Dear doctor Sher,

I am 33 years old and my husband is 36. After 5 months of trying to conceive (that was back in November 2022), we decided to visit a fertility specialist in
Switzerland where we are currently located. He ran the basic hormonal exams on the 4th day of my cycle (4th day from flow, 5th day from light spotting) identifying a low AMH (0.56 ng/ml). For reference my estradiol levels were 723 pmol/l, my FSH was 4.5 IU (I know high estradiol could have suppressed this hormone) and my LH was 7.4 IU. He did not check for testosterone or DHEA levels. AFC on day 8 of the cycle was 5 (only in one ovary – I should probably mention that only one ovary has a normal size while the other is small which I know is another indication of a reduced ovarian reserve). I did ovulate slightly earlier than what I am used to that month and had my period earlier as well. Ovulation was confirmed on day 10 (through ovulation kits I have confirmed that I am ovulating between the 11th-14th day). Follicle was of mature size. Progesterone levels after ovulation were normal (luteal phase duration is also normal – 15-16 days long).Thickness of uterus was good as well. In the following months, I also did a hysteroscopy and everything appeared normal. I should probably mention that my husband had 1% of normal sperm morphology (everything else is good). Thus, we decided to proceed with IVF and more precisely, ICSI.

My doctor had me on Primolut n for 5 days and on the 4th day after I stopped taking it, I got my period. On the second day of my period, I started taking Pergoveris
350 IU per day. I took it for 3 days and then I went in for blood work and an ultrasound (STIM DAY4). The ultrasound showed only 4 very small follicles, two in each
ovary. The doctor commented that they were still small and that the bloodwork corresponded to their small size. He augmented the dose to 400 IU per day for 3 days again. On STIM DAY7, I went again for bloodwork and an ultrasound. Still he could only see 4 follicles (13.5 mm, 10.8 mm, 10.9 mm, 9.8 mm). Oestradiol levels were around 1230 pmol/l while LH levels were more than 9 IU. On that day he increased the dose of Pergoveris to 450 IU and on that night I started taking Cetrotide 0,25 mg. Two days after, I went for another round of blood work and ultrasound (STIM DAY9) where he told me that estradiol was increased but did not mention how much. Ultrasound showed 5 follicles this time (two smaller than 10 mm, 1 at 11 mm, 1 at 12.5 mm and one at 18.5 mm). Thus, on that day I took another 450 IU of Pergoveris during the day, a Cetrotide 0.25 mg and Ovitrelle 250 μg during the night. He advised us to go through with the retrieval of eggs just to see also their quality, although in reality there was only one mature follicle (he also mentioned that my uterus was ready). I did go through the retrieval yesterday (36 hours after trigger shot) and they informed me that they had collected two eggs but both of them were immature. We were surprised as one of the follicles seemed to have had the appropriate size. The day of the retrieval would have been day 11 of stimulation. On day 10, I received no hormones.

I apologize for not having more details with regards to my blood exams but this is what I remember from what he had shown me at the office. I don’t have any of the blood work results from the ovarian stimulation phase. I am not sure if the protocol was the right one for my case or if I have an egg quality problem along with the poor response and the problem of the low ovarian reserve. I am starting to believe that I am a lost cause and that I should not proceed with another round of IVF. I always wanted to have at least one biological kid but I also wanted to adopt. We are not considering donor eggs. I would very much appreciate your expert opinion on my case. I did read your response here http://sherfertilitysolutions.com/ask-our-doctors/egg-immaturity/ and if I understood
correctly there were some things that the doctor could have done differently. Therefore, my question is am I a lost cause or some modifications to the protocol could bring better results?

P.S. Doctor mentioned that I may be a poor responder because the FSH receptors on my ovaries do not communicate properly with my pituitary gland which is shown from me not responding to high doses of FSH. Could that be a possibility and is there anything that can be done about it?

Also, I have been taking these vitamins – http://www.fol-ino.ch/women/fr/index.php – that my doctor prescribed but I wonder If I should have been taking something else (CoEnzyme Q10 and DHEA along with folic acid and Vitamin D?) as they seem to be appropriate only for people with PCOS. I have taken them for 2.5 months.

Thank you in advance for your response and thank you for taking the time to read my very long email.

Kind regards,
Alexandra