Types of IVF treatment for very low ovarian reserve?

[magda22]

I am 37 years old and last year was found to have very low ovarian reserve with an AMH of 1.3 (possibly is lower by now) and an antral follical count between 1-5 depending on the month, but averaging 2 or 3. I was advised by 2 clinics to do Natural Modified IVF, a very low stimulation protocol which aims to collect one or two eggs naturally maturing. The argument was that women with such low ovarian reserves often don’t respond to conventional stimulation, resulting in cancelled cycles, and you may well get further with a Natural Modified approach.

I did 3 NM cycles with the following results: 1st cycle 4 mature eggs collected and fertilized, only one embryo was good enough quality to freeze. 2nd cycle one egg which did not fertilize. 3rd cycle one egg which was immature. So at the end I am extremely grateful to have one embryo to try a transfer, but two cycles failed altogether.

My partner is younger than me and not ready to start a family, so we are not planning to transfer right away. Given that in the future I will not have the option to try again if the embryo does not implant, I am considering a fourth cycle now with whatever is left of my fertility. I would love to have one more embryo if possible.

After the failure of my third cycle I enquired at two different clinics about how they would treat me. One suggested the results with standard IVF would be very similar and I should probably stick with NM for a fourth cycle (it’s cheaper and easier on the body), the other was very gung ho about getting me on full medication because ‘you don’t know how your body will react until you try’ and sometimes more follicles show up over the course of the stimulation. So I’m feeling pretty confused and wondering if any women here have similar fertility stats to me and have experience of success or failure with standard IVF, or NM IVF. Right now I’m feeling like I should try something different for my 4th go because NM failed for me twice, but confused by conflicting advice and opinions from fertility experts.

Any wise words greatly appreciated...

[Hidden]

I am so sorry you have had to go through all this. When will you be thinking of trying to use your eggs and have they given you any idea of the quality of the embryos? Xx

[magda22 in reply to Hidden]

The embryo I got is considered top quality, 8 cell grade 1. So I'm really glad for that. But I won't transfer for a year or so feel I want to try for one more now. Thanks for your comment 😀

[Hidden in reply to magda22]

That's great. You know you have an amazing quality embryo. Is it standard to wait for a year before you transfer?

[magda22 in reply to Hidden]

No, it's just our choice because of our current circumstances. Most people transfer soon after I think. xx

[Hidden in reply to magda22]

Ah ok. I understand xx

[Orla9298]

Hey, I have done two out of 3 of my NM 3 cycle package. I also did two “normal” ivfs on max dose before that and the results were very poor. The NM seems to be better for me. My amh is 2.7 ish. Did they change your protocol at all in the natural modified? My first NM cycle involved 5 days of tamoxifen and only 2 injections of low dose bemfola. Got 3 eggs and have 1 good quality frostie. My second cycle they upped my stims so still the same dose (150iu) but I did 7 consecutive days. This resulted in 6 eggs but the 5 embryos I got are all pretty poor, 3 are grade 5CD and then the other two are early blasts so not ready to grade. I made my clinic freeze them even though they have little chance. My 3rd and final cycle we are changing it a little again and doing daily stims from day 2, but omitting the tamoxifen and introducing cetrotide early on to suppress my LH as he thinks my eggs might not like LH.

I have in the back of my mind that if none of the embryos work, I might try another max dose round, but with a better clinic than my nhs one, but I’m also at the point of thinking of donor eggs. I think given the huge cost of the drugs when you do max dose, I feel like with my small chances we would be better spending it on donor treatment after the £12k we have already spent.

My NM clinic have actually cancelled me twice at baseline - I have had between 4 and 10 follicles at the start of the cycle. I tried to start cycle 3 last month but at the scan there were only 4 follicles and they just say don’t bother let’s wait til a cycle where you have more follicles in day two. Did your clinic manage your cycles like that? Ie scan you on day 2 and wait for a cycle with 5 follicles? As getting 4 in the first cycle is great and ideally that’s what you would want all your cycles to be like xx

[Globalstig in reply to Orla9298]

Hi - would you mind private messaging me which clinic you are using? I’m in a similar position amh wise etc and am looking for another clinic to try my next cycle with. Many thanks.

[Orla9298 in reply to Globalstig]

Sure xx

[Sarah_S]

I'm 37 with low reserve but slightly higher AMH than you. I had 3x long protocol cycles with max dose drugs, and never got more than 5 eggs, and never any top quality embryos. On the 3rd cycle none fertilised. They decided to stop blasting me with drugs and had 4th cycle on short protocol, with DHEA beforehand. Got 6 eggs, 3 fertilised and 2 good quality to transfer. So in my experience I would say don't go for long protocol, but maybe ask about short protocol? I was on Fostimon and Merional for stim drugs, with CARE Fertility x

[magda22 in reply to Sarah_S]

Thanks so much for the info.

I was on DHEA for 1 month prior to my first - most successful - cycle. I continued to take it and by the time I did my 2nd and 3rd cycle it was over 3 months of taking it. Clearly the idea of the cumulative dose improving performance has not worked for me. One idea I have for trying a 4th cycle is that I restart DHEA (I've now been off it for 2 months) and try to recreate the kick start effect it had for me in the first cycle. I was on bemfola very low does, so the idea of trying a different stimulation is also interesting. Thanks

[emu2016]

I was 34 when I did my first cycle. Short protocol ivf. I have very low AMH and AFC too. short protocol produced 2 eggs and neither fertilised. The quality was so poor. Lots of luck in your journey. Shorter protocols do seem to be a recommendation I see a lot where low AMH/AFC comes in to play x

[precioce]

I had an AMH of 1.3 4 years ago and get between 4-5 follicles as standard. I got put on DHEA straight away and tried 4 long protocol, max dosage rounds when I got pregnant twice but lost two babies. I started taking uboquinol and Omega 3 as well and had another long protocol round which was unsuccessful before switching clinics in Bristol to try something new and they recommended Natural Modified. We signed up to a 3 cycle package and we got pregnant on the first try with one follicle, 1 egg only. It was the best quality we had to date, grade 1. Was much nicer a treatment and worked for us.xx

[rivershark]

Hi there

I too have low reserves

After 9 ivf cycles (6 to do embryo freezing) it seems for me I respond much better to lower meds at the start of treatment. I have done mostly modified natural cycle but have also started 2 cycles on 600 the highest dose which yielded the first time one follicle one embryo and the second time one poor quality egg that disintegrated. Using natural modified with a dose of 75 (fostimon or merinol) at the start I have always had more than one follicle growing and on 3 occasions we had 4 follicles growing.

modified natural cycle aims at better egg quality by using lower doses of meds

My clinic has frozen the embryos straight afterfertilization. Perhaps it is worth asking about this ? It is supposed to be better for the embryo to freeze before they divide but of course we do not know the quality of the embryos

Wishing you best luck with your journey

[Orla9298 in reply to rivershark]

How are you getting on with the 6 rounds? When do you think you will be doing a transfer?xx

[rivershark in reply to Orla9298]

Finding it exhausting ! We don’t know yet when we will transfer

How about you? Are you doing any more frozen rounds?

[Orla9298 in reply to rivershark]

We have our last round starting next week then we will work out when to transfer. I have a hysteroscopy booked for 11th June as part of miscarriage investigations and I’m considering the nk test before transfer xx

[rivershark in reply to Orla9298]

Oh best of luck for your last round and for the hysteriscopy. Have you had tests for clotting disorders ect? Are you taking high strength omega 3 (DHA and EPA)? As I read that can help if you do have high nk cells

[Aefemera]

Hi Magda, I was just told today that I have a egg count. I’ve been having irregular periods and not ovulating.

On the ovaries scan, there were zero follicles and the doctor told me that I might not be able to do ivf or IUI.

I don’t know what the results are on amp but what are the chances of conceiving?

[Hidden in reply to Aefemera]

If you have no follicles at the moment then it might be time to consider donor eggs? Xx

[magda22 in reply to Aefemera]

Hi Aefemera, you'll have to talk to your doctor about chances of conceiving, certainly you do need some follicles to conceive with your egg, but this can change from month to month, so might be worth trying again. I guess The truth is, with few follicles the chances are low, but not impossible.

Of course there are other ways to become a mother - donor egg, surrogacy, adoption. I know that if my IVF treatment doesn't work I will start thinking about that. For me these are wonderful options. But it's very personal, I think everyone has to find the right path for them, and at the right time.

I wish you lots of love and luck! Fortunately there are many women on this forum ready to share advice and experiences and to give support xx

[magda22]

Thank you so much everyone who commented - theres a treasure trove of knowledge and experience here!! Xx

[Alexie07]

hi! Do you mind me asking where you ended up?