continue to grow together and in the end I get good quality ones from the 8 as worried about the attrition rate. I have another scan on Monday which will be day11, let's see 🙏🤞

Great news 👏 hope all goes well for you x

Don’t be disheartened with 8!

I got 6 eggs, 5 mature.
4 fertilised and all 4 made it to blastocyst stage 😊