Not exactly DOR, but some other ovarian reserve issue.... thoughts?

[Anonymous]

I’d love to get some thoughts on where to go from here. My official diagnosis is unexplained. I just turned 33. My AFC is 15-17 and my lowest AMH is 1.8, but most recent is 2.17, FSH is 7.7. After two IVFs, it’s clear my response is not good so there is some kind of issue with my ovarian reserve that these tests are showing. One thing that maybe could be playing a role is that I also have two well controlled autoimmune issues.

IVF #1 started with bcp. I stimmed for 12 days, initial dose of 150 menopur and 75 Gonal was upped to 225 menopur and 75 Gonal after 3 days. I had 10 follicles at trigger, estrogen was around 1400. Retrieved 7 eggs, 5 were mature, 3 fertilized with ICSI and made it to day 3. One was transferred at day 3 and resulted in a miscarriage at 5w5d. None of the others could be frozen (one arrested and one made it to early blast on day 7, but didn’t have enough cells).

IVF#2 we did estrogen priming (estrace 2mg 1xday starting the day after ovulation, orilissa 4 days later due a short luteal phase). Then we did 375 menopur for 8 days with cetrotide starting on day 5. Estrogen two day before trigger was 1117 (last time it was taken). Also 2 days before trigger there were 6 follicles between 13-15mm and 10 between 10-11mm. We again got 7 eggs, 5 mature, 4 fertilized with ICSI. We froze a 8 cell grade one day 3 embryo (we don’t have any children and we’re hoping to do some banking)and are still waiting on the final results from 2 10 cell grade 1 embryos and 1 14 cell grade 1. I’m not really holding out hope though.

My doctor seems to think my second protocol was a better one for me even though the results are similar. She suggested we go again with the estrogen priming and menopur (not sure if she plans to tweak it or not). We plan to meet with her before doing another cycle and talk to a few other clinics. Any one have any thoughts on why we are getting so few eggs/no blasts and what we can do to improve our odds of getting blasts? At this rate we would have to do at least 3-4 more retrievals and I’m not eager to do that. Is there anything different we can do?

[Anonymous]

You sound like me, my base level numbers were DOR, but my response was awful. I was labeled a poor responder, which I don’t thing you technically meet criteria for. We tried everything and unfortunately never had success after 5 cycles, BUT we also had MFI so it may have been the double whammy that made it too much to overcome. Ask about HGH, during storms and/or HGH priming. Didn’t work for me, but other poor responders swear by it. Good luck, it’s a hard road for folks like us.

[Anonymous]

I am in a similar boat -- AMH was I think 1.29 and FSH like 6.9. I just never really responded to the drug correctly -- over two cycles had a total of about 18 eggs but only one made it to a medium quality 3BB blast which failed to implant. I am exhausted and running out of money -- we are not using donor eggs. Getting this across the finish line means a lot more to me than the genetics. Hang in there.

[Anonymous]

I would read up on supplements to improve egg quality. And put your dh on Fertilaid for men. Do everything you can to improve embryo quality.

Also get your vitamin D levels tested, and supplement into the higher end of normal range. Get sun on your skin when you can. Studies show a link between vitamin D and ovarian function.

What are your immune issues? Do you have thyroid issues? Do you know what your tsh level is?

[Anonymous]

Anonymous wrote:You sound like me, my base level numbers were DOR, but my response was awful. I was labeled a poor responder, which I don’t thing you technically meet criteria for. We tried everything and unfortunately never had success after 5 cycles, BUT we also had MFI so it may have been the double whammy that made it too much to overcome. Ask about HGH, during storms and/or HGH priming. Didn’t work for me, but other poor responders swear by it. Good luck, it’s a hard road for folks like us.

Ugh yeah, sorry you dealt with this too. I guess I just thought it would be relatively easy for me, even after our first round didn’t yield many eggs, especially after we had that fleeting success from our first transfer. This second round has been a real walk up call. I will ask about HGH. I’ve also heard of testosterone priming, did you try that?

[Anonymous]

Anonymous wrote:I am in a similar boat -- AMH was I think 1.29 and FSH like 6.9. I just never really responded to the drug correctly -- over two cycles had a total of about 18 eggs but only one made it to a medium quality 3BB blast which failed to implant. I am exhausted and running out of money -- we are not using donor eggs. Getting this across the finish line means a lot more to me than the genetics. Hang in there.

Sorry do you mean now* using donor eggs? I’m definitely open to that. My husband isn’t yet. I think we will reassess after one more round.

[Anonymous]

I would do natural cycle if you are ovulating.

[Anonymous]

Anonymous wrote:I would read up on supplements to improve egg quality. And put your dh on Fertilaid for men. Do everything you can to improve embryo quality.

Also get your vitamin D levels tested, and supplement into the higher end of normal range. Get sun on your skin when you can. Studies show a link between vitamin D and ovarian function.

What are your immune issues? Do you have thyroid issues? Do you know what your tsh level is?

Yeah I’m on all the supplements. My husband is just on a multivitamin though so I’ll look into that. The last time I got vitamin d checked it was high normal but I’m now on about 2500 IUIs a day.

I do have hashimotos and type 1 diabetes. My tsh is 1.6 at last check and my A1c is 5.4 so there is just not much more I can do there, although who knows if the antibodies are playing a roll. My doctor did say thyroid antibodies increase your risk of miscarriage even if tsh is normal.

Any thoughts on diet? I eat extremely healthy and low carb, but not keto and I eat dairy and gluten. I had been resistant to giving that up before, but at this point I’ll try anything. The evidence seems mixed though and my doctor says it won’t help.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I would read up on supplements to improve egg quality. And put your dh on Fertilaid for men. Do everything you can to improve embryo quality.

Also get your vitamin D levels tested, and supplement into the higher end of normal range. Get sun on your skin when you can. Studies show a link between vitamin D and ovarian function.

What are your immune issues? Do you have thyroid issues? Do you know what your tsh level is?

Yeah I’m on all the supplements. My husband is just on a multivitamin though so I’ll look into that. The last time I got vitamin d checked it was high normal but I’m now on about 2500 IUIs a day.

I do have hashimotos and type 1 diabetes. My tsh is 1.6 at last check and my A1c is 5.4 so there is just not much more I can do there, although who knows if the antibodies are playing a roll. My doctor did say thyroid antibodies increase your risk of miscarriage even if tsh is normal.

Any thoughts on diet? I eat extremely healthy and low carb, but not keto and I eat dairy and gluten. I had been resistant to giving that up before, but at this point I’ll try anything. The evidence seems mixed though and my doctor says it won’t help.

Sorry vitamin d was low* normal

[Anonymous]

Anonymous wrote:I would do natural cycle if you are ovulating.

Interesting suggestion. Is that because egg quality might be better? My feeling was that we kind of don’t have enough info to know if it’s an egg quality issue because we are getting so few. Plus our fertilization rate is pretty decent and all Fertilized embryos are making it to day 3, but I’m open to do anything that would maximize egg quality.

[Anonymous]

OP Update— all three remaining from my second cycle arrested on day 4. I expected this, but it’s also devastating.

[Anonymous]

OP, you sound a lot like me. I got a fewer eggs each retrieval because one of my embryos was behind my uterus and they couldn’t harvest from it, but my numbers and age were similar. I got a diagnosis of POF, which you can only get with multiple failed cycles.

We ended up using donor eggs and now I have three kids (6,4,1) from two DE cycles (and one frozen embryo from the second cycle). My outcome is great and I only wish that I had switched to donor eggs sooner and not put us through so many heartbreaking failures. Nothing fixes poor egg quality and DE IVF has a really high success rate when that is the main problem. I wish you all the best.

[Anonymous]

Anonymous wrote:OP, you sound a lot like me. I got a fewer eggs each retrieval because one of my embryos was behind my uterus and they couldn’t harvest from it, but my numbers and age were similar. I got a diagnosis of POF, which you can only get with multiple failed cycles.

We ended up using donor eggs and now I have three kids (6,4,1) from two DE cycles (and one frozen embryo from the second cycle). My outcome is great and I only wish that I had switched to donor eggs sooner and not put us through so many heartbreaking failures. Nothing fixes poor egg quality and DE IVF has a really high success rate when that is the main problem. I wish you all the best.

Thanks for replying! Donor eggs is something I definitely plan to discuss with my doctor. I have a lot of work to do before me and my husband feel ready for that though. I feel like it’s so hard because we did have that transient success. If we hadn’t gotten pregnant in our first cycle, I feel like I’d feel a lot more ready to move forward with donor eggs. I think we are definitely going to do one more round at this point and then reassess. I’m glad things worked out for you though!

[Anonymous]

I'll add another donor egg story for you.

I started TTC around age 35. IUI failures, surgeries to find/clear endometriosis, then tried to do a completed IVF cycle but I was a poor responder (this was back in late 90s, early 2000s so meds were different)
We did donor egg in 2001 (with a proven donor who had produced 6 quality embryos) We also got 6 embryos, transferred 3 and put me on immune-suppression protocol. I had a singleton who just turned 18. From the other three embryos that went to the freezer (on day 3, I believe) I transferred two, two years later. and I have 15 year old boy/girl twins. Again, we did immune-suppression protocol, which I mention because while I do not have thyroid or diabetes issues, I have other problems that are likely also auto-immune (allergies, and the endometriosis).
I believe that my infertility/poor ovarian response is related
Donor egg was the greatest thing to happen to me!!

[Anonymous]

20:59 here. I tried DHEA for a while, which is testosterone like and maybe what you're thinking of?, but didn't notice a difference and didn't like the side effects.

I would also urge considering donor eggs/donor embryos, if you're open to that. We were secondary infertility so decided to just stick with one, but I seriously considered it and it is really a good option for folks like us. I have no idea why this happened to us, but sometimes there's just no fixing broken. I'm so sorry, it's really hard.

Also about the fleeting success, we had two early natural conception miscarriages during off cycles while in treatment and had a child naturally a few years ago. It is HARD when it seems so close. Our miscarriages definitely made me keep going longer because it made it seem possible. But ultimately it wasn't. They were still crappy quality embryos, just slightly less so and actually made it to blast.

Speaking of blasts, you said you have good fertilization and arrest after day 3? That was us too. Consider a DNA fragmentation test and second opinion from somewhere like Cornell. We never did and I regret it. It feels off that we could get pregnant a few years ago, I was young enough (34 at the time), and had gorgeous day 3's that could never make it to blast. The urologist said it wasn't him, but I just don't know and I wish I would have looked into it at least. Maybe it wouldn't change anything, but maybe it could have. Worth a shot.