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Low Ovarian Reserves


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#1 causeway

Posted 07 July 2010 - 07:28 PM

Hi,
Today our FS called to give me my AMH results from last week. Apparently a normal result is 10-20, mine is just 2. FS has recommended that we start IVF sooner rather than later. I'm devastated. I am almost 36 and have had no gyny problems. Ultrasounds show healthy uterus and I am ovulating. Last visit to FS I had a Day10 scan which showed a follicle ready to go, but note that it was actually a lot larger than he would have expected. Mine was 33mm where as normal was something between 14-23mm (I think). He's recommended IVF so we address the problem immediately because if we leave it too long, we might miss out. We have no indication as to the quality of my eggs so fingers crossed, they are still in good condition. DH is 36 and healthy. We've been TTC for about 9 months.


I've done some 'googling' and have found many discussions about AMH and Low Ovarian Reserves but no one has had results as low as mine. Is there anyone who can offer any advice and good new stories out there?

Much appreciated

#2 shebap

Posted 07 July 2010 - 08:05 PM

Hi causeway

Sorry to read your post.  I was diagnosed with this too at 37 and was terrified.  Am still not sure what to think but like you I went straight to ivf.  I'm about to start my second cycle.  Go with their recommendation.  Best of luck.

Sheba

#3 causeway

Posted 07 July 2010 - 08:15 PM

Thanks for your response. Was your result as low as mine? Most threads I've read on other sites indicate results between 5-8. I find mine very discouraging. Fingers crossed for your next cycle.

#4 Gordo's Girl

Posted 07 July 2010 - 08:37 PM

Hi Causeway & Sheba

I feel your pain!  I have just turned 37, and had an AMH test a couple of weeks ago after my first IVF/ISCI cycle was cancelled due to a poor response (only 3 follies).  We are going down the ICSI path due to DP's sperm morphology and motility - so didn't think there would be issues with me too sad.gif

Anyway, my result came back as 1 !!!  I couldn't believe that my ovaries had just shut up shop completely, and I'm still not sure what it really means.  Like you I've googled heaps and can't really get much info that makes sense.  I did ask a Nurse at my clinic, and she said they like that number to be at least 5 or 6 to be classed as 'normal'.

My FS has changed my protocol for this cycle, and I am doing an antagonist.  Currently on Day 12 of stims.  It's odd because last Thursday (CD6) I had my first u/sound - there were NO follicles!  I couldn't believe that my result this month could be worse with twice as much FSH (cycle 1 - 150ui Gonal F, cycle 2 - 300ui Gonal F).  Anyway, this has been my week:

CD6 - no follies (E2 <150)
CD8 - 1 x 10mm on the right (E2 - 400)
CD10 - 1 x 14mm on the right and a couple of 'tiny' ones on the left (E2 - 690)
CD12 - 2 x 17mm, 1 x 14mm on the right, and 1 x 10mm on the left (E2 - 1200)

So, as it stands I'm still in the game and that AMH of 1 has probably meant that I have a low response, but not totally 'eggless'.  I really really hope that they can get me to the EPU stage and will keep you posted.

I am sure some of these test results fluctuate and not all FS's will even do them, which should be giving us all hope I think.

Hope you're doing ok, and keeping positive about it all.

GG

#5 causeway

Posted 07 July 2010 - 08:50 PM

Thanks GG,
I wish you the best of luck. Please post back to let me know how you go. Fingers crossed for you.
I am currently in the 2WW. I'm now CD17 and on CD10 was given an injection of Pregnyl after an U/S revealled the 1 follicle ready to go. FS explained that this would make me ovulate within 36 hours and to go home and 'get busy'. I am not hopeful. I also had an HSG on CD10 and am still spotting, which is an after effect of the HSG.

We have been given a script for Clomid for next cycle and will take this as directed and then visit Dr CD11 for scan and possible Pregnyl injection again. At this time we will discuss with FS starting IVF. Thinking this will be in September as we will need August cycle to take the Pill. We live in Central QLD and have to travel to Mackay and the lab is only open 5 days so my cycle needs to be sync'd to ensure the lab is open on the days I need them. Have been told that I will need to see FS at least four days during the cycle. We live about 250km from Mackay so will need to take days off. I work full time and have never taken a lot of sick leave but I think this will be my opportunity to make up for it!

So, we've got a plan now and will discuss with FS when we next see him during my next cycle. (or fingers crossed we see him as our OB in 2 months time cause I'm successful this cycle.

Thanks and best of luck to you.

#6 petal71

Posted 09 July 2010 - 09:33 AM

Hi girls,

It is a shock to get this diagnosis, isnt it? I had an AMH of 4.5 about a year ago, but I have a feeling it fell even more in the 9 months between having the blood test and my first IVF, because we only got 2 eggs that cycle (flare) - BFN after 3dt. Reading around on some forums I saw that one specialist had said to someone that - in their experience- AMH (in pmol/L) *roughly* matches the number of eggs retrieved at IVF. So that's why I thought it had gone down further.

TBH, I was very despondent about my chances and thought donor egg was probably the way to go.

But in my case I have had much better results with a change in protocol and DHEA - 8 eggs this last cycle, with 3 (of only 4 fert) making good quality blasts, one transferred resulting in a chemical pregnancy, awaiting FET.
So no BFP yet but much better results. This has made me feel much better about continuing with my own eggs for the time-being.

Studies from the US show that DHEA can increase the number of eggs available and even increase quality. Worth checking out the website of CHR, the American clinic that pioneered it. It usually needs to be taken for 2-4 months for any effect though, and it doesnt work for everyone. Check out the DHEA buddy group (not many current posts, but lots of old ones) for more info.


A while ago, when I was feeling really down about my chances, I made a spreadsheet of all the cases I came across on UK/US forums of pregnancies with low AMH or high FSH. I know that there definitely were cases on there with AMH's of 1-2. There have even been reports in journals of pregnancies in ladies with "undetectable" AMH. It seems that AMH relates to quantity but not to quality.

Causeway - good luck with your 2ww. Hope it works for you and you dont need the IVF.

Gordo's girl - I have everything Xd that your follies keep growing and give beautiful eggs.

Shebap - good luck with your 2nd cycle.

#7 Gordo's Girl

Posted 17 July 2010 - 05:41 PM

Hi ladies

Just thought I'd let you know how this cycle has progressed.  I had an EPU on Monday, and they got two nice little eggs.  Unfortunately only one of them fertilised overnight (with ICSI), but the other one made it to a 3 day transfer on Thursday (it was a 5-cell Grade 2 that morning apparently).

My blood test will be 26th July ... so until then I'm just going to keep crossing my fingers.

Hope you're all going well.

GG

#8 daisy2009

Posted 17 July 2010 - 06:07 PM

Hi Gordo's Girl,

I did have a low OR ( level is 2) with BT this year ( last year still normal).

I asked my FS and he said do not worry about that, as it is only a number ( even with OR of 1, you still have many eggs there, and you only need 1 egg to get pregnant).

And he told me one of his patient had just got pregnant with OR of 1.

Hope this wil help.

Daisy



#9 petal71

Posted 20 July 2010 - 12:17 PM

Hi GG - great news that you are PUPO!! I have everything Xd for you for your BT.

Daisy - that's reassuring to hear from your FS. Can I ask how old you are? I think FS's are more optimistic about low OR in younger women, as theoretically the egg quality is still good.
Are you currently cycling?

I am awaiting AF in the next week or so and then will do my first FET.

Good luck to all



#10 causeway

Posted 21 July 2010 - 08:05 PM

Hi all,

Just wanted to post back. Well my 2WW ended on day 21 which I then called day 1 as AF arrived. Called and spoke to FS to see if it was AF as had had a terrible time since having the HSG on day 10. I had light pink spotting, annoying at times which then proceeded to brown spotting with a show of red on day 18 - thought this could be a sign of implantation as it turned brown again but definately led to AF. I am now day 10 again and have taken Clomid days 5-9 as per FS (I do ovulate on my own). Appointment with DH and FS tomorrow for a scan. I assume that I'll get another injection of Pregnyl and told to go home and get busy!! Fingers crossed. I keep having these dreams that we have triplets - 2 boys and a girl!! Will find out tomorrow how many follicles are ready to go. Have a lot of questions for FS which I have written down so we can make an informed decision about the way forward.

GG - waiting with fingers crossed for 26 July - I hope you have a BFP!!!

Daisy and Petal71 - I hope you post back and let us know how you are going!

#11 causeway

Posted 24 July 2010 - 03:18 PM

Just thought I'd pop back and update.

Went to FS on Thurs and I had a good sized follicle (24mm)(Only 1 and I've been having these dreams of triplets!!). I was given a Pregnyl injection and we've been BD. Fingers crossed for me please!! Funny thing is I'm not having the same side effects as last cycle from the Pregnyl. Boobs aren't sore - not sure what this means! I can't remember when they started to hurt last cycle but tomorrow is another day.

We also spoke about IVF and we have a set up interview this coming Thursday. If I get a BFN then we'll be undergoing IVF early September.

This cycle I've been on Clomid, the only side effects I had were a few hot flushes, both during the day and the night.  

I'm so hoping for success this cycle.

Ladies, please post back and update me with your news.

#12 petal71

Posted 24 July 2010 - 06:11 PM

Hi Causeway - sorry the last cycle didnt work out, but hope this one will do the trick. Have fun! Perhaps your dream will be predictive - wouldnt that be amazing? Good idea to write down Qs for your FS, as if you are anything like me then you forget them the minute you walk in the room.

GG - just a couple more days of 2ww'g, hey? I have everything crossed that this will be your sticky BFP!

Shebap - how are you going with your cycle?

AFM - AF came yesterday so now planning for the FET in around 2 weeks, depending on when I ovulate, as it is a natural cycle. Feeling OK about it, will be nice not to be jabbing and less appts to schedule etc. Am wondering if I should do immune testing if this one fails - but I guess I shouldnt really be thinking about that!


#13 Puddycat

Posted 24 July 2010 - 06:57 PM

Hello.

I thought I would drop in and say hi.  I always thought there should be a buddy group for poor responders/LOR/POF gals.  This may be the start of one!  

I have not had the AMH test.  My FS didn't see the point, as he knows that I'm a poor responder.  My FS also didn't want me taking DHEA.   Im a regular stalker of the DHEA buddy group.  I see some people have had a good response to it, and other not.

My history is as follows:
Cycle one - 1 egg
Cycle two - cancelled due to poor response
Cycle three - two eggs
Cycle four - four eggs (one frostie - yay!)
Cycle five - FET with frostie
Cycle six - EPU is Monday, but there are three possible follicles

We also have MFI issues.

So, EPU is Monday.  I was hoping for four eggs again, but if there are three follicles then I will probably only get two eggs.  One will fertilise, and one wont.  So here is hoping that I will have something to transfer on Wednesday.

Good luck Causeway.  Here is hoping you don't need IVF.

Petal - I think I read somewhere that you have two frosties???  Here is hoping one of them in the one!



#14 Gordo's Girl

Posted 24 July 2010 - 09:32 PM

Hi ladies

Thanks so much for thinking of me.  Just thought I'd let you know that AF arrived on Thursday, so this first ET hasn't worked for us unfortunately.  I think part of me was really hoping it would, and then another (the sensible side) had talked me into thinking that there was a 1 in 5 chance of it sticking ... and that if it didn't work this time, our time would come eventually.  

I'll still go in on Monday for the BT, as the nurse has said that it is still important to do that.

I've decided that I'm going to spend the next 3-4 weeks trying to get back into some sort of level of fitness (I've done nothing since starting this, and can really notice) and then hopefully the next cycle (my third one) will be the one!!

Puddycat:  I am so keen on the DHEA, and am definitely going to talk to my FS about it when I see him next.  Best of luck for your EPU on Monday.

Petal:  it must be nice to know you have an ET in a couple of weeks and you don't have to deal with injections every day!  I'd love to get to that stage original.gif

Causeway:  24mm follie is awesome ... let's hope it's got a lovely strong egg in there.  My fingers are definitely crossed for you original.gif

Hi to everyone else ... hope you're having a nice weekend!

GG

#15 petal71

Posted 26 July 2010 - 11:16 AM

Hi girls. Im keen for a poor responder's BG!

Hi Puddycat - so sorry to hear it's been such a long, rough road for you. Im so hoping that this cycle gives you that super-sticky BFP. I take it you do ICSI?  Thinking of you for your EPU today.

GG - so sorry to hear that AF arrived - very disappointing and upsetting. It really sucks after going through so much...Good to hear about your plans for getting fit in the month off - I know this has helped me in my month's break.

With the DHEA, it certainly seems to be true that some ppl respond well and others dont. I have been lucky in that it seemed to boost my numbers of antral follies and eggs a lot and probably quality too in that in our 2nd cycle, 3 of the 4 that fert made it to blast. FS's seem to differ widely in whether they think it's a good thing or not...it is a tricky one in that you are taking an artificial hormone and it hasnt been extensively tested, but I am reassured by what I read on the CHR and other sites.

Saw this recently, which is a pilot study of DHEA (tiny - only 20-odd patients in the DHEA group). Sadly not many details about the IVF cycles etc-  Have pasted it since the link asked you to subscribe and didnt show the info...

http://www.sciencedaily.com/releases/2010/...00701145535.htm

An antiaging drug, sold over-the-counter (OTC) worldwide, improves in vitro fertilization (IVF) treatment outcome in poor responders, according to a new study.

Researchers at Shaare Zedek Medical Center (Jerusalem, Israel) conducted a prospective, self-controlled study of 43 women aged 26 to 44 undergoing IVF treatment. The women identified as poor responders (less than 4 oocytes retrieved) were treated with at least three months of 5-Dehydroepiandrosterone (DHEA) supplementation (75 mg/day). Biochemical parameters recorded before and after DHEA supplementation included serum-cycle day 3 Follicle Stimulating Hormone (FSH), Anti-Müllerian hormone (AMH), Inhibin B, E2, and DHEA. Ultrasound parameters recorded included antral follicle count (AFC) and endometrial thickness. To assess markers for ovarian function at different stages of follicular maturation, very early AMH, early inhibin B, AFC, and the number and quality of oocytes both before and after DHEA supplementation were recorded.

The results showed that following DHEA supplementation, there was a significant increase in antral follicle count, while no significant changes in baseline biochemical parameters were noted. The change in response to IVF treatment was also significant, with an increased peak E2 concentration, the number of follicles over 15 mm on the day of human chorionic gonadotrophin (hCG) administration, and the number of oocyte retrieved, with consequent increase in the number of metaphase II oocytes and the number of embryos. There were 11 clinical pregnancies after DHEA treatment. The study was presented at the 2010 annual conference of AYALA, the Israeli Fertility Association, held during May 2010 in Tel Aviv (Israel).

“DHEA appears to improve IVF treatment outcome, with an increase in the number of oocyte and embryos, and appreciable pregnancy rate,” concluded lead author Jordana Hyman, M.D., director of the Shaare Tzedek IVF clinic, and colleagues. “It seems that the mechanism does not include recruitment of more preantral or very small antral follicles, but rather rescue from atresia of small antral follicles (increased AFC).”

DHEA is an endogenous steroid that has been implicated in a broad range of biological effects in humans and other mammals. DHEA is produced by the adrenal glands, gonads, and the brain. It acts on the androgen receptor both directly and through its metabolites, which include androstenediol and androstenedione, which can undergo further conversion to produce the androgen testosterone and the estrogens estrone and estradiol.


(Hospimedica.com)

Although this is a tiny study,  it does provide useful info - but it isn't a placebo-controlled study like most FS's would like to see. I *think* it's a "before" and "after" study...


Puddycat -  yes, 2 frosties, which we were v surprised about. Trying not to get my hopes up too much as I know they dont always thaw, but it is does at least give us a bit of a breather.

Edited by petal71, 26 July 2010 - 04:15 PM.


#16 workingitout

Posted 26 July 2010 - 12:32 PM

Sorry - deleted cos posted in the wrong place.

Edited by workingitout, 26 July 2010 - 12:34 PM.


#17 Puddycat

Posted 26 July 2010 - 05:04 PM

Hi All,

Well, I got two eggs.  I just hope to goodness they both fertilise.  Find out tomorrow at 0930.

Its gut wrenching to lay there and here the other FS come out and tell their patients "18 eggs" or 24 eggs" or "12 eggs".   And I get "two eggs, which is great for you" from my FS.  I promptly burst into tears and said to him "We have to do something about this.  Its not fair" etc etc.  he said "I know its hard on you, but really, two is better than some of your cycles you have done".  I know I should be grateful that I have two eggs.  I know there are women out there that have gone though the full stim cycle and got zero eggs.  I know that.  but at this particular point in time its just not helping!

Why is my body such a poor responder.  I feel like I'm not really a woman.

I hate how IVF is a numbers game.  I hate how by starting with such low numbers in the first place there is such a massive risk that we wont make it to transfer.

I hate how I have to do a stim cycle each time, which is a massive toll physically, emotionally and financially whereas others are lucky to have 15 frozen embryos.

Fingers crossed my two fertilise and one of them is the one.  



#18 Puddycat

Posted 27 July 2010 - 09:26 AM

No fertilisation for us.    cry1.gif     cry1.gif      cry1.gif

#19 Gordo's Girl

Posted 27 July 2010 - 09:37 AM

Awwww Puddycat, that's not the news you wanted to hear this morning I'm sure.  It's totally heartbreaking.  Sending you lots of big hugs bbighug.gif , and hope you and DH are taking care of each other today.

I agree with all your 'hates' in your last post as well ... that's exactly how I feel.

GG

#20 petal71

Posted 27 July 2010 - 09:43 AM

Oh Puddycat, that is just devastating. Im so sorry that your cycle has ended up like that...it is just completely unfair and disappointing in the extreme.

Sending you many hugs. As GG says, take care of yourself.

#21 Puddycat

Posted 03 August 2010 - 06:53 PM

I have finally though of something positive about being a poor responder!!!  You can do back to back cycles!!!  (mind you.....if we had more eggs then we could also be doing back to back FETs, but thats a whole other story!).

So, Ive decided to flog this damn dead horse one more time and am awaiting AF to arrive.  Should be here on Sunday/Monday.

Will be doing an another antagonist cycle, with prednisone and aspirin after transfer (as I WILL be making it to transfer this time).  I'm going to ask him about assisted hatching and also about Clexane.

Anyone else got any other drugs they can suggest I ask him about???

Hows everyone else going?

#22 Gordo's Girl

Posted 03 August 2010 - 08:50 PM

Hey Puddycat!  Well done on making the decision of having another go!  Fingers crossed we both get better results with these next cycles.

I would suggest giving the assisted hatching a go - from what I've seen it seems like us "poor responders" can have better results.

My next cycle will also include this Androderm (Testosterone patch) which I have to start 5 days before I start injections.  Maybe you could ring the clinic tomorrow and ask if you can throw that into the mix as well?  I think that it is something along the lines of DHEA but not needed for 3 months (well, that's how my FS explained it).

I'm not sure about the Clexane.  I had ankle surgery last year, and had to take it for 2 weeks following (hence why these IVF needles seem like a breeze) and that was to keep my blood thin and stop the chances of getting DVT.  I'm assuming it does something with the blood flow/thickness to help with implantation?

Let me know how you get on.

GG

#23 causeway

Posted 04 August 2010 - 06:25 PM

Just wanted to pop back and check in. Was sad to see that our group has no 'graduates' so far, I am not the exception as it looks like AF is on its way. Back to Day 1 tomorrow and another attempt at a Clomid cycle. I have to go away for work for 4 days (CD12-15) so it will be a miracle if we get lucky!!!

We've had our set up interview with our fertility clinic and are on the list for a Nov EPU. We can't do it sooner as either the FS or we are away on holidays!! This does mean that we will get another couple of cycles in before IVF and fingers crossed we get there before November.

Fingers crossed for you lovely ladies and I look forward to checking back in to hear your news.

#24 Melb girl now

Posted 04 August 2010 - 07:29 PM

Hi All

Was going to setup a seperate post but do you mind if I join here?

I received my results back from FS and AMH is only 1, which he says is not good.

How bad is 1?

Just wondering has anyone else had bad AMH results and any luck with cycles getting eggs?

Also it is myunderstanding AMH refers to your reserve not quality??

Wishing everyone good news with their upcoming cycles.

Mrs L

Edited by MrsLouise, 04 August 2010 - 07:30 PM.


#25 Gordo's Girl

Posted 04 August 2010 - 07:55 PM

Hi Mrs L

I had the AMH test about 2 months ago (after my first cycle was cancelled due to poor response), and my result was a 1 as well.  Since then I have had 1 cycle with 2 eggs, only 1 fertilising.  I had a 3 day transfer with the 1 embie but had no luck that time.

Next cycle we are using Testosterone patches to try and boost the egg numbers, and my FS is also going to add assisted hatching and transfer on day3 (2 embies - if we get them!).  Will let you know how that goes.

DHEA seems to be something that a few ladies are trying out as well, so you may want to talk about that and the Androderm (patches) and see what they say.

Good luck with it all ... keep us posted!

GG


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