Bad news :(

[DogMum7]

I finally got my NHS consultation after all the tests back in Feb. She could only see 4 follicles but said other test results were fine. I'm 38 and she said it should be 8-15. She's still referring us for IVF and we should hear in the next month, but this feels like pretty negative news. We don't yet know the quality of the eggs or of my partners sperm. Did anyone receive similar news at their first consult? Any advice welcome, I feel pretty much like this isn't going to work already.

[raverg]

I don’t know if it’s as dire as it sounds, as most women in IVF have numbers similar to yours and that’s why they’re doing IVF in the first place. It’s probably okay for your age and the treatment itself might stimulate a few more. What’s your AMH?

Our fertility truly falls off a cliff after 33, and definitely after 35. I went from monitoring 13 follicles at 35 to nudging along 6 at 36, but they managed to get 9 in the end. So in that respect you’re probably doing quite well with 4 at 38. A friend of mine who is 40 was elated to have 4 follicles after lots of prep with supplements, diet and exercise, cutting out stuff.

So prepare for the IVF cycle as best as you can (both of you, there’s lots of resources) as that will improve quality. And don’t delay the treatment, which is easier said than done at the pace that NHS has sometimes.

Good luck! Xx

[DogMum7 in reply to raverg]

Thanks for taking the time to respond. That's interesting (and good to hear!) as most of the posts I've read people are seeing 12+ follicles and then saying 3/4 egg retrievals is bad and I now feel doubtful I will even get one! I think comparison is the thief of joy sometimes. My friend is also starting the process at the same age as me and has plentiful eggs so feels like I need to just focus on myself. That's awesome they managed to get 9 - how were they able to get more than the 6? I have read a couple of posts saying some had theirs missed. I'm taking conception vitamins and she recommended additional vitamin d so will do that. Not sure what else I can be doing? I'm very fit and active. Any tips gratefully received!

I checked all my tests results and can't see AMH anywhere?!

Thanks so much xx

[raverg in reply to DogMum7]

I mean, sure, 12+ follicles is ideal and 3-4 might take longer to get you there, but we are where we are at our age and we have to work with what we’ve got. You’re right that it’s pointless to compare, because we all have different profiles from age, to female factors (PCOS, endo, low AMH) to male factors (varicocele, high DNA fragmentation, low count).

And numbers are relative, the quality is what matters. For example, on my NHS cycle I had 13 follicles > removed 11 > got 7 eggs > 4 were mature > 3 fertilised > 2 blastocysts, one average resulted in chemical, 1 poor didn’t work.

For my second cycle, a private one, I had done a lot more prep beforehand, plus they already knew a lot about me from the first cycle, so we went in with a higher stims dose and more progesterone. I had lots of interim scans, one every 2 days (as opposed to none before), my dose was lowered twice and my final stats were: 6 follicles > 9 eggs > 5 mature > 4 fertilised > 1 blastocyst high quality and now I’m 9 weeks. We likely lost the embryos after day 3 due to my husband’s varicocele, but not everyone will have this problem.

I think that the way they got to 9 was that some follicles might have been hiding behind the ones they were looking at? Or the treatment activated some more? Who knows, but it’s possible.

What we did for prep the second time around was to go on Proceive Max both of us because of our age, we cut out processed stuff, junk food, sweets, alcohol, and we don’t smoke. Ate looots of fruit and veggies. My husband has a varicocele which was causing him some pain so he iced every day for 2+ months, he ate blueberries every day too and tried to include things with lots of tomatoes in our diet (mostly for antioxidants to improve his sperm parameters). We both worked out and have been quite active. We cut out things with phthalates (perfumed cosmetics, cleaning products) and reduced our plastic use (not sure if these helped but we did it). I did acupuncture for 3 months beforehand, and my husband due to the varicocele was told to ejaculate every other day for a week before sperm collection, leaving one day between the last one and the day of sperm collection. Probably everyone should do that. I also did a vaginal microbiome and discovered i had gardenerella for which i had to take an antibiotic and lots of probiotics. So we threw everything at this cycle but it seemed to work. And this was the cycle where we were told by the urologist to get the varicocele procedure done before another IVF cycle, but because my parameters dropped so dramatically in a year, the IVF consultant suggested we tried a cycle before the procedure too as the recovery for that can be quite long and my stats could have gotten worse.

So what worked was probably a mix of our prep which took 3 months (as it takes about 3 months for new eggs and sperm to generate), close monitoring during the stims phase (do press for interim scans to check you’re on the right dose!) and them having a clue about what sort of dose or protocol to go with after observing the first cycle.

Hmmm the AFC (number of follicles on scans) should be looked at in conjunction with AMH (ovarian reserve) and the numbers tend to be pretty close usually. Like I had an AMH of 8.4 at the last count, started with 6 follicles but they retrieved 9 eggs, so things were revolving around those numbers. The number of follicles that you see on a scan can vary from month to month so I wouldn’t panic just yet, but the AMH number will provide more context. Also your husband’s sperm analysis will provide some clues whether you can do IVF or need to go for ICSI (egg injected with sperm manually, which is what we've done, due to the varicocele, that’s why our fertilisation rates were so high).

My god I could write a book on this topic, but I’ll stop here. And feel free to ask if you have any other questions xx

[IVFat40 in reply to DogMum7]

I found the book 'it starts with the egg' by Rebecca Fett, as well as a fertility nutritionist, really helpful. All the best of luck

[raverg in reply to IVFat40]

Yes, that’s what I used as a starting point as well, but took everything with a pinch of salt as that book goes quite extreme on some of the recommendations. A fertility nutritionist is an excellent idea!

[IVFat40 in reply to raverg]

I agree the book does need a pinch of salt it can be a bit severe

[DogMum7 in reply to IVFat40]

I'm intrigued now - ordered it yesterday 🤣

[EjHack]

Yes very similar. At 36 had 4 follicles my AMH dropped from 27 to 5.1 in a year. I put it down to dramatic weight loss in order to get ICB funding to go through the NHS. Stims gave me a further 3 follicles. Got 7 eggs and one embryo. At the time I thought the world had come to an end. It didn’t and it hasn’t, turns out one will do! 😊 It’s not necessarily a numbers game, more luck.

If I look back, losing 8stone was beneficial for me, my health and carrying but ultimately, I have put weight back on (def not all!) and despite all the gremlins telling me that I am failing, it’s not so far.

Just go with it for now, do what would make you feel more comfortable to prepare, whether that by acupuncture, all the vitamins and healthy eating, but ultimately, I believe, it’s in the laps of the luck gods!

[EjHack]

oh and vitamins I wish I started sooner! COQ10 and DHEA. If you can start those 3 months prior to stims I think possibly I would have had an even better follicle count. X

[DogMum7 in reply to EjHack]

Thanks so much and congratulations to you ♥️ Are there any brand of COQ10 and DHEA you recommend? Finding a lot out there :§

[EjHack]

No not particularly, I think I went for the close your eyes and plum for one technique! Recently, I advised someone from work and I am pretty sure she didn’t take the same ones as I did and it had a good result. Also vitamin D…. I’m not sure whether all of this just creates expensive pee but made me feel better!

[DogMum7 in reply to EjHack]

Thank you xx

[EjHack]

you’re welcome! Always here for a chat if needed! It’s a lonely journey! Xx

[Estherlovescats]

I had 5 follicles agw 39. 2 rounds of failed ivf got pregnant naturally first natural cycle after that with mira ovulation tracker and fertilily conception cups. I think we have a better chance naturally sometimes. Ivf was not the holy grail for us. I also lost weight did a Mediterranean diet. Coq10 ubiquinol life extension brand 600mg daily. Dhea 75mg daily but you need dhea-s bloods and testosterone bloods for that. Vit d. Magnesium. X

[Singershope in reply to Estherlovescats]

I couldn’t agree more about having a go naturally too if there’s not a very obvious reason that really warrants IVF. Particularly if you’re like me in late 30s with low AMH and varying follicle counts each month. We only get one blast each time with two then three mature eggs. So it’s, it’s all about the quality. It only takes one healthy egg. Discovered my partner had a varicocele too so working on that. We’ve been pregnant before naturally but it was an early miscarriage then my partner was diagnosed with melanoma just as we wanted to try again and we weren’t able to due to the chemo so froze the sperm before meds and did IVF. First fresh transfer failed with only one very early blast and now currently in the TWW on a medicated FET due to lining being thin at scan , but have 5AA this time. Did all you’ve mentioned above with same supplements and did acupuncture and uterine PRP for lining. Praying it works but we plan to try again naturally if not as with only one blast each time at IVF that’s what id get naturally!

Can I ask if you took DHEA due to low testosterone? I was considering taking it but didn’t as my DHEA S came back good and testosterone on the lower side of normal. Maybe it’s still worth taking?

anyway biggest congrats on the natural pregnancy 🥳 x

[Estherlovescats in reply to Singershope]

Hi i was just told to take dhea by a consultant 3 years ago due to low amh and high fsh it brought them in range alongside coq10 to qualify for ivf on the nhs i also had to loose 3 stone. I did it tho but got pregnant naturally at 40 after 2 failed ivfs. The ivf meds may have boosted my ovaries. I have since read tho to have dhea ur meant to get testosterone and dhea-s levels done first as it can do more harm than good. All the best to you. X

[Sams25]

hi there, I’m the same age and had 5 follicles in my last IVF cycle that was visible during the ultra sound.

I opted for a full anaesthesia follicle extraction procedure (my clinic usually does not provide anaesthesia if less than 6 follicles). And to everyone’s surprise there were 16 follicles all hidden behind. You never know with these ultra sounds , they can be deceiving !

Fingers crossed for you 🤞🏻🤞🏻

[DogMum7 in reply to Sams25]

That's awesome! And gives me some hope.thank you ☀️

[Vassi]

Hi, I'm a lot older than you with a lower amh, and I was getting between 9-15 eggs at egg collection so I wouldn't worry too much. I also think quality over quantity is better sometimes, the round I got 15 eggs I ended up with no blasts and on a 9 round egg retrieval I got 3 blasts. It's really hard to know what's going to work best, unfortunately it is a bit of trial and error sometimes. My advice is have thorough testing before you begin (including partner) and do what you can in terms of diet and supplementation.

The supplements I'm taking are coq10, melatonin, myo inositol, vit c, vit d, vit e, acetyl l carnitine, magnesium, ubiquinol, folinic acid, and a pre natal. I like the life extension brand. It's a lot but that's what my clinic recommend and i figure it can't hurt.

All the best xx

[Ell777]

I was 39 with low amh as well, and they only saw 4 follicles initially. After stims that number jumped to 7. Some of the follicles were hidden, so they didn’t even see a few until collection day and I was surprised. Ended up collecting 7 mature eggs, all fertilized with ICSI, with 4 day-5 blasts. Did PGTA because of my age and 1 was genetically normal. At every stage I thought I would end up having to do another collection as I was told it may take a few tries, and I kept this in mind to soften any bad news (the drop-off in numbers is really a kick in the gut). However, it stuck and am now 23 weeks, so don’t give up hope.