Confused about AMH and letrozole/trigger and IVF

[PenpalLdn]

Hi,

I have a history of early miscarriages. Under recurrent miscarriage clinic, I am told to take progesterone and aspirin from positive results, and clexane from 6 week scan. I've not had any medicine under previous pregnancies that led to miscarriages.

I also have very low AMH. Experts have said usually people with low AMH are told to go to IVF, but since I've been getting pregnant, then it is sufficient to keep trying. Some other people said IVF is not a good option as it's just not necessary for me, it will be expensive for no benefit, and that it is better to improve egg health instead through diet and supplement support.

My partner and I had COVID late last year, so while I have become pregnant easily last year, last 4 months, not much has happened. I got worried maybe low ovarian reserve hence I might have low chances of getting pregnant, that maybe I missed my boat. So I went to another doctor to do semen analysis and hormone tests, but instead of doing any of that, I got told to do ovulation induction, with letrozole, follicle tracking and some injection - I have no idea what any of these really are, I just thought it would give me best chance of getting pregnant and then actually get to follow protocol. I just took her word for it, and am already CD7, but now I'm thinking should I have just continued trying as usual? All this treatment is making me achy and tired, and not sure if any benefit. I guess I got impatient to get pregnant but does it actually make sense for me...

Anyone with low AMH and experience taking letrozole?

[RekaV]

hi PenpalLdn, I have a similar history. I had 4 natural miscarriages- never had an issue getting pregnant . I also used progesteron and aspirin with my last natural pregnancy but it made no difference. we went to a very good clinic in London and they said that because of my low AMH ( it was 6.2 pmol at the time) it will become more and more difficult to get pregnant. They said we can still try for about 6 months naturally but recommended IVF afterwards. I didn’t want to wait so we started IVF straight away. We’ve been doing ICSI with PGT-A testing, the latter helps specifically for people with miscarriages- they can check if your embryo has a chromosomal abnormality. So far we have one normal embryo frozen and we keep going to see if we can get another one. Sorry I can’t help with letrozol but good luck to you!

[PenpalLdn in reply to RekaV]

Thank you for replying, it does sound similar. I'm so sorry for the MCs, I had 3 last year and I was devastated, for each one.

I have 1.75 pmol AMH. So I feel desperate, but my AFC is 6 on each side, and since I've been getting pregnant (at least last year), everyone I took advice from have said IVF is very hard on the body and continue naturally. How is your AFC?

I'm scared they're wrong and I'm too late, but I just think that because nothing happened since my last MC in August. I restarted in Nov, so it has been only 4 tries.

Have you found out any issues that might lead to the MCs? I have blood clotting that I found out about much later, so I will have progesterone, aspirin and heparin from positive test. I've never tried that before, so I am hoping to get pregnant to try.

I have also heard of NK tests, that would be my next step, I'll give it 6 months or so.

[RekaV in reply to PenpalLdn]

Hi, I got a lot of tests done last year and I also have blood clotting issue which I didn’t know about previously however the progesterone and aspirin really didn’t make a difference in my last pregnancy. We also had sperm DNA fragmentation issues which can contribute to miscarriages - lifestyle changes greatly improved sperm quality and with ICSI it doesn’t matter. there are no other issues, most likely egg quality caused chromosomal abnormalities that caused the miscarriages -was confirmed for two of my embryos ( 1 natural and 1 IVF). We also had NK cell testing done but I spoke to different doctors about it and they say that most of the time it’s done from blood and it’s unreliable - the treatment also attacks your immune system so I decided not to have it but it’s a personal choice. It was the most expensive test and I wouldn’t do it again.

My AFC before treatment was 4 or 5. I’m also a poor responder to stimulation and can only get one embryo from each cycle but we are doing this to avoid further miscarriages- I don’t think I can go through more.

I didn’t see your age but I’m sure you know the likelihood of miscarriage increase with age - for me doing IVF decreases the chances of that. Good luck to you x

[PenpalLdn]

RekaV thank you for replying. Yes, if possible, we have to do everything we can to reduce likelihood of miscarriages. I'm sure I'm being irrational, but I also feel I'm weaker after each MC. I didn't have blood clotting after first MC, it only showed consistently after 3rd.

I am 37, I've had my MCs at 36. I wish there was a cheaper and less invasive test for egg quality. I think that's also my issue. I noticed you have not been prescribed clexane? May I ask if your MCs were early? Mine were weeks 5-6. I think mine are egg quality issues, so I am hoping then it's a numbers game (I hate when people say it).