# High AMH but poor responder



## rosebud5 (Apr 19, 2005)

I wondered if anyone else had experienced this.  I have a high AMH (44) but tend to take a really long time on stims.  I was on stims for 19 days in my last round of treatment.  I started on 225 of menopur and ended up going up to 300.  It was the short protocol.  I got 7 eggs and ended up with 2 blasts (a 2BB and a 1BB).  I also had a very large number of very small follicles.  The doctor said I am very confusing and that it is very difficult to figure me out as I don't respond at all the way you would expect someone with a high AMH to respond.  They have decided to treat me as a poor responder next time.  I will be on the flare protocol.  They have warned there is a risk of OHSS, but they are going to monitor me closely.  Being on stims for such a long period of time does reduce the chances of success I think, so they are trying to cut this down.  It feels quite lonely being in my own special category of infertility.  I have googled and googled my type of response but found very few other people to have had it.  If anyone else has had such a response I would love to share experiences.  Thanks, R x


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## Luv one (Nov 7, 2010)

Hi Rosebud, I too have a similar experience to you. My AMH is now satisfactory 30 pmol but last time it was 40.69 so in the space of a year it went down. For my first ivf they did the short protocol starting at 150mg gonal f then up to 300mg then down again. I too had lots of under 10mm follicles and they claimed i had polycystic apperance as one ovary showed them pearl like. I stimmed for 16 days and there were 42 follicles in total and only 6 eggs were collected which was soul destroying as I was expecting more.

This time I will be on long protocol starting down reg day 21. So lets see how I get on this time round. Apparently this ivf is a trial and error thing as they havent a clue how one would respond. So they tend to do the generic short antagonist protocol if the amh is ok. This new clinic wondered why I was on that protocol and asked me what went wrong...like I would know. I actually have info session tomorrow so will know what meds etc I will be on. Its all very frustrating when you think things would go smoothly due to the amh but then find out that it didnt. I ended up months later with couple of cysts and fibroids so had to wait till those went naturally to begin. I pray they do not return whilst stimming and hope this will be the protocol that work for me. Good luck to you!


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## Jennyren (Jan 15, 2010)

Hi Rosebud

I am so pleased I found your post. I am exactly the same!!

My AMH was 114 !! so they strongly suspected I would over stimulate. They put me on a short protocol starting on 150 menopur, after 7 days at this dose they increased to 225 menopur for the next 6 days. 7 days into it I had only 3 follicles, 13 days in, I still only had 3 follicles. They suggested I cancel the cycle and start again on the long protocol with a higher dose of stimms. So I too have this weird kind of infertility that makes them dumbfounded. 

I have PCOS with none of the usual signs other than the fact that my ovaries are covered in little cysts or follicles and I never have periods so never ovulate. I think the doctors thought all the little cysts would turn into eggs and they were over cautious with me. 

We decided to go ahead against their advice. Had egg collection today and have 3 eggs. Waiting for the call tomorrow to see if any have taken,,,,, I'm not getting my hopes up a I know the odds are against us. We just figured we had got that far we may as well see it through.


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## rosebud5 (Apr 19, 2005)

Hello Ladies,
Its so great to hear from you both.  I had given up on getting any response to this post.  I'm sorry that you are both experiencing similar difficulties, but it is nice not to feel so alone.
Jennyren I totally understand why you decided to go ahead.  At my last round they thought I might get around 3 eggs and they did mention cancellation.  But they didn't go as far as saying I should definitely cancel.  And as everyone says ... it only takes one!  You also have a plan B which is the long protocol ... I always like a plan B ... keeps me sane.
Luv One - I hope the information evening was interesting.  Did you find out about the meds?  I totally agree that ivf is a trial and error thing.  We are lucky to have a little one through ivf from 2009.  I had a similar response then but they learned from my responses and it eventually worked.  It was the long protocol I had been on. When we began to try for this one they put me on the short protocol (which they hadn't previously offered when ttc #1), but on really low doses of the drugs for me (I think it was 125).  They kept me on this for over 2 weeks without increasing it which drove me nuts, then they cancelled. I then moved to GCRM because of their success rates and thought well if I have to pay for it all this time round I might as well have the full private experience.  I also thought they must be able to figure me out as they have such a good reputation, but I'm still a confusing/ trial and error case to them.  We're aiming to go again in October probably.  They have recommended the flare for me and suggested starting me on really high dose of 300 (that's how stubborn I am).  I'm a bit confused really as no one seems to be suggesting to me that I do the long protocol which is what worked last time - although whilst it worked it always seemed like a roller coaster where I teetered on the edge of cancellation and then got a fairly good number of eggs.  They did say either the long or the flare would be best for me but seemed to err towards the flare.  I don't want to second guess them, but if this doesn't work then I might ask for the long the next again time ... I'm so optimistic aren't I! 
Good luck to you both ladies. Its really nice to "meet" some people with the same experience.  Let me know how you get on.  Wishing you both BFPs soon! R xx


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## jane29 (Aug 11, 2013)

Hey i found this thread and I am worried about this too as my AMH is good but when I tried an injectable cycle at 75iu fostimon nothing much was happening, had 2 follicles growing but not enough and loads of tiny ones. As i'm about to start IVF i'm really paranoid that i might not respond to the drugs, as i'm doing an egg share i have to produce at least 8 eggs so i'm so scared :0( x


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## Niceanimal (Nov 26, 2013)

Hi Jane

My situation is similar. I have crazy-high AMH (119! the highest my clinic has ever seen) plus PCOS, but only with irregular periods and multiple ovarian cysts (no other PCOS symptoms). 

My first round of IVF failed but NOT due to the stims now working. I got 16 eggs! Only two fertilized but neither divided, but we found out today that this was probably due to the outer lining on my eggs being super thick and my response to the stims was actually very good. 

In fact, they are happy to fund my second wound of IVF and we will use ICSI next time to get through that outer lining.

I was slow to respond to the stims - which is common with PCOS - so they jiggled around with my dose a bit. It was nerve racking but we got there in the end. They say they will just keep me on 150mg of Menopur all the way through next time and know that I might just take a while to get going. Last time, I started on 150mg, went up to 225mg then dropped to 75mg.

BTW, I didn't respond to Clomid or Tamoxifen. 

Try not to worry! Most people do respond to the stims and your clinic can adjust your dose if they don't see anything happening. 

Be prepared for OHSS if they do need to up your dose. My top tip for this is protein bars and shakes and Zero Highs to keep your electrolyes high. I was drinking 3 litres of water with electrolyes a day throughout my IVF and really needed it!

Good luck


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## jane29 (Aug 11, 2013)

Niceanimal - thank you so much for your encouraging reply. I already have decided that i will be doing ICSI as my partner has 'suboptimal' sperm. Its encouraging to know that they can tinker with the doses and hopefully find a dose that i respond to. I have been recommended to start Metformin too, did you do Metformin before your IVF? i've heard good and bad things about metformin so i'm a little worried, i don't want it to lower my egg count in anyway x


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## Niceanimal (Nov 26, 2013)

Jane29 - no problem. I've no experience of Metformin I'm afraid. But us PCOS-ers do tend to get lots of eggs so I hope that will be the same for you. It's hard not to worry with so much riding on the IVF but you do have a good chance of getting the eggs you need. Sending you lots of sticky baby dust! X


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## babycrazy35 (Jul 29, 2013)

Just to throw another one into the mix. I have/had an AMH of 81 and have just had ICSI. I got around 20 mature eggs but hardly any of them fertilised and after day 2 most of them were slowing down. I was on a short protocol. I have PCOS. It is so hard. Does it mean that our eggs do not develop as well as other non-pcos'rs?

Wishing you luck on your journeys.


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## Gulnaz (Dec 6, 2012)

Hi all

I am so happy I have found ladies going through the same. For the the last 2 cycles I have been put on the lowest dose for fear of over stimulating. 150 menopur and 225 cetrotide but both times got low number of eggs. My cycles previous to conceiving my daughter I got OHSS and got over 15 eggs each time, but after ICSI they dwindled down. My AMH is 36.73 and apparently in line with someone suffering from PCOS which I have been diagnosed with. Our last cycle abroad was our worst yet, on low dose stims and got 6 eggs but none made it pat day 1. At our review they discussed donor eggs which we are not even considering. They also suggested doing a mini IVF using clomid (which I respond well to thank god). Anyone have this suggested to them? Also since our last failed cycle I have been taking Metformin as I have read it improves egg quality. I thought generally PCOS sufferers stimulate too well?? Also all our eggs can't be bad?? I am desperate for a sibling for my DD. 

Good luck to all.

Gulnaz


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## Niceanimal (Nov 26, 2013)

Hi babycrazy35 and Gulnaz

My first IVF was certainly similar to your experiences. Lots of eggs but none made it very far. Saw our consultant yesterday and she says there's no reason why we shouldn't get to ET stage, however, if we use ICSI, so am trying to remain hopeful. 

We are seeing Zita West in Jan so will let you all know what she says on this issue. 

Good luck ladies! Stay in touch. Xx


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## foxglove (Jul 20, 2013)

Hi ,

I have an amh of 69.

My first round was cancelled due to poor stimulation  - I got quite a few but they didn't grow. My E2 levels also dropped and so we cancelled. That was on long protocol with menopur.

2nd cycle we did short protocol - started on norethisterone to bring on bleed then was on 150 gonal f and cetrotide. My E2 levels still baffled the consultants and half way through they boosted my dose to 300 despite seeing lots of follicles. The levels still remained quite lw but they did rise and went ahead and we got 24 eggs! This was a complete surprise if you were just going on the e2 levels. I am now 12 weeks pregnant! 

I think every cycle is different but don't loose hope. I really didn't think my eggs would be any good! 

Don't give up hope xxx


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## Niceanimal (Nov 26, 2013)

Hi foxglove - thanks so much for your happy story! Need to hear those today. Best of luck for the next few weeks! Xxx


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## babycrazy35 (Jul 29, 2013)

Hi I went for follow up today for my failed ICSI cycle. I was put on a short protocol as I had previously mentioned I had an AMH of 81. My husband has sperm issues so that is why we had ICSI and his sperm has improved slightly on vitamins etc. However, today the doctor at consultation said that although I had a good number of mature eggs 50% of those were poor quality and were dark around the edges and were difficult to inject with sperm. The ones we had put in the embryoscope did fertilise however the ones outside did not, well a few did but they didn't get very far. Dr said that my eggs don't really go with my age 35. Dr also said they wouldn't change my dose the next time and there is nothing I can do to improve my egg quality. I came out thinking that I would just be throwing my money away if I even tried. In the next breath the doctor said I do think that you can have your own biological child it really is just a flip of a coin whether you get in next cycle or not - when she was just previously telling me my eggs were rubbish. Do pcos'rs have quality issues with eggs? I just really feel that although I have eggs, they aren't really worth doing anything with. Sorry to come across so down, but at the end of the conversation the doctor looked at their watch and said, well I have a patient on the hour every hour up until 7 pm and at that we finished the consultation and it was just left, well see you how you feel in the new year.  +++


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## jane29 (Aug 11, 2013)

Hey well Lister just sent my doctor a letter recommended that I start Metformin before my IVF, they didn't state a dosage. My doctor prescribed me 500mg but then I was reading lot of people on forums saying that it was only effective taking 1000mg so I upped my own dosage to 1000mg. I've started feeling really guilty though that I should be just taking what i was prescribed and that maybe i was being irresponsible taking 1000 so i've gone back down to 500mg. I'm so confused about how much I should be taking and whether it will be beneficial for my IVF, I found this on the internet though:

Metformin and IVF Research

"We are currently testing the hypothesis that the administration of metformin to women undergoing IVF may improve multiple outcomes including egg and embryo quality and pregnancy rates.  In a retrospective review of 125 ovulatory, non-PCOS patients (mean age 34.9 ± 3.9 years) undergoing a repeat IVF cycle with the administration of metformin ER (1500 mg/day), we found that pregnancy rates were statistically significantly increased across multiple groups.  This data was presented at the American Society for Reproductive Medicine annual meeting in 2009.  Additionally, a group out of Tokyo, Japan, recently demonstrated that the administration of low dose metformin (500mg/day) to women undergoing repeat IVF cycles improved pregnancy rates in a significant fashion.  Thus, we hypothesize that the administration of metformin to patients undergoing IVF will improve pregnancy rates and that this improvement may be due to enhanced egg and embryo quality."


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## Gulnaz (Dec 6, 2012)

Hi

All my cycles have been short protocols. My cycle in 2012, I was prescribed Metformin and took it the month I stimmed. Out of 6 eggs using ICSI, 3 embryos were decent and we transferred the best 2 but I bled before OTD. I feel the Metformin helped improve my egg quality but I stopped taking it after that failed cycle. I wish I had continued to take, maybe my cycle this year may not have turned out as bad as it did. Hence why I started the Metformin again. I am taking 1000mg daily and also taking inositol 1300mgs daily.


Good luck


Gulnaz


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## jane29 (Aug 11, 2013)

I didn't know you could take Metformin and Inositol together? x


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## Gulnaz (Dec 6, 2012)

Hi

Yes as far as I know it's ok to take together.


Gulnaz


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## Niceanimal (Nov 26, 2013)

Hi all. I had a consultation with Zita West today and asked about this issue. She said that high AMH alone isn't an indicator of poor egg quality, it's just that PCOS can make achieving a number of quality eggs via IVF trickier, and PCOSers often have high AMH. She has recommended Inositol for me and given me a fact sheet on it. She was also v positive about our ability to conceive. (We are not doing IVF with her; this was just a one-off consultation.) 

Let me know if you'd like me to upload the fact sheet

Best of luck fellow high AMHers!


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## jane29 (Aug 11, 2013)

DD stands for Daughter right? There is an old wives tale that if you take loads of cranberry (juice or supplements i'm guessing) that you are more likely to conceive a daughter! whether its true or not i have no idea! x


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## Gulnaz (Dec 6, 2012)

Hi

@niceanimal

Did she say how much inositol to take? I am taking 1300mgs daily and just wondering if that is enough. I would be very great full if you could upload the fact sheet. Thank you.


Gulnaz


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## Niceanimal (Nov 26, 2013)

Hi Gulnaz

Zita gave me an inositol plus folic acid powder. It says in contains 4gm a dose plus 200mcg of folic acid (been on other folic acid supplements for years of course)! I guess that means 4000mg of inositol a dose. It's one dose a day. 

I have scanned the fact sheet but can't work out how to upload it! Will get back to you...


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## Niceanimal (Nov 26, 2013)

Hi Gulnaz

I have uploaded the Zita West inositol fact sheets in the Gallery under Miscellaneous. Hope they look ok; the scan was a bit wonky, then I had to convert it from a PDF to an image!

Any problems, let me know.


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## Gulnaz (Dec 6, 2012)

Hi

Thank you very much for uploading it to the gallery but it seems very blurry. Cannot make the words out. If poss could you email it us. [email protected]
Thank you again.


Gulnaz


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## Niceanimal (Nov 26, 2013)

Hi Gulnaz

Sorry for the delay on emailing you - am having some computer problems - but wanted to let you know I haven't forgotten!


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## Niceanimal (Nov 26, 2013)

Hi Gulnaz

I've finally been able to email you the file! 

Sorry for the delay.

Let me know if it doesn't arrive.


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## Gulnaz (Dec 6, 2012)

Thank you very much niceanimal, I got your email. I have recently purchased inositol powder off eBay and am now taking 4g. It must be working coz within a few days of starting I had signs of ovulation. I don't normally ovulate so early in my cycle, my period app had me down to ovulate about a wk later. Will continue to take.
Thank you again.


Gulnaz


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## Gulnaz (Dec 6, 2012)

PS

Forgot to say, wishing you all the best with your upcoming cycle.


Gulnaz


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## Niceanimal (Nov 26, 2013)

Great news Gulnaz! Best of luck with your cycle too.


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