I would do the most aggressive IVF protocol your doctor agrees to. Soon.

I agree with others to skip IUI. It's a waste of time and just there as a place holder while women get comfortable enough to do IVF.

Anonymous wrote:An RE will tell you that your AMH is really low.
I'm not sure that IVF is any more stressful than waiting and being disappointed each month...and not brig as aggressive as you can be about the outcome.
Plus, with IVF you can do PGS testing and know for sure that you're transferring normal embryos. That lessens your chances of miscarriage -- which are much higher when you're older and trying naturally.

Your AMH isn't that low. Mine was .30 at age 35 and I still got pregnant naturally. With that said, you've been trying for 8 months. Either it will work easily or it won't. Seems like it's not. Personally, I wouldn't waste more time. Do the IVF.

Anonymous wrote:DO NOT BOTHER WITH IUI AT 40. (I didn't mean to have caps lock on, but in retrospect, it's probably an accurate sentiment.)
I did three IUIs starting at age 41, all unsuccessful. My numbers were better: AMH of 2 and FSH of 8.5.

At 41, I did two IVF cycles with ICSI. No PGS testing, which I regret in retrospect. I miscarried in the second one. The third cycle, a month after turning 42, was unsuccessful, too.

If I could turn back time, I would skip the IUIs and go straight to IVF with ICSI and PGS testing. I would have had a baby by now, had I done that.

We obviously all make choices with the information we have in front of us at the time, but this is just my advice based on what I learned.

It's probably more accurate and kinder to say that my numbers were more optimal, not "better."
Stupid numbers.

DO NOT BOTHER WITH IUI AT 40. (I didn't mean to have caps lock on, but in retrospect, it's probably an accurate sentiment.)
I did three IUIs starting at age 41, all unsuccessful. My numbers were better: AMH of 2 and FSH of 8.5.

At 41, I did two IVF cycles with ICSI. No PGS testing, which I regret in retrospect. I miscarried in the second one. The third cycle, a month after turning 42, was unsuccessful, too.

If I could turn back time, I would skip the IUIs and go straight to IVF with ICSI and PGS testing. I would have had a baby by now, had I done that.

We obviously all make choices with the information we have in front of us at the time, but this is just my advice based on what I learned.

honestly, you don't have much time and your numbers are not optimal. (but they aren't horrendous.) you need to get to an RE asap. you want to be as aggressive as possible.
i would skip IUIs at this point. Totally worthless at your stage.

I started TTC at 40. My biggest regret is the waiting I did. We got pregnant naturally inbetween IUI cycles, but we MC. We took this to mean I could get pregnant, just needed to try harder. It delayed IVF for a year. It was dumb, dumb, dumb of me. Finally got pregnant many years later with DE.

DO NOT DELAY! Time is not your friend. Get a full work up NOW. Move on to IUI. You don't have to decide IVF Yes or No at this moment. But don't waste your time as you try to decide. Get some things moving forward. You can make the choice, at any time, to stop. But if you delay, the choice will be take out of your hands.

Your FSH is high. Having said that, as someone who went into IVF with better numbers (40 y.o., 3.65 AMH, 7 FSH) and a year on still has no baby and not even a pregnancy, I can tell you that ART is not a panacea either. I thought I'd have success with my numbers and embryos in the freezer by now. Nope.

With 20/20 hindsight here is what I'd do in your place:

1) do a comprehensive work up with an RE. Insist on comprehensive. Reproductive clinics are in the business of selling their services, the standard testing in places like SGF is bare bones minimum.


2) Give yourself X months to keep trying naturally, IF you're going to try for real: sex every other day in fertile window. What you've been doing is not really trying. If that's the best DH can do, then go to IVF straight, at 40 once or twice a month is not doing yourself any favors.

Good luck!

Book your appointment!
If you had "normal" fertility you would be pregnant by now (8 months in). Sex 1 to 2 times during the fertile window is plenty if people are fertile.
Something is going on---maybe just age. You likely have some degree of sub fertility.

IVF has a better chance of working at age 40 than 41. Don't wait to age 41 to find this out!

OP's AMH isn't that low. Mine was only slightly higher when I was 12 years younger than OP. THAT was low.

I think OP your numbers indicate you still have a decent reserve for your age but it's starting to dwindle. Age is the biggest determinate in egg quality so I'm guessing that's the issue here. I'd book your appointments soon since it takes a couple months to get in and have all the testing done. You could try an IUI or two if you wanted but IVF is probably your best bet.

I would do IVF. My AMH was lower than yours and we had success.

Did your husband have a semen analysis done?

An RE will tell you that your AMH is really low.
I'm not sure that IVF is any more stressful than waiting and being disappointed each month...and not brig as aggressive as you can be about the outcome.
Plus, with IVF you can do PGS testing and know for sure that you're transferring normal embryos. That lessens your chances of miscarriage -- which are much higher when you're older and trying naturally.

I would meet with an RE and get all the appointments out of the way - it can take a month or two to do the necessary stuff for Shady Grove or whatever fertility place you go to. In that time you can ramp up the sex during the fertile period. If you wait to do all the necessary stuff for the RE it will push your timeline back further if you do decide on IVF, this way you can make your decision sooner rather than later if it comes down to it.

Assuming the cost won't be prohibitive, I'd do IVF. Your numbers aren't bad for your age (my numbers are worse at 33), but you don't have a lot of time to spare. You don't want to end up with regrets if trying naturally doesn't pan out in the next year or two.

FSH of 10.8, AMH of .816. Prolactin, thyroid normal, HSG came back clear. I'm 40, no kids, been trying for about 8 months, but perhaps not having as much sex as we could in the fertile window. (Sometimes just once or twice). DH is reluctant to think about IVF and wants to just keep trying, perhaps in a more concerted way, is worried, I think, about stress of IVF. I lean towards wanting to increase our chances of actually getting pregnant, but do worry about the stress if it's not so likely to work out. What would you do in our shoes? I'm feeling like just waiting to see if it happens isn't so realistic. But don't know how good my IVF chances are, either.