So confused! IVF over 40 and low AMH

[Louise_2023]

Hello everyone.

I’m at the beginning of my journey. I am looking for clinics globally, the advice is so mixed!

I have a low AMH - 2.8 and am 42.

Clinics offering:

- mild ivf

- multiple I’ve cycles and then fert/ transfer of those which pass PGT screening.

- standard ivf cycles one by one with no PGT.

I am so confused and have no idea what to do, given the costs it’s important to make a good decision.

Is PGT necessary or advised due to age?

Success with multiple collections and one implant.

Is Mild IVF worth a try? How to work out which option is best? What tests/ results will help to identify the best course?

Gosh this is hard

Any advice very welcome.

[Hidden]

Hi Louise, it is indeed a hard journey with many difficult decisions. I had the same AMH at 38 (I’m 40 now) and went for a natural and a mild cycle. These work better for us as there aren’t many eggs to retrieve and stimulation doesn’t do much of a difference. We retrieved one egg in each of my cycles so even the mild stimulation didn’t achieve more than the natural cycle. Banking is a good idea so I would buy a package of three cycles instead of paying for individual ones. It’s cheaper on the long run and you have more chance of getting a blastocyst.

We paid for PGT but haven’t got the chance to use it yet as no blastocyst for us. (We wanted the test due to our age and having a piece of mind.) But each case is different and you might get much luckier than us. Fingers crossed you will. Good luck with your journey.

[EllieHere369]

Hi

I was in your boat last year and picked embryo banking with testing. After my first conventional cycle yielded poor egg numbers I went on to mild ivf.

All the methods are a gamble of sorts because they won’t know how your body will respond until you try.

PGT is advised because of the high incidence of eggs with chromosome abnormalities that are common at age 42. It’s not mandatory there’s some controversy about it but if you do get an egg that passes the test you’ve got a good chance of pregnancy.

My advice would be prepared to be to make a choice with a back up plan & knowing that whatever you pick is uncertain because the whole field is somewhat uncertain and we are each unique cases.

Good luck

[Systema23]

Hi Louise. I am 40 and have an AMH of 2.8. Like you I looked into PGT-A testing. I decided to proceed with it based on my age, What I will say is this, PGT-A testing does take longer to get started. So I had a failed cycle in November last year. I initially spoke with a nurse in December about starting private treatment and she kind of put me off the idea. We agreed I would start ICSI 3 months later, which would give me a chance to take DHEA for 3 months before starting treatment. The thought of PGT-A was still niggling at me, so I researched a bit more. I paid for my treatment at the end of February and was booked in to start my new cycle in March.

I emailed the nurse outlining the evidence I found and stating, on reflection I would prefer to go with PGT-A testing. I figured I would remain with the same dates, pay a little bit more upfront and all would be good. I was totally wrong. I needed to have an appointment to do special consents which I couldn't get till mid April. My treatment won't start till end of July (as it is based on the dates available with the clinic undertaking the biopsies); it will take my hospital 6 weeks to get back to me (at least), with a view to transferring (if I have any to transfer) 2-3 months later.

All clinics will be different so please don't be put off, just ask the questions. I will say that I do not regret my choice to undertake PGT-A testing as my embryos were very poor quality the last time - the best was a 3AB grade embryo, although I managed to fertilise 7 eggs (at 39 years). I merely regret not trusting my instincts and insisting on it sooner, so there wouldn't be this delay. I based my decision to opt for PGT-A testing on age; the fact that I produced a lot of embryos last time; and my limited finances - I can afford one cycle so I wanted to make sure I give it everything I got. My rationale is - if, due to the supplement; diet; exercise and mindfulness changes I make I produce a lot of better quality eggs (egg quality seems to be the predominant factor in unexplained infertility in my experience), I do not have the time or finances to waste on implanting eggs which are chromosomally abnormal eggs, which may not result in a live birth. What I will say is this. PGT-A testing does not guarantee a pregnancy or baby at the end of it. It merely offers you the opportunity to transfer a chromosomally normal or low level mosaic embryo, which is good, but it does not guarantee that implantation will be successful. I wish it did. I took the view it will increase my chances, that's all. The downside is, if the biopsy does not show an embryo as euploid or low level mosaic, the clinic will not transfer, even if it is a 4AA or 5AA graded embryo, so you risk discarding good quality embryos. All clinics are different in every country, so check with each provider and look at each country's governing body website for more information.

This is a personal choice for you, all I would say is do your research; weigh up the pros and cons and trust your instincts. Whilst the wait to start treatment is unbearable for me at times, I hope that the fact that I will have had 8 and a half months of supplements; dietary changes and exercise has negated the fact that I will be fast approaching 41 by the time I do my egg retrieval and will hopefully have increased the quality of my eggs enough so that next year I produce a healthy baby.

Sending you lots of baby dust xx

[DianeArnold Partner Nurse Fertility Network UK]

Hi. If anyone replies mentioning clinics by name, please do so by PM/DM so you don’t advertise. Thank you. Diane

[Daughterofaking]

Hi, I will say for your age mild ivf with will be better as this increases your egg quality. It addreses the quality of eggs rather than quantity. n my opinion, there is no point having more eggs of less quality that will not result in pregnancy rather it's better to go for few eggs qith high quality that will result in a possible pregnancy. At age 38 I did a mild ivf and had 9 eggs retrieved, 6 fertilised and 5 blast. Transfered and had a positive pregnancy at my first try and still had good quality of embryo to bank. I later had a natural pregnancy after my first child. I wish you all the best on your decision.. xx

[Louise_2023]

thanks everyone, for reference… I’m single and also doing this privately.

I am finding the advice so mixed and it’s really difficult to process… I know it’s early to be stressing about it but I just feel so much pressure and am so uninformed!

Appreciate the support and advice ❤️

[Hidden]

hi Louise,

I’m 39 and my partner is 45. I can relate to your difficulty understanding all the choices. We had hoped for a lot more explanation and assistance in making the right choice from our clinic (privately funded). But felt that we were basically sent a price list and asked to choose. We didn’t get any information about timescales at that stage and that is something I would with hindsight absolutely insist on knowing (as someone said above - particularly with embryo testing). I do find that our clinic was very evasive on time scales and the reality was once you paid your money you were at their mercy to finally get you a date for your cycle - so which ever option you go for, particularly give age is a factor, I’d try to pin them down on this. I don’t know what other’s experiences are?

We went with privately funded ICSI but decided against the testing because of the massive delay, and that I had heard that embryos are also lost in the process due to them having to be frozen to be sent for testing. As it was we only had 1 embryo on transfer day and that was a low grade CB which I would be nervous if it would have survived a freeze/ thaw to test. That said we have been one of the massively lucky ones and I am now 28 weeks pregnant with that untested low grade embryo. I’m glad we didn’t test, especially as we only ended up with 1 embryo. I think it may be different if you end up with a batch of possible embryos…

Good luck on your journey. There are so many decisions and I do think clinics can do better in providing advice rather than just a shopping list with costs. x