This is not a chapter I anticipated ending the way it has, but it is important I write it anyway in order that other people going through IVF are prepared that this too may happen to them.

In my last chapter I referred to the AMH blood test that it was recommended I have in order to give a more accurate idea of my ovarian reserve. The FSH test is okay, but AMH is far better. I duly arranged this, (although it cost £80.50 and was not available on Guernsey, so I had to arrange to send my own blood sample to a London laboratory). Shockingly, in spite of my earlier FSH result of 10, (which I thought was not terrible, although a little high), my AMH result came back as 0.92, which is essentially in the "virtually undetectable" category. This is not good, as it indicates virtually no eggs left, and a high risk of pregnancy not going to term even if fertilisation were to be successful.

My next 24 hours were spent in a very depressed state, and I spent a lot of time in tears. I emailed the results to Bourn Hall and my specialist "Mr Verwoerd", telling him I suspected from my own research these results were awful, but wanting his honest opinion on my chances. I suppose deep down I knew what his response was likely to be, and I was right. He kindly came back to me and said the following:

Dear Cindy

I’m afraid you are right – a level of less than 1 pmol/l is considered to be extremely low. My honest opinion would therefore be that your chance of success with IVF using your own eggs would be so low, that it is probably not feasible to consider. Donor eggs would offer you a far better chance of success. Please let me know if you would like to discuss this further with me.

Kind Regards,

Mr Gideon Verwoerd FCOG (SA) MRCOG

IVF Specialist

Bourn Hall Clinic

+44 (0) 1954 719111

www.bourn-hall-clinic.co.uk

AMH with Assisted Reproduction
AMH levels correlate with the number of antral follicles. Women with lower AMH and antral follicular counts produce a significantly lower number of oocytes compared with women with higher levels. Fertilisation rates in women with lower AMH levels would seem significantly inferior compared with women with higher AMH levels, irrespective of the method used to achieve assisted fertilisation. Women with low AMH levels have fewer oocytes, have lower fertilisation rates, generate fewer embryos, and have a higher incidence of miscarriage during fresh transfers, ultimately culminating in a halving of the pregnancy rate per IVF cycle compared with women with high AMH levels³. When compared to using FSH and age, AMH acts as a superior predictor of live birth and anticipated oocyte yield.

Ovarian Dysfunction
AMH levels cannot measure the actual number of oocytes, but it strongly correlates with the size of the ovarian follicle pool. AMH is a reliable serum marker of ovarian response that can be measured as a stand alone assay any day of the menstrual cycle. It does not correlate with lifestyle factors (smoking, body mass index, alcohol consumption, ethnic origin, chronological age), or reproductive history (age at menarche, years since menarche and gravidity)⁴. Findings such as premature ovarian failure can be effectively diagnosed by unexpectedly low AMH levels. Polycystic Ovary Syndrome (PCOS) manifests with two or three fold increases in the number of growing follicles, reflected in a two or three fold increase in serum AMH levels.

It would seem that serum AMH is one of the best hormone markers to assess the quantitative aspect of ovarian reserve or dysfunction¹. Measuring AMH will not predict whether a woman is able to become pregnant – there are other important factors that have to be taken into account – lifestyle, infection, genetic abnormality, quality of sperm and other male factors – but it is considered the best hormone to date to reflect the decline of reproductive function and potential reproductive capacity.

Okay I thought, (now scraping the barrel desperately), I sent the following email back to Mr Verwoerd:

Dear Mr Verwoerd,

Thanks for your honest reply. Not too sure where to go from here as I don't know quite how I feel about donor eggs. Also, how much does using donor eggs affect the costs involved as we are on a pretty tight budget for the treatment? One other question, if we were to consider the donor egg route, then is it too late for my older sister to be considered a donor. She is 44 years old, but has offered if it were possible? I shall discuss your reply with Richard, but in the meantime would appreciate your reply to my further questions so I can give him all the options.

Thank you

Regards

Cindy

I then received this disheartening, but honest, response:

Dear Cindy

The cost would be the same as for your own treatment with you using the maximum dose of stimulation medication (i.e. around £6,000 for IVF with donor eggs, or £7,000 for ICSI with donor eggs). All donors need to be younger than 36 years, so unfortunately your sister would not be able to donate. If you needed to go on the waiting list for anonymous egg donors, the waiting time is quite long – 18 months to 2 years.

Please call the clinic and ask to speak to Gillian Bellars, if you wish to go on the waiting list, or if you would like to receive information sheets about egg donation.

Best wishes

Kind Regards,

Mr Gideon Verwoerd FCOG (SA) MRCOG

IVF Specialist

Bourn Hall Clinic

+44 (0) 1954 719111

www.bourn-hall-clinic.co.uk

I then sadly sent the following reply:

Dear Mr Verwoerd,

It is with much regret that I have to contact you to confirm that cancellation of my treatment is obviously the best option. We couldn't possibly afford £7000 even in two years, by which time inflation would no doubt have affected prices also. To be honest £6000 would be a major struggle for us and we were only ever in a position to cover about a maximum of £4000 on the gamble that one cycle of IVF might have been successful. I also feel that I would have been more comfortable using donor eggs if they were from a family member, but there are no suitable females of the right age group in our family.

What should I now do about the nasal spray I have been taking, should I stop taking it immediately, or is there any slight chance it may help me get pregnant naturally if I complete the current bottle and then we stop using contraception?

Thanking you in anticipation of your response.

Kind regards

Cindy

I then sent two 'PS's', (after further research), as follows:

Sorry to bother you again Mr Verwoerd, but I just found the following post on a forum for infertility and wondered what your feedback on it was:

"Hi - Yes! I was 36 and diagnosed with low AMH of 0.3, and very high FSH. My RE said my chances of using my own eggs w/IVF, getting and staying pregnant to full term were "in the single digits" - but he said if we still wanted to give it a try he would tweak my protocol. We went for it and on the first cycle I got pregnant and I'm now a mom to a very happy and healthy 4 month old boy. Basically he had to give me almost twice the amount of stimulant (Gonal F) than most patients receive. I think that did the trick (plus transferring two 5 day embryosas opposed to 3 day olds). So it can happen".

I found this post on the following forum http://www.medhelp.org/posts/Fertility/Low-AMH-and-IVF/show/865790

I await any feedback you might have on this with a little bit of hope.

Thanks again

Regards

Cindy

I followed this up with one last desperate hope:

Would Clomid improve my chances at all?? Thanks Regards Cindy

To which I quickly received the following response:

Dear Cindy

It is always difficult to give advice in this situation. In the case you mentioned, the AMH level gave a false impression of that lady’s chances. It is true that no test is 100% accurate, but unfortunately statistics only give you an impression of the population as a whole, rather than a specific individual. It’s an average of people at the top and others at the bottom. It is therefore impossible to tell you with 100% accuracy what would happen in your specific case. I would have to give the same advice to you as the doctor gave that lady, but also take into account her age of 36. The average success rate drops after 38, so your situation would be different.

I cannot really tell you more than what the statistics show. You would have to make your own decision. I take it that your decision to cancel is then not final? Please let us know as soon as you have decided.

To answer your other questions: No, taking Synarel would not increase your chances of conceiving naturally. Yes, clomid might improve your chances, but without monitoring with ultrasound scans we would not advise it. We do not prescribe clomid at all.

Best wishes

Kind Regards,

Mr Gideon Verwoerd FCOG (SA) MRCOG

IVF Specialist

Bourn Hall Clinic

+44 (0) 1954 719111

www.bourn-hall-clinic.co.uk

And so my last email was as follows:

Dear Mr Verwoerd,

Based on the information you have given us, and follow ups to our questions, regrettably we are going to cancel the IVF idea. It is simply too much of a financial gamble for us and we cannot face the idea of waiting for up to 2 years to have an egg donor, that may still not work, and leave us in loads of debt in the process, (plus not totally being our own baby). We now feel our best option is to leave our situation "in the lap of the Gods" and if all else fails we might consider adoption in the future, but want to wait a few years before resorting to this route.

Thank you again for all your help, and can you advise me what to do about coming off the nasal spray, and if I can expect any side effects?

Kindest regards

Cindy

No doubt it goes without saying that I am still feeling pretty numb and in shock at the moment. None of this was what I was expecting, and all I can now hope for is a miracle. Will I ever forgive myself for my one and only pregnancy termination? No, I never shall, and now wish it had been illegal for such procedures unless the pregnancies were as a result of rape or incest etc. I just hope that this is all a part of a greater plan, and that my usual belief that "everything happens for a reason", proves to be accurate in this case also.

Wish me luck, send me your hopes and prayers, and if by some blessed miracle I do beat the odds and get pregnant naturally, I shall let you all know here on hubpages. Meanwhile, I shall tough it out as per usual, keep on living, loving my pets and showing compassion for those around me. Perhaps that is what I am here to do and a baby is not meant for me in this lifetime, who knows for sure, but I know I haven't given up all hope yet!