Follicles not responding to stims

[CatSimp]

I’ve never posted on here before so I’m sorry for the long post.

I am 38, have an AMH of 2.1, all other test results are in normal range and my BMI is 32 which is something I’m working on. My periods are irregular, my last 3 periods have been medically induced.

Mid June I had my IVF baseline scan. Due to an enlarged follicle and the size of my uterus lining we could not start meds. We were moved onto the long protocol.

On 6 July I started suprecur. And on 17 July I started stims. Had my tracking scan today and my body is not responding. I have 5 follicles, 4 of these have not responded to stims (they only measured 5mm) and the 5th follicle measured 12mm.

Our consultant has said my options are:

1- Continue on this cycle but it is high risk, only 50/50 chance of the follicle having an egg and it is unlikely the other follicles will “wake up”. Plus we run the risk of the follicle rupturing.
2- Stop this cycle. Go back to day 1 and try a longer, lower dose of stims. In the hopes the follicles wake up. But again there is a high chance this won’t work, I might not even get one follicle and it will cost us all of our scans/meds again.

It is awful but the cost does play a factor because we can’t afford infinite attempts. The extra cost is significant to us and we’re not sure it’s something we can actually afford again.

We’ve considered a 3rd option ourselves.

3- Stop/cancel this cycle due to the minimal likelihood of success and consider it failed. Have a partial refund. Continue to work on lowering my BMI to try again but on the NHS, if we’re lucky to do so.

Can anyone offer any guidance or clarity on what to do?

Sorry you’re in this situation. Being brutally honest, at 38 with an AMH at 2, I definitely wouldn’t delay things.

Ive been in a similar position to you. It’s a bit of a gamble as no one can tell you what the outcome will be. And IVF can be so random with a lot of chance involved. If you can only afford one go then it might be worth cancelling this round and trying again doing something different to maximise your chances, but nothing is guarantee.

If it’s any help, my story is 1st IVF round did short protocol, got 4 follicles growing, was offered option to cancel or switch to IUI, but we opted to continue. Got 3 eggs collected, 2 were mature but only 1 successfully fertilised and made it to blastocyst - was transferred fresh, but failed to implant. Went straight on to a second round and tried long protocol with different drugs to try get more follicles. But this time was even worse - had 3/4 follicles, but only 2 ever grew to a decent size and only 1 looked good, the others stayed small. We knew this would be our last hope so continued to egg collection. A lot of clinics would have cancelled my round with those numbers. But we got that 1 egg collected and I am now 12 weeks pregnant.

I had very low AMH and it was declining quickly - went from 4.7 to 1.8 in about 6 months.

Good luck with whatever you decide!

Thank you for responding and congratulations, I know how draining our position can be so it's nice to hear there is hope at the end.

I think I'm in a similar situation you were in on your second round and actually if I try again I might not get even one follicle so end up worse. I'm just wondering if the risk is worth it with only one follicle.

Feeling a bit overwhelmed and unsure what to do I guess, I have one day to let the clinic know.

I think I would look at changing clinics. You need to look at what your FSH is at the start of your cycle. If it’s too high, you won’t respond to the stims. Suprecur will down regulate you (ie reduce the FSH) but it’s not the optimum route for someone with low AMH as it also suppresses your follicle count so you can start with lower. That being said, I’m 13 weeks pregnant from my wife’s round of IVF with two follicles that grew (both became blastocysts). The best option for us turned out to be oestrogen priming in the cycle before (to reduce FSH) and then a short protocol. You take it for about 7 days before your period starts, either orally or via a patch. That gave us 5 eggs, 4 blastocysts. She has an AMH of 3. Best of luck and don’t give up hope - it really does only take one.

Hi, thanks for replying and congratulations.

That was my concern starting long protocol with a low AMH, I did air this with the consultant but they said it would be fine. My FSH tested in the normal range. Unfortunately changing clinic and incurring all the costs again isn't an option for us.