# Protocol for Over 40's - Low AMH



## Jammybabe (Nov 4, 2009)

I' m a bit confused and am sure I' m not the only one out there! I just want to find a clinic I feel 100% confident with but each has a different approach.
I thought I' d start this to see if any lady had +ve /-ve experiences at the different clinics with regard to monitoring during stims and changing stims as progress through this critical period.

ARGC - anyone add what happens here having just registered with them, it seems the rumour is that Mr T is quite unorthodox gets results but is pro drug use. Monitoring is close twice per day in latter stages and drugs can be changed daily depending on blood tests. Baseline hormone test are all done at start anda monitoring cycle performed which I think shows a commitment to treating you seriously!  

CARE - anyone know if you are closely monitored and stims adjusted with this group? I am beginning to think that all CARE clinics follow same reasoning once you' re in - has anyone found this or does it really depend on your personal circumstances and which consultant you get?

North West Fert - seems the thinking here is that monitoring is fairly close once stims started maybe every 3/4 days but no alteration of meds. I understand from our consultation that stims are not changed as there is no clinical evidence to suggest that drugs can change anything substantially in such a short time.

Oh I wish I knew what to do! The more you start to find out the less you feel sure about! 

I am getting a sense that being over 40 and having a certain low AMH gets you in the door, esp if everything else seems in good health, esp having to have ICSI too (guaranteed more costly treatment)so all 4 clinics I'm considering will give me a whirl (nearly 44) but maynot be as keen on doing the baseline tests again (if already had them in 1 year - we had one failed cycle) or even a monitoring cycle. I am getting a sense they think we'll give her a go then its Egg Donation.
ARGC however do offer this, to me they are taking your case seriously so that you know where you are  starting from, alright added expense but better than forking out for full cycle and being in the dark! Afterall I am led to understand that alot can change in 1 yr or even a few months for women over 40!  
Anyone any good advice/experiences on this particularly in relation to the above clinics?

Jammy


----------



## Lyzbeth (Feb 7, 2008)

Hi Jammy,

I've used both Northwest fertility twice and CARE Manchester once. 

Of the two NWF did a more thorough monitoring of my cycle and adjusted my medication to suit. Having said that CARE Manchester put me on a different protocol (short flare with ICSI) which gave me better results, ie more follicles and more fertilised eggs, however, I didn't get a BFP with either protocol.

After 3 attempts we started to look into IVF using donor egg

Good luck with what you decide and please message me if you like for more info on the clinics we used.

Beth
xXx


----------



## Jammybabe (Nov 4, 2009)

Hi Beth,
Thanks for this, as we are about same age and using ICSI it seems interesting that I was advised to do the short flare protocol at ARGC too. Monitoring seems key to it all at this place. NWF Manchester doesn' t seem to have such close monitoring  - where did you have yours done? 
I was told up there that changing the dosage probably won' t be done as it is considered that no evidence to suggest this actually works...when you think incorporating acupuncture can also affect FSH levels. 
Can I ask which consultant you saw? What stims did you take, did these vary much daily and did this include an antagonist cetrotide?

So many questions! At the end of the day if it is going to happen then I think it will happen. 

I am so sorry to bombard you and do appreciate your input. Thank you so much.
Jammyx


----------



## Lyzbeth (Feb 7, 2008)

Hi, I had my monitoring done in a satellite clinic in Altringham and my main treatment at Liverpool Womens Hospital, which NWF are affiliated to.

With NWF I had a cetrotide cycle and saw Dr Nardo, once I started taking the drugs my ovaries were scanned approx every 3 days by the fertility nurse (at the satellite clinic) and the dose gradually increased to produce the maximum number of follicles, having said that CARE said that once over 40 the flare protocol is much more effective way to stimulate and we did get more eggs with that protocol, so that seems to be true.

The bottom line was that with me I could produce eggs but the quality wasn't brilliant and although we did get some to fertilise I didn't get the elusive BFP  Having said that I am glad that we did try 3 attempts with my own eggs (on two different protocols) as it meant we had explored that possibility before moving on to donor eggs.

Beth
xXx


----------



## Jammybabe (Nov 4, 2009)

Beth  - we are also with Nardo in that he saw us and recommended a protocol. Were you prescribed HRT/cycloprogynova for the first month too to put the follicles 'on hold'?
I just don' t know what to go with, the short flare (AGRC) or this one.

Quality is the thing and its so hard to understand when no fertilisation occurs. Did you do the short flare first or were you with Nardo?

Best of luck with your pregnancy - sounds fantastic! We may address donor in due course but as you say I need to try with own first.

Thanks again
Jammyx


----------



## Lyzbeth (Feb 7, 2008)

Hi Jammy I've PM'd you 
Beth
xXx


----------

