I’ve taken a 6 month break to work on my physical and mental health before embarking on this gruelling journey.
I have very low AMH (2.9) - no other identified issues and all other hormone levels good.
Husband has borderline morphology issues but has seen a specialist andrologist who has said that given quantity and mobility no procedure would make a significant difference for him.
About 8 months ago we were recommended a three cycle ICSI package, where any embryos are frozen and any that make it and are good enough quality are implanted at the end of cycle 3.
I have three questions I’m agonising over
1. Will starting this process accelerate the end of my fertility - stims will release any eggs I do have right? So if we do the three rounds and fail, could there end up being no eggs left because we forced them all out?
2. In your experience does ICSI actually improve things where the morphology is very borderline? Would we be better trying standard IVF first?
3. Frozen vs fresh - in your experience would we be reducing our chances if we have embryos each round but freeze them and then only have one attempt at implanting at the end?
thank you! It’s really hard to trust the people making money off of these decisions and because I have such low AMH levels - I don’t want to waste any eggs we might retrieve by following a path with lower chances of success!
Thank you and best of luck with everything you’re going through! Xxxx
Written by
WanderingWonder
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Decisions like this are so hard when you don’t really know who to trust for the best advice that isn’t financially beneficial to the person giving it!
regarding your questions:
1. No there is no evidence that IVF will do this to your egg reserves. We naturally have lots of follicles recruited per cycle it’s just the body selects a dominant one to ovulate. The others are still lost at the end of that cycle IVF just aims to get all to developed together at a good size to collect the eggs
2. We tried IVF first and despite low numbers of eggs we’ve always had 100% fertilisation of my mature eggs. My husbands morphology was borderline when we followed clinic advice for 3-5 day abstinence but after seeing an andrology specialist and doing sperm DNA fragmentation he was advised 24h abstinence only (he has great count) and morphology was then great. If you collect very few eggs then some clinics prefer to do ICSI to help ensure something fertilises but for context we once had one egg and it still fertilised with IVF to make a top quality blast. We’ve decided letting natural selection of sperm for us is better and avoids the potential risks of ICSI however if we’d had bad results in our first cycle then we would have been open to use ICSI
3. I think this really depends on your age which you haven’t shared. I also think it’s very difficult to know how things will go without ever having done IVF before. Each cycle can be different and you learn from response to various protocols. If you’re over 35-37 and thinking you’ll do PGTA then batching makes sense. But if you’re younger or not going to do PGTA then you are likely better transferring as you go. While freezing is very low risk now it’s not no risk - you will still come across people who have lost blast to the thaw.
However you’ve said you’d only have one chance at the end - if you get more than one blastocyst in the freezer by the end of the batching nothing (besides finances) would stop you doing multiple frozen embryo transfer cycles with these?
Up until recently because I have low reserve and low numbers of eggs and therefore blasts at each cycle, we’ve always followed advice that best to transfer as we go. However now I’m 37 and we’ve had pregnancy losses and multiple failed cycles we’ve decided to try PGTA so then it can make more sense to test and freeze. Also if you end up with transfer that implants but then ends in loss that can take you out of treatment for a while, so if you have a low AMH issue it can make sense to batch while you’re younger and reserve best it’s ever going to be, and then do transfers later.
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