Low Antral Follicle Count and IUI

[sienasmama]

Hi everyone,

I'm 35 and TTC#2. I had my day 3 ultrasound yesterday, and found out that my follie count is low. Only 2 on one side and 5 on the other. My RE said she likes to see 6-10 on each side and anything under 10 total is low. When I was TTC my first 3 years ago, my count was 23 with an FSH of 4.3, so it's quite a drop. Last time, we did IUI w/ Femara and it took on the second try, so the plan was to do the same thing again. But of course, I came home and did some googling, and most of the info I've found on AFC's similar to mine are from people doing IVF. So now I'm wondering if Femara would be a waste and maybe I should go straight to injectibles. It was offered as an option at my initial consultation but I said no because I thought if Femara worked last time it would probably work this time. And there was the cost difference of course. I never expected such a difference in numbers after only 3 years.

Does anyone know about, or had low AFC, and what treatments/meds did you have?

Thanks!

 

[sienasmama]

Anyone?

 

[lulubun]

Hi Sienasmama -

I found your post because I have the same question, and I am also 35. Except, I'm TTC #1. On my CD 3 ultrasound, I had the similar results, 4 follicles on one side, and 3 follicles on the other. 7 total. I have an IUI and HSG scheduled for next month, but I'm worried that my follicle count will be an issue

 

[sienasmama]

Lulubun - (((Hugs)))

I remember what it was like TTC #1. There were times when I thought that maybe I wasn't meant to be a mom, and that was why we had so much trouble. I don't know how women who spend 3, 4, or 5 years TTC do it. I'd have lost my mind! Anyway...I posted this same question on a FB group and I heard from several women who had counts similar to ours, or even lower and they did end up getting pregnant. One had only 3 follies total and conceived naturally while waiting to be seen for fertility treatment. Like they say, it only takes one good sperm and one good egg. It's not much comfort when you're the one having trouble conceiving, I know.

Do you know what your FSH level is? When I was TTC #1, it was 4.3, then 3 months ago it was 5.9, but my RE wanted to recheck this month, so we'll see where it's at when the results come in. The AFC was a shocker to me because I thought with a normal FSH, I'd have plenty of follies. Anyway, I'm having my HSG tomorrow, and then I have my follow-up consult with my RE in 6 days to go over the results. I am going to talk with her about whether my count is going to be an issue and what else we can do to improve my odds, so I'll definitely come back here and update you.

Hang in there!

 

[lulubun]

Thank you so much Sienasmom. Your post brought tears to my eyes. I feel like I cannot share this information with anyone else in my life, and it was a great comfort to have someone reach out and be so sweet to me.

I went off the pill in December 2011 and expected to be pregnant immediately. I decided to see an RE to make sure we wouldn't spend too many months trying before getting help. I actually did my AFC on CD5 (not CD3). We couldn't do the FSH blood test last cycle because it was Presidents day and the labs were closed, so they scheduled it for next cycle. I'm around 13 DPO, and awaiting AF so I can schedule my FSH blood test. As a side note, I took the over the counter (urine) CD3 FSH test and it said "normal", but I'm not really sure what the threshold of normal is for this test and how accurate it is.

Also, my husband's SA came back with 25% motility, 19 mill/ml, and 3 ml total. I thought it was a male factor, but maybe I'm the problem... We are going hard core this month: an HSG (just to be thorough) + clomid + IUI all in the same cylce after AF shows.

But, I sit here and think, if clomid helps me produce a better egg, and I ovulate every month, what does it matter how many follicles I have? I'm not sure I understand the statistics of what this number implies. I know that for IVF, you want more eggs so you can implant the ones that make it, but even women with 25+ follicles sometimes don't get pregnant.


Huge hugs to you tooo!!

 

[sienasmama]

Hi,

I think the reason the numbers matter is because a low number can indicate that we have a low number of eggs overall, since we're born with all we'll ever have. The Clomid is supposed to help the eggs you do have develop better, but odds-wise, the fewer follicles we have, the less likely a healthy one will drop. Of course, my RE said that the good news is that our eggs are most likely better quality than someone older than us with more eggs.

And I don't think it's "just" you! Ideally you'd want DH's sperm at 50% or higher motility, so it could be a combination of you and him. If I recall, I read that 30% of infertility is female factor, 30% male factor, 30% a combination of male and female, and 10% unexplained. We were unexplained last time. I'm anxious to see what DH's semen analysis looks like now. Let me know how things go at your next appointment!

 

[julesjules100]

Hi ladies

Totally understand how you feel; I am 36, low AMH (2.1 in the UK) and an AFC of 8 but when tested my FHS was was normal/good. Re the FSH, when I expressed surprise at this to my consultant, he said that as you get closer to menopause/get older, the level starts to oscillate before going much higher, which is what he suspects mine is doing so for me it's a bit of a misleading result.

My concern from the low AFC is running out of time. I tried one cycle of clomid with IUI. The clomid just gave me one follicle (which was happening normally anyway) but made the lining thinner (I have a really thin lining which my consultant is now more concerned about than the AFC). We opted to move straight to injectiables so this month's IUI I did Gonal F, which gave me 4 follicles (ideally my consultant was looking for 2, one in each ovary so I responded a bit too well). I thought I'd take the risk of multiples, which the consultant was worried about, given the borderline lining. I'm in the 2ww now so will keep you posted....

Hugs x

 

[Cloe1979]

I am totally confused too. I have a low egg count of 3 on one side and 4 on the other. My FSH is 7.5 and my AMH is .51, if my FSH and AMH are good why does it madder that my egg count is low? I am ovulating and menstrating regularly. I get that my time is running out faster then others my age (33) but if my egg quality is good shouldnt my chances be good too? Am I a better canidate for IUI or IVF? My FS says my results dont look so good with my low egg count and I should do IVF. I am thinking I will do IUI for a few months then IVF. We have been TTC for 2 years.

 

[julesjules100]

I am totally confused too. I have a low egg count of 3 on one side and 4 on the other. My FSH is 7.5 and my AMH is .51, if my FSH and AMH are good why does it madder that my egg count is low? I am ovulating and menstrating regularly. I get that my time is running out faster then others my age (33) but if my egg quality is good shouldnt my chances be good too? Am I a better canidate for IUI or IVF? My FS says my results dont look so good with my low egg count and I should do IVF. I am thinking I will do IUI for a few months then IVF. We have been TTC for 2 years.

C

Have a read of my post above yours. Pretty much the same antral follicle count as me (mine was 8), which isn't great, similar FSH level (both of those results for us were good) but we both have bad AMH numbers (if you're on the US scale then yours is the same as mine). Your AMH number is slowing low fertility. I was confused by the fact that my FSH was ok (typically they expect it to go high, ie bad, when the AMH is getting low) but my consultant said is oscillates as you're starting to run out of time.

I did 3iuis with no BFP. Consultant said I could do another one but I couldn't face it. Went straight to ivf instead. Despite having low fertility numbers, I made quite a few eggs (see ciggy) and now pregnant. We have 3 frosties on ice too for the next baby. The benefit of ivf is that if you get enough viable embies then at least when you're a few years older and the numbers may have fallen again in terms if fertility then we can still have a go at using eggs from now when I'm 36.

Personally I may have had one go at IUI and then gone straight to IVF. I'd be guided by your consultant. One final thing to say, if you do do IUI then discuss doing it with injectables (eg gonal f). I had a great response to it and clomid was useless.

Hope this helps.
J x

 

[Cloe1979]

I am totally confused too. I have a low egg count of 3 on one side and 4 on the other. My FSH is 7.5 and my AMH is .51, if my FSH and AMH are good why does it madder that my egg count is low? I am ovulating and menstrating regularly. I get that my time is running out faster then others my age (33) but if my egg quality is good shouldnt my chances be good too? Am I a better canidate for IUI or IVF? My FS says my results dont look so good with my low egg count and I should do IVF. I am thinking I will do IUI for a few months then IVF. We have been TTC for 2 years.

C

Have a read of my post above yours. Pretty much the same antral follicle count as me (mine was 8), which isn't great, similar FSH level (both of those results for us were good) but we both have bad AMH numbers (if you're on the US scale then yours is the same as mine). Your AMH number is slowing low fertility. I was confused by the fact that my FSH was ok (typically they expect it to go high, ie bad, when the AMH is getting low) but my consultant said is oscillates as you're starting to run out of time.

I did 3iuis with no BFP. Consultant said I could do another one but I couldn't face it. Went straight to ivf instead. Despite having low fertility numbers, I made quite a few eggs (see ciggy) and now pregnant. We have 3 frosties on ice too for the next baby. The benefit of ivf is that if you get enough viable embies then at least when you're a few years older and the numbers may have fallen again in terms if fertility then we can still have a go at using eggs from now when I'm 36.

Personally I may have had one go at IUI and then gone straight to IVF. I'd be guided by your consultant. One final thing to say, if you do do IUI then discuss doing it with injectables (eg gonal f). I had a great response to it and clomid was useless.

Hope this helps.
J x

Thanks for you comment. I just got back from my IUI and i am cramping a little. My FS recomends me do IVF because he says with low egg counts somestimes comes bad egg quality but there are no test for egg quality and they would not know until IVF. Also my Prolactin levels were a little high so they have me on Bromocriptin until I get pregnate. My hubbys sperm count was at 58 million for my IUI and the doctor says that is great count.

 

[julesjules100]

Good luck!! X

 

[2have4kids]

Hi ladies, I was put through the work up Feb 2012, FSH=16, 1antral follie and she gave me less than 5% chance to get preggers on my own. I ordered DHEA and took a cabinet full of supplements. I cut sugar out of my diet to a great extent and started exercising more. Hot packs cd1-o. On the 11th month of ttc we started using softcups and got a chemical bfp, 2months later we got another proper bfp while using softcups.

At nearly 9 weeks I m/c. Just had an u/s 3weeks ago and the technician said I have 4 antral follies working now (2on each side) and a nice thick 9mm lining.

FC just gave me prometrium to get my cycle back and it worked on the second day. So here we go again. I'm on synthroid as my thyroid was 3.6 and for I've they want it above 2 for optimum adrenal function before IVF. Vitex, vit b6, b12, d, e, EmergenC, folic acid and 50mg DHEA. Antioxidants: N-Acetylcisteine (NAC), Selenium, inositol, pycnogenol, acta-resveratrol & grapefruit extract. Also salmon oil & EPO for inflammation, lemon balm (strong antioxidant and great anti-depressant/sleep aid) before bed. Think I'm crazy? I'd better get another bfp soon or it's IVF in March for us.

There are things you van do to get the machine functioning. My fs said there's nothing I can do but iui (which didn't work) and ivf. She said sometimes the fertility drugs awaken the natural follies which then start producing more eggs. Well, I feel the supplements have done the same thing for me.