Best IVF Specialist - Low AMH Australia

[hoping4mymiracle]

Hi all,

After two failed IVF attempts (one with a 5 day transfer) and the 2nd one a day ago where no eggs were fertilised, I am looking for some suggestions. I have low AMH and age is also not on my side (39).

While I don't have anything to complain about my current specialist with Genea, I am looking for a doctor who will try and customise my treatment. I read in one of the forums(not sure where) that there is a fertility specialist in QLD who is not afraid to go the extra mile and try different regimes. I have low AMH but with both cycles, my doc didn't increase my stim dosage from 300iui, I have read some other doctors do take it up to 400iui. This time I did try DHEA for about 10-12 weeks though.

Sorry for the long story, I guess I just needed to vent, still feeling sore after my egg collection (not sure why but I bled a lot during the procedure) then reacted to the nausea plus processing the fact that it was all for nothing as none of the two eggs were fertilised.

Any help/suggestions would be really appreciated.

[Risa78]

Sorry to hear about this cycle. I’ve been there and it’s such a letdown after all that effort. Big hugs xx

What type of cycles have you done? There’s a few levers to try so it’s not just about dose.

- Type of protocol - Antagonist or long down reg? If you have only done one type, maybe try the other? This is a good blog post from a US specialist, Dr Sher, on the different types specifically for Low AMHers http://drgeoffreysherivf.com/ovarian...sion-protocol/ (note: Dr Sher is famous for his agonist-antagonist conversion protocol with estrogen priming so of course that’s his answer, but not the only answer... although I am trying that protocol for my last shot personally)
- Priming - you could ask about testosterone or estrogen priming? Both are designed to try to recruit more follicles up front. Testosterone priming didn’t work for me personally (but did for a friend). I am trying estrogen priming this cycle (not many FS’s do it)
- Meds - were you 300iu Gonal? You may need a higher dose but also ask about the types of meds. Eg You could try a mix of Gonal/Menopur (eg for me it was 600iu - 450 Gonal/150 Menopur) or Menopur only (but that is a gamble as works well for some but dreadfully for others). Or should you add Luveris etc?
- Extras? DHEA, growth hormone ($$$s). I found DHEA increased my day 3 follicle count after about 4 months
- immune/implantation/clotting blood tests - normally not done until after 3 failed transfers but if it’s hard to produce eggs I reckon ask for this now so you don’t waste any hard-earned embryos. Costs around $200.

The specialist in Brisbane you have likely read about is Waz. He is retiring on 21st December though.

Some others who are quite proactive include:

Charlotte Mooring, QFG Brisbane (has worked alongside Waz for years)

Robert Lahoud, IVF Australia at Greenwich (plus other locations in North and Western Sydney)

Lyn Burmeister, has her own clinic in Ballarat, Victoria

Kee Ong, Monash at Gold Coast

Glenn Sterling, Life Fertility in Brisbane

I’m sure there’s plenty more though! Shout if any Q’s or PM me if you’d like to know more about any of the specialists as we can’t say too much in the forum. But you’ll need to do a few posts first before you can PM...

Best of luck!

R

[hoping4mymiracle]

Thanks a lot for your detailed message. Both my cycles were long down reg 1st with 300 Gonal F, we had one egg and a 5d transfer.

2nd cycle I took DHEA and CoQ10 for almost 3 months before. Again Long down reg cycle but with 300 Menopur. This time we had 2 eggs but none fertilized, with ICSI.

I asked my FS abt estrogen priming and human growth hormone but she flatly refused.

Abt 5 mins before reading your message I found Dr Waz but didn't know abt his retirement. Will try ringing his clinic tomorrow even if I can get a consultation. BTW just realized what is the process of changing Fertility specialists. Will a referral from GP be enough?

Best of luck with your cycle.May I ask who are you with? I am with Genea and had heard they are great. The staff is very nice but I feel they don't provide personalised solutions whichI believe is warranted especially with the amt of $$and emotional stress the patients go through.

[Leish15]

Thanks a lot for your detailed message. Both my cycles were long down reg 1st with 300 Gonal F, we had one egg and a 5d transfer.

2nd cycle I took DHEA and CoQ10 for almost 3 months before. Again Long down reg cycle but with 300 Menopur. This time we had 2 eggs but none fertilized, with ICSI.

I asked my FS abt estrogen priming and human growth hormone but she flatly refused.

Abt 5 mins before reading your message I found Dr Waz but didn't know abt his retirement. Will try ringing his clinic tomorrow even if I can get a consultation. BTW just realized what is the process of changing Fertility specialists. Will a referral from GP be enough?

Best of luck with your cycle.May I ask who are you with? I am with Genea and had heard they are great. The staff is very nice but I feel they don't provide personalised solutions whichI believe is warranted especially with the amt of $$and emotional stress the patients go through.

Hi there,

I’m so sorry you’ve experienced what you have and you’ve been unwell after egg collection. This journey just absolutely sucks at times. I don’t think I’ve ever been such a big giant ball of emotions prior to my journey. My poor partner didn’t know what he was in for but soon got used to the random bursts of crying - from the stupidest of things too. God only knows what my partner is thinking sometimes. The poor soul. Fancy having to put up someone crying uncontrollably just for finding one long hair on their chin. My meltdown was out of this world but it’s part of this journey. It’s not fun at all but I promise you aren’t alone in feeling bad at times and sometimes we just need reassurance that everything will be ok. And you know what? It will be because we will all get there one way or another. It may take a while, cost us an arm and a leg in finances (and turns out in my case, my sanity) and seem like it is never going to end but I really believe we will get there.

If you’re in Melbourne or wishing to travel to Melbourne, I suggest Dr Nick Lolatgis in Clayton. He knows the American specialist who risa was talking about, Dr Sher, personally, which made me feel so at ease. I’ve just moved over to Dr Nick and I am quietly confident and very positive. Dr Sher is a big believer in trying to get things moving along when it comes to low AMH (I am 34 and two years ago my level was 4.8pmol/L) but Nick wasn’t as worried as Dr Sher - he puts more emphasis on autoimmune issues rather than low AMH and the reason being (which makes sense) is as long as women have any eggs, there’s always a chance of them having a baby. Plus he follows Dr Shers protocols too and his results speak for themselves.

One female specialist at Genea in Melbourne, who I went to for a 3rd opinion, doesn’t test nor treat autoimmune issues and Lynn doesn’t much either but Dr Nick does. As I said, his results speak for themselves plus he picked up something that no one else tested for with my partner and I, saving us the rigmarole unlike my previous specialist who didn’t do two egg collections when she could have, potentially denying us the only opportunity to have a child.
Thank god Nick tested us because I’m about to get treated for it.

I know your question wasn’t relating to autoimmune in the slightest, but I wanted to give you information on Nick as so far I’ve found him and his team really lovely, thorough and they’ve listened to my needs. He is straight down the line, tells you how it is and I’ve had many separate recommendations. His Monash nurse Catherine has been so bloody unreal and I’m only at the very start of my journey with him. Its the first time in two years that I can actually say I am optimistic with this one and positive. I actually can’t wait to continue this journey and see where things go with him.

Good luck to you.
I hope your journey ends soon resulting in a healthy pregnancy.m and that you are feeling better soon!
Best wishes, Leish

[hoping4mymiracle]

Thank you so much Leish for the encouraging words. wishing you all the best with your journey too. We have to keep hoping for the best.

I am in Mid North Coast so Sydney or Brisbane are easier to commute to for me but at this stage we are willing to try anything even if it means flying to Melbourne. Thanks for mentioning autoimmune disease too, I had a brief discussion with my FS re this but they were not interested in exploring this. I will start making some calls next week to all the specialists you and Risa have mentioned and will see where I end up .

Sending lots of baby dust your way, hopefully your move to Dr Nick results with a healthy pregnancy.

[Risa78]

Thanks a lot for your detailed message. Both my cycles were long down reg 1st with 300 Gonal F, we had one egg and a 5d transfer.

2nd cycle I took DHEA and CoQ10 for almost 3 months before. Again Long down reg cycle but with 300 Menopur. This time we had 2 eggs but none fertilized, with ICSI.

I asked my FS abt estrogen priming and human growth hormone but she flatly refused.

Abt 5 mins before reading your message I found Dr Waz but didn't know abt his retirement. Will try ringing his clinic tomorrow even if I can get a consultation. BTW just realized what is the process of changing Fertility specialists. Will a referral from GP be enough?

Best of luck with your cycle.May I ask who are you with? I am with Genea and had heard they are great. The staff is very nice but I feel they don't provide personalised solutions whichI believe is warranted especially with the amt of $$and emotional stress the patients go through.

I was originally at IVFA with a lovely but too conservative FS. I switched to QFG and did some cycles with Charlotte and Waz, both were great. They throw everything at it and high doses. I am currently doing my last own egg cycle with Dr Lahoud here in Sydney as I wanted to do an agonist-antagonist conversion protocol with estrogen priming (and Waz was on holidays and now retiring!).

A few ideas to try:

(1) antagonist
Why? Long down reg hasn’t been working and might be over suppressing you (ie shuts down your ovaries and they may be struggling to wake up). Antagonist doesn’t shut down your ovaries, it piggy backs off your own hormones and may help with quality. I think you need a good dose of Gonal (maybe 600iu?) 300 isn’t doing much. You seem to have done better quality wise on Gonal so either all Gonal or a 3:1 ratio of Gonal:Menopur (a small amount of menopur may still help, but too much didn’t do much for you).

(2) agonist-antagonist conversion protocol with estrogen priming. On day 1 of period start the OCP and take for 21 days. From day 15 start an agonist (like Synarel). On day 1 of next period start estrogen (pills and patches). Stop Synarel and start 1/2 dose antagonist (cetrotide) instead. Day 6 start stims. Again I’d suggest higher dose either throughout cycle or with a ‘step down’. I’m doing 600iu Gonal for 1st week then stepping down to 225iu. Adding 75iu Menopur for last few days only.
Why?
- The pill ensures you don’t have LH early in your cycle (helps with quality)
- The Synarel flare stops you being over suppressed from the pill
- Estrogen helps recruit more follies and primes the FSH receptors so they are more receptive to stims
- The 1/2 dose antagonist prevents ovulation without oversuppression
- The initial high dose of Gonal is to get the eggs growing but the step down is meant to let the poor eggs drop off (the ones that wouldn’t have worked anyway) and focus on quality of the good eggs.

(3) Waz does a standard antagonist with estrogen priming or a long down reg estrogen priming, so a bit different to above. Charlotte doesn’t do estrogen priming.

(4) Antagonist with testosterone priming.
Why?
Same as #1 but the testosterone priming is meant to get you more follies. More FS’s do this than estrogen priming so easier to find

(5) Antagonist with Gonal plus Elonva/Luveris - I haven’t researched but heard some good things, could be worth a look

Growth hormone is interesting... it may or may not help quality. I am taking it as it’s my last cycle so figured it was worth a shot. Costs $1500 though.

Egg quality supplements I take:
- 75mg DHEA
- 600mg CoQ10 (uniquinol form)
- 5mg melatonin (script from FS)
- 2 x triple strength fish oil
- 40mg zinc
- 1000iu Vitamin E
- 3000iu Vitamin D
- High dose multi B vitamins (eg Berocca)
- 500mg Vitamin C
- baby aspirin
- I meant to start l’arginine but never got around to it

Good luck with your 2nd opinion. Pm me anytime if Q’s.

R

[Risa78]

Unfortunately most FS’s don’t do much about immune testing and treatment. But I 100% agree with Leish it is so important! If it’s hard work to produce a good embryo you want to know it has a chance to stick!

Here’s the list of immune, implantation and clotting blood tests I recommend. Your FS sounds conservative so you may need to push for these. Or any of the FS’s we’ve mentioned will arrange these.

MTHFR c665C>T and c1286A>C
Factor V Leiden
ACL Anticardiolipin antibodies
ACA
ANA Anti nuclear antibodies
Anti sperm antibodies
ATA anti thyroid antibodies
Prothrombin gene mutation
Activated Protein C resistance
Protein C thrombosis screen
Protein S thrombosis screen
Homocysteine levels
TFT Thyroid function test
Glucose tolerance test
Vitamin B1, B6, B12, serum folate
Lupus anticoagulant

NK cells
* CD3-56+
* CD69+(CD55) ‘Dim’NK cells
* CD57

These tests cost me around $200.

R

[hoping4mymiracle]

Thank you so much Risa, I have never been given even half of this information from my FS and all the professionals I have seen.

I have an appointment on 24th with my FS will try and ask abt the tests and all alternative protocols. Can these tests be recommended by GPs? I am thinking of asking my GP next week if I can have these tests b4 visiting the FS.

Goodluck with everything and thanks for all your help.

[Risa78]

You could try your GP, many are reluctant to order tests they don’t know how to interpret though.

R

[Froyo]

You could see Gavin Sacks or Gamal Matthias. Both are in Sydney.