IVF vs trying naturally with low AMH

[Greenfig123]

Just had second round of IVF with a failed fresh blastocyst transfer and a first round with no blastocysts (I am 43 with an AMH of 0.8).

When I had my initial consultation, I’m pretty sure that the consultant told us that our chances if trying naturally were at around 5%. He said (I think) that our chances with IVF were around 20%. I knew that was still low but my plan was to do as many cycles as we could over the next year until hopefully we were successful.

The first round was short protocol, which produced 4 eggs, 2 fertilised and 0 blastocyst. The consultant I spoke to afterwards was surprisingly positive, saying apparently it was a ‘good’ cycle and that he would change meds for next time.

The second round was long protocol, which was more successful with 5 eggs, all fertilised, 1 blastocyst. I got feedback from the embryologist, who was quite negative about the early fragmentation of my embryos, which she said never leads to high conversion.

I also had a consultation with a different doctor, who said even though my 1 blastocyst was good quality, the fact that it didn’t implant wasn’t surprising at all, given that 90% will be genetically abnormal:(. She said my chances with my own eggs will be 2-5% with ivf. She mentioned freezing and genetic testing for next cycles but also donor eggs.

I feel I’ve put too much into this to give up so quickly. But also questioning why I was recommended to start IVF at all (rather than just continue to try naturally) and I’m feeling dispirited... Apparently with my AMH they would have expected 1 egg, so my cycles haven’t even been so bad..

I’m thinking of arranging consultations with some of the more experimental clinics, for the best shot with my own eggs. Just wondered if anyone had any insights into chances at my age, as I have been told different things!

[Gerbear22]

I think 2-5% is about right for your amh and age.When I was 40 I had amh of 7.7pmol/l and was given a 10% chance of ivf working.Thankfully we had luck on our second cycle.Got pregnant again naturally but ended in miscarriage in April but gave me hope i can still get pregnant.Going for ivf again now at age 42 with basically non existent amh.First cycle cancelled but starting another cycle with a change of protocol.Going to keep trying until my next birthday with my own eggs and be happy we have done all we could to give our daughter a sibling.x

[Loveelou]

Hi

Sorry it did not work out for you.

If you look the OPIS IVF calculator that can give indication of predicted success with IVF. At 43 chances would be up to 5% for your first cycle with a cumulative chance up to just below 20% after 6 cycles. I found this useful to allow me to be realistic about chances of success. Also Robert Winston a pioneer of IVF has a useful question and answer website which you coukd take a look at. I honestly feel the clinics are not giving realistic advice to women over 40 about IVF.

[Greenfig123 in reply to Loveelou]

Exactly - I don’t feel I was given realistic expectations at all. But I hope the chances do accumulate with subsequent cycles. My initial consultant spoke of potentially a baby at 43 and a frozen embryo for a sibling! A lovely idea but miraculous if any baby was to happen by the sounds of it

[Loveelou in reply to Greenfig123]

Well it’s possible! Just the chances/likelihood some seem to give is unrealistic. I think it’s a good idea to consider trying clinics with more experimental approaches and from reading on here those tend to be in London/abroad. Don’t lose hope as there are many stories of success on here just maybe expect to have to do more cycles for success with OE. Wish you the best of luck.

[Sja1981 in reply to Greenfig123]

Im 43. In my first cycle in July, my doc was SO optimistic that he wouldn't even let me discuss a plan b.I had 5 mature eggs taken, 4 fertilised and 3 formed good day 6 blasts. Then PGTA said they're all abnormal.

At this age, roughly one in every 10 eggs is fully euploid. Others will be mosaic or aneuploid.

So it really becomes a quality and numbers lottery.

I won't be doing PGTA again.

Check Greece for clinics who offer upfront tests, or add-ons but they're expensive. If you DM me I can share who in switching to.

[Sarah770 in reply to Loveelou]

where are you located? Frankly I am quite experienced with IVF (I have 3 kids incl 2 born with IVF and am waiting for the result of my last transfer) and I am very surprised about what you were told. Where are you based? Contact me by email I will give you the co tact details of clinics that are excellent. Your AMH is not bad!!!

[Kitkat10]

hi, I was in a similar boat when I was 42. My consultant told me 5-7% chances at my age with amh 1.1. I have a son via IVF so I knew it ‘could work’ but despite getting 3 ‘top quality ‘ embryos, none of them worked. You may have been quoted cumulative chances and there is an IVF calculator which I’ve used, it’s based on evidence from many cycles of women of various ages and for me I think I needed 6 cycles to have a decent chance of success.

I really don’t mean to be insensitive or dispirit you, I just want to be honest about my own experience because I know first hand how emotionally and financially hard IVF can be. I moved to donor eggs 1 month after my 43rd birthday and the first transfer worked, giving me my daughter born 11 weeks ago.

Donor eggs will always be there and the stats look fairly stable until around 47-48 years old. So I don’t mean to say don’t try again with your OE but just wanted to share my honest experience xx

[TopGuntastic]

I’m 42 with an AMH of 6.6. I’ve been told that my biggest challenge is that 80% of any day 5 blastocysts are likely to be abnormal. Overall our chances with ICSI are 5-10% but if any tested blastocysts are normal then my chances become 50:50 at that point. My consultant has strongly suggested testing, no matter if I have 1 or more blastocysts. Good luck for what you decide next 🩷🤞 ✨

[IVF-er30]

Have you considered mild ivf? It worked for me at 43. Untested day 3 embryo sat in my lap after a feed. He arrived just 6 weeks shy of my 45th birthday.

See my old posts on this. Good luck. I’m guessing you want to exhaust all possibilities before moving onto donor eggs.

Read it starts with an egg and follow the egg whisperer on YouTube.

[MontsJ in reply to IVF-er30]

Really inspiring to see this post, I’ve looked through some of your replies. I’d love to hear more about your story and your protocol and clinic, were you unexplained infertility and what was your AMH, FSH and AFC. I’m sorry to have so many questions, I’m 43 and struggling with feeling hopeless and chances at my age. And the decision of whether to push on to day 5 and PGS testing. If you’d prefer I can private message you.

[Greenfig123 in reply to MontsJ]

We found PGS testing so hard to make a decision on too. We also had so many questions about day 5 transfers and freezing, which has been so time consuming to find answers for. Speaking to an embryologist and a doctor has been really helpful, so I think it’s worth pushing for extra support/information that isn’t necessarily offered by your clinic.

I remain unclear about why day 3 transfers happen though, so this is something I will ask the doctors about.

[Sarah770 in reply to Greenfig123]

I tested 15 embryos with PGD and 11 came back all good. I of course only transfer these embryos. If you have any question about PHD do not hesitate

[Sarah770 in reply to Sarah770]

*pgd

[Greenfig123 in reply to IVF-er30]

Same as MontsJ, I found your story intriguing too, if you wouldn’t mind sharing your AMH etc? I was unsure if mild ivf was suitable for low AMH or not, but it’s definitely something I will look into!

[Scruffy01]

I am 43, had my first nhs ivf consultation at 42 doctor gave me a 5% chance AMH 3.9, didn’t realise at that appointment I was already naturally pregnant. Unfortunately it ended at 9wks miscarriage. Then went private IVF just turned 43, as too old for NHS funding, the doctors mentioned that the miscarriage could have been due to chromosomal abnormalities but didn’t mention any percentage of chance nor my age. First cycle 9 eggs 6 fertilised. 2 transferred on day 3, wouldn’t advise this as percentage that stuck at this stage very low. At day 5 had 2 blastocyst 4ab quality. So I had another transferred on day 5. I got pregnant, at 16wk found out that it had chromosomal abnormalities had to have a termination. 1 frozen the rest not suitable for freezing. Decided to PGT-A test it, survived the initial thaw but needed to grow more cells for the biopsy by day 7 they said it was no good, couldn’t do the biopsy. I was not offered PGT-A testing as it’s not seen to be beneficial in our age group. In Europe for anyone over 38 it is recommended. I wish I had done the PGT-A from the start. Even though I had good quality embryos I had a 15% chance that 1 could be normal, that is 1 embryo out of the 6 I had. Unfortunately for me I didn’t. I know it’s a big decision but I believe for me the only way forward is donor eggs. Good luck with your journey, I hope you get a doctor that gives you good advise and not just in it for the monies. It’s a hard enough journey as it is. Wouldn’t wish the trauma that I went through on anyone.

[Kel8018580]

I am now 44 with Amh of 0.5 . I was told by NHS my 5 mc we’re likely due to this and that although it wasn’t impossible I would unlikely ever have a baby. I considered ivf but the chances of success to me were the same with my own eggs as the chances of succeeding naturally again. I have decided not to throw the money at the wall and leave it to chance. My opinion is that IVF will happily take the money when without DE there is an unrealistic chance on success.

I have chose not to use DE and that is my fate.

There are always the exceptions to the rules and some people will be lucky but for me the figures did not make sense

I wish you luck with it x

[Estherlovescats]

I was told at 37 with an amh of 3.4pmol that ivf was the only option i had to loose 40lbs to qualify for nhs funding. Two failed rounds later got pregnant naturally with the help of mira ovulation tracker and fertilily conception cups coq10 ubiquinol and dhea tho you need dhea-s and testosterone bloods for that. When I looked into it docs often run to ivf quickly especially as its a business. When cumulatively over a year a 40 year old woman has a 50% naturally if no other issues like tubes endo etc. I was given completely the wrong info and wasted 3 years gearing up for ivf. More women should be educated about ovulation tracking and drugs like letrozole and clomid discussed. Neither were mentioned to me or iui. Mira gives a 7 day window when most ovulation trackers give a 2 day window it also confirms ovulation. Im not on commission for them i promise but it was a game changer for us. Im 39 weeks pregnant now with a baby boy i turn 41 next month. X

[IVF-er30]

Hi there

Started IVF aged 42. AFC 8-10, AMH 5.1 pmol. Was on pergoveris at the first clinic high dose, only supplements I took at the time were standard prenatals. The USS picked up my large posterior wall fibroid. At the time - no one thought it would impact on pregnancy, so it was left. 1st cycle - 7 eggs collected, 4 mature,only 1 fertilised and that was abnormal in terms of cell division (This clinic used embryoscope). This embryo made it to day 5 - graded 4ab and I had a fresh transfer- was only on cyclogest and started bleeding before OTD, so knew it had failed even before taking a pregnancy test.

2nd cycle oestrogen priming was used to try and get even growth of the eggs, 15 follicles grew but on zero eggs collected with same dose of pergoveris, to say I was disappointed was a bit of an understatement.

3-5cycles I went with a clinic specialising in mild ivf (well known chain!). Started DHEA 25mg od for 3/12 and thyroxine ( normal thyroid function levels but my consultant recommended starting a small dose 25mcg to improve egg count quality as TSH was 2.5, optimum level 1.5.)

Repeated my AMH (turned 43 at this point) it was 11.5, I believe it can fluctuate or possibly be due to better diet (started a Mediterranean diet aswell). AFC was the same for though.

Was treated with bemfola (150units) for stimulation, first cycle 8 eggs/ 2nd cycle 7 eggs 3rd cycle 5. 90% fertilisation with ivf no ICSI.

Had a huge drop off of day 3 to day 5 conversion with first cycle, only 1 blastocyst 3bb. So consultant and embryologist advised storing a couple of day 3s in the subsequent cycles. 2nd cycle 1 day 3 8 cell grade 1 embryo frozen, took remainder of embryos to day 5, again only 1 day 5 embryo frozen 4cc.

final cycle - only 5 eggs retrieved. Only 2 day 3s looked good (1 8 cell and 1 6 cell they were frozen) the rest had less than 5 cells with fragmentation- none made it to day 5.

At end of 3 cycles of mild stimulation- 2 day 5s and 3 day 3s.

Transferred two day 5s( untested) - embryologist said 3bb was too small to biopsy and 4cc wouldn’t have enough cells for PGTA. That it was up to me. I transferred them despite the risk of miscarriage. (Explained in a previous reply somewhere).

After recovery from my myomectomy, I had a hysteroscopy and transferred 2 8 cell grade 1 embryos. My consultant said that the embryos sometimes do better going back in in some women and she had good outcomes in older women with day 3s. It’s an individual decision and only you and your partner can decide what’s right for you. I wasn’t prepared to give up on my own eggs at that time. So, I took the risk and it thankfully (by the grace of god) paid off.