# Over 40s success with AMH <1??



## Val74 (Jan 3, 2015)

Hi, I've posted in the low AMH/high FSH thread but haven't had any response yet.  I'm almost 41 and had my AMH results back recently only to find that in a year and a half it has dropped from 10.6 to 0.5!  I had arranged the test myself after my right ovary was removed, thinking that if my level had dropped a fair bit that would help me make my decision on donor eggs. Now that it's almost non-existent though I still find myself clinging on to the thought of using my own. I think I'm being ridiculous but have only had 2.5 goes of IVF as in my head the last cycle doesn't count as it had to be converted to IUI as I responded so poorly. 

Am just wondering if anyone has any success stories, or stories in general with similar AMH and general poor response?  Most I ever got was 2 normal eggs.

Thanks

Val xx


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## Tincancat (Mar 19, 2012)

I had similar AMH with one ovary and only ever one or two eggs collected which always got me to transfer of one or two apparently good embryos which never got further than a 10 week miscarriage and a chemical once.  In the end I had to face a life without kids or use DE. 
I got my lovely boys first time with DE and wished I hadn't wasted so much time and heartache with repeated OE cycles failing.  However I had to come to terms with using DE and I could only do that once I knew OE were not going to work.  I discounted every other cause of the cycles not working by having hysteroscopy to rule out physical causes and treatmebt for high endometrisl NK cells to cover immune.  I do think if I'd have known about my immune issues earlier I might have had a chance with OE but by the time I'd found out my eggies were simply too old.
Good luck with whatever you decide to do next.
TCCx


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## WhatWouldBuffyDo? (Feb 13, 2012)

Hello Val74,

Hope you're doing ok.

I have a low AMH (last measured in 2012, age 38 at 2 clinics on the same day and it came out as 1.9 and 0.9, so there's definitely some variation between labs...) and a low (3-7) antral follicle count. I have both ovaries. I cycled in Sept/Oct 2014 6 weeks before my 41st birthday with OE (presume the AMH would have reduced over the 2.5 years since the last test) and am today 30+1 weeks pregnant (fingers crossed, touch wood, etc etc - still can't stop saying that). Was a bit of a battle to get here - see signature.

On this most recent try, I went for a natural cycle but ended up with four days of 150 Menopur (previous OE cycles had all been 10-12 days on 450...  ). This gave me 4 eggs, 1 of which was immature, and 3 day-3 embryos. I _think _the previous cycles were, in chronological order, 3 eggs and 1 day-1 embryo (left that clinic sharpish), 4 eggs and 2 day-3s (miscarriage), 7 eggs and 2 blastocysts, and 8 eggs and 2 day-3s, so the lower stims may have contributed to the recent result with regard to quality.

From my personal experience, I feel that hormone levels are a guide, and can usefully help in deciding which route to take, but they aren't necessarily the only factor. Like Tincancat says, making that move to DE can be tricky, so if you feel that you need to know you've exhausted every line of OE enquiry, then it's probably quite important to do that, if you can. I did it a bit backwards as clinicians were all so adamant that it must be my eggs after the unsuccessful OE cycles (had had some immune tests and had been on steroids and clexane for most of those cycles), so I tried DE abroad with no joy and then, still abroad, went back to pursuing other possible causes, found some more issues and tried dealing with them.

I hope you find the way that works for you, Val.

Bxxx


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## Val74 (Jan 3, 2015)

Thank you TCC and WWBuffyDo for your replies.  Both of your stories are equally beautiful!   TCC I've read some of your thread recently.  What an amazing and exhausting journey you have been on.  Hope little Chunk and Titch are doing well!  xx

It's so nice that you both understand the importance of exhausting possibilities with my own eggs first and that I've not been judged for not being able to immediately make that switch without any emotional wrangling; if I could I so would, I'm just overwhelmed by future implications at the minute.

Could I ask Buffy what clinic you had your natural cycle at?  I had a consultation in CREATE in Bristol but they said I would have to have mild/natural modified; then they said I would need an op and would need to lose weight.  I had another consultation at a different clinic who agreed I needed the op (which was, sadly, to remove my ovary) and requested IVF Lite (similar protocol to the mild at CREATE).  This was then changed to standard IVF, then back to lite (as I panicked I didn't have enough money) and then was back to being kind of a mix between the both.  I really do believe that over stimming women with low reserve is the wrong way to go from what I've read so was hoping that a gentler protocol would be better for me.  We changed meds this last cycle but I responded so poorly that they had to introduce Menopur before cancelling and converting to IUI anyway.  The options I've been given are either donor egg or to try once more with my own using Gonal F (have used Menopur and Bravelle in the past).  Could I ask what additional tests you had?

Thanks again.  Val xx


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## WhatWouldBuffyDo? (Feb 13, 2012)

Hey Val,

Gosh, I don't think anyone would judge you for needing to emotionally wrangle! Everything to do with fertility treatment is a massive decision involving body, mind and soul (and, sadly, bank balance...). and I think everyone reaches turning points in their own time and way.

I had the natural cycle at Serum in Greece - there's a section on the overseas board. As I had a few follicles on day 8, it was suggested that I might like to try a tiny bit of stimulation, so I did, so I guess it ended up like a mild cycle? It is a great clinic and they're happy for you to suggest things. They also do seem to genuinely adapt the treatment to whatever your body is doing at a particular time, rather than insisting you follow a standardized protocol. I also had a laparoscopy and hysteroscopy in Greece - didn't find a lot, but had implantation cuts which again may have helped.

I'd had NK cell tests and all the Level 1 immune tests at the Lister in the UK, but after the DE (Serum again) didn't go anywhere, I went the whole hog and shipped blood out to Braverman in the US. He does a massive battery of detailed tests in his standard immune panel, giving a very in-depth picture of what's going on at a cellular level in the body. 

I've only ever had Menopur, so I have no experience of other drugs to share, but I'm absolutely with you on gently stimmed cycles being possibly better for people with low reserve. A friend with an amh lower than mine (can't remember the number, but almost zero) had a v good experience at Create, starting out with 2 cancelled cycles due to non-response but the third month a mild cycle yielded 2 eggs and ultimately one daughter.

I know going abroad isn't for everyone, but it might be worth having a free consultation on the phone with Serum just to get another view? 

All the best,

Bx


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## Val74 (Jan 3, 2015)

Hi Buffy, sorry it's been a while!  How much did everything cost with the Braverman tests??  I hadn't even heard of him so googled as soon as I read this.  I did actually get around to emailing the clinic too and they responded but I've not got back to them yet, kind of got sidetracked with clinics and what to do next, getting a bit immersed and lost in it all!xx


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## berberprincess (Oct 8, 2013)

Hi val,

Sorry to hear you're going through a tough time. I know my world totally fell apart when I was told my AMH was < 0.57. That was last year.

After a natural conception MMC in 2013 my whole cycle went haywire leading to all kinds of gynae investigations and eventually to the diagnosis of diminished ovarian reserve. My fertility consultant told my to start DHEA 75 mg daily. My one and only IVF attempt resulted in a AFC of zero. I couldn't face doing any of that again for a 1-2% chance of success. At that point me and hubby decided DE was probably our best chance at getting a baby but we wouldn't do it immediately. In the meantime to exhaust all reasonably practical options, I started drinking traditional Chinese medicine (prescribed from a qualified practitioner) , charting my BBT to establish if my ovaries were even functioning and took clomid. As yet I won't class myself as a success story but I'm 10+3 weeks pregnant. We had however just paid for a UK clinic to find us an egg donor. we were both just ready to have another baby, we were not exactly miserable but our whole lives just felt in limbo. Waiting for something that may or may not happen.

It's so tough knowing when to switch from OE to DE. I remember a particular conversation summer last year, with hubby and I burst into tears saying I'm not ready to give up on my body yet but spent the rest of the afternoon racking my brains as to when that point may be. I worked out it was knowing my ovaries either worked or didn't hence the BBT and some ultrasounds and bloods to check response to clomid.

I did buy a book called inconceivable by julia indichova which blew my mind as her FSH was >100 and she still conceived naturally. She has a website called fertile heart which is worth a look at. Wasn't quite sure on finding your inner child bit tho 

Anyway I hope this gives you a glimmer of hope and thought for whichever road you chose.

BP xx


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## Val74 (Jan 3, 2015)

Gosh that's lovely to hear berberprincess!! Congratulations!  Really hope everything goes well for you.  Will have a look at that website, that's insane isn't it! Was your clomid cycle monitored by any clinic? I've never had clomid as was told it was only for women who don't ovulate regularly. As far as I'm aware, I do. Though my bbt isn't great as I'm terrrrrible in the morning (probably as I'm awake til ridiculous o'clock like now!) so it's kind a peak and troughy, generally have positive OPKs but have noticed a change since my ovary was removed. Thanks for tip on amount of DHEA to take too, I've only taken it since _I_ asked it was ok to take, they agreed it was 'ok' but didn't tell me how much/often, getting to feel a bit defeated to be honest as hoped they would give me some definitive advice and direction. Thanks again!  xx


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## WhatWouldBuffyDo? (Feb 13, 2012)

Hey Val,
Sorry for delayed response! Trying to reduce internet use! Braverman cost about £2k in total. His fees were kind of impenetrable (though I have been shouted down on here for saying that, so maybe I'm just dim) but the reception ladies should be able to email you a list. When I was using him, the fee list didn't give the prices of the tests, which are in addition to any 'packages' listed (my logical brain thought that a package would include everything... but it doesn't in American). The lab he uses should be able to give you those test prices. Also there are the costs of shipping blood out to the Big Apple. I did that though TDL (The Doctors Lab) on Wimpole Street in London as they take care of the Fed-Exing for you. Had to do it a few times unfortunately as the first time the flight was delayed so blood no good by the time it arrived, and the 2nd time there weren't enough cells in the blood!
If you do decide to test with Braverman, I recommend emailing him directly and being very forthright and persistent and dealing with admin departments as little as possible. I found the admin depts almost impossible to communicate with, but again, might just have been me being dim. He is great and innovative and very willing to suggest all manner of ideas (beware, he may suggest infesting yourself with worms as an experiment (seriously)... I told him a resounding 'No!'   ) but clearly v busy so sometimes doesn't answer all queries without a bit of pushing. Also, make sure you ask for the raw lab data as his summary and interpretation won't include the numbers and you may find them useful if cycling with another clinic. You can get Braverman to oversee your cycle, but that plus his drug protocol suggestions were prohibitively expensive for me, so I used the info from his tests to guide what I did next and how I did it. 
Hope that's vaguely useful and hope all's well with you!
Bx


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## berberprincess (Oct 8, 2013)

Hi,

I know at some point after my miscarriage in 2013 I wasn't ovulating regularly as my cycle was haywire. I had hysteroscopy from which they diagnosed simple endometrial hyperplasia due to anovulation. Things gradually went back to normal after that hysteroscopy early in 2014 and a 21 day progesterone was high so I still ovulated on my own at times but I suspect it was really erratic. Have you considered using another method of ovulation monitoring like ov watch- seemed quite pricey tho or using duo fertility company or that saliva ferning test??. 

I'm really not sure on each clinics / consultants criteria for prescribing clomid. I know there's a LOT of research to discourage ladies over 40 taking it. I had no hope for it working after reading all of this but it was all my consultant would give me. Someone might correct me but I think for those with high AMH it's a no no as can lead to multiple pregancy. My first Clomid cycle at 50mg was monitored so day 14 AFC scan and day 21 progesterone. I think they assume if it works at the initial dose 50 mg, it'll keep working at that dose so there was no need to monitor further cycles for me as I fell preg with first round. 
Have you asked your clinic about trying Clomid if only for a month. Would it lose you anything by just trying? 

As for DHEA, my consultant told me to take it but I did get my saliva DHEA tested through genova labs- cost me about £50. My levels were really low but quickly corrected with the DHEA. I had a few side effects like v greasy skin but I put up with it. I know some ladies take a lower dose as its very experimental treatment with unknown long term effects. I know it's not supported to be taken longer than 12 months. 

I did take lots of other supplements too like fish oil, selenium, coq10 to help build those good eggs. 

Hope this helps, happy to help more if I can,

BP xx


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