It is well known that ovarian reserve testing is a predictor of ovarian response where an estimate about ovarian response to stimulation can be made if the AMH is more than 10 pmol/l.
It is also well known that when the AMH levels go fewer than 3pmol/L pregnancy rates seem to be affected. This could be due to any reasons. Once the AMH test plunges below 3pmol/lt it is likely that the ovarian reserve is diminished and ovarian stimulation where aggressive stimulation is carried out, often fails to recruit the small eggs ( follicles) which fail to grow due to severe deficiency in their numbers. Thus during IVF where ovarian stimulation is carried out, ovaries are stimulated aggressively and these ovaries often produce one or two eggs.
There is also some evidence that in addition to the number of eggs being decreased, there is also an element of abnormality of the eggs and, hence, pregnancy rates, even with single or two embryos is substantially lower than with women with AMH of more than 5 at a similar age. Thus, many centres in the UK would not treat women with an AMH of less than 3 or 5 .
We have come across a unique plan where we can offer women the chance to mirror the pregnancy rates at their age even with a low AMH. Thus, while these ovaries can respond to mild stimulation and may produce one to two follicles, they may not do so for a huge stimulation of the ovaries.
We offer a unique stimulation package where we can stimulate the ovaries mildly and collect the eggs and freeze them. Thus, not transferring a single embryo with a single egg mirroring the success rate of a natural IVF cycle which can vary to an extremely small numbers. If we can manage to get one to two mature eggs then we could repeat this cycle in the next or a previous cycle or the following two cycles, with a similar protocol where we can, hopefully, get, again, one to two eggs.
We aim to build an egg bank of close to five to six eggs before we plan to thaw all the eggs, perform an ICSI treatment (since eggs have been stored, ICSI has to be done) and transfer two embryos from a selection of three to four embryos. The technology of egg freezing through a new technique known as vitrification has given excellent results with live birth rates increasing in the UK as well as in other partrs of Europe and the United States. Thus, we use the same technology which allow us to get excellent results by thawing of these eggs and perform ICSI. We aim to put back two embryos but this, again, from a selection of three to four embryos, which mirrors the success rate of routine IVF where we break the default position of nature of having one egg and one embryo, are able to select two embryos from a pool of three to four embryos.