High AMH but poor egg quality

[TheFoxes]

Hi All. Just 2dp5dt from my second cycle. I only had one viable embryo at the end of the first cycle and was really disappointed that it was the same story this time. I collected 15 eggs, 9 fertilised but day 3 only 3 embryos and by day 5 only one was suitable for transfer and the others were graded 3cd so not suitable for freezing. In both cycles I have had a short antagonist protocol (12 days of gonal f with 7 of cetrotide). I have high AMH for my age (I am 36 and AMH is 29), my fsh is 6.1 and basically everything is normal, there are no foreseeable issues that have been uncovered by testing. Dr isn’t worried about my AMH. So the problem seems to be egg quality and I have taken all the supplements (not DHEA because it is only recommended for women with low AMH). Supplements have made no diff. I don’t smoke, I don’t drink alcohol and my diet is fairly healthy (not perfect but not bad).

We are a gay female couple so not entitled to any free NHS treatment which means we’re like £20K down already and money is fast becoming an issue.

Here is my question. Has anyone with a similar issue had success with a particular protocol? I do feel positive about the embryo that has been transferred but am realistic that I may require future intervention and am keen to hear if anyone found a treatment cycle that worked well for them in similar circumstances.

[soccerkt6]

Heya, sorry to hear that you only ended up with one suitable d5 blast but I'm hoping for you that the transfer works!

Have you had your glucose and insulin levels checked? There's not a clear medical consensus about the relationship between high AMH and insulin resistance, but some studies have shown a correlation. If you do have some insulin resistance, myo-inositol (if you're not already taking it) would help improve your insulin sensitivity as well as improve egg quality.

You may also want to check what your most recent LH numbers were. LH and FSH should be in about a 1:1 ratio, but if your LH is 2-3x higher than your FSH it can be an indicator of a metabolic imbalance. Good luck, keeping things crossed for you xx

[Millbanks]

I don’t have high AMH (13) but my most successful cycle was with gonal f & menopur (with higher dose of menopur which is supposed to help to mature the eggs more I believe). The trigger was 12,500 Gonasi and I think the strong trigger also helped to mature the eggs. We got 8 blastos from that cycle compared to 2 from the previous cycle with higher gonal f and lower menopur. Although I’m still not pregnant so who knows if that is better... x

[TheFoxes in reply to Millbanks]

Hi lovely. Thanks for this. Really interesting that the medication may have created such a different outcome. 8 is amazing! I am not sure that supplements really make any diff or lifestyle really apart from the obvious which is be relatively healthy and don’t smoke, drink etc.... It’s kind of crazy-making isn’t it? I feel like you just shed £1000’s and so much physical and emotional investment to be none the wiser really. 🤷🏻‍♀️

[Millbanks in reply to TheFoxes]

I really do think the protocol of drugs is the most important factor for creating embryos - like you say, you can take all the supplements in the world, be fit and healthy and if you're not on the right doses of meds it can all go to s***But then on top of that the embryos have to be "normal" which is another thing entirely. I do think that taking a high dose of ubiquinol helped us to get better quality embryos - but we still don't know if they are normal so who knows.

It really is enough to drive you crazy - so many variables!! The good news is that we often see on here that people often get their BPFs with low quality embryos - so there really is no rhyme or reason to it. xx

[TheFoxes]

Thanks Soccer- it’s interesting you say that because I have a general “feeling” that I am sugar sensitive. I have been tested for diabetes many times and I am nowhere near diabetic but I have a general sense that sugar doesn’t work well for my body because of tiredness, thirst, need to pee frequently. I did take Myo inositol but it doesn’t seem to have made any difference. Maybe I really need to be very disciplined with sugar. Gah! I wonder if it would really make any diff. Thanks for the tip on LH v’s FSH I will def bring this up with my doc. X

[soccerkt6 in reply to TheFoxes]

Oh interesting. Yeah, if you already had a sense that sugar doesn't work well for you then I would definitely try cutting it out. It's an inflammatory food and causes low-level, persistent inflammation in lots of people. There's also a huge grey area between ideal blood sugar, “normal” blood sugar, and diabetes, so it's possible to have some low-level insulin resistance that isn't being flagged. I actually bought an inexpensive glucose monitor (like diabetics use) so that I can check my fasting glucose levels in the morning and while I'm nowhere close to diabetic, my levels are higher than normal. Knowing that has given me a good incentive to keep on track with exercise and avoid added sugar.

Lately, I've been relying quite heavily on dates to satisfy any sweet cravings. Also dark chocolate (anything above 70%) is healthy for lots of reasons so it's the one thing I eat that has added sugar.

I can't say that cutting out sugar will make a difference in the egg quality, but it definitely won't hurt! xx

[TheFoxes in reply to soccerkt6]

Thanks Soccer. This is so interesting. You are so right, I may not test as anywhere near diabetic but I should just listen to my instinct on this one. I don’t eat tonnes of it but honey on my porridge, and maybe a dessert once per week. Have a 2 of squares of chocolate everyday which is mostly 70% but sometimes not. Also have the odd low sugar oatcake and you know there are probably other sugars slipping in unconsciously (bread maybe?) that I don’t even think about. Hopefully I am preggo but in any case it won’t hurt to address this for long term health. Thanks for sharing your approach- I feel empowered 💪🏼

[soccerkt6 in reply to TheFoxes]

Good luck! I've also found that so many random items have sugar added...like mayonnaise and mustard. Granted, they contain small amounts, but if I'm giving up biscuits I don't want the odd bit of mustard to be what's ruining my sugar-free streak! 🤣🤣 xx

[Bluebirds7]

I had good AMH but took DHEA. I was getting pregnant naturally but having miscarriages. I did an IVF cycle which included Human Growth Hormone and it was successful! No idea if it was the HGH that helped but as I understand it, it does help with egg quality. Which at my age of 42 (at the time) was most likely the problem since my AMH and FSH etc were all great!

[TheFoxes in reply to Bluebirds7]

Thanks Bluebirds. That’s awesome! Congrats. Am off to research HGH 😬

[Anonymous501 in reply to Bluebirds7]

Hi, was that HGH called Zomacton?

[Bluebirds7 in reply to Anonymous501]

Yes it was.

[McQueeny]

Heya. No real advice to offer, but a similar-ish situation - I have a good level of AMH (25 at 38yrs) but both my cycles (which were done almost three years ago) had good egg yield and poor embryos - 17 eggs collected, 12 fertilised but by day 5 only 2 blastos! First cycles both came up BFN, second cycle we got our BFP..... so you only need one ☺️ We are currently trying for a sibling and doctor recommends to just try the same again with slightly higher stim doses as I’m 2.5 years older .... 🤞

[TheFoxes in reply to McQueeny]

Congrats! Thanks McQueeny. Hopefully this is the one 🤞🏻

[Lozza8]

Hi there

I found this research very interesting from CHR in the US..

centerforhumanreprod.com/fe...

It talks about a certain type of PCOS patient having low androgen levels (like me) and DHEA supplementation ahead of IVF helping them. I’m trying it this cycle as my IVF history is very bleak and I feel I have nothing to lose by trying. If you do go down this route, make sure you test via medichecks before starting and regularly test throughout (every 2 weeks) until you get it right. My dose is so so low but hoping it’ll help 🤞🏻 Wishing you all the best

[TheFoxes in reply to Lozza8]

Thanks Lozza. This is really interesting. Really good luck with your cycle. Everything crossed for you. Xxx

[Lozza8 in reply to TheFoxes]

Thank you! Be careful with it, clinics in uk will not recommend it so just ensure you research it and keep an eye on your levels 😊 xx

[TheFoxes in reply to Lozza8]

Will def discuss with my consultant. ❤️

[Crabonks]

Hi there. I have AMH of 45 (I'm 42) and had 30 eggs removed, 18 mature, 4 fertilised and 2 made it to day 5 for the PGS testing - of those 2 only one came back as a possible transfer (low level mosaic trisomy X) but I'm currently 15w4d and all is looking well - she's even corrected herself and no longer has the extra Xs. I had pre-diabetes and so my endocrinologist put me on Metformin before I the transfer and now I'm on Insulin as pregnancy makes you more resistant. I also am on levothyroxine for a "normal but slower than we want for a healthy pregnancy" thyroid function. My Antagonist protocol (I'm in Canada so might be named differently) 2 weeks of birth control, 10 days of Menopur and Rekovelle then Cetrotide and then Decapeptyl for the trigger (no HCG as I was a potential for OHSS - which I didn't get in the slightest).

[TheFoxes]

Ah wow. Congratulations. Thanks for sharing this awesome story. Xxx

[Crabonks in reply to TheFoxes]

Good luck! I really hope you get great news!

[Spicycurry]

I’m so sorry. It’s frustrating. Could you do Access Fertility? Also, with a high amh, could you do mild stim cycles? That way it only focuses on quality and not on quantity. Also sometimes things like cetrotide can affect egg quality. Also, are there any factors affecting sperm quality? Could they use IMSI instead of icsi and/or do a dna fragmentation test?