Low ovarian reserve - what was your protocol?

[Skittles11]

Hi ladies

Am interested in hearing from anyone with low ovarian reserve in terms of what your protocol was for IVF. I have had a number of cycles with mixed results and have recently consulted with two new clinics - their recommended protocols for me were very different from each other.

So I'm interested to hear from anyone with low ovarian reserve as to what protocol you were put on by your clinic.

Thank you as always ladies x

Edit: By low reserve I'm particularly interested in the protocols where AMH < 9.00 and / or where FSH > 10.00 (my AMH has measured at 3.5 and also at 9.3 🤔)

[XOXO13]

Hello,

So my Ovarian Reserve is on the lower end of normal for someone of my age, so it’s not low low but not high either! With my first clinic, they recommended long protocol and told me I wouldn’t get too many eggs. I got 8, 7 mature and 7 fertilised. With my second clinic and second cycle, they recommended a short protocol and again said I wouldn’t get many eggs but not to worry as it’s about the quality. I got 9 eggs, 8 mature and 8 fertilised. So both protocols worked for me. Whilst I didn’t get many eggs vs some, I had age on my side and therefore the quality of them seemed to be good.

I preferred the shorter protocol, it was tougher and more advanced than the long protocol and therefore I felt the effects more, but the long protocol really felt too long and I felt more exhausted from it. I also felt more bloated on the long than I did on the short for some reason.

As I said though, I don’t have low, low ovarian reserve, just not the best for a 30 year old (it’s like 9 on the scale).

Xx

[Purpledoggy]

It depends on how one defines low OR. I am classed as having low OR but that is mainly due to age - my AMH was 7.6 pmol/L when measured at 39yo. It's not a bad level for my age but still classed as LOR relative to all women in general. I did basic long protocol (downreg buserelin, stim with FSH (Bemfola)) and had good results on the 2 cycles - 8/9 eggs, of which 7 on both cycles were mature and fertilised normally, then 4/5 blastocysts. My clinic use long protocol for those at less risk of OHSS but I don't know what they use if AMH is very low (eg <2 pmol/L). xx

[Kichwaa in reply to Purpledoggy]

Hi purple.Which day did you start the Buserelin? How long did you stim with it?

[Purpledoggy in reply to Kichwaa]

I started it on d19 cycle 1 because my natural cycles had been 26 days, and I think d20 cycle 2 as they had been slightly longer. Cycle 1 I was on buserelin for 2 weeks, cycle 2 for 3 weeks. This is because it took me longer to bleed and downreg on cycle 2. They don't ask you to check ovulation but I did anyway because I had been monitoring it. Cycle 1 I ovulated as expected on d13 and had a bleed I think d28/29, so only needed to be on buserelin for 2 weeks total. Cycle 2 I ovulated late on d18 ie only 2 days before I started the buserelin (instead of the expected 6-7 days). This delayed my period significantly so cycle 2 I was on buserelin for 3 weeks in the end. It did not seem to hurt as cycle 2 was my successful one. xx

[Kichwaa in reply to Purpledoggy]

Thanks for the feedback.Congratulation dear.My best protocol was with Buserilin but I lost my twins at 26 weeks due to Preclampsia and Hellp syndrome.

[Purpledoggy in reply to Kichwaa]

I'm so sorry to hear that, that's heartbreaking. I wish you so much success on this round xx

[jengi]

My AMH was 1.4 pmol/L at 38, FSH was 13 (I think!). Short protocol was disaster, tried 4 times, only ever harvested 1 egg which failed to fertilise with IVF. Long protocol resulted in 4 follicles, 3 eggs retrieved. The one mature egg didn’t fertilise with ICSI. The other two were immature, one of which matured overnight in lab & fertilised next day. It was considered a poor grade embryo. Transferred at D3, didn’t work. What I know now is that the first division didn’t go very well. Apparently, the earlier things start to go abnormally the less likely a positive outcome will happen. I had to accept that I not only had low egg numbers but egg quality was also very poor. We eventually moved to donor eggs and I’m typing this as I nurse my 9 month old boy. He is my world. I wish you all the best of luck. Look after yourself & each other because it is a very tough journey, both physically & emotionally. Please feel free to PM me if you eve need to chat, off load or discuss advice etc. Xx

[Pnw2020]

Hi Skittles,

My AMH dropped from approximately 8 to 5.4 in one year (tested via medichecks and with clinic at both results very similar). I had two fresh short protocol IVF cycles with max dose stims - gonal f 450 for a few days that was then changed to meriofert. Same drug protocol for both cycles (costly due to high hose stims!). I can't recall the exact AFC at baseline but it was higher the second cycle. First cycle I got 5 eggs,4 mature, 3 blastocysts and 7 eggs, 5 mature and 4 blastocysts the second cycle. So not loads of eggs but each time all embryos became blastocysts, which is apparently quite unusual. I may not have been suitable for long protocol due to history of DVT/PE so I was put on aspirin and clexane after egg collection.

[pink_lemon]

Hello, I had AMH 1.9, fsh perhaps around 12, can’t remember exactly. Short protocol with lower dose meds and 5 eggs (out of what I was told was 1 follicle - obviously there were more. This was the best cycle. One month break. Short protocol again, highest possible meds, 4 eggs from 4 follicles, all fertilised but all stopped developing. I had decaceptyl as trigger, which as far as I understand acts similar as the down regulation part in long protocol. I wanted to do another cycle immediately as my period just started the day I learned we were going to have no embryos from that cycle. My doctor said he would try long protocol with me but took my bloods first to check levels. The decapeptyl pushed my fsh down to about 7, so he said let’s just try short again as I was already where he wanted me to be to start with. He upped the stim meds too again. 10 eggs collected. 5 fertilised but 1 five day embryo only. My doctor mentioned that long protocol can give 2-3 more eggs on average but quality can be compromised. He specialises in low AMH. So the first lower stims cycle was the best for us really - 2 nice blasts out of that one. I thunk there is no one size fits all recipe. You just have to try what happens/works for you.

[Linzeeee in reply to pink_lemon]

Sounds like what the doc did worked. May I ask which clinic you went to? And where it is ? I have low AMH too and had two rounds already which failed spectacularly.. thanks !

[pink_lemon in reply to Linzeeee]

Hi Linzeeee, I am not in the UK or Europe so I am afraid my clinic/doctor recommendation won’t be much use for you (unless you live downunder). If you still want to know, feel free to dm me, I think we are not allowed to share clinic names publicly.

[zytajones]

Hello!My AMH is extremely low for my age (0.9 pmol/L) where AFC was not too bad (I think it was around 8).

Recently while on long protocol, they collected 4 eggs, 3 fertilised, and 2 were great quality. But it didn't result in pregnancy.

Now I'm on long protocol again, Friday I should now how the follicles growth looks like.

In the past (6 years ago) I also had a long protocol (AMH was around 3) - they collected 7 eggs, all of them fertilized, 5 was of great quality, but only one resulted in my son.

So for me it works overall, but yes, it is loooong, and very tiring!

[Rhubarb5]

Hello,I am interested in this too. I have low AMH (8.4 when I was 33 which was a year and a half ago) and have had 2 fresh cycles. Both cycles were short protocol, one with Gonal F+Luveris and one with Pergoveris. Both times I got embryos but no blastocycsts. First one was an ectopic pregnancy, second one failed to implant. What have the two clinics recommended for you?

[MsLuna]

I have very low ovarian reserve at 2.8mpol and I’ve just started a short cycle (currently day 3) I am on 300iu of Ovaleap then 0.5m of Fyremadel. I am not doing a transfer at this time, just trying to make some embryos to freeze for later on,

I had 10 follicles at my scan back in October when i had my AMH blood test done. I had 8 follicles on Monday at my baseline scan, may have more as one ovary was half hiding. Whether they all have an egg and will grow, who knows!?

I am only doing one cycle though as I’m on my own and get no funding. I’ll let you know how I get on and if I get any eggs! 🙏🏼

[Lemms]

Hi Skittles.

I’ve been placed on long protocol. Down regulation with buserelin (for a whole month due to scheduling at the clinic) then gonal F. Haven’t had egg collection yet but my early scan found 8 follicles but only 6 likely to be good enough in size.

It’s interesting to hear all the different approaches. I’m already expecting this cycle to fail and wondering what I’ll be placed on next time.