* Author Topic: Low AMH / High FSH Cycle Buddies Part 5  (Read 102728 times)

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Offline LXP

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Low AMH / High FSH Cycle Buddies Part 5
« Reply #2030 on: 24/01/18, 13:41 »
Afternoon Ladies

I hope you don't mind me jumping on this well established thread. I have tried to catch up but there is a lot!

We are both 35 and we have been trying since May 2015. In November my AMH was 2.7, it had been 4.2 in July and my FSH was 10. We are currently going through our first IVF cycle, and it took me a week longer than hoped to Down Regulate. I am now stimming on 375 Gonal F and we had our first scan today which showed 3 follies on my left ovary 2 at 9mm and 1 at 10mm. My right ovary likes to play hide and seek but they did eventually find it with 2 follies about 5mm. The nurse said the low numbers were due to my AMH. I may now also have to stim for longer as well but they are not upping the drugs.

Has anyone else had this, who can offer me any tips or success stories. My hubby is so positive and says well if this one does work we will go again. I guess it is easier for them.

Cheers.   

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    Offline Briss

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    « Reply #2031 on: 24/01/18, 17:40 »
    Not good news I'm afraid, we managed to get two eggs out and I think at least one was mature cos they were able to do icsi but none fertilised. Feeling down and totally drained so much effort was put Into getting those eggs, although I suppose I should be happy we at least got to the point of collecting mature eggs. When the cycle started i was really scared with no lining, no follicles and no estrogen so at least I know I'm still ovulating.   Interesting how I ended up having an afternoon egg collection. Never had that before as my eggs tend to ovulate early in the morning but this is brave new world with egg collections as late as day 20. I suppose that alone should mean it's not an optimal cycle but I was very encouraged by my estrogen levels. Not taking progesterone so not sure what to expect in terms of LP length. Also again a two dominant follicle cycle in a natural setting is just not a promising thing as I find time and time again. Am taking some time to get over as it really hit me how bad the eggs are a d then hopefully I can pick myself up and try again.

    're endocrinologist, I'll come back to this as turns out my tsh is playing up again. I used to have a good endocrinologist in harly st who helped me after my miscarriage and throughout my pregnancy I just need to dig up her contact details. Although I'm not sure what her fees are as my work insurance paid for it 

    Offline katkat2014

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    « Reply #2032 on: 24/01/18, 21:02 »
    Hello briss first of all it's good news about your ovulation / estrogen levels / lining. I assume that you've stopped BF and that this also plays a role that your cycle has changed ( to be more positive). So I think it's going in the right direction! I would say that EC on day 20 isn't ideal and I would probably next time just cancel if it happens again (easier said than done I know). On the other hand, can you ask them how the eggs looked like upon injecting them? Who knows maybe the sperm was to blame (as well)? If I don't take progesterone after EC then your luteal phase may be a bit shorter than usual. Are you taking ubiquinol to give those eggs some energy and protein shake to give them a bit of a boost during the follicular phase? And B6 to balance out the cycle. I think it's a really good start and am sure you'll manage to get a good egg soon

    LXP just a quick welcome and hope some of the other ladies can help. My issues are slightly different, but I know that more follicles can appear throughout the cycle

    Mac no idea about primrose but this sounds like a good month to ttc anyway...

    Sunshine yeaaahhh this sounds so good, fingers crossed for tour embryos!!

    Klik so nice to hear from you. You sound busy busy busy! What did Dr Trew suggest?

    Bluedolphin maybe a bit late but just Google Ali pharmacy shadwell

    Offline Babyhopeful

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    « Reply #2033 on: 24/01/18, 23:32 »
    Briss - I知 so sorry to hear your news. I agree with katkat about asking about what your eggs looked like. I asked the embryologist a million questions about the eggs that failed to fertilise on this cycle and I got loads of useful information and I felt quite reassured afterwards. It could just have been a weird cycle. I知 finding that I知 getting them more and more with either late or early ovulation. I知 taking a good vit B complex at the mo to try and even things out when we池e ttc naturally.

    LXP - I had a similar issue on my first IVF cycle. We learned that my ovaries just don稚 bounce back from a down reg so my 2nd go was short protocol with BC and this go has just been a short protocol. I converted the first IVF with down reg to an IUI as I did have 3 good sized follies in the end. IVF is very much a learning process, trying to discover what works best for our bodies. You may be surprised however by how much your follies have grown by your next scan. I値l keep my fingers crossed that the next scan will be more positive for you.

    Offline AdelineX

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    « Reply #2034 on: 25/01/18, 16:48 »
    Hi ladies, I read your updates with great interest, exciting times on this thread!

    Briss, I totally sympathize with you, no fertilization is a such a bummer, especially after so much trouble with work, travel, and turning everything upside down! I'm truly sorry, but there is hope, after a short break perhaps you could try again. Older eggs are of poorer quality, but I refuse to believe that all of them are like that! Please don't be disheartened, if you feel you can do it again, you still have time!

    LXP - BCP before IVF is oversuppressive in poor responders. It happened to me on my first IVF in November. Keeping everything crossed for you and a successful next round! 

    Sunshine- wonderful news! I hope you have great embies for transfer!

    AFM - I'm totally confused again. My dr. wants to start estrogen priming on day 26! Why??? AF usually starts on days 24-25, why on earth would I start priming in the follicular phase? I asked her if it is a mistake, as I knew estrogen priming usually starts in the luteal phase, on days 19-20, so that it brings FSH down, evens out follicular growth, etc. Does anyone know this approach? Has anyone tried it? I'm so confused! There is not one study that mentions this and with my very low chances I feel that they just do weird things that jeopardise them even more.

    Offline ShadyWheat

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    « Reply #2035 on: 25/01/18, 19:25 »
    Sunshine - that's wonderful, I'm so pleased that the mild has worked out better for you and you've seen better fertilisation rates.... hope all 4 embryos are still going strong. I think a result like this makes it easier to have faith to keep sticking at it (that's what I found for me, anyway...). I didn't consider back to back stimming because I did find it tough, both physically and juggling work commitments, plus Lister don't let you do it.

    BabyHopeful and KatKat, hope the 2ww is going well and that you are staying calm and positive. BabyHopeful, you are right, it's the time I find the toughest, as it just involves waiting!

    Briss, so very sorry to hear that neither egg was good enough for fertilisation. However, it is a step forward from the past few months, though it may not feel like it right now, I know its devastating when you put yourself through so much and end up with nothing. It does sound like your cycles are starting to get back on track, slowly but surely, and I hope that soon you will be able to get all factors aligned and collect an egg that fertilises.

    Blue - thank you! I hope you find a good recommendation for a RE, I'm afraid I haven't seen one so I can't advise.

    LXP - welcome, and sorry to hear you've had a slow start. As others have said, this is not unusual after downreg with low AMH. I actually think your response doesn't sound too bad considering its early days in the stimm process- my AMH is very similar to yours and downreg and BCP completely suppressed me. I didn't even do very well on an antagonist cycle without downreg, and normally only expect to get 3-4 follicles and eggs, so have been doing mild cycles instead. One of the worst things about DOR is just having to try a number of different protocols before you find one that works for your body, which is an expensive, time consuming and emotionally draining experience. But I hope that you are luckier and that your follicles pick up.... there are various schools of thought on whether increasing stimms actually has any effect (and may in fact be detrimental to egg quality), so I would go with your clinic's recommendation for now, and see if a slightly longer stimm at 375 gets you a few good follicles.

    Klik, I love how you say you're going to do a short note and then write an essay! What did Dr Trew say about your lining and did he recommend any more interventions? Would the scarring have been caused by implantation, or rather the surgical intervention? I have to say I have been worried since I had the ERPC whether it was the right decision or not, and your experience doesn't fill me with much confidence. On the other hand, I know its rare for things to go wrong (but I seem to be terminally unlucky, so I'm sure I would be someone it would happen to!) I'm just tempted to go with putting one back soon, as it is possible to overthink things, and then if it fails to implant maybe I'll consider more investigations and more collections. However, it's then difficult to know for what reason it would have failed, as they could be a handful of reasons in my case.... so maybe I won't be any the wiser.

    Work this week has been very weird. The CEO and my director both resigned, I really think I need to get out soon, it's like rats deserting a sinking ship. Plus, four girls on my floor are pregnant, it's like there's something in the water... everyone came back from Christmas holidays announcing they're pregnant. Slightly sad, as had things gone to plan, so would I.


    Offline klik

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    « Reply #2036 on: 25/01/18, 23:34 »
    Sunshine: my fingers are super crossed for your four embryos!!! Well done and good luck!!!!

    Mac: no idea about Evening Primrose but it sounds to me like you're ovulating! Good luck on your natural attempt!!!

    LXP: good luck! I'm personally a fan of mild for people like us, but higher doses work really well for some DOR women! Maybe it will take a while but I hope you get a good healthy batch of embryos from this cycle!

    Briss: I'm so sorry you got no fertilisation... I'm glad you at least got one mature... I have a sense that your follicles still had one or two days to go but as I don't know your actual LH numbers I'm really just pulling this out of the air. Still, I'd really think about katkat's advice to maybe use an antagonist next time, to give your follicles more time to mature well... Shady is right--you're getting closer to the mark... I think you will get there in the end--I'm just sorry it's so difficult and painful...

    katkat: how are you holding up in your 2ww?!

    Babyhopeful: good on you, asking loads of questions. I think that's best, if at all possible!

    AnnaKay: I cannot understand why you'd be told to start oestrogen priming from day 26... I wonder if she meant 16?! Cornell wanted it to start about a week after AF arrived (which, for an average luteal phase of 14, means starting one week after ovulation).

    Shady: I'm so sorry you couldn't join in with the wave of pregnancy announcements... So much heartbreak... Re. your ERPC, I'm really sorry, I shouldn't be spreading my own trauma and paranoia to you... The scarring can apparently only be caused by two things: surgical intervention or infection (in my case, almost certainly the former). Apparently it's not even about how careful the intervention is--some women are just genetically predisposed to uterine scarring, and I seem to be one of them... There's an Asherman Syndrome (what I have) support group, and they quoted some study (which I haven't read) that has found 31% of women who have ERPC end up with adhesions... and that these adhesions are underdiagnosed. 31%. If anyone had given me those stats I think I would have skipped it. But I have a sense that there are conflicting stats from other studies--I just haven't looked into it, to be honest, because it's kind of irrelevant to me now I know ERPCs are just not for me. If your gut feeling is to do a transfer ASAP, I think you should go for it. If your lining is behaving normally, you won't have a reason to suspect adhesions. If, however, you find that it is thinner than what is usual for you, then I'd go have it checked. So yeah, perhaps an HSG now would be overzealous--your lining thickness should be a good indication of whether or not you need it. And hopefully you won't, and your recently pregnant uterus will be clamoring for another pregnancy asap!

    AFM: I do have Asherman Syndrome. Darn it. I'd been suspecting/dreading it all along. What I find kind of odd is that two really good REs missed it altogether, and it was only my own sense that my lining used to be ok and now it's not that has gotten me to obtain this diagnosis. So yeah, despite the completely normal-looking 3D HyCoSy, two walls of my lower uterus are stuck together by some scar tissue. It hasn't shut my uterus completely, so the liquid for the HyCoSy and HSG could get around it, but Dr Trew was adamant that no doctor who knows that my uterus is in this state would ever do an embryo transfer for me. So thank goodness Dr Ozturk cancelled the November transfer due to thin lining. Implantation is obviously possible (hence my recent chemical) but the chances of miscarriage are ridiculously high... The scar is low in my uterus so if I understood him correctly Dr Trew is planning to do keyhole surgery, through my vaginal wall into the uterus (rather than a hysteroscopy) with a camera and microscissors... then he'll cut the scar tissue so that my uterine walls can separate again, and he'll put a gel there to keep the walls from immediately gluing to each other again... the gel will go away by itself after a while. He said if the scar turns out to be filmy, I don't even need another HSG--I can just have a transfer my very next cycle... if it turns out to be hard tissue, then we'll do another HSG to make sure it hasn't re-formed. If it re-forms, we'll need a second surgery. So, we're hoping for filmy.

    He said given my clinical picture (thinner lining post-ERPC, plus lighter periods (I think) than before), this was the best possible diagnosis. Had they found nothing, he would have suspected a much worse, more intractable problem (I didn't ask for details--he's very short on time!) This, on the other hand, he is confident that he can address...

    So, more time, more money, but at least there's a light at the end of the tunnel. And no more ERPCs for me, ever, if I can help it (though of course hopefully I'll never need one!)

    Online Hopeful_81

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    « Reply #2037 on: 26/01/18, 00:42 »
    Hello from a hot New Zealand! Just taking some time to catch up with everyone's news now that we've moved.

    Klik, I'm really sorry to hear about your Ashermans diagnosis (as you know it's also my fear, of which see more below...). It sounds like you have a plan and are getting some great advice/care. I will cross my fingers for the "filmy" outcome and that it is relatively straightforward to sort. Sigh, nothing is easy is it?  ^hugme^

    Shady, sounds like you totally know what you need to do about work.  I know it's easier said than done but I never thought I'd be able to make the break (from pretty stressful "career" job where it seemed everyone was constantly announcing pregnancies) and now I've done it I honestly feel liberated.  Ok I had to move to the other side of the world but that's extreme 😂 Klik's so right - if your gut feeling is to transfer and your periods don't feel any different/you don't have any different pain then I'd go for it. I am in the other camp at the moment so would prefer to address that before we do any further transfers. I think I read that your (physical at least) ERPC recovery was relatively straightforward? I was still testing positive 4 weeks later, didn't stop bleeding for 6 weeks and had to have a further operation for retained products which is a v different scenario. Can you get some further advice? Best of luck with whatever you decide.

    Briss sorry to hear you've been having wonky cycles and that there was no fertilisation this time. Fingers crossed that this last cycle is a sign of things settling a little. How are you getting on in your new job?

    Katkat, sounds like a great attitude for this cycle! Fingers crossed, hope the 2ww goes ok.

    Hi to everyone else, the thread is so active!

    Afm, we've no immediate plans for a cycle out here but think we will book in a consultation with the doctor we've been recommended. I've not changed clinics before - is it best to get our notes sent over first? I guess that could take a few weeks. Really enjoying some time out of treatment, although my ticking clock is never too far from my mind (my mum went through the menopause at 40 and her mum at 39). It's hard being in a new place and not having work or children to form social bonds but I'm taking the time to relax and look after myself. My major concern is my lining, I'm convinced all is not well in there. I've always had thin lining but my periods have changed since my pregnancy/ERPC and further op to remove retained products (Klik, am I right in thinking you had that too?). There's no other way to describe it than it feels like the blood isn't able to come out properly and I get localised pain for about 7 days which is getting worse each cycle. It could be endo but it doesn't feel like it. Anyway, I will ask the doctor we see here for advice but it's difficult not knowing if there are any specialists in this area here. Klik, do you think Dr Trew would be willing to do a phone consult to give some initial advice? Maybe I'll get in touch to ask. I can literally walk down the road and pay to have a HSG - no referral needed. Obviously we are trying naturally in the meantime but I can't shake the feeling that the problem has been my lining all along - we make some good embryos in the lab so how have we not had a sniff of a natural pregnancy in over 4 years? Maybe we'll be one of those stories you hear, "she quit her job, moved to the other side of the world and got pregnant!" Maybe...?!

    Oh also, before we left, our consultant agreed to prescribe me tamoxifen, which has been shown to increase lining thickness. However, I'm terrified of it causing another endometrioma. Does anyone know anything about tamoxifen and whether it can cause cysts? I can't find much on the internet about it xx

    Offline klik

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    « Reply #2038 on: 26/01/18, 05:48 »
    Hopeful_81: I can't sleep, so I might as well respond! Thank you for the lovely wishes! I was thinking I should really PM you, so I'm super glad you're in touch! Yes, our m/c stories are quite similar: embryo's heartbeat stopped, so we had an initial ERPC, followed by hysteroscopy to remove RPOC. And you and I have both been deeply suspicious of our lining since then... If you hadn't moved to NZ yet I'd have "gently nudged" you to see Dr Trew or at least Prof Hemingway for the HSG... I was in NZ briefly a year ago, just on holiday, and I was shocked at how easy and cheap fertility-related healthcare was... That said, I should mention that Dr Trew emphasised the importance of the radiologist's experience when looking for adhesions. My impression is, he's worked with Prof Hemingway for a long time... Four ideas come to mind--first, as you said, you could ask for a phone consult with Dr Trew--I don't know if he does them but it's worth a try. He does his private consultations at 92 Harley Street so theirs is the number to call... Second, you could search around for so-called Asherman A-list doctors in New Zealand... The support group I've been looking at has this page: http://www.ashermans.org/support/support-groups-by-location/ which does have the contact info for an Asherman sufferer in NZ who might be able to point you in the right direction (though I've no idea if that info is up to date...) Third, I've read that Dr Charles March, in California, is so passionate about Asherman's that he responds to emails from international sufferers for free, giving advice... Also not sure how up-to-date that info is, and different specialists have different approaches so unlike Dr Trew he might advise you to have another hysteroscopy instead of an HSG--really no idea... Fourth, you could of course just have the HSG and see if it picks anything up--just try to see if you can find a really experienced radiologist... If you find something, you'll know you need to do something about it. If not, then you'll have to decide whether to pursue it further anyway...

    One more note: the Asherman's support group is adamant that, if adhesions are found, they must be addressed only with microscissors... the idea is, those who have developed Asherman's are very sensitive to foreign objects in their womb, and, say, suction (for instance) to try to remove the scars could in fact just complicate the problem...

    I'm sorry you're in this situation... it is terrible, not knowing if there's something wrong with your uterus, and whether or not it can support life. It's just terrible. I still do have a wild hope that, as you say, you'll be one of those lovely stories of women who left everything behind and just got pregnant and had a baby! NZ is certainly a beautiful place for it... One way or another, I have a feeling you'll get that baby in the end... I hope you meet lovely people soon who will welcome you into their lives... Moving in your adulthood is pretty tough--takes a while to build a little community around you...

    Good luck with it all! And if you ever want to PM me, I'm here, rooting for you from afar! xx

    Offline Cloudy

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    « Reply #2039 on: 26/01/18, 06:53 »
    This thread has been locked as it's a bit long, a new thread can be found here: https://www.fertilityfriends.co.uk/forum/index.php?topic=390185.0

    Thank you xxx