# high FSH aged 31yrs!!! Third embryo transfer failed....HELP!!!



## sarahg83 (Dec 21, 2012)

Hi I'm 31yrs old, high FSH of 13.2. Other investigations normal, womb ok etc. DH has low sperm count and motility. 
Our clinic is at the Hewitt centre, Liverpool women's hospital.
Our first IVF cycle wasn't very successful, we used the short protocol using high dose stims (600iu menopur)
We got three eggs, two fertilised. Only 1 made it to day 5 and was a morula=BFN  
Second IVF cycle was much more successful. I took DHEA 75mg daily, coenzymeQ10, multi vits. 
We got 13eggs!!! 11 mature, 6 fertilised, 3 made it to blast level.  
Had a fresh blast transferred but was BFN!!!! 
We had two frozen blasts that ere very high quality 5AA and 5AB. 
I have just got a BFN with a medicated FET, I'm devastated!!!!!   I really thought I had a chance with such good quality embryo. I'm starting to think has something been missed.....why are these blasts not implanting. 
We have our one little frozen embie left after that we have to pay. 
I'm seeking advice from anybody else in the UK who has high FSH who has any experience of good IVF centres that are experienced with patient with  high FSH as currently the Liverpool women's hospital don't seem to be tailoring the protocols to my high FSH needs, my doctor leaves the decisions up to myself. The next cycle we have to pay for so are looking for a different centre.
Any other similar stories would be appreciated also as I'm loosing my mind here aaarrgggggg


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## karenanna (Dec 27, 2008)

Hi Sarah

I'm going to move your post to a more general area, as I don't think it's posted in the right place - is there a particular area in the country you are looking at for treatment? we might be able to help a bit more if so.

KA

Moderator

PS I have decided to move to the negative cycle area as I think you'll get people responding there who are going through similar things


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## CrazyHorse (May 8, 2014)

Are you open to traveling abroad for treatment? The logistics are a pain in the bum, but it *is* doable -- more doable than you'd think. And significantly cheaper, even with travel costs.

In most respects, I was much happier with my treatment at Reprofit in Czech Republic than at the clinic I went to in UK. I know a lot of other low-AMH/high-FSH ladies have also been happy with Serum in Greece.

Try having a read of the low-AMH/high-FSH board: http://www.fertilityfriends.co.uk/forum/index.php?board=535.0. You'll find lots of ladies talking about their experience with different protocols.

It looks like you got pretty good results with high stims in terms of number of eggs (assuming your second cycle was also 600 iu/day), but I am wondering whether you might get better egg quality on a lower-stim protocol. Do you know what your AMH is? I'm guessing low, if they started you at 600 iu/day, but I'm curious as quite a few of us with extremely low AMH have done poorly on high stims and then unexpectedly well on mild/mini IVF.


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## sarahg83 (Dec 21, 2012)

Thanks for the reply. I had AMH tested and when I went back for results they said they have stopped using this as it was unreliable but I happend to notice in my notes it was 6.34 I think. I remember him saying its low but not really really low. I would be open to traveling it just seems a lot to do but will do anything to better my chances. I've been trying to do reasearch of clinics in UK who are good with high FSH patients but they all just sing their own praises so how do you choose a clinic? 
Thanks for the suggestions I shall most definitely bare them in mind. 
When u cycle abroad is it just the egg collection and transfer you have to physically go over there for?. 
Thanks for the help!


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## CrazyHorse (May 8, 2014)

Yes, it's usually just the egg collection and embryo transfer you go over for, although depending on your clinic and your issues you might go over prior to then for other stuff, like a hysteroscopy.

I think the best thing to do when choosing a clinic is to skim through the threads for the current cyclers at various clinics -- read the chatter, get a feel for the general approach of the different clinics, see what kind of drug protocols and procedures they seem to use in practice. Obviously, also check out the clinic's published success rates, but that's only one piece of the puzzle, because those numbers don't show how early they encourage poor responders to switch to donor eggs, what their criteria are for canceling an IVF cycle, etc.

AMH of 6.34 is not bad at all, I'm really surprised your clinic started you off at such an aggressive dose of stims right out of the gate.


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## swanlake (Nov 7, 2012)

Hi Sarah
Have you looked into immune testing? Have you had this done? I have low amh and have had cycles that failed to implant - after on paper looking quite good- and after tests (level 1/level 2 immune tests)  and immune treatment found a host of things that may have been stopping implantation. The treatment in theory did work for us as got bfp (but mmc maybe egg quality) 

We were advised to look into these as after 2 failed ivfs it was classed as recurrent implantation failure and there may be other reasons for it rather than just low amh......sometimes.

The immunology thread with agates guide to learning from your failed cycle is a good source of info.

Good luck xxx


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## sarahg83 (Dec 21, 2012)

Thanks crazyhorse, I shall do that! I think they started me on high dose stims based on my FSH alone as my clinic don't use AMH test anymore but next cycle I'm thinking of reducing the stims dose to take a bit of pressure off my body as read high dose stims can be damaging to eggs.

Hi swan lake, thanks for your reply. Immune testing is the top of my list of things to rule out and intend to ask my consultant about this. I have no signs or symptoms of having an immune issue but suppose you never know. Especially as this blast was top quality I think we need to investigate further instead of putting it down to quality all the time.

Are u from England? Did u have immune tests on NHS?  
I am sorry to hear of your mc, how devastating.

Thanks I will look at that thread!


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## ustoget (Mar 6, 2014)

Hi crazy horse,
I'm so sorry u are in this position... I can really relate as  I was last year although slightly different..but I was probably the lowest I have ever been in my life, so totally understand your frustration!!
We made great eggs (although not as good as yours) 6 blasts from first fresh cycle last April ..  the first fresh transfer ended in misscarriage at 8+5 and the next 5 embryos over 3 transfers failed to implant.. My clinic said it was just bad luck/ bad chromosomes etc but I just could except that.. So I started to do my own research and with loads of help from women on here I set about to make my own plan.

I concentrated on the implantation failure, in February I went to serum in Greece to have a hystoroscopy (approx £1500) which is where there check out my uterus for any scar tissue or polyps that could stop implantion and cut away anything that shouldn't be there. Before this I sent my menstral blood to them to check for hidden infections (£100) which they found I was positive with chlamydia (which is common even when tested here and your clear) myself and dh were both given 3weeks antibiotics to take to clear it.

I also paid to have my Nk cells test at warwick implantation clinic in Coventry £360 which showed my levels borderline (nk cells are where your cells flare up and reject/kill the embryo)

So during this cycle I took more antibiotics up til transfer to stop any chlamydia flare up and now I'm on and off for 5 days up til 7 weeks pregnant 
I have to take steroids daily  to suppress nk cells this was from transfer to 12 weeks 

And if (please God) my scan goes ok on Friday I will start injecting clexane to stop any blood clots.

As this lead up was to our next fresh we also went on a strict fertility diet/supplement plan to make sperm and egg quality as good as it can be (embryo gradings don't always tell the correct story as the sperm can high fragmentation- so we removed all toxins from lifestyle and food) my dh motily is also bad, morphology improved a lot from antibiotics and diet. (It's been known that people get pregnant naturally after the serum tests and treatment too )

Also My fsh in dec with 11.4 and my clinic were not concerned in the slightest and only put my stims up to 250 for the fresh cycle we had this March !! We got 9eggs,7fertilised and 6 blasts and am now 6weeks pregnant..

I was told numerous times that fsh usn't important its only an indication of your reserve and as the stim counteracts your natural cyvle it doesn't matter.

My way was the most I could do without going down the Dr gorgy full immune testing route and maybe as u still have one frosties left u might consider trying a couple of things now !!??

Hope this helps and u find your way


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## CrazyHorse (May 8, 2014)

Hi, ustoget, I think you meant to address your response to sarahg83, right? 

It's AMH that's the marker of ovarian reserve, but doesn't really provide info on egg quality -- a lot of women with extremely low AMH (e.g., < 2 pmol/L) still get decent-quality eggs, just not very many. High FSH usually indicates that you'll be a "poor responder" to stims, and it does correlate to some extent with egg quality; women with really high FSH (e.g., > 20) usually have egg quality issues, although surprise natural BFPs still aren't unusual if the Fallopian tubes are open. Lots of women with FSH between 10 and 15 still seem to get good quality eggs, though. AMH and FSH together provide a fuller picture of ovarian reserve and potential egg quality, but I do think the FSH measurement probably provides more useful information than AMH in most cases, if for some reason you were only going to look at one of the two numbers.


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## ustoget (Mar 6, 2014)

Oh yeah sorry


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## sarahg83 (Dec 21, 2012)

Hi ustoget thanks for your reply!!  
Congrats on your pregnancy!! You have given me hope.im sorry to hear all what you have been through, it's so frustrating.
You have certainly given me food for thought. I will most definitely be asking to test NK cells, did you get it tested at Warwick because it was cheaper?? As I will need to know where is best as not sure my current centre does these tests. 
Also what was the reason for traveling to serum? Was it a cost issue. I just presumed because all my dye and ultrasound scans of womb were normal that everything was ruled out regarding womb but suppose they can't see polyps or scar tissue can they from just an USS. 
Can I ask what protocol you were on? You done really well with your embryos  
Also where have you recieved your treatment as after this last frostie we will be paying privately and wish to change clinics as feel I have to do the work of the doctors in discovering protocols and what to do next.

When u say u removed toxins....what do u mean as I'm currently reading a really good book called "it all starts with the egg" and it talks about not using any plastic or anything with fragrance in (which is pretty much everything in life) do u mean stuff like that? 

Also do you have details of the strict diet you were on?
Sorry for all the questions but feel I can learn a lot from you  

Good luck with your scan Friday, I'm sure all will be fine
Thanks


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## swanlake (Nov 7, 2012)

Hi Sarah

Thanks for your thoughts. Xx
Yes uk based level 1's can be done through gp, level 2's were through private clinic. As ustoget has said with her advice, which was interesting too to read ustoget- other tests can be done in other clinics, mine were Chicago tests which they send away to a lab in the usa- I too think I will be doing the hidden c test. I had no symptoms at all and was a big shock when it came back positive for high nk's and thrompohilia and pai-1 gene thingy. So was on steroids, clexane, and intralipids. 

I took Pycnogenal, and co enzyme q10, and reservatrol, cut out caffene and alcohol (for three months at least before txt. I read somewhere that white wine is bad for egg quality??!! May be true or not but once read I couldn't unread it and so didn't want to risk it!!  Tried to cut out gluten but felt so miserable without being able to eat bread!!

Would be interested too to hear ustoget's diets/toxins. Some people really rate dhea for low reserve?

Some Drs prescribe empirical immunes just in case when embroys fail to implant? So do low steroids, aspirin/clexane, intralipids etc? As ustoget says may be worth trying some thing? - these drugs are shown to be fine for first 12 weeks and some beyond, so some Drs feel won't do any harm, and could actually help. 

It's awful having this low amh as I think for me anyway can never know really if eggs are bad quality, and the feeling of not being able to do much about it 😳😳

Xxx


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## ustoget (Mar 6, 2014)

Hi Sarah,
Ask as many questions as u like.. I don't claim to know everything, to be honest little compare to many on here but if I can help in anyway and give back like others on here have to me I'm happy!

So to answer,
I basically done a lot of reading on here and went to the fertility show and had a free consultation with Dr gorgy and penny from serum. I liked them both but after more research I found out the serum will treat immune issues empirically like swan lake mentioned instead of always having to find the problem which to be honest for me was the better option financially. So I decided to tick as many boxes as I could without going down the full immune Chicago testing route.

No ultra sounds do not show a clear picture of womb condition they need to go inside to find out.. I also had implantation cuts at serum which I think are the only clinic to do this.. Deeper cuts instead of scratch to help implantation.

At the Last minute after months of begging Oxford to let me tests/help me get answers they actually said yes. The director of Oxford had just meet with prof quenby from Warwick and Oxford have now decided to send patients to her for this nk test and then they will support what is recommended. It felt great to have another support system, I meet prof bronsen who was great and got my results through from prof quenby and she is scanning me this Friday free of charge too 

I was on a long protocol (last year I was only on 150 gonal f daily ) so they upped it to 250 although it got dropped during scans and ended in 115 I think.

Toxins- yep excatly what u said, I haven't read that book but heard its good. I decided to go to mel b the nutritionist and she gave me all the info... £200 for couples Skype consultation and I had all I need in one place, and support if any queries.

Swan lake- unfortunately my clinic wouldn't' todo level 2's but yeah there's lots that will like Argc for example. Because I was funded I was told if I moved I would go on the new funding scheme which would of meant no more transfers. The only symptoms I had was brown spotting and very light periods.. My period after treatment was the heaviest I've had for years but it was also my stimms bleed so difficult to say it was 100 % the antibiotics or hysto but together they seemed to do the trick. I highly reccomend it if only to tick another box and feel like you've done everything u can! I also heard of INtralipds but prof quenby doesn't believe in them and couldn't.t go to yet another clinic for something else so decided to drawn the line there.

U can also get your embryos tested after they fertilise.. By having pgs cgh which again isn't cheap about 3k and it checks the chromosomes are correct. If they are not they would not of gone to a pregnancy. Or u can use embryoscope (we did)which gives 24hrs survelence of what the embryos are doing, for example if they skip a cell division some embryologist see this as unnatural progression and would then have that info later on when choosing which embryo to transfer.. This was £415. None of ours done anything they thought was not correct so not sure if it was worth it in our case but I know for others it's been really benefiticial.

Immune testing does seem to be the way to go for most people but so far so good for us, I have no idea whether we would of had the same result if we had done nothing but I'm glad we did what we did and are where we are.. It feels good to have a heathly body and know that we done so much really.. It really made us feel positive throughout and just hope and pray it's continues


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## sarahg83 (Dec 21, 2012)

Thanks swanlake, good to know I can get level 1 through GP it's amazing what you can find out on here! 
I'm also suprised at how many ppl go abroad for tx and investigations and it something we will consider.
I will also ask about empirical immunes as that will be our cheaper option but still cover some bases.
I know how u feel with low AMH and high FSH it really is devastating and makes this journey do much more challenging for us!!

Thanks for your reply ustoget!! 
You've explained things really well as I don't always understand some abbreviations. Also really good Uve included costs as helps to get an understanding of how much these investigations are.

I've already been online looking at Warwick implantation which gave a clear plan of what is included within the price which is really helpful. I've also looked at Mel b nutritionalists website.

I also think PGS is something we should consider its just do expensive!!!! 

I feel like now I've got a plan and have something to focus on. 
Thanks for your help xx


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## ustoget (Mar 6, 2014)

My pleasure.. Let me know if there's anything else u need to know.. 
Oh and I started a threat caled gorgy v serum or something like that, might be good for u to read as its where I got alot of my answers from.

Take care & good luck xxx


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## sarahg83 (Dec 21, 2012)

Thanks will I will most certainly look at that thread as that's exactly what I'm looking for!

Thank you so much, take care xx


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