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
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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.
Wow, thank you for such a thorough, thoughtful and informative reply!
I am 34, soon to be 35.
We would also prefer the natural selection element of standard IVF and my husband also has very high quantity and good mobility, so perhaps I can talk this through with the clinic.
Your advice is so sound, I’m so grateful to you! Sounds like we would maybe be best to try one round of ‘normal’ ivf and see if we get anything from it and then make the next decision based on that.
For us finances will restrict as much as my egg supply - at around £25k for a 3 cycle package - we will be cleaned out! I am sure we could save up again, but not immediately. My low AMH takes me out of a lot of the finance plans available.
I’m sorry you’re having to go through this. I wish I could reciprocate with some wisdom. I hope there’s some amazing news for you very soon.
I really hope you can find a plan you’re happy with.
I was gutted when my AMH at 34 meant I couldn’t get NHS treatment. We were able to get a 100% 3 cycle refund package which has helped us keep going but there are pros and cons to these packages. We got 12K back, but did have to pay the medication costs, often pricey when you need high doses with low AMH.
I don’t want to raise your hopes and maybe you’ve already had it tested more than once but my AMH has varied anywhere from 2.4 pmol/l to 7.6 in space of a couple of months. So sometimes it can be worth retesting if helps make you eligible for better package. I’ve done checks via medichecks occasionally. Then you don’t have to share if it’s worse 😂but can share if it’s better. Variations in the numbers this small really doesn’t influence drug dosing.
One thing to be mindful of is that history of a failed cycle can make you ineligible for certain packages (refund ones usually) so just be wary of that. But yes the first cycle in particular or any major change to protocol becomes a bit of Guinea pig territory to see you how respond and what happens with the embryos.
I’ve had three tests so far one from the clinic and two with hertility and they varied between 2.9 and 5.6.
I will have one last look at the repayment packages before we get failed rounds on our record! Someone also told me about going private in an NHS setting today, so I will look into that too - as maybe they are less money focused with their advice??
I’m sure we will speak again but best of luck to you too Xxx
The only thing I found with private within NHS is that the drs mentality was still very NHS. By which I mean thinking about cost to NHS of treatments rather than be willing to try things outside the box. Also they were so much more Monday-Friday 9-5 and therefore scheduling around them rather than how my ovaries worked! Pros and cons to everything! xx
I wouldn’t personally do this if it’s your first attempt as I would try one cycle with fresh transfer and then take it from there, the first cycle is sometimes a learning one but it might also work for you and you will have spent a lot of time and money doing 3 full cycles when it could be one from the first cycle that works. It also gives the chance for a day 3 fresh transfer etc if only to be of 2 embryos going at that stage. ICSI worked for us but we used frozen donor sperm ld get a second opinion from another clinic and if both recommending ICSI I would probs just take their advice. Ps we went private at an nhs clinic much much cheaper. Best of luck xx
My nhs clinic have a self funded option. It’s a different admin team and the costs etc are all on their website but the treatment is the exact same as if you are an nhs funded patient (except no waiting list and no 30 BMI restriction). I had my first son though the same clinic with nhs treatment and it was the exact same when I self funded for a sibling in terms of the process, nurses and consultants. One cycle including meds costs about £6k where as the same cycle just across the city cost £8.5k at fully private clinic xx
Yeah should have said you don’t have to qualify for nhs funded to get seen as a self funded patient at my clinic, as in I have a child so don’t qualify anymore and my BMI was just over 30, age 42 and they still took me xx
I completely related to some of these questions, 1 fresh cycle or 3 cycle package with transfer at the end. Having discussed with our clinic we opted for 1 cycle which they said if failed i could then transfer into a 3 cycle package but you’d then have to pay for any more transfers as you’ve already used your one. Our first round failed with nothing viable for freezer so we had to go through the whole process again. The clinic offered us discount on 2nd cycle too. Maybe worth asking if they are offers your clinic offers? (The discount on 2nd cycle was not ‘advertised’ anywhere but offered to us after the failed cycle) 25k for 3 cycle package is extremely expensive! Our clinic was about 14-6k depending on what additional options you choose.
I think from a logical perspective a frozen transfer can be more successful from our body’s perspective. When doing fresh our bodys are pumped with all drugs from collection process. With frozen transfer i think your body n maybe state of mind is in lot better place to recieve the embryo. That said our 2nd fresh transfer worked and we’re currently 22wks pregnant.
Hello WanderingWonder last year I had very similar questions to you. I'm currently 15 weeks pregnant after ICSI due to a combination of low AMH, low morphology and age.We did a double stimms cycle (2 egg collections in same cycle), with ICSI fertilisation after 3 days min. abstinence, and the PGTA testing of the embryos.
I was over 37 when we started, so the three clinics we went for consults recommended PGTA and therefore freeze transfers as they said my egg quality may not be the best.
With my low AMH (it was at 7 when we started) we got told we shouldn't expect more than 6 mature eggs per round, and that was if everything went amazingly well. We only had at the end of the process 4 frozen blasts and we were extremely lucky that all have been good grade and euploids (genetically good).
Its been said before, it depends on your case and your capabilities. We did the numbers before choosing the treatment option and decided to do the PGTA to reduce risk of miscarriage from implanting genetically abnormal embryos (another 1,100€ on top of the treatment cost) and do the batching to just go through the hardest part of IVF once condensed in a month.
I'm not sure about normal IVF vs. ICSI, we got told that with my OH morphology (between 0 and 3% normals), the chances were very low without the ICSI so we never considered as an option.
It's true that with freezing there is a risk the embryo will not survive the thaw, but if you get several embryos in one cycle they will only transfer one or two, the rest will go to the freezer anyway.
If you don't do the genetic testing, you could ask if they can do a fresh transfer with the best looking embryo and freeze the rest for siblings/if first transfer doesn't work?
The batching is normally to shorten how long you are going through stimms and ensure you do that upfront with "younger" eggs. If after each stimm you try a transfer, you may have to wait a couple of months before starting the next round, so with three cycles that would converse into 6 months process? May be worth asking your clinic.
It's not easy, and you need to think about the financials long term. For us, we saw the first objective to have some embryos available with my own eggs, and then have me ready to welcome them from the first attempt, and that idea directed our treatment. We "invested" in more tests, supplements, etc. ahead of starting to maximise our chances of it working first time. The frozen transfer is cheaper than another full round. Meds will be about £1,000 for stimms cycle on top of everything, so that cost cannot be dismissed. I had to do an hysteroscopy before the transfer and that also added up - but I didn't want to risk losing an embryo if my womb wasn't perfect.
Hope my ramble helps, whatever you decide, be in peace with your decision and let yourself go, trust your gut when you choose treatment and as you go through it - we know deep down better than the doctors what works for us. And read as much as possible to have enough information to help you decide.
This forum is great for sharing experiences and learning, ask anything!
Thank you very much for your reply! Congratulations on your pregnancy!
Your advice is super helpful and I think, given my low AMH and low follicle count, banking anything we do manage whilst Im as young as possible seems wise. Xxx
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