# High AMH risk of OHSS?



## sarahndave21 (Oct 9, 2016)

so im pretty complex... My husband has cystic fibrosis so although hes got the little swimmers they cant get out without been extracted - which means icsi. Ive got children from my previous relationship, been with my husband 6years now and my youngest is coming upto 7yrs old. 
In that space of time ive developed Endometriosis and now im not sure if i may have something else going on as my AMH has come back at 88 which is pretty high.  my FSH when tested in Jan was 4 so pretty normal.. Dont get to find out anything until 31st they shouldn't really of told me my AMH.. Has anyone any experience with a high AMH and if it means the risks of OHSS are too high? xx


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## Talkingfrog (Apr 17, 2014)

Hello davensarah, 

If your clinic are concerned about  ohss because  your amh is high they can adjust your protocol accordingly.  They will also monitor  things carefully  and if they think  there  is a risk (I think ohss can be made worse if you are successful ) they will do a freeze all and  transfer  in a separate  cycle so that tour body can recover.  

I had ohss on my first cycle about  a week  after transfer,  and a high amh when tested at a different clinic 4 yrs later.  They used  long protocol  instead of short protocol  and although  on a similar dose of menopur had a similar number of follies and eggs.  Not as bloated before  ec and no ohss ( but unfortunately  no bfp.

Good luck.


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## Cloudy (Jan 26, 2012)

I hit all the risk factors - high amh, high antral follicle count, low bmi, early 30s - and experienced OHSS on both fresh cycles.

If you are high risk there are a few options:
- mild/natural IVF (e.g. minimal drugs) which is becoming more popular, clinics like Create are pioneering it so maybe check out their website for information;
- low dose stims with close monitoring on a short protocol - so that's straight into stimulation drugs from your bleed rather than having a two week "down regulation" first and doing the progress scans earlier than usual. You can still get ohss with this method so they will often suggest you freeze all of your embryos and have transfer a few months later - which is what I should have done - although if you aren't showing any signs of OHSS you can still have fresh transfer;
- some clinics will also offer IVM where they take the immature eggs and mature them in the lab, but none of the clinics I have been to have offered this procedure.

I had mild OHSS the first time and it wasn't too bad, I've had worse flu! This time I was incredibly poorly and was in hospital with severe OHSS for nearly 2 weeks which I have to admit it was bad enough that I wouldn't do it again! Although it is very rare to get it so bad, don't worry!

Xxx


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## sarahndave21 (Oct 9, 2016)

Thanks for your replies 😁 I know how sensitive I am to pretty much everything, I've not had any contraception for over 8 years probally longer thinking about it, because the side effects where terrible to most things depo and the pill. That's good that they will cater for it if your high amh and they will give you a low dose. I had over 20 follicles in my baseline scan, I'm 7 1/2 stone wet through and I'm 32, so very similar cloudy. I think and obviously I'm just guessing at this stage but given how sensitive I am I will prob end up having to wait and have a fet.. I would love the idea of a natural cycle talkingfrog but I'm not sure it's an option but will defo be asking if i can go down this route. Xxx


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## Cloudy (Jan 26, 2012)

I don't know if its a possibility for you but the Fertility Show is on in London next month and they will be doing talks about natural/mild IVF and other options and there are also lots of clinics there and you can get free mini consultations as well as discounts on full consultations and special offers. Its quite a useful day.

Xxx


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## sarahndave21 (Oct 9, 2016)

It's abit far for us to go at the minute, but thanks for the info I will look into it. With husband having to have extraction think it limits us to our options but I'm going to go armed with a list of questions on the 31st 😁 Did they give you a low dose cycle with you having a high amh and folicle count? Sounds like you've had a rough ride of it. Did you manage to get to egg collection stage this time? I've looked into the down regs and that way and by the sounds of it that would send my endo into overdrive and I've just managed to get to a point where I can walk properly without screaming in agony so I don't think I'm up for that method... But I can never say never... Xxx


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## Cloudy (Jan 26, 2012)

Actually down reg is often pretty good for endo - it supresses it. In fact it's the same sort of drugs that you have for endo to put you in to the chemical menopause (more complex than that, but thats how i always think of it). I had 3 months down reg using prostap to help with my endo, it was the best few months i have had since i started my periods at 13! However, they wont use it for me with an IVF cycle because of the added OHSS risk.

Yes I was able to have egg collection and embryo transfer on both occasions, despite the OHSS. However on this occasion I had embryo transfer on the Monday and was already showing signs, and by the thursday i was incredibly dehydrated and admitted to hospital as an emergency. 

I had 150 menopur which they lowered to 112.5 after 5 days: they wanted to start me on 112.5 but i was worried that it would be too low so begged them to reconsider - something else i regret! Unfortunately I have a chromosome problem so am unable to have done natural/mini IVF, although if it wasnt for my chromosome I would do as both my AMH and AFC are over 50 and it would have been physically easier.

xxx


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## sarahndave21 (Oct 9, 2016)

Well i will be keeping everything crossed for you, 
Sorry for the late reply ive been trying to put it out of my mind - waiting and me dont mix very well and ive been pulling my hair out with what ifs.. 
Im getting together a list of questions. And making sure ive got all the info for all the avenues  
Thankyou for your help xxx


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## sarahndave21 (Oct 9, 2016)

been reading more info on this, and think im at the stage where im worrying myself silly - but on something i read it said it can cause the tubes or ovaries to twist which can cause serious problems.. 
Now my womb is retroverted and ovaries are almost upside down or facing backwards, (thats what they said when i had a follicle scan) so is that going to cause more risk if they swell when already misshaped?


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## Cloudy (Jan 26, 2012)

My ovaries were over 15cm each at one point (and as a size 6 that is massive!) and I didn't get torsion despite my ovaries being awkward and my womb being severely retroverted. I think torsion is more likely if you do something active, I could barely walk when I had ohss, never mind go on a trampoline or sky dive  

Seriously honey they will take care of you and high amh doesn't mean its a certainty. Plus, just have a busereline trigger and a frozen transfer and OHSS won't happen (or mild IVF). It's so rare that i think you are reading too much into it all and getting yourself upset unnecessarily.

If it helps in the whole 12 days I was in hospital none of the staff (other than my consultant) had ever met anyone with severe OHSS and I was at the specialist regional center that deals with OHSS! I was like a novelty to them  

Xxx


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## sarahndave21 (Oct 9, 2016)

Cheers cloudy your right, I'm stressing myself about most things lol but this seems to be playing heavily. We've been funded 2 cycles. And I think my main concern is they will want me to do it their way and I won't have much say in things, I've put some money to one side incase freezing isn't part of the plan they have. Only got to wait till Monday now - and hopefully I'll have time to reel of my a4 question sheet 😁 Xxx


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## Cloudy (Jan 26, 2012)

If you are funded then thats even better as they are heavily monitored on OHSS cases and they do everything to avoid it. my NHS cycle I had to do what they wanted (quick stims, early egg collection, busereline trigger, single embryo transfer), whereas with my private cycle I pushed for what i wanted which probably wasnt in my own best interests!

Just to add too that I had a double embryo transfer which initially resulted in triplets (we think!), then twins, so this will have made my OHSS worse.

xxx


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## sarahndave21 (Oct 9, 2016)

Wow that's crazy amazing 😁 I had a nosey at your diary and noticed the Ronnie comment and did wonder if that's what you ment. That would defo send you into hyperdrive lol. That's good to know then I thought they would be more focused on results and wanting to get as many eggs poss to fertilise. 2 more sleepless sleeps to go xxx 
Thanks


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## sarahndave21 (Oct 9, 2016)

They will start me on the lowest dose and they will freeze as part of the package so all in all a good app 🙏🏼 oh and I have polycystic ovaries just to add to the endo - it's no wonder I'm a hairy hormonal mess. Xxx


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## Cloudy (Jan 26, 2012)

I thought they would - that's good news  

Oh, and don't worry about the pcos and Endo - all the best people have both  

I would recommend inofolic powders you have in water twice a day: You can just take folic acid and myoinositol separately but I got fed up of taking loads of tablets so it was a nice novelty! You can start using them straightaway as they can help the other side of pcos (I definitely noticed reduced body hair and improved head hair and skin after a month)

Xxx


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## sarahndave21 (Oct 9, 2016)

Thankyou cloudy again  its all so new i will defo look into it - i do think taking folic acid has actually made me have a proper period this month maybe :/ well it was a 28day cycle not the usual 32-35 still as heavy mind xxx


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