Dear Dr. Sher, five and a half years ago my husband and I conceived naturally in our first cycle. I gave birth to a healthy baby boy 9 month later. Two years after that we tried to have another child, after six cycles my gyn said I should go to a fertility clinic. I was 37 at that time and I had a low amh of 0,33 but regular menstrual cycles. 1,5 years later, with now 39, I am still within this journey. Summary of treatsments:
1) ICSI: Stimulation with Pergoeris 375 IE from day 3 to 10 -> two follices but no egg retrival
2) Natural ICSI few months later: 0,25mg Clomiphene from day 3 to 8 -> one follicel, 10 cell ambry transfer 3 days after punction, negative
3) Next cycle tried yet again with Clomiphene, same plan: more follicel than usual in both ovaries but no growth or even shrinking. After getting off of Clomiphene eventually one follicel did grow but persisted as my fsh and lh levels were high even due estrogen was high too
3) after pausing for few months we started now with a new stimulation cycle with 150 IE Menopur from day 3. As it looks for now just one follicel is growing and the other ones are not or some of them with smaller size disappear.

I am getting really frustarated with my clinic as they just have two possibilities high or “low” dosage of stimulation. I still have reagulary cycles with ovulation, high endometrium line (before ovulation approx. 9-10 mm, 7 days after ovulation approx. 13 mm), and in normal cycles my eggs will grow till approx. 12 mm and then stop to let the dominate follicle to grow further. But with stimulation starting on day3 everything changes and except the dominant follicel others just stop growing or shrink/disappear. I am always downregulating at day 7, never before that. I do not have much eggs and in most cycles 3-4 are visible on day 2.

Dr. Sher, what could be the reason for my body to react like what could be a better stimulation protocol for someone like me? I know that I will not produce many follicels, but I cannot understand why my body just refuses to accept any stimulation drugs.

Thanks in advance!

Best