Age 43, AMH and AFC ok. High or Low dose stimulation? Hysteroscopy? Additional tests?

[Orangeflowers]

Hi all,

I've approached 2 clinics in Greece. Each have offered very different protocols.

A - One in Athens is suggesting clomid (x3 a day) with perhaps 150 menopur added on, aiming for better quality eggs. They say I have polystic type ovaries (not the syndrome)

They are also saying I need a hysteroscopy. I've had no polyps or anything on my scans and no other clinic have suggested it is repeated, so I'm not sure it is worth it? It costs the same as in the UK.

Also they are suggesting a lot of sperm tests and fragmentation tests, although my partner is already on supplements and we are using ICSI, so I'm not sure the results would be that useful?

B - The other, based in Thessaloniki are suggesting 375 or 400 units of a stimulation drug such as Merifert or Menopur. They are keen on PGT-A testing.

My AMH is 13.6 and AFC 14. I've had a total of 3 fresh cycles:

1) Age 41 - IVF - 300 stim, decreasing to 225. 1 3ab fresh transfer BFN. Double transfer of x2 day 6s on frozen cycle - daughter born, now 13 months

2) April this yr - IVF - just turned 43 during cycle - 450 stim - over 30 follicles by day 9 - used alternative non HCG trigger - 18 eggs collected - 13 mature - 2 fertilised! 2 blasts on day 5 - one transferred BFN; other still frozen (grades 4bb)

3) Cycle in July - ICSI - 300 stim - 11 mature, 6 fertilised, 2 very early blasts transferred fresh on day 5, one frozen day 6 4BC+ (not as good grades as round 2)

I'm worried that due to my poor embryo development I could be left with no blasts on a low dose protocol (A, Athens). Otherwise it seems attractive, but I am wary of the add ons...

Has anybody with a reasonable AMH tried a modified natural/ mild IVF and it has been more successful?

Thoughts and experiences appreciated

Hope all is well with everyone 💜

[Ell493]

Do the hysteroscopy right before transfer. It helps the embryos stick.

[Orangeflowers in reply to Ell493]

Thanks for the advice 💜

[Bomboncita]

Hi, I can't really tell what's best but I see that you still have follicles and eggs. I had a hysteroscopy last year but it was because my doctor saw that my cervix was narrow and croked, which made transfers difficult and painful. Still painfull though but that's a small price if i want to succeed. I will be happy to hear how things go for you. Perhaps other ladies can give you advice. Fingers crossed 🤞

[Orangeflowers in reply to Bomboncita]

Thanks for sharing. I've had one before and found it painful. I'm not sure of the benefit of another if I don't have anything flagged to investigate. But as other poster has said it may act as a scratch, but is quite a bit more £

[McQueeny in reply to Bomboncita]

Hello. Sorry to jump in like this, but can you explain the need for the hysteroscopy please? My cervix is also narrow and crooked, some transfers have been totally fine, others a bit awkward, but a hysteroscopy was never mentioned? Thanks ☺️

[Bomboncita in reply to McQueeny]

Hia,

during my first transfer my doctor got worried when she saw that she couldn't get the 2 embryos inside. For 20 mins she was trying without luck. She looked nervous.

Anyway, after that she told me that the start of my cervix is not only very narrow (they struggled to find the right size equipment) but also in a weird angle. Great.

After that experience, every time I have had a transfer the doctors liked to do a mock test to make sure that they can manage to get through successfully.

Transfers are a painful experience for me.

After my first transfer, the doctor recommended a hysteroscopy to dilate my cervix. After the surgery they also found that I have moderate endometriosis. So in theory it is good to know this but honestly I can't tell much the difference as transfers still hurt (and usually I'm ok with needles and all that).

So going back to you, perhaps in your case it is more manageable and that's why it was never mentioned.

In my case I wonder if it is scar tissue that has caused the cervix being in a weird angle.

Good luck to you my lovely.

[McQueeny in reply to Bomboncita]

ah I see…. Ok, thanks so much for explaining. Good luck to you too 💫🍀x

[JoyfulStar]

Hi Orangeflowers, your age attracted me to your post as I had success aged 43 a few weeks before my 44th birthday. You have great AMH for your age. Mine was 9 at 43 and was considered quite good.

Like you I went to several clinics and two suggested high doses and I suggested mild IVF. After weighing up the information I went with the clinic that did not push add ons. I have always been wary of them especially given the information the HFEA has on some of these add ons.

I had ICSI and the one thing my clinic suggested was back to back cycles of IVF to take advantage of my age as they said they rarely saw success in older women using their own eggs. So I had 2 cycles where embryos were frozen and a fresh transfer on the third cycle which worked. I did no add ons and was on a pretty high dose. I would definitely be wary of PGS testing if you do not have many embryos to “play with”. I can’t comment on hysteroscopy as I have never had it.

All the best and I will be rooting for you 🙏🏾

[Orangeflowers in reply to JoyfulStar]

Thank you so much, that is super helpful. I am thinking that I'll go with the higher stim approach. You give me so much hope. Congratulations x

[JoyfulStar in reply to Orangeflowers]

You’re welcome and all the best hun x

[Bomboncita in reply to JoyfulStar]

Oh wow, you give me hope! Sorry to interrupt the flow of conversations but did you do anything special that may have improved chances?

[JoyfulStar in reply to Bomboncita]

It is hard to know what made a difference but I wanted to do what I could do to improve my chances so I took CQ10, ate 2 portions of oily fish a week instead of fish oil tablets, exercised a lot, cut out alcohol and during stims stopped taking caffeine.

I also think the back to back approach worked for me as it improved my odds with my body responding better to the stimulation drugs each subsequent round. My reasoning is that if my chances were about 1 in 10 eggs being good quality, then if I had lots of egg collections in one go without a transfer, at least one was likely to stick.

I really hope you get your miracle. 🙏🏾

[Bomboncita in reply to JoyfulStar]

Thank you for sharing your experience 🤗

[Kichwaa in reply to JoyfulStar]

How long did you wait to do the back to back cycle.Did you wait for like a month or more? Thanks

[JoyfulStar in reply to Kichwaa]

Hi, I had a month between each back to back cycle. So, cycle 1 was in January, cycle 2 in March and 3rd cycle was in May. I was on a short protocol.

[Star3129]

Hi Orange flowers,I recently had a hysteroscopy done which was suggested to me by many doctors as I have implantation issue until now so i would highly recommend doing it as it can help your doctor see and put you on a treatment accordingly. My Doctor also said it was difficult for her to enter as the cervix was narrow and she said she has curreatred if I remember proper.

All the best in what you decide.

[Orangeflowers in reply to Star3129]

Thank you x