My 31-year-old sister went in to her local fertility clinic for her baseline ultrasound and FSH day-3 testing today to see if she can donate eggs to us.
And apparently her antral follicle count (AFC) isn't so great, given her age and our desire to use her as a donor. They saw 4 on one side, and 3 to 4 on the other side.
Ugh.
We are still waiting for the estrogen, FSH, and LH levels to come back today. And we are waiting on her AMH levels too.
We'll have to repeat all this in Denver if we decide to go that far...but what we don't want to have happen is for my sister to go out there and fail the screening like the anonymous donor did. Then she'd be out 1-2 sick days and we'd be out another $6,500 + her flight and hotel costs. So we were trying to get a good sense ahead of time that she would pass.
Needless to say, after hearing the antral follicle count was this low, Will and I are having a sinking feeling about this.
My sister, on the other hand, was blissfully unaware that this was not great news until I told her this morning that the Denver cutoff is usually 12 for a donor, although they might make an exception since she is my sister.
One thing that is puzzling us is that we think my baseline count has never been so great (like 6 on each side or something), and when stimulated, I crank out 18, 19, 22, 25, eggs, like a veritable egg factory (not that it has done us much good so far...)
Another thing is that my sister just got off of the birth control pill a little over a month ago...wondering if that could affect her AFC still?
So I'm a bit confused about how much weight to place on this.
So now I turn to you...how correlated has your antral follicle count been with your egg retrieval numbers? And how old were you? It would be great for us to hear (the good, the bad, and the ugly) and would also be a good resource to others who may stumble on this page down the line.
Maybe this isn't "meant to be." Maybe we aren't "supposed" to go with my sister? But I'm not even sure what that means anymore, really.
Feeling sucker punched, again. Seems like we can't catch a break over here.
God, I hate this whole process.
Mo
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My AFC was 10 and I had 24 eggs retrieved and 18 were mature and fertilized. So if her FSH and AMH are ok, I think it would be ok to proceed. I think the AFC varies monthly.
ReplyDeleteI hope she gets some good numbers back on other tests.
we never saw as many resting follicles as then were retrieved. usually we saw 3-5 on each side, then at retrieval, got 15 twice, and once we got 30 (that resting follicle u/s showed 6-8 on each side).
ReplyDeleteso, i don't think it is the end for her, especially as she is a good age, and hopefully her amh and fsh come back within normal.
also, you have a very close relationship with ccrm at this point, i am sure that if you wanted to proceed with her even though her numbers came back not so stellar, they would allow you.
good questions for your nurse coordinator now, so you don't have to suffer in the land of 'what-if' while waiting on her other b/w.
thinking of you- very hopeful and excited as you begin this fresh process.
My AFC was over 40 and I had 12 mature eggs retrieved. I don't have PCOS -- just petite and 25 so I was on a really, really low dose of stims. I agree that AFC is likely not the best indicator of how your sister would respond. Fingers crossed that her other numbers look good!
ReplyDeleteI always had more eggs retrieved than my AFC indicated. I think AFC combined with AMH is a better indicator. After my failed IVF's and FET, I went to another RE who actually checked my AMH and it was a dismal .24 and my AFC on that day was 4-5 total. I still have hope that this can work, the waiting for the results must be so hard.
ReplyDeleteMine was very correlated - I had 3 AFs, and 3 eggs. But I've heard way more stories of people who don't have a strong correlation than those that do. And it's also true that most people seem to get more eggs than their AFC suggests. I think the AMH and FSH results in combination will be the biggest indicator. Hoping hard for you that they come back great!!
ReplyDeleteI never had a lot of antral follicles (first cycle, ZERO was counted - got 12 eggs). Second cycle, and much better cycle, there was a couple on each side and I got 16 eggs I think (and these eggs were better quality). I think the other stats like FSH is a better indicator (my FSH was always within the normal range).
ReplyDeleteI'm staying hopeful!
Three years ago, age 27, I had 11 antral follicles & was begun on a low dose of stims. We retrieved four total eggs that cycle... three mature & one immature.
ReplyDeleteA few months ago, age 30, I had 9 antrals & we began with the highest stims our clinic does. I ended up with 18 follicles, but only 9 eggs at retrieval of which five were mature & four immature.
I know that doesn't "help", but I hope that helps as far as a range of the possibilities.
Oops, sorry. Six were mature, three immature for this last cycle.
ReplyDeleteMy clinic (a big one in NYC) didn't even do AFC, as they thought they were so unreliable a predictor of egg development. I know that it seems like you cannot catch a break, but I really do believe that this is going to work out and that Denver will let her proceed ahead.
ReplyDeleteHope this helps!
Mine were always pretty correlated as well. On IVF #1 I had an AFC of about 30, retrieved 21, 14 fertilized. BFN on fresh cycle, BFP on FET but then m/c. On IVF #2 I had an AFC of 35, retreived 30, 25 fertilized. BFP, twins, delivered safely at 36 weeks.
ReplyDeleteI would be curious to know with those with the lower AFC's but larger numbers at ER, did those cycles result in successful pregnancies? I wonder if there is any correlation between successful pregnancy rates and ER's higher than expected based on AFC???
I really really hope this works out for you guys with your sister. No more whammies! Come on now!! Praying you guys catch a break...
I had way more eggs retrieved than my AFC. MY AFC was 12 and I had 29 retrieved - 22 mature.
ReplyDeleteUGH! I just want SOMETHING to go perfectly for you all for a change! I don't think my clinic ever did AFC testing, though. The feeling being that it wasn't a great indication of how someone would perform on stims. She's young, and as long as her other numbers are coming back good, I'd say "PUSH FORWARD" And, no, this is NOT the universe telling you that this is not meant to be. It's frustrating, but it doesn't sound to me like this is something worth giving up over. Miss you, hope you're weathering the holiday season. We're going to be in town this weekend--give a holler if you want to go drink cocoa/tea?
ReplyDeleteWell...my relatively low AFC was always higher than the number of follicles that matured. I do NOT stim well, for whatever reason. My donor had an AFC of 30 and got 15 eggs retrieved (14 mature); she'd hyperstimmed on another cycle so I suspect my RE wasn't as aggressive as she could have been.
ReplyDeleteTaht said, I'd only consider AFC in light of other things (like FSH level); it's one piece of the puzzle, it varies from cycle to cycle, etc...
Still, disappointing. I want you to get stellar news for once!
It's quality not quantity, right? That was my RE's philosophy on why she advised us to go ahead with IVF even though I only had an antral follicle count of 3. They were able to retrieve 4 eggs, two that looked nice and 2 that were probably not mature. One of those two that matures is my little Maddy. I know I was in the ridiculously lucky category, but it does sometimes work with just two...
ReplyDeleteoh, and I was 39 at the time.
ReplyDelete@ Inbetween what day during your cycle did you have your AFC done? I went to my 1st consultation w/ a RE last week. My plans were to freeze my eggs for later use. On CD 2 he saw 2 AF on my right & 1 on my left. He didn't sound very hopeful. I kept asking him what's the best way to get pregnant naturally or IVF. He said it was my choice ugh I didn't like his bedside manners. Finally he said I should try naturally & do it now b/c I'm going to have complications getting pregnant regardless. I'm so worried I waited too late. I'm 38 turning 39 Feb. He gave me a blood test. I have to wait 4 agonizing days to confirm. Please give me some insight thank you
DeleteM
Hi!
ReplyDeleteThanks for commenting on my blog (do you read french?) and welcoming me on yours! Sorry in advance for weird phrasing and mistakes, english is obviously not my mother tongue!
After 18 months TTC, we found out my FSH was high following a Clomid Challenge Test (14.9). Because my AFC was not too bad (12 at day 3) and because I was 35, my RE decided to try IVF even if it was not looking good on paper.
I did 3 IVF in less than 12 months (and gain 30 pounds at the same time, urgh - but that's another story!). I always had good AFC at retreval time (22, 13 and 18) but very few embryos at the end (1, 1 and 3). Those bad numbers were probably a result of my poor ovarian quality, that is why we decided to try DE for our last IVF.
So, like others, I think that your sister's b/w is a better indication and I do hope for the best for you. Your story touched me deeply. I admire you both for the strenght and resilience you showed in the face of adversity.
Sans cigogne (literally meaning "no stork" - yeah, I do not longer think a stork will bring me a baby. I put all my hopes in Petry dish now!)
Every single cycle my AF count changed so I just don't see how you can base something this important off of only 1 AF count.
ReplyDeleteOver the past 18 months on CD I have had as many as 17, a 9, a 7, a 12 etc all over the place really. CCRM knows how to stimulate so they will get lots of good eggs out of her regardless of her AF count!
Knowing whats on the line I wouldn't be daunted by this-if it were me, I would push forward with my sister and ask CCRM to "bend" their rules if need be.
My AFC was low (8) at CCRM. They made a big deal about it and decided to use microdose lupron flare protocol. It yielded 20 eggs but only two fertilized. My first fertility clinic never checked AFCs and they went by my FSH and used regular long lupron which yielded much better fert rates. The second cycle we did at CCRM I begged them to forget about my AFC and do long lupron again--better maturity and fert rate but again, no success.
ReplyDeleteI guess I'm rambling but I think it really doesn't matter if those are 8 GREAT eggs that fertilize. I think it can push them to use an aggressive protocol which (in my humble opinion) can be damaging if not really necessary.
Sorry to not really give advice, just throwing my own personal story into the mix since you asked...
Hi Mo and Will
ReplyDeleteAnonymous doc from Canada here again...thanks for your comments to me btw, re my "lupron makes you hotter" comments to you. Things are going well for us. 26 almost 27 weeks pregnant via surrogate with our Little Miss...
I read your blog post today. I hear you loud and clear. And while I understand your concerns, because antral count can be at least somewhat predictive of what might happen with stims and retrieval, at the end of the day, you and Will are going to have to exercise your voices and be your own advocates. If you want your sister to be your donor, then she should be, and I wouldn't suggest hanging your decision on her AFC alone. (FSH etc to follow I am sure) You've gotta be GOOD with your decision to work with your sis...and if you and Will and she want to do it, I don't think they are gonna say no based on that AFC...
You need only one good egg! And I dont say that with any other meaning than just that...One is all it takes, and one is all you need...and the stimulation protocol used will likely result in more eggs produced/retrieved than whats seen on AFC...and, its a quality/quantity issue too as you know. A large number of eggs retrieved is not predictive of quality of those eggs...we found that out with our last donor cycle....lots and lots and lots of eggs...36, and only 17 mature, and only 12 fertilized and only 6 decent embryos...however, we are pregnant with an FET...our donor AFC was 6 and 5...what if your sister doesn't make a pile of eggs, but they are of good quality and they make super embryo(s)?
And, if its any consolation at all, my ruptured ectopic was the result of an egg retrieval of my own "past their best before date" eggs...from my one and only lame ovary, with an AFC of 2 resulting in 1 embryo...and really, that retrieval never should have happened, but, it did, because we wanted it to, and said so to our doc. It was a gamble, and we really did win...and it was a fluke that derailed that situation in the end...we don't regret that decision...it led us to the path we are on now.
So, speak up. This is as much about following your heart, as your head...you have to be good with this in your hearts, and I suspect you are...and I kind of like the fact that your sis was unaware that the AFC was less than stellar. Its a flashback to the innocence of a first fertility treatment where you figure nothing can go wrong, and of course it will work...remember those days?
Perhaps it's that piece thats missing in the mix.
I wish you all the best in making your decision. Don't overthink it...
Hi Mo and Will
ReplyDeleteAnonymous doc from Canada here again...thanks for your comments to me btw, re my "lupron makes you hotter" comments to you. Things are going well for us. 26 almost 27 weeks pregnant via surrogate with our Little Miss...
I read your blog post today. I hear you loud and clear. And while I understand your concerns, because antral count can be at least somewhat predictive of what might happen with stims and retrieval, at the end of the day, you and Will are going to have to exercise your voices and be your own advocates. If you want your sister to be your donor, then she should be, and I wouldn't suggest hanging your decision on her AFC alone. (FSH etc to follow I am sure) You've gotta be GOOD with your decision to work with your sis...and if you and Will and she want to do it, I don't think they are gonna say no based on that AFC...
You need only one good egg! And I dont say that with any other meaning than just that...One is all it takes, and one is all you need...and the stimulation protocol used will likely result in more eggs produced/retrieved than whats seen on AFC...and, its a quality/quantity issue too as you know. A large number of eggs retrieved is not predictive of quality of those eggs...we found that out with our last donor cycle....lots and lots and lots of eggs...36, and only 17 mature, and only 12 fertilized and only 6 decent embryos...however, we are pregnant with an FET...our donor AFC was 6 and 5...what if your sister doesn't make a pile of eggs, but they are of good quality and they make super embryo(s)?
And, if its any consolation at all, my ruptured ectopic was the result of an egg retrieval of my own "past their best before date" eggs...from my one and only lame ovary, with an AFC of 2 resulting in 1 embryo...and really, that retrieval never should have happened, but, it did, because we wanted it to, and said so to our doc. It was a gamble, and we really did win...and it was a fluke that derailed that situation in the end...we don't regret that decision...it led us to the path we are on now.
So, speak up. This is as much about following your heart, as your head...you have to be good with this in your hearts, and I suspect you are...and I kind of like the fact that your sis was unaware that the AFC was less than stellar. Its a flashback to the innocence of a first fertility treatment where you figure nothing can go wrong, and of course it will work...remember those days?
Perhaps it's that piece thats missing in the mix.
I wish you all the best in making your decision. Don't overthink it...
So sorry you didn't get the news that you were hoping for/wanted. My AFC has definitely changed from month to month...but it's usually been +/- 5 follicles or so. I've noticed big changes when going in after bcp and/or on cd2 vs. cd4.
ReplyDeleteHey sweetie, I wish I had constructive feedback for you- I don't. But, I do want to echo your this sucks statements. Always pulling for you.
ReplyDeletebtw, still wanting to meet in person, I am thinking we have a lot in common. My email address is on my blog.
Your sister is quite young so seven really should be plenty of follicles (even though many REs will tell you that it isn't enough). The BCPs absolutely could have a suppressive effect that could wear off too.
ReplyDeleteFor comparison, on my successful cycle I was 39 years old, started with 9 follicles, 11 eggs were retrieved (so two more popped up during stims), 8 mature, 6 fertilized, and 4 made it to blastocyst. 2 were transferred, one of which is now my daughter, and 2 were frozen.
P.S. My friend at age 35 had 5 antrals and 24 eggs retrieved, so clearly a lot more can pop up.
ReplyDeleteHi Mo,
ReplyDeleteNever posted before, but there is a big group of us High FSH gals online. At 30, I had an AFC of 2, ER of 3 and have healthy triplets!! I know, absolutely insane. But low afc does not correlate with bad quality. Your sister has age on her side. I believe that CCRM is low AFC friendly so thats a plus. A lot of clinics have follie minimums and we stay away from those. I've followed you for a long time and wish you the best of luck. You have one heck of a story.
Allison
This comment has been removed by the author.
ReplyDeleteHi Mo,
ReplyDeleteI don't remember much about my AFC, other than it did not make sense for me to cycle with OE.
Why can't couples who have been through so much already just have things go smoothly and trouble-free?!
I've had four IVF cycles. My last cycle (first at CCRM) I went for my ODWU in Aug and had an AFC of 16. When I started my cycle in Oct after a month of BCP, my AFC had dropped to 9. I am 33 with high FSH and normal AMH. I was on a fairly low dose antagonist protocol (150 Gonal/75 menopur). I had 16 eggs retrieved, 13 were mature, and 11 fertilized. So I definitely think AFC can fluctuate, and you can get more eggs than the AFC (especially at CCRM). I would think with your sister's age, you should be able to get some nice, normal embryos even with a lowish AFC.
ReplyDeleteI think my AFC ranged around 6; I did my first IVF at 34, the one that worked at 37, and my last at 41 (only one ever worked but it worked from beginning to end). I also had FSH that ranged 10-16 and had to switch clinics to be allowed to cycle at all (the original clinic that turned me away has since changed its thinking on that and funnily enough is also the last place I cycled ... I did always do MDL protocols though I tried an antagonist once and got canceled. Oh, and one uncancelled cycle that was SIRMs conversion protocol but that too was a BFN.
ReplyDeleteMy sense is that research is finding that outside of maternal age, FSH and AFC don't mean much ... i.e. they correlate, and FSH goes up and AFC down with age, and fertility down too, but that independent of age, neither AFC nor FSH tell you much, except at the real extremes? My other sense is that a consensus is developing (I wouldn't say it's gotten as far as "emerging" yet) that harvesting a ton of eggs is the best strategy for IVF? That less stimulation and a decent (say 10-15) but not wildly excessive harvest of mature eggs is better than the same woman's ovaries being pushed to produce even more eggs in a single cycle? That "excessive" stims (whatever that constitutes, and believe me, if it exists, I had it, but I never produced more than 8 eggs or more than 4 embryos in a single cycle) increase the chances of aneuploidy and that it's better to aim for the middle ground (if possible) of "enough" eggs with still a good chance of healthy embryos?
My antral count was 25+ on both IVF cycles. I'm PCO though, and my AMH was right on the edge of high fertility/PCO. That wasn't helping me get pg with our MF and my crummy hormone levels. I was on pretty lowish doses of hormones given my high AFC each time, and actually pushed for higher doses myself each time because I knew how I'd responded to stims in the past for monitored cycles. I ended up with 12 of mature size at trigger, 16 retrieved, 14 mature, 13 fertilized, and 6 blasts. I know my RE was aiming for around 10-15 mature eggs at retrieval, rather than risking OHSS.
ReplyDeleteI agree - don't flip out till you see what the bloodwork shows. I think there's a really good chance that your sister will still work out as a donor. Maybe you could wait another month off the pill and redo the scan to see if things improve?
Fingers cross all will work out well for you!
My AFC was 2 (I think, if that)and my FSH was 15. My FSH was just starting to get high. My first IVF we got 2 eggs 1 mature. IVF #2 6 eggs and 2 mature. Who really knows with this stuff. Hoping your sister's FSH and AMH is normal.
ReplyDeleteHi Mo and Will,
ReplyDeleteMy first comment though I've been following for awhile. HTH:
I was 41 when I cycled at CCRM- normal AMH, FSH around 10, AFC was 10 or so. They thought it was on the low end but didn't seem too discouraged. They put me on the MDL protocol-- I got the sense that for me that was less aggressive than the EPP would have been. (Our issue was RPL, so I don't know how much of a factor that was-- we knew we could make blasts but likely had a high number of abnormals.)
We had some scary times during monitoring when they thought we would only get 3-4 eggs or so and gave us the option to cancel, but we chose to push on, and shockingly ended up with 12 eggs retrieved, all mature.
9 fert, 4 blasts, 1 CCS tested normal which is now our 1 year old.
So from our case at least there can be success with low-end AFC.
Wishing you the best,
Connie
I wish that the stress and struggle would just fall away for you. :-( Hoping that the bloodwork comes back good so you can proceed!
ReplyDeleteSurprisingly enough, I don't remember the antral follicle count from the IVF cycle. But we were able to retrieve 16 eggs. Out of these three were immature, and the rest were taken to the next step. Nope, the number did nothing for us in terms of a successful cycle.
ReplyDeleteI hope that the rest of the 'digits' of your sister will be more encouraging. It is only at times like these that one realizes the magnitude of one good sperm statement/ one good egg.
Take Care....
I have nothing to add to the conversation as I really have no idea what that even is! However, just wanted to offer support and good thoughts.
ReplyDeleteI hope you don't mind hearing from someone who didn't go through IVF or infertility, but at age 38 I had an antral follicle count of 7 with an FSH of 6.5. I got pregnant with an unmedicated IUI (one dominant follicle). So a lower AFC doesn't necessarily mean gloom and doom!
ReplyDeleteBy way of another point of view on this, NYU doesn't even do antral follicle counts (didn't for me, I mean, and I'm 99% sure didn't for our eventual donor) because they consider day 3 FSH and LH a much better predictor. So there is clearly not consensus on this point.
ReplyDeleteI turned 31 during our first cycle and my AFC during my work up a few months prior was around 30 total between the two sides. After stimming at unusually high doses for my age, I had 8 eggs and all were mature and all fertilized. They didn't grow well. We transferred 2 on Day 3 and had a BFN. Only one made it to blast, we did an FET and there was just an empty gestational sac and ended in a miscarriage. The doc said my ovaries acted like they were about ten years older than they should have. The second fresh cycle I was still 31 and had about the same AFC, high but consistent doses of stims because then they knew more about how I responded, got 10 eggs, 8 were mature, and 8 fertilized. They still didn't grow that well and we transferred the best looking three of them on Day 3 (8-cell, 8-cell, 10-cell) and now we have two year old triplets.
ReplyDeleteSo I'd say that at least in my case AFC didn't predict very accurately how many eggs would be there to retrieve.
Good luck to you both and I hope something just *works* for you guys soon! I wish it didn't seem like life is so intent on beating the crap out of you.
Hi! Mo, you are my inspiration. I wish you all of luck in the world! I was 31 when i did both IVF cycles. 1st IVF: I had 11 at the resting follicle count that turned into 26 mature eggs. Unfortunately, we did not get pregnant. For the 2nd IVF, I had 13 at the resting follicle count that turned into 19 follicles, 13 of which had matured eggs. I think your sister would have to get stimmed more aggressively, but I don't think low resting count means she cannot go through a cycle for you. GOOD LUCK!
ReplyDeleteAnd Mo-
ReplyDeleteHere is the study that I always cite that age trumps fsh levels.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2729851/
Allison
Dear Universe
ReplyDeleteI know you've listened to me once or twice, or at least, on those one or two occasions you have chosen not to thwart me. So, I am asking as gently as I can, please give Mo a break. Because this? This serial (and occasional parallel) fucked up fucked-up-edness is really more than anyone should have to deal with, ever. Ever.
Thank you.
Kate
M - I actually don't remember, I'm so sorry. I hope the blood tests came out ok!
ReplyDeleteMo