ICSI IVF, Follicle Growth. I'm In Need Of Advice.

[sparkle183]

Hi everyone,

So a bit of our story.....i have a Very Low AMH Level, we have had two previous ICSI IVF cycles which unfortunately failed. The first round, one mature egg and one immature egg were collected. I believe this round failed because the egg quality was poor, it didn't even fertilise. The second round, one mature egg and one immature egg were collected again. Egg quality looked great and the egg fertilised, but unfortunately the embryo didn't implant.

I've been told because of my very low AMH level that I can only expect 1 mature egg each ivf cycle.

We've just started our third round. I started Menopur 450iu on 1st December 2021, and started Cetrotide 250mg on 2nd December 2021. This morning (9th December) I went for my first of three scans.

I have 5 follicles which for me is fantastic as I have a very low AMH Level and so for me this was great. But...two of the follicles are already quite big, the dr told me that these two follicles grew faster than they should have and will unfortunately be poor quality and so would have a poor quality egg inside if there were to be an egg inside them.

They are going to continue meds, and concentrate on the three good sized follicles. In hopes that, that will be where my egg will be.

My worry is that since I only have produced one egg during egg collection up until this point, that my one egg would be inside one of the bigger follicles and so would be poor quality. Instead of one of those good sized 3 follicles. I know there is no way of knowing which follicle my egg is in until egg collection.

I don't know whether to cancel this round, or to continue?

We don't have a lot of money and this may be our last try and chance at ivf and having our own baby.

I'm scared, has anyone else had this same choice to make?

What would you all do?

Any help, advice, or opinions would be greatly appreciated.

Thank you xx

[Spheres]

I had a similar situation in my first IVF cycle (I also have very low AMH). What my clinic did was that they allowed the bigger follicles to grow bigger than usual before trigger (standard is 18mm, but mine reached 22-23mm before trigger). In such case you still have a chance to save the leading follicles which grow quickly, but you also give time for smaller ones to catch-up. Perhaps this would be an option for you too?

[JA-fnuk Partner Nurse Fertility Network UK]

Hi sparkle183Maybe you should talk with the clinic/doctor to see what they advise your next step to be- tell them all the points that are concerning you they know your history and will want what is best for you

Thinking of you

Janet

[Marisa32]

It looks like you are only making 1 mature egg pre cycle with stims, which is what happened to me. The stims aren't increasing your quantity and I always felt they fried my eggs and made them worse. It's best to do natural IVF (if you need IVF for whatever reason like blocked tubes etc), or IUI or trying naturally without pumping your body with meds. It will take many cycles to find 1 good egg but it is what it is for us low AMHers.

[DianeArnold Partner Nurse Fertility Network UK]

Hi sparkle. I would have thought that if and when you go for egg collection, if the large follicles are still there, then they will be aspirated too? Sometimes it can be better going for the long protocol, even with a rubbish AMH, as Cetrotide can stop you ovuating, but can sometimes prevent the smaller follicles from maturing. Dificult decision making when you have two groups of follicles at different stages of maturation. Thinking of you and wishing you both all the best. Diane

[MrsOrangejuice]

On my first round they started me on very low meds as I have a high AMH but nothing really happened so they kept upping them. I had two big ones at around the mid point and not much going on until they upped the meds a lot more, then smaller ones came through quite quickly. By collection (after 17 days of stims) I had a couple of very large ones which they said could be cysts but we got 9 eggs including from those big ones. NHS waits even on FETs were huge so had another round privately straight after and at day 10 I had one follicle that was over 15mm - they wanted to cancel as they said it would become a cyst and I'd waste my chance and money. I carried on as the previous round had worked out eventually and went up to max meds - 17 days of stims again and we got 5 eggs including from the big ones (no idea what size they were by then but at least 22mm at the last scan) and from some small ones that had come through right at the end. So I don't think AMH always works with how you react and how many eggs you can get, or quality. Also, my lead follicles slowed while small ones came through and caught up, after stimming on max meds for ages - I'd heard stores about overcooking and frying (not very helpful terminology!) but they were all fine. Your recent results sound better than what I was gambling with so I hope it works out if you decide to carry on, but the pressure of the decision is horrible - I just went with my instinct and hoped I could be at peace with whatever the outcome was X