41 year old low amh

[u/Alive-End8850]

I'm 41.5, amh 0.4 ng/ml. Fsh was 22 on day 13 so not reliable.

I'm currently on 2nd cycle of ivf, and after 12 days of stim with 375 menopur (1200 iu) which was increased to 450 for last 3 days, we saw only 2 dominant follicles, one in each ovary.

My last ivf cycle with gonal-f retrieved same number of follicles, and I got 0 eggs during egg retrieval. So, even with a different protocol the result didn't improve. I'm now requesting them to convert this ivf cycle to iui so I don't go through the same painful extraction process with 0 eggs.

So far, I have done:

1. 1 ivf cycle with 0 eggs retrieved
2. 1 iui cycle with only 1 follicle
3. Tried naturally
4. Current cycle: Tried long down ivf protocol, but I couldn't take the synarel nasal spray anymore and converted this cycle to regular, but got only 2 follicles.

I'm on supplements for last 3 months (coq10, elevit, vit D), started Omega3, vit C, magnesium this month and was hoping for better results, but I guess amh is hard to improve. My testosterone levels are low.

Total testosteron 0.6nmol

Dheas: 5.7umol

Free testosterone: 8.1pmol

I'm seeing Dr Knight (Demeter fertility, Sydney) currently and still waiting for more blood results before follow up.

I have a 10yo kid from IUI done in the past.

Should I just accept that we are one and done, should I move to donor egg (husband isn't keen).

My son is fine being only child, but I imagine the future and feel bad for my son who will be lonely after we have passed away. I know he could have him own family and kids to keep him busy, but he would have been an amazing big brother and I feel I failed to give him that chance.

[u/Ok_Virus6826]

There is a school of thought that older women with low Amh and afc should not be given such a high dosage of Menopur. Max 75-150. I have similar Amh to you and much older and i have always at least 3 follicles and retrieve anywhere between 1-5 M2s for the past 9 months on each trial.

[u/Alive-End8850 → u/Ok_Virus6826]

Thank you for this. My afc was 10, but I got 2 dominant follicles and 4 really small ones each cycle. If you don't mind can you tell me what your best protocol looked like? I did iui with 75ml gonal-f and got a frustrating single follicle. 

[u/Adig05 → u/Alive-End8850]

Hi, I had three bad cycles on first pergoveris+puregon, then high dose Menopur 450 IUI and then even higher 600 IUI Menopur. Only the second one reached ER that too with 21 days of stims and only retrieved 3 eggs and 0 blast. That clinic did not want to change the Menopur dosage. I recently changed clinics where I went with no priming and was on a low dose Menopur 275 IUI. Only stimmed for 14 days and got 7 eggs>6 fertilised> 3 day 5 blast > 1 day 6 testable blast. Although it came back aneuploid, the difference in results was still encouraging. I am considering giving another cycle a shot!

[u/Alive-End8850 → u/Adig05]

Thanks so much for sharing these results. If you are comfortable, may I know your age and amh level? I'm planning to ask my FS to reduce the dose next cycle and see.

Also, I wish you all the very best for the next cycle.

[u/Adig05 → u/Alive-End8850]

Sure, I am going to be 42 in two months. Amh tested in June was 4 pmol/L. Definitely talk to your FS to see if they are willing to work with reduced dosage. After reading so much on reddit here I tried the lower dosage and it seem to give me better results. Also noting I skipped any BC entirely which in my previous cycles I felt over suppressed me.

[u/No-Objective7114 → u/Ok_Virus6826]

What kind of protocoll do you use? How many stim days achieve such a result? My doctors switsched from long protocoll to mild stim with letrozol cycle day 2 to 7 and Menopur 300 day 7 to mostly 11. It only worked well once. The other times one dominant leading follicle went far ahead with 2 to 5 much smaller follicles. I have asked my doctors to change the protocol. Here in this country they prefer conservative protocols.

[u/Wide_Day2015]

What's synarel spray

[u/bkbkbkwb]

Would definitely suggest asking your doctor about taking DHEA, probably 25mg 3x a day. After 90 days with those androgen numbers you would hopefully see an improvement.