# can IUI be successful with a low AMH - mine is 4!!



## Dreamer1 (Apr 12, 2012)

Hi  Ladies

I was due to start IUI this month but my AMH level has come back as 4 so have to wait for consultant apt to discuss whether IUI is worth a go or if IVF would be better. 

Has anyone been successful with IUI even with a low AMH level or is IVF my only option?? xx


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## Sarah1712 (Mar 6, 2011)

Hi, didnt want to read and run. My personal opinion is i wouldnt waste time with iui, success rates are quite low. Whereas ivf you could have the unused fertilised eggs frozen and you would have drug support such as progesterone to help with implantation. Ivf is intense but i have to say that i didnt find it all that bad and i have a massive needle phobia. As u can see from my sig i have low amh too. Iui isnt an option for us so i cant comment on the tx. I would perhaps get some reading material to help you decide such as an ivf guide or something similar. Many people will tell you "you are young and have time on your side" blah blah blah in my view with a low amh we dont have as long as they think.
I wish you lots of luck
Sarah xxx


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## Dreamer1 (Apr 12, 2012)

Hi Sarah

Many Thanks for your reply - this whole experience is daunting and until a week ago we just had unexplained infertility now reading about low AMH i am really losing hope. Want to go to my appt looking as though i'm clued up so think further reading is a good idea.

Thanks

Dreamer xx


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## Sarah1712 (Mar 6, 2011)

Dreamer, in this infertility game knowledge is defo power. Have you considered having your immunes looked at, not sure the nhs do this fully but u certainly can go private for it, cost is around £2500ish. Low amh isnt the end of the world, after much reading, its just a low egg reserve and tbh its quality and not quantity in ivf particularly. So get on ya vitamins like pregnacare conception and sanatogen is not recommended. Plus take some kind of omega 3 additionally. Dietry wise lots of greens, veg, fruit etc. limit red meat to twice a week and focus on proteins like eggs, chicken, fish like salmon, seabass etc. cut alcohol to under 5 units a week so 2 glasses of wine or 2 beers or 4 pub measures of vodka/malibu. Cut down on fizzy drinks and ready meals and think natural and organic as much as possible. We arent made of money so only have anfew organic things and have been going to butchers for meat so its better quality. At least a litre of water a day too and cut down caffeine. This applies to u and dp. Wish you lots of luck and if ya need any more info please do pm me

Sarah xx


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## Dreamer1 (Apr 12, 2012)

Thank you so much Sarah - a trip to Boots for Pregnacare and Tesco for Veggie's is in order! Always looking for a reason to be healthier and cant think of a better reason than this. 

Speak soon - i'm sure i'll have more questions and worries.

Thanks

Dreamer xx


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## Sarah1712 (Mar 6, 2011)

Of course and my advice would be ask the questions before your appointment then you are armed with knowledge. If theres somthing specific i can always look it up in my library of books and medical journals!!! Honestly i did a heck of a lot of reading, we went to a zita west nutritionist that specialises in infertility diets and im not claiming to be the font of all knowledge but i have worked darn hard to be knowledgeable enough to argue my case with GP's and consultants. Like i say knowledge is power. Look forward to hearing from you and hopefully supporting one another through this mindfield commonly known as a jungle otherwise known as infertility!!!LOL

Sarah xxx


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## Jules13 (Feb 13, 2012)

Hi there, just thought Id pop by and say I know exactly how you feel.

I also have a low AMH of 4.2 but that was when I was tested last Aug so I have no idea what it will be now. My NHS clinic offered me 3 cycles of IUI followed by 2 IVF's. If I can be totally honest with you I was so confused about whether or not to even try IUI but my consultant said to try it, afterall they wouldnt waste their time or money on me if there wasnt any chance of it working so I got my name added to both IUI & IVF waiting lists. The only reason I went ahead with it was because the waiting list was only 1year for it and 2yrs for IVF so I figured Id try my 3 IUIs and if they all failed then by that time I should be close to the top of the IVF list.

I dont want to put you off IUI but Im actually regretting it now. Im so worried that Ive wasted too many follicles/eggs with the IUI drugs and wish Id saved them from my already low reserve and just paid for a private IVF cycle instead. Everyone is different and Ive heard of IUI working for some people with low AMH, unfortunately it hasnt worked for me. Its a hard decision but I believe that I'll have a higher chance of it working when I can finally start IVF.

Wishing you luck with everything. You too Sarah!

jules x


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## Dreamer1 (Apr 12, 2012)

Hi Jules

thanks for your advice - i'm getting the general idea that moving straight to IVF would be more benficial for us.  We too are considering private IVF as the waiting list for us is about 18 months was just hoping like you that IUI in the meantime might be the boost we need but now i know i have low AMH its probably not the best decision.

Hope you dont have to wait too long for your IVF xx

Sarah - thanks for more of your advice i have been reading up on nutrition - thought i had quite a healthy lifestyle but just shows there is room for improvement.

Thanks Ladies the support and advice is just what i needed  xx


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## Jules13 (Feb 13, 2012)

No probs. I dont think theres a right or wrong answer its just down to personal decisions.

I felt grateful to be offered IUI on the NHS and that was also a contributing factor in making my decision. Some people I know have been too old for it and had to pay privately. I have one more IUI to go and Im actually still not sure if I should take it or not. Im too scared to refuse it in case it couldve been 'the one' that worked and Im scared to go ahead with it in case I waste more eggs. I'll need to decide soon! Unfortunately my name wont be at the top of the IVF list until Xmas time so we've decided to go for a private IVF in June anyway. We've picked our clinic and putting every penny aside for it. If it doesnt work then at least we'll have our NHS ones to fall back on.

This infertility malarky isn't easy! x


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## Dreamer1 (Apr 12, 2012)

I dont know if it depends on the NHS trust you are with but are you able to seek private treatment whilst on NHS waiting list or does it count against you?? Considering we've been TTC for nearly 4 years i feel really new to this whole process - all i've done for the past year is wait for appt after appt and dont seem to have gotten far so have so many queries now!! xx 

i want to be in the know before my next consultation so i dont get led into something i dont want. 

If you decide to go for the IUI i will keep everything crossed for you!! xx


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## Jules13 (Feb 13, 2012)

I actually dont know if having a private shot would go against you having NHS treatment. Do they have to know about it? Thats something Im unsure of myself but what I do know is that theres no way I want to wait until xmas in case my AMH gets even lower. As I said I was tested last Aug so by the time I start IVF it'll have been over a year and I dont know how quickly AMH levels drop in a year so I guess Im kinda panicing in case I leave it too late. Maybe Im being paranoid but it just scares me. When will you find out what they decide to offer you? x


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## Sarah1712 (Mar 6, 2011)

I recommend contacting your local pct, should be able to google it for contact details and pose the question about having private tx whilst waiting on nhs list. I went to my pct as my gp wouldnt initially refer us so i went over her head and now have an appointment in 6 weeks. Of course with having any treatment, you will have to register with the HFEA which is done as part of the tx process whether that is private or nhs so it could be checked. Sometimes, depending on your pct, if you have had private tx they just take one of your goes off you. Think its worth baring in mind the average in having a success is 3 times so be wary it could get costly. Our private tx was £12,000 so not something that could be repeated 3 times for us!!!! Lol

Sending lots of baby dust to all

Sarah x


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## Dreamer1 (Apr 12, 2012)

got an appointment on Monday 23rd April to discuss which path we going to choose - was meant to be May but iphoned and said that i've been waiting and waiting and would like some answers so luckily i've managed to get an earlier apointment. Still trying to get hold of my PCT to find out about going private and if i will jeopadise my NHS attempts -  that i wont - as you said Sarah it gets expensive. I cant believe how the cost of private IVF clinics varies so much. I'm looking at CRGW in wales but not sure how you are meant to choose!! The fee's list is so confusing and i'm finding it difficult to work out how much it wil cost each time  

Sarah - are you waiting for an appointment to get on the NHS ivf waiting list or are you starting IVF in six weeks? 

Jules - June is not long to wait now. 

lots of   for both of you xx


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## Sarah1712 (Mar 6, 2011)

Dreamer, im having my first nhs appt in 6 weeks so it will be longer before tx starts. Do you live in wales? We had tx in london, commuted 3hrs every day but was worth it. I would advise looking at success rates but dont be driven by it. Visit these clinics and see how it feels to you, does it feel right.myou want a clinic that tailors tx to you as an individual really. Ot has a one size fits all approach that some of them have. Look on the HFEA website where all the clinics are registered, you can put in you postcode and look at clinics within a certain distance, our distance limit was 120 miles which seems excessive but we wanted to be able to compare. I did a spreadsheet of success stats, distance from my home, expenses etc. as for costs i would allow around £1500 for drugs plus the cost of the ivf which usually included the scans, consultancy appt and actual process of egg retreival and transfer. There are additions a long the way. Go to your gp to get your HIV, hep b and c, chlamydia and fbc done so you dont have to pay coz you will have to pay for it if you go private. And then get your gp's to print off the results. Get copies of everything, it helps if you ever need a second tx. Hubby will also need hiv, hep b,c and chlamydia so can get it done through gp as well.

Sarah xx


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## Dreamer1 (Apr 12, 2012)

thanks Sarah

i think i've had most of those tests done when i was first referred but had better check on Monday and if not i can get a GP appointment. can the GP refuse to do these tests??

xx


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## Sarah1712 (Mar 6, 2011)

Not really, they have to. Clinics will want results that are less than a year old if they are then just ring your surgery and get copies of the results. It does sound like im ridiculous about some stuff but if you have paper copies at least you can take them with you to any clinic. Plus any results relating to your investigations and your dh sperm analysis result. You are entitled to copies, they are your notes after all! Also if your GP will do it see if you can have a vitamin d test and also might be a long shot but maybe see if they will do level 1 immune testing, might need to google the nhs guidlines on this but worth a shot


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## Dreamer1 (Apr 12, 2012)

thanks Sarah - looks like i'll be a busy bee next week getting all my test results in order! x Looked on the CRGW website and the HIV/Hep tests are £100 so hopefully i can ask my GP to do these. I'm pretty sure my other tests are less than a year old xx 

Very anxious about my appointment on Monday now - really want something solid to work feel really up in the air at the moment xx


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## Sarah1712 (Mar 6, 2011)

Honestly chick, it will be fine. See it as an opportunity to get some answers and dont take any rubbish like its ok your young enough and maybe try for another few months, utter rubbish!!! Dont be nervous, its the first step to achieving your dream. All those results dont need to be done for yout first appointment but if you have ivf then they wont start tx until theyve been done for the both of you so no real rush, even private tx takes a while as they generally like to do a monitoring cycle first to see what your hormones do in a complete month so day 2/3 tests then day 21 tests and a scan mid cycle i think. It was a few months ago now so could prob look to jog my memory! Keep me posted and massive good luck. If u got any questions between now and monday just wack em on here and i will try and help for you.

Sarah xx


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## Jules13 (Feb 13, 2012)

Sarah1712 said:


> I recommend contacting your local pct, should be able to google it for contact details and pose the question about having private tx whilst waiting on nhs list. I went to my pct as my gp wouldnt initially refer us so i went over her head and now have an appointment in 6 weeks. Of course with having any treatment, you will have to register with the HFEA which is done as part of the tx process whether that is private or nhs so it could be checked. Sometimes, depending on your pct, if you have had private tx they just take one of your goes off you. Think its worth baring in mind the average in having a success is 3 times so be wary it could get costly. Our private tx was £12,000 so not something that could be repeated 3 times for us!!!! Lol


Thanks Sarah. We've decided to go for one private treatment before our NHS ivf's as Ive got a low AMH and I dont wanna hang about. Ive contacted my GP, the NHS hospital & the private hospital and they've all told me that going private will not affect my NHS tx. The only way my name will get taken off the waiting list is if I become pregnant either naturally or with private tx. I live in Scotland so not sure how other countries/regions work but I agree with you, its definitely worth checking it out first!


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## Dreamer1 (Apr 12, 2012)

Hi Sarah /Jules

I checked with the NHS clinic and i can self fund two cycles and still be eligible for NHS treatment - dont think we could afford more than two so fingers crossed.

If i dont speak before i'll let you know how Monday gets on.

Good Luck Jules - when do you think you'll be getting a private appt?

xx


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## Sarah1712 (Mar 6, 2011)

Hope monday goes ok and thats great about being able to self fund 2 before it affects your nhs goes. 

Let us know
Sarah x


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## Roxychick (Jan 19, 2012)

DREAMER1 
I am currently doing my 2nd round of iui. I am 35 and had an amh score of 4 too!!!! We did ivf and I had 5 eggs but unfortunately none of them fertilised (problems with the sperm). So my husband and I chose iui. My first cycle I was on a very low dose and it was a slow process so my consultant upped my dose very slightly from 0.75-100 for only 2 days and i had 3 follicles which then turned into 6 follicles. Unfortunately my clinic only allow 2 follicles because of the risk of multiple births so my cycle was cancelled.
Anyway I started a second cycle a month later and I have been kept on the same low dose 0.75 gonal f every day which then got moved to every other day. My left ovary behaved and stayed quite. My right ovary had a 15mm and an 11mm follicle on Friday. I am triggering tonight with insemination Tuesday  I have a total of 10 follicles!!!! All be it most of them small but not what youd expect from someone with a low amh result and a very low dose of stims.
So dont give up keep options open.


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## Dreamer1 (Apr 12, 2012)

Hi RoxyChick

thanks for sharing your experience - i have an appointment tomorrow to discuss my options so hopefully this time tomorrow i will have a better understanding of where we are heading! 

Good luck with your insemination on Tuesday - keep us informed on how it goes.   ^p


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## Dreamer1 (Apr 12, 2012)

Hey Girls

Had my appointment today and consultant has advised me to take advantage of the 3 NHS cycles of IUI i'm entitled to. He said due to my age even though i have low AMH there is still a good chance although i may need a higher drugs dosage. They've fitted me in for my teaching session on thursday so starting to move forward at last xx

good luck for 2moro roxychick x


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## Kittykong (Feb 15, 2012)

Hi all, I also have a low AmH - found out a few months ago. Doc said that if it hadn't been for sperm issues that he would have recommended we carry on trying naturally as My progrsterone check showed that I was ovulating each month and therefore for natural conception perfectly normal. The problem with AMH is that if it's low, it could mean you haven't got many childbearing yrs ahead and so if there is a sperm problem as there was with me then they recommend you go straight to IVf rather than IUI as it is far more successful and fixes the MAle infertility factor - that is the key. Don't however bank on having frozen embryos as low AmH means that you will potential get far less (that is what the test was originally used for - to evaluate likely response to IVF stimulation. But - on the plus side - we just did our first IVF, I'm the equivalent of 9dpo and just saw my first ever very faint BFP...

Hope this info helps a bit xx


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## Dreamer1 (Apr 12, 2012)

Thanks Kitty

luckily we havent got male factor issues so think thats why they want us to give IUI a try - that and its cheaper for them probably!! xx
Very exciting about the faint BFP - i thought after IUI you have to wait so many days before you test - when do you know for definite or is it a definite ...fingers crossed xx


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## Kittykong (Feb 15, 2012)

Yes - if no male fertility issues at all why are they suggesting IUI? Have they already confirmed you are ovulating each month? And if so, why the need for IUI? When you got the sperm check, did they check for anti-sperm antibodies as this is a new test and often missed in 'standard tests'. Count, volume, motility etc can be fine but if there's antibodies it can effect their ability to actually break through & fertilise the egg. Just a thought. I suppose my thinking would be if you are ovulating each month but not getting preg naturally, I'm not sure IUI is worth it - I'd be tempted to go straight to IVF.

For me - I tested very early (8dayd past my embryo transfer). There is a risk that the test is measuring hcg from the trigger shot that may still be in my body but the nurse said highly unlikely so I need to test again tomorrow & the next day & the next day & hope it gets darker...!!


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## Jules13 (Feb 13, 2012)

Hi dreamer, thats good you're getting started. Have they told you that you'll get IVF after IUI if they are unsucessful or are you only entitles to one or another?

I was given 3 funded IUIs on NHS and so far I havent had any sucess. We wont be top of the IVF list until xmas time so we've decided to start our final IUI when AF comes this week and if it doesnt work we'll pay for a private IVF cycle in June or July while we're on the waiting list. Im just really worried that my AMH will have dropped by xmas time and Im not willing to wait to find out so we're definitely going down the private route.

Congratulations kittykong, thats so exciting


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## Dreamer1 (Apr 12, 2012)

i've been told that if the 3 cycles of IUI are unsuccessful then i will be entitled to 2 IVF cycles but there is 18 month wait. The consultant believes that because we have unexplained fertility then IUI can be successful - i did ask if IVF would be better but due to my age they wanted me to try the IUI. 

Jules - hope the final IUI is 3rd time lucky xx 

Kitty - hope that line is getting darker xx


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## Sarah1712 (Mar 6, 2011)

IUI is successful for a lot of people but the age comment is a complete cop out from the consultant coz out fertility declines from the age of 25 and of course every year you are releasing at least 12 eggs. Ladies in our position (i have low amh) then that amh level will continue to deplete. Plus if theres an 18 month wait that will defo take you over the age of 30. If youre happy with their decisions then great and i wish you well but if you have doubts then challenge them. I still believe you should at least go for immune testing through nhs, the basic one as it seems alot of people who are classified as unexplained have immune issues. I cycled with a lady who was unexplained and she went private for immunes and found she had issues which were dealt with through ivf tx as well. She is pg and due anytime.

Wish you loads of luck though
Sarah xx


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## Dreamer1 (Apr 12, 2012)

many thanks Sarah - i have my teach session tomorrow so think i will ask the nurse about immune testing - do you think my GP would do this? xx we've decided that if the IUI not successful we'll definately seek private IVF xx the few months giving IUI a chance will help us save up a bit more xx


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## Sarah1712 (Mar 6, 2011)

The gp should test yes but you may have to be pushy. Good luck with the iui though, sounds like a good plan but it might be worth pursuing being on the nhs list during the time you have private, ya never know!! I hate the fact that we have £13,500 debt coz we rushed into private tx but hey hinsight is a wonderful thing hey! I feel very frustrated at the moment coz we cant start any treatment and i know trying natural is almost pointless but hey onwards and upwards. Its strange, you almost become obsessed with having tx!!! I am a complete needle phobe but i never thought id relish the day that i look forward to hormone injectiins haha! Obviously with the help of the amazing emla cream!

Sarah


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## Dreamer1 (Apr 12, 2012)

Is that how much one attempt cost you? x I'm staying psoitive that IUI can be successful for me - i'm doing lots more health wise - taking supplements, having reflexology and eating plenty of Veg etc - trying to sneak more Zinc and selenium into DH diet - he wont take supplements. So any tips on better food diet to trick him would be great - haha!! xx

What is Elma cream?? xx


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## Sarah1712 (Mar 6, 2011)

Emla cream is a numbing cream for injections, im a whoos!! Yes thats how much it was, we went to the ARGC in london which is a top clinic but very expensive plus included in that is the immunes treatment. It was £4200 for icsi plus around £2500 for drugs plus travel there and back plus £3000 for immunes tx cant remember what the remaining amount was for.
As for men and supplements, i had the same argument with my dh and it p'd me off so much i flipped at him and said if this is something you want then you have to try too, it cant be all one sided. I take a supplement so should you was my argument and the it takes two to tango comment came out lol
Holland and barrats do a great Ground flaxseed, pumpkin seed etc bag which is fine granules, i add it to stews, soups, currys pretty much everything. Plis we have taken to homemade smoothies which we add it to aswell so smoothies are a great idea.
Xx


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## Sarah1712 (Mar 6, 2011)

Oh and high dose of vit c for me, 1000mg is best


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## Dreamer1 (Apr 12, 2012)

I'v managed to get my DH to a healthier diet but think thats the limit - think i've seen those seed bags so might give that a shot - he probably wont notice xx

what is immune tx?? or am i being stupid??

had my IUI teach today - overwelming a bit!! been sent off with my bag of tricks - hopefully they can fit me in on next AF cycle...fingers crossed!! all seems real now!!! xx


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## Roxychick (Jan 19, 2012)

Hi ladies
Unfortunately our last iui wasnt successful. We did get to the 2 ww though which to me is an achievement in itself  but we had a BFN. Now on our next go of iui. Scan today I have a 12mm, 11mm and lots of smaller ones so my dose has now been lowered to 37.5 gonal f every day. Scan again Wednesday and I hope only the biggest 2 follies have grown!!!
Good luck every one.xx


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## Dreamer1 (Apr 12, 2012)

Hey Roxy

Sorry the last IUI was unsuccessful but this one sounds promising - fingers crossed the 12mm and 11mm will grow without anymore xx keeping fingers crossed for you.

We were put off by clinic to start this month because of low staff levels - seems like all i do is wait  xx but hopefully it will be worth it in the end xx


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## Jules13 (Feb 13, 2012)

Hi Roxy,

Thats good to hear you've got 2 follies around the same size, fingers crossed they get big soon and this IUI will bring you the BFP youve been waiting for. Good luck for Wednesday!

Dreamer, think Ive posted to you on the other thread. As they say...... Good things come to those who wait! 

x x


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## Roxychick (Jan 19, 2012)

Thank you dreamer and jules 13.
I think this is probably the biggest waiting game we ever go through in our lifes!!! IVF/IUI involves so much waiting doesnt it. We have set ourselves 3 goes of iui not including our first one that was cancelled as i produced to many follies. Then after that im not sure, we just hope we dont get to that stage. I guess we can only benefit from becoming stronger people going through all this. 
I am taking pregnacare daily and trying to eat as many veg and fruit as i can i also started yoga today who knows maybe it will help. I try to remain as positive as possible throughout although every visit to my clinic is nerve wracking as i wait to see the screen and hope i dont see many big follies!!
xx


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## Pyra (Apr 1, 2012)

Roxychick and Dreamer and others,
I wonder how you are getting on with IUI. I'm in a similar position - my AMH seems to have dropped from 9 to 4 in 5 months. My Antral follicle count is 8 (low) although Day 3 FSH is normal at 6. DH's tests all OK, as our my immunes and hysto, and I seem to ovulate every month. We have conceived naturally twice before (one termination, one mmc) and will be private on all fertility tx. My consultant has recommended proceeding with a super-ovulation IUI cycle, although thinks success rate for me would only be about 10%, before considering IVF. Some questions I hope you can help me answer:

1. How many cycles of IUI are you thinking of before proceeding to IVF?
2. From what I have read, AMH indicates egg quantity rather than quality, and FSH is a better indicator of quality. Would you agree from what you have heard from your REs?
3. If you over-stimmed during IUI, did you get reduction performed? Was that painful?

I've been told to take 75mg DHEA every day - which seems to be standard for a low AMH indication. Any other tips welcome.

Pyra


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## Jules13 (Feb 13, 2012)

Hi pyra,

Thought I'd answer what I could based on my experience of low amh and iui. My amh level was tested aug 2O11 and it was 4.2

Since then I've had 3 cycles of iui (with gonalF) all resulting in BFNs. I also had one other cycle that was abandoned cos I had 5 follicles (clomid + gonalF). I had all my cycles on the NHS and they don't seem to do reductions, just cancel cycles instead. I felt all throughout my cycles that my hospital weren't that great in comparison to others I'd heard about. My fsh level was never even mentioned only my amh! However, today I had my first appt with a private clinic to start ivf and the nurse took blood to test amh again so I'm curious to see how much is gone down by since Aug. Its definitely something I'm worried about. She aslo said that its definitely quality over quantity that matters. 

If I was being totally honest with you then I'd chose ivf over iui if I was paying for tx. We only tried iui on NHS while we were saving for ivf. I also got told I only had a 10% chance of it working and tbh I didn't have much faith that it was going to work anyway. Its a personal choice when deciding on fertility treatment but I wish u lots of luck with iui and hopefully you won't need to move onto ivf!

Jules x


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## Pyra (Apr 1, 2012)

Thanks, Jules. I hope your AMH has gone up than down. My consultant at CRGH mentioned he has seen 40% variability (up and down) in AMH results over a few months - and he believes AMH isn't as stable an indicator as previously assumed to be. Unfortunately I've only seen the 'down' variation so far :-(
I'm probably going to go for one super-ovulation IUI to see how I respond to drugs, before moving on to IVF. All the best for your cycle.


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## Jules13 (Feb 13, 2012)

Really?! I had no idea it could go up. I always thought you were born with your eggs and they slowly declined with time. I didn't even know it was possible to have an amh level rise. Just goes to show u can learn something new every day!


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## Pyra (Apr 1, 2012)

Apparently recent research shows that AMH levels can be under-stated if one has a Vitamin D deficiency, among other things. My consultant believes there can be significant inter-cycle variation in AMH, but in view of lack of more reliable markers, it still remains the gold standard for assessing ovarian reserve...


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## Dreamer1 (Apr 12, 2012)

Hi Pyra

You certainly have done your homework - like Jules i only thought it could go down. I had mine tested in March 2012 and was 4. The consultant thought that IUI wasnt going to be an option due to the low level but a second consultant decided that because of my age it was worth a shot especially as we are entitled to 3 funded cycles on the NHS. He also said that a low AMH does not indicate poor quality and as we only need one good egg its not all bad news. We've made the decision to use the 3 cycles before moving onto IVF (saving in the meantime). it is a good idea to use IUI as a way to see how you react to the drugs rather than pricey IVF. 

Our NHS area do not do reductions like Jules only cancel if I over stimulate. I'm still waiting to strat my first cycle (June - hopefully)


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## Pyra (Apr 1, 2012)

Thanks, Jules and Dreamer. What's the maximum # of follicles they'll proceed with, would you know? Given my low AMH and AFC, I think this should be the last of my worries, but am strangely paranoid about cycle cancellation.


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## Jules13 (Feb 13, 2012)

Morning,

Most clinics allow up to 3 follicles but I've heard of some only allowing 2. You should check with your clinic for a definite answer. I had five with my first cycle and they abandoned it as they wouldn't risk a multiple pregnancy. We still tried at home hoping at least one or two would work but still got a bfn.


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## Pyra (Apr 1, 2012)

Thanks, Jules. Hope your IVF consultation went well. I spoke with the nurse at my clinic, and she said they would be able to reduce in case of over-stimming, or even convert to IVF - so that's one worry taken care of. I just hope I don't end up with a cyst in my next cycle which would definitely lead to cancellation :-(
Are you ladies on DHEA?


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## Pootle77 (Oct 17, 2009)

IUI worked for us, we have a nearly 2 year old, have no idea what my AMH was when we conceived him, but in Nov 2010 it was 3.something.  We're trying again and our clinic has said stick with the IUI for the moment, definitely quality not quantity


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## Dreamer1 (Apr 12, 2012)

we've been told that a maximum of 3 follicles allowed before cancellation. Being the NHS it wouldnt be converted to IVF  xx


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## Pyra (Apr 1, 2012)

I'm really really confused now   I met a consultant (not at CRGH) who is very familiar with my case for a second opinion. She found my combination of current day 3 FSH (6.2), LH (4.5) and dramatic fall in AMH (4 pmol/l, down from 8 in Jan 2012) extremely surprising. Assuming the results as they stand today are accurate (despite what I mentioned previously about possible variation in AMH), she stresses I should proceed straight to IVF, without wasting time on IUI (as you recommended, Jules), even if that means waiting out a cycle without tx. Her theory is that if egg reserves are depleted already, why put them through additional stress and risk a poor response during a subsequent IVF cycle? Not sure if that makes sense though - I had assumed that in any tx cycle, you only work with the antral follicles which would have been used/wasted anyway, rather than depleting additional ones?

It's going a little too fast for me - I do trust this doc's opinion, and IVF was offered as an option for my cycle at CRGH, although the consultant there recommended a cycle of super-ovulation IUI to start. However he did say that the success rate for me would be more like 10% rather than 20%. My only concern is if I do go for IUI in June, and it is unsuccessful, then I will in effect 'lose' 2 cycles, assuming there will some down-regging for a subsequent IVF cycle. I don't want to wait any longer than I really have to, and risk making it even tougher for my body to go through IVF successfully. I'm still in the middle of my current cycle, so a course correction from IUI to IVF should still be possible at CRGH.

What do you think, ladies?
Pyra.


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## Roxychick (Jan 19, 2012)

Pyra
Last Monday I had 6 follicles in my iui cycle. I had the reduction done (which was £200) They popped 3 follicles and luckily left me with 3. Their policy is normally 2 but they allowed me 3 as Im 36 and ive already had 1 cancelled iui, 1 bfn iui ad prior to that a negative ivf cycle. I am now in my 2ww and hoping and praying this is our time. We have decided we an only do this another 2 times financially as its over £1000 a cycle. The follicle reduction procedure- i had gas and air which i found did nothing for me. I wasnt in any pain just very uncomfortable I could feel the consultant moving the wand around inside to see the follicles but i think what the gas and air did do was keep my mind on breathing and not so much on what was happening down below. I did bleed a bit though, then they let me rest then did the insemination. I think due to me having cramps i ovulated later that night. I would absolutely have the reduction done again instead of cancelling a cycle. I had an amh of 4/4.5 but even with that low score I have responded very very well to treatment and am very sensitive to even a low low dose of gonal f. First iui i had 6 follicles, 2nd iui i had 2. 3rd iui 6 again.


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## Pyra (Apr 1, 2012)

That's a very good response, Roxychick! All the best - I do hope you get your BFP this cycle.
May I ask what your day 3 antral follicle count before tx was?


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## Jules13 (Feb 13, 2012)

Pyra,

With hindsight I'm not sure iui was really for us. We had 3 cycles including one abandoned and I'm not sure if this was a waste of my egg reserve? I'm just glad I've moved onto ivf now before my amh gets any lower. Actually wating on my new amh results. Got tested on mon.  Fingers crossed. Hopefully they'll sort out a treatment plan for you soon, whether it be iui or ivf.... Good luck!


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## wolla (Jul 19, 2004)

Hi. I've got am amh of 2 and hav got a 5 yr old and a 5 month old from iui with Clomid.  With both successful cycles I produced 2 decent sized follicles.  Amh wasn't tested when ttc #1 but when it came back low when ttc #2 the cons tried to convince me that iui had no chance of working - am glad I had faith in my body!

Good luck
Wolla x


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## Roxychick (Jan 19, 2012)

Wolla
Wow that's very encouraging. How many iuis did you have to get your bfps? I am 10days post iui now and feeling nervous about testing. This cycle I had 3 follicles when they inseminated.


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## wolla (Jul 19, 2004)

Roxy -got my bfp on 2nd attempt both times. The difference between the bfn and the bfp both times was that I had the trigger jab with the bfp cycles. I know we were incredibly lucky, and feel truly blessed - but just wanted to give u some hope that it can work. Very best of luck for testing x x

Wolla
X


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## Pyra (Apr 1, 2012)

Roxy, hope your 2ww is going well and will be worth the wait.
It's been very encouraging hearing your story, Wolla. After a lot of agonizing mulling and  another consultation, I've decided to go for one cycle of IUI. My main concern was further depletion of ovarian reserve (sounds a bit drastic, I know - but I'm really paranoid about AMH now), but the doc says one cycle isn't going to make a difference. He does say though I'd likely have to go for 2 rounds of egg collection before we will have a decent number to work with.


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## Roxychick (Jan 19, 2012)

Hi ladies
Well my af came today. One day before I was due and due to test. :-((( so another unsuccessful iui attempt. Haven't even bothered doing test this time as I can't bear to see the result!!! Losing hope and motivation to do anymore. So much money and emotions to have same thing happen again. :-((


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## Jules13 (Feb 13, 2012)

So sorry to hear that  x


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## Dreamer1 (Apr 12, 2012)

Sorry Roxy - wish i could say something positive to you but i'm sure you've heard it all xx


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## wolla (Jul 19, 2004)

So sorry to hear that roxy - best of luck with whatever you decide to do next x x


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## Roxychick (Jan 19, 2012)

Thank you ladies
I kind of feel numb at the moment. I haven't bothered to test as af came so couldn't bear to see the 1 line on test aswell. We have said we will do 2 more cycles of iui. Which would then make 4 plus our one that was cancelled. I'm just not feeling positive about it at all. I worry that we will do iui again and same thing happens and then its game over as we can't afford the £3882 for ivf but obviously the other thing is that without doing ivf we don't know the quality of eggs or anything. It's so hard isn't it. I haven't even told the clinic yet as I don't want to phone them and tell them yet again its a negative. It's so hard to know what to do, I'm feeling very despondent at the moment. We would start another cycle end of July instead of now as we are on holiday at moment. So mYbe the break will benefit us as we have been doing back to back treatment. Who knows!!!


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## Jules13 (Feb 13, 2012)

Roxy, its always hard knowing what to say cos as Dreamer was saying, you've probably heard it all before. Hopefully your break will do you some good. Maybe once the pressures off you'll relax more and you never know what could happen.....

Also I just wanted to give you girls a bit of hope about AMH levels. I was tested Aug 2011 and my AMH was 4.2 .Since changing hospitals Ive had my AMH tested again and its now 4.5 Its been almost a year between the 2 tests and I honestly cant believe its gone up (very, very slightly but its still higher) despite having four cycles of IUI and a whole bunch of drugs. 

I hope Im not the only one that this has happened to and it gives a bit of hope to those who have been worrying about amh levels, I know Ive been stressing over them recently.

Hope everyones well x


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## Pyra (Apr 1, 2012)

*Jules*, it IS good to hear about your AMH levels - congratulations! Looks like the research I read wasn't entirely baseless. For all you low AMH ladies out there the other thing I was told was that test results may not be consistent across labs (since apparently the assays used are different - go figure) which could lead to 10-15% variation in results from different labs.

*Roxy*, I'm sorry to hear you're feeling down. I can totally relate to your indecision and hope you have now made up your mind with a course of action you are comfortable with.

afm, I'm waiting for my next cycle (next week) to start super-ovulation IUI, but have firmly made up my mind to move to IVF if that is unsuccessful. I'm still paranoid about my AMH results, and my consultant feels they may have to do 2 rounds of EC before they'll get a good number of eggs to work with :-( Still, can't say for sure until they see how I respond, and what the egg quality is. I'm really hoping my normal FSH is more indicative of egg quality than the low AMH.


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## Pyra (Apr 1, 2012)

Wondered how you ladies are getting on. I'm sure some of you would be on the June 2012 IUI thread, and I'm hoping I can join you there soon.

*Dreamer*, hope all's going well in your IUI cycle

*Roxy*, hope you are feeling better and have a plan on next steps

*Jules* hope you are chuffed about AMH! When do you start IVF?

By the way, for those of you taking DHEA, do you take as much as 75mg a day and have you noticed any side effects?


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## Jules13 (Feb 13, 2012)

Hi pyra. I'm due to start ivf once af comes then it'll be day 21 of my cycle that things will get started 

I've been using the June iui thread for my last iUi cycle and still keep up to date with it so hopefully keep in touch to find out how you're doing. good luck with ur cycle! X


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## Kittykong (Feb 15, 2012)

Hi ladies, For those moving on to IVF, I just wanted to share my story to give you guys a positive experience of IVF.

I was diagnosed with an AMH of 4.84 in Feb. went straight to IVF based on doctors advice due to DH sperm problems as well and we ate now 12 weeks pregnant after the first try. Having Anit of a scary pregnancy with some spotting and bleeding but completely unrelated and baby appears to be doing well do good luck to those thinking about IVF as their next step... xx


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## Pyra (Apr 1, 2012)

Kitty, many thanks for sharing your story with us. Congratulations on your BFP and best wishes for a relaxed pregnancy!

If you don't mind my asking, what protocol did you use and how many eggs did you get at EC? This is something I'm feeling jittery about given my AMH.


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## Kittykong (Feb 15, 2012)

No problem. I used lOng protocol on advice from my consultant but did umm and Ahh for ages. His view was you can never tell for sure 1st time round, and he has always had better success witong protocol. The main risk as I understand it with long protocol that you can over suppress the ovaries but the downside of short protocol is that the eggs may not all be at the same growth rate from the start which can actually mean you get less to work with. With long protocol, they are all the same size and so the doc can stimulate you for longer to get them to right point. If he starts with short and they are at different points, at collection you may only get x number that will work well for fertilisation.

Anyhow, I got 8 and all 8 fertilised... I also took quite a few supplements for a couple of months before - L'Arginine to help protein absorption, quite a high dose of Co-q10, zita west prenatals & zita west DHA supplement... And a high protein diet is recommended...

I also requested progesterone injections as well as pessaries (and heparin for blood clotting & Prednisolone for  any possible immune issues there's every likelihood that I didn't need either (particularly the immune drug) but after doing some research a lot of the top clinics have started prescribing heparin and I just wanted to ensure all based were covered!!! Oh - and I also had an endomtrial scratch done before hand as I read that this can aid implantation by 'fluffing up' your lining when it builds up.

Who knows if all that helped but it worked and will probably do the same supplements for baby no.2 (which I've been advised we need to try for immediatelt when ready after no.1 as they don't know how quickly my AmH will drop...)

Good luck to you all... I hope this gives you some hope..

xxxx


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## Pyra (Apr 1, 2012)

Thanks *Kitty*. It's really helpful to read about your supplements, protocol and response (and I caught up with your diary too). Definitely something I should discuss with my consultant if I go for IVF, since I had a dominant follicle in my IUI cycle, which only let one more mature. So i totally relate to your point on not having the same growth rate for all follicles with short protocol.

Sending you  for your pregnancy


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