high AMH but no PCOS? insights on IVF/shady grove?
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jkimtysons
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Hi, I am 34 and we've started seeing Dr. Levens at Shady Grove. I like him a lot but have also heard the common critiques of SG feeling like a factory and them not being open to thinking outside the box. We have yet to do anything beyond testing. So far the two concerns are DH's morphology (3%, they didn't seem too concerned since the other #s are good, but it's still low) and having high AMH (18.7 ng/mL). I guess the high AMH is a concern not just for OHSS risk, but also acc to this article by Geoffrey Sher, "However, both high and poor responders have one characteristic in common, namely that in both cases, there is a high tendency for their eggs to be chromosomally abnormal (aneuploid), which leads to embryos that cannot develop into a “normal” baby." (http://haveababy.com/fertility-information/ivf-authority/ovarian-stimulation-what-high-responders-and-poor-responders-have-in-common) Sigh.
Dr. L seems pretty confident that I don't have PCOS and I don't have symptoms (ovulate regularly, 33 day cycles generally), normal weight, etc., so I'm guessing I'm in the potential high responder-but-no-PCOS camp. Any insight from folks on 1) Whether we should spend time on Clomid (which he already suggested)/IUIs, or limit time there and go on to IVF? (also b/c of the morphology issue) 2) If you have any experience as a high responder without PCOS and how that affected your IVF experience 3) Whether this situation seems within the realm of things that SG is equipped to deal with (impossible to predict, but any insights are appreciated), or if there are other recs. (Sidenote, spoke with Dr. L again and he's unconcerned about the high AMH and says it shouldn't affect things other than tweaking an IVF protocol to take into account being a high responder. But 18.7 just seems incredibly high! And in a "there must be something weird/wrong" way, not a "wow, sounds great" way. I still do have to do my AFC, so that will give some more info.) We have great insurance (thank you state of MD), but I was thinking we might do Shared Risk b/c the cost of FET's could potentially add up, and then we have the insurance to fall back on if we need to see someone else in the area that's covered. All hypotheticals, but it's nice to throw our situation out there in a pool of people who have gone through this and see what people might know. |
Anonymous
| I don't have any advice (sorry!), but I'll be watching this thread as I am in the same boat. I have high AMH (especially high given my age), and am going to shady grove for the first time this week. Docs don't think I have PCOS, so just wondering how the AMH will affect everything else. Good luck to you! |
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Hi! I was in a fairly similar position. I have a high AMH, and my dh has low morphology but normal counts/motility/etc.
It's debatable whether I fall into the PCOS category or not...I have somewhat long/irregular cycles but usually ovulate, and I'm normal body weight. My first RE just called it 'excellent ovarian reserve'. I'm also on the young side for fertility treatments (28). We tried two (unsuccessful) IUIs before moving on to IVF. We considered trying one or two more IUIs, but I was getting impatient, and the IVF process takes awhile (especially if doing PGS testing, as we were due to a previous miscarriage due to a chromosome abnormality). My first cycle at GW was a total bust - 12 eggs retrieved, but no blasts that could be used or frozen. I switched to Shady Grove for my next cycle and had a great result - 22 eggs retrieved and 11 made it to blastocyst stage and were frozen. (9 were PGS tested normal, and 1 inconclusive, so I would provide counter evidence to the assertion that PCOS or high AMH eggs having a higher risk of being aneuploid) I highly recommend Shady Grove, based on my experience. They were pretty aggressive in terms of stims, but I had the Lupron trigger and did not get OHSS. Overall, I found the process to be relatively easy and had only minimal discomfort after the retrieval. If IUIs are covered by insurance, I would try a couple first - even if they are unsuccessful, they get you used to the process of going to the doctor all the time and waiting for the nurse to call back with next steps. |
Anonymous
| I had a high AMH and high AFC (38 or 40ish) but my dh was MFI so we went straight to IVF. I would advise you not to do shared risk because MD health insurance is great! I got pregnant on my 3rd transfer (One freeze-all IVF, failed FET, before my lucky FET). I also switched clinics for thyroid and other issues. If SG is working for you, then that is awesome. Another reason to use your insurance is so you can switch if you decide you don't like them. With shared risk you are stuck. Also, insurance pays a fraction of what they are charging--4.5K for an IVF cycle and 1.5K for an FET, so you don't make a huge dent in that lifetime cap very quickly. |
Anonymous
| Following this thread with interest. I have high AMH (8.6) and no PCOs. Very regular cycles. My AFC was also high (30). I'm 37 and just scheduled my first ivf for November after many failed iui's. There is some MFI but not extreme. |
jkimtysons
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Thanks everyone for sharing your experiences and so glad to hear of successful IVFs!--15:52, with Shared Risk I thought that you could withdraw at any time and get the $ back? (Although it'd certainly be a hassle, esp if you have frozens there) Also, 15:52, did insurance count that as 3 separate cycles, or 2? (As in, did it count the "freeze all" as a separate cycle from the failed FET, even though nothing was transferred for the freeze all?)
MD maxes you out at 3 cycles, but it's unclear if they 1) cover FETs (seems like you have to petition) and 2) whether the FET counts as a cycle, or if they just count the cost towards the lifetime cap (which would be great). I believe they do count FET as a cycle/attempt. Just don't want to get maxed out in case we needed more tries/FETs--hence, the openness to shared risk. (Have Carefirst BCBS through the State) |
Anonymous
15:52 here---you get your money back if you don't get pregnant now that I think about. I think my objection is more that you are stuck at SG--SG works for some but I had a bad experience there and left. If I had shared risk, I would stayed on the treadmill and wasted my time. My freeze all was counted as atransfer even though there was no transfer. My estrogen was over 4K when I triggered and my progesterone rose before the trigger. When you have a high Amh it is more likely you will end up over-responding. That said, they tried to persuade us to pay out of pocket for the FET because it was discounted at 2.5K.....we considered it but went with insuranc. When I leftSG I still had 19.5K of my 25K lifetime lef--from two transfers (one transfer really) and the cancelled cycle. I think I just hate the fact that they charge 3 times what insurance pays and they just jacked up the price of theFET out ofofpocofpocket. |
Anonymous
Sorry! Massive phone issues! All of this is just one personas experience! You have to go with your gut and do waht is best for you!! Good luck! |