Gradual ovarian failure and IVF

Dear Lord Winston,
I listened to you with great interest on Jeremy Vine’s radio show yesterday. We began private fertility treatment in 2007 (an NHS test showed my husband had too many abnormal sperm and were told to go privately as the waiting list was 2.5 years long). First sperm test was normal and so were subsequent ones. We then underwent two attempts at IUI with me taking clomid (first cycle I had to have follicle reduction as 5 follicles responded). Neither cycle worked. In January 2009 my AMH was 15. As we were then advised to try IVF, the clinic repeated the test and in January 2010 it had dropped to 5. We proceeded with IVF (I was on maximum levels of drugs) and I got 5 eggs (1 was no good, 4 fertilised, 2 were put back in, 1 frozen and 1 didn’t get as far as blastocyst). Thankfully I fell pregnant and went on to have my little boy who is now 4 (November 2010). I suffered from post natal depression so we left it a couple of years as I wanted to be sure I was ready to try again (we continued to try naturally). We did the frozen embryo in September which didn’t work and were then advised to try IVF again. Again, maximum levels of drugs and this time only 1 follicle responded. The egg fertilised and was top grade but sadly it didn’t work. We’ve since been back to the clinic and they have recommended we try IUI again and then natural cycle IVF. I think I ovulate too early and have low progesterone, combined with a short cycle (23/24 days) which they say all corresponds to having a low AMH. We have invested a lot of money in the clinic and I’m just not sure if we should proceed with them. I am now 39 and my husband is 40. I would be very grateful for a second opinion. With kind regards, K

Dear K,

Thank you for your enquiry.

The global figures for pregnancy rates after natural cycle IVF in older women, or women with lower AMH levels are not good, and there is the strong impression that women like you are as likely to get pregnant naturally having regular sex as by having IUI, natural cycle IVF, or stimulated IVF cycles. Added to this, in your case there probably is some rather good evidence of gradual ovarian failure (I would like to know what your FSH levels are at repeated intervals) as you yielded rather few eggs the first time and only one follicle the second time. If you were my relative I think I would inevitably agree with your apparent decision not to proceed.

I am delighted you got pregnant and you should be very grateful to the doctors and the clinic that treated you. But I just visited the clinic’s website before writing this answer to you and I have to say I am always very concerned when clinics do not clearly spell out the cost of the treatment (there seems to be a lot about how to pay but nothing about what it costs) and also it is not clear to me what the actual success rates are there after the treatments they are advising you. Perhaps these things are on the website and I missed them but I am a bit concerned when these important details are not very clearly addressed.

Best wishes
Robert Winston