Poor pre-testing? Is IVF worth it?

We have had 3 girls naturally (& were very lucky to conceive quickly) we want to try for our 4th child and would like a boy so are thinking about IVF

I have had really poor pre test results..

AMH 2.4 pmol/l which i believe is very low for my age (35)
AFC 6 follicles on day 2 of cycle.

Naive of me, but very shocked at my results considering 3 natural and easy conceptions. Will IVF work for me? As its for gender selection - obviously with less eggs to start with my chances of a boy are much lower (as I am obviously immediately dismissing all healthy girl embryos). Is it worth pursuing considering the cost?

Thanks xx


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Hello,

Thanks for reaching out. Yes your AMH and AFC are below what we would hope for your age, but I do not think IVF is out of the question. I would need to see all your results from day 2 testing to get an accurate picture (FSH/E2/AMH/AFC). This testing does not mean you are infertile, as obviously you have not had trouble conceiving previously, but it does give an indication of how you would respond to IVF medications. You are correct in that with a low AFC, we would have less eggs and therefore less embryos, so when doing gender selection this would decrease the chances for success. I'd be happy to speak with you further about your specific case and success rates if you are interested. Wish you the best.

Dr. P

Thanks for coming back to me - I really appreciate it.

Can I ask whether the progesterone only pill and having a baby 4 months ago (it was 4 months when I did the original tests) would make a difference to AMH and AFC and lower true results?

I am due to re-do the tests after this months period as i have come off the pill so it will be interesting to see if there is a bit of improvement (& it will be 6 months since having our baby)

I didn’t have any other tests - just those 2 I’m afraid. Can I come back to you once I have the second set of results please?

Also, do you ever have it that ALL the embryos that reach blast stage are ALL girl or ALL boy or is it more a case that you always have a mix of gender even with just 5 or 6 embryos - but it’s that the quality of the boy ones you do have are not up to scratch and that’s what rules out use? I’m wondering if you ever have cases where someone would like a boy but ends up with 5 blasts and all of them are girl?

Thanks
Vanessa




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Thanks for coming back to me - I really appreciate it.

Can I ask whether the progesterone only pill and having a baby 4 months ago (it was 4 months when I did the original tests) would make a difference to AMH and AFC and lower true results?

I am due to re-do the tests after this months period as i have come off the pill so it will be interesting to see if there is a bit of improvement (& it will be 6 months since having our baby)

I didn’t have any other tests - just those 2 I’m afraid. Can I come back to you once I have the second set of results please?

Also, do you ever have it that ALL the embryos that reach blast stage are ALL girl or ALL boy or is it more a case that you always have a mix of gender even with just 5 or 6 embryos - but it’s that the quality of the boy ones you do have are not up to scratch and that’s what rules out use? I’m wondering if you ever have cases where someone would like a boy but ends up with 5 blasts and all of them are girl?

Thanks
Vanessa




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Hi Vanessa,

Yes the pill could have an effect on both AMH and AFC. Yes, I do recommend getting retested on Day 2 or 3 of your cycle and also including FSH and estradiol.

Yes, we do have cases where all the embryos are boys or all are girls, it’s less common but it happens. Each embryo has a 50/50 chance for gender so it would be like flipping a coin 6 times and getting heads every time.

Best,
Dr. P

Dr Potter,

Thanks for coming back to me.

I had some tests redone. It was on day 3 of my cycle and they seem better if I’m interpreting correctly? I got the extra ones done that you suggested too.

FSH 8.4 IU/L
OESTRADIOL 137 pmol/L
AMH 3.8 pmol/L
AFC of 10

This is 4 weeks since stopping the pill and exactly 6 months after having my last baby. My AFC last time (whilst on the pill) was 6 and my AMH was 2.4

What do you think? Better? Worth doing IVF? Does it give an indication of how many eggs they would collect?

What’s the average % of healthy eggs on day 5 - is it about 50% of what’s collected are healthy or less/more?

I’ve been taking CoQ10 to give the egg quality an extra boost, have quit alcohol and caffeine (1 month before egg retrieval - is this long enough/worth doing?) and am trying to eat healthily. Someone also recommended DHEA - is that worth it in my case do you think and would it interfere with any of the stim drugs etc?

Thanks again x


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Sorry to bother Dr P - just wondered if you had managed to have another look at my latest results? Thanks


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I realized I did not get your age, as this will also have be a factor, how old are you currently?

Dr. P

I am 35

We are due to have our first cycle in August but we are contemplating delaying till October for a few reasons 1) it will be 9 months post partum (I had my third baby in jan) and I will be 4 months off the pill (both of which I think affected my results in June)
2) we have a lot of stress on at the moment with a house move and our business
3) it will give me a bit longer to sort my diet and do some relaxation/yoga/acupuncture
4) I believe I have low ovarian reserve so it will give me longer on DHEA and CoQ10, especially as I only received the DHEA today (so I will have 3 months on it rather than 3 weeks) to improve egg quality and possibly quantity?

What do you think? Good idea?

Thanks again


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After reviewing your new results, IVF will be a challenge, but I think it’s possible. You do have diminished ovarian reserve, so you would likely need higher dosage of medication and a more aggressive protocol. I’d say 1 out of every 6 embryos would be normal, and since you’re doing gender selection that is another hurdle. But if you do have a normal male embryo to transfer, the success rate at our clinic would be about 80%. I would recommended cycling sooner than later, every month can make a difference. As long as you are no longer breast feeding and have had a bleed, you can start the process. I’d be happy to have a consult with you if you would like another opinion. But either way I wish you the best of luck in your journey.

Best,
Dr. P


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