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1st fertility appointment at Guys Hospital - NHS - what should I expect? Questions to ask?

(16 Posts)
LondonBerry Mon 18-Apr-16 10:12:36

Am 38 years old.

TTC for 8 months.

2 chemical early miscarriages.

My GP has done lots of fertility tests and results are:

Day 21 progesterone = 36 nmol/L
Day 1 LH hormone = 7.6 IU/L
Day 1 FSH hormone = 5.1 IU/L
Thyroid TSH function = 3.64mIU/L

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We are waiting on results from husbands sperm.

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What further tests will fertility clinic do?

Any other questions I should be asking them?

I was going to ask these questions:

1. Levels above for progesterone, FSH, LH etc are they all in ideal range?

2. Can we do a test for antral follicle count? What would be the normal range for someone of my age?

3. Would taking progesterone help?

4. Would taking clomid help?

5. Can we try IVF?

Londonbased87 Mon 18-Apr-16 10:26:47

Your FSH/LH/progesterone are in normal range for ovulating.

2, 3, 4, 5 all depend on your CCG and your local funding. In most of London, you will be sent home at 8 months to come back when you have been trying for longer. You are very unlikely to qualify for clomid or IVF or the investigations that precede these at this stage, and most likely will just get a scan and some general advice. It is worth checking your own CCG's infertility funding.

LondonBerry Mon 18-Apr-16 10:32:08

Thanks Londonbased87

I will look into CCG/local funding.

What type of scan will they do? And what will they be looking for?

How many months will they ask us to try before offering IVF?

Has anyone else been to Guys hospital for fertility appointment? What was your experience?

LondonBerry Mon 18-Apr-16 11:52:16

Anyone else got experience of this?

RebeccaNoodles Mon 18-Apr-16 13:15:13

Hi LondonBerry

I am not the world's greatest expert on this but wanted to try and help. (Hello again!) As far as my experience went, our first appointment was mainly them asking questions that we'd already answered a million times - depressingly. I also had an internal scan with dildocam on the day, to check AFC and generally look around smile. Next step was a HyCoSy a few weeks later - this was to check tubes were clear - and also AMH which checks ovarian reserve (though not quality). The AFC just counts how many follicles you have (so similar test to AMH though the latter's meant to be a little more reliable) and that was done at the same time as AHM. And of course the sperm analysis (SA) results.

Your case is a little different though, as you've conceived twice which would suggest no problems with tubes or sperm? So I'd bear that in mind while asking questions. I could see IVF being a next step for you because that could enable them to gauge your egg quality, ie see how your eggs respond during the process.

One thing I wondered was about your thyroid. Again please check with your doc as this is anecdotal but I have heard of thyroid issues being associated with miscarriages in the first trimester. The 'normal' range for serum TSH is 0-5 in the UK, however there has been talk of lowering that upper limit as most healthy people fall below 2.5 And yours is a little higher. I know this article looks American and hysterical but it might be worth doing some research? (http://hypothyroidmom.com/is-your-thyroid-doctor-using-the-old-tsh-lab-standards/) I have googled this one myself quite a bit as I'm tired a lot but my thyroid seems normal alas!

As for the timings - it's true that most GPs will send you away if it's before 6 months, but at age 38 and after 8 months, and particularly with two cps, I'd be vv surprised if Guy's refused to put you on their list for IVF. The fact that you're already seeing a consultant is great.

I replied the other day to your thing about AF - I promise I'm not stalking you! I am 38 and london based too so I remembered you smile I really hope things work out for you. It is all so hard and grim but sounds like you've got it all in train which is great.
Good luck smile

RebeccaNoodles Mon 18-Apr-16 13:16:56

Oops, there's that link again
hypothyroidmom.com/is-your-thyroid-doctor-using-the-old-tsh-lab-standards/
Can't believe I am looking at websites called HypothyroidMom ... the joys of ttc!

Onsera3 Mon 18-Apr-16 13:38:49

My exp was prob a bit different. I had been TTC for 12 mo at first appt. My Gynae at Kings had said to get ball rolling with bloods, sperm etc at GP after 6mo as I have endo. I was 31 and didn't have to wait.

So I had first appt at Guys early Nov and embryo transfer by early Feb. Successful!

They did scan to check antral follicle count which was high - I think 14/15 per ovary. They said ovaries appeared polycystic (has since been confirmed by my regular Gynae).

They didn't check my Fallopian tubes as I'd had it done by my Gynae and they decided I wasn't a great candidate for IUI. But I would have had one if I'd chosen IUI.

They did bloods.

We had to attend a seminar in a lecture hall. You can ask questions.

I live in Southwark and I was given the option of either 3 cycles of IUI or one full round of IVF. Guys advised against IUI for me. If the fresh round of IVF had failed I would have been eligible for two attempts at a frozen round. (But as they explained many people didn't have any to freeze. And I ironically if you do, you're more likely to have had a successful fresh round!)

I was given progesterone to insert for first couple of months of pregnancy.

Once they decide they can help you at Guys there was no wait for me. The only delay was waiting for my period.

I do know people who've carried to term with progesterone after mc but I think you can just get that from GP? I had a month's worth from clinic and the next month's was from GP.

Clomid is just for those who are not ovulating isn't it?

My sister had similar situation to you with the chemical pregnancies. She had a short luteal phase I think. She tried one of those digital clear blue ovulation kits and found it really good- as opposed to the charting she had been doing. She found out she was ovulating later than she thought.

LondonBerry Mon 18-Apr-16 14:06:05

I live in London Bridge hence referred to Guys Hospital (had to plead my GP a lot though to get the referral!).

Thank you RebeccaNoodles for that thyroid information.
I will bring that info along with me to the consultation. Hopefully they will do a scan and AFC and AMH count. Its useful to know what tests to ask for.
What hospital did you get your tests at and are they offering IVF?
How long have you been ttc?

Hi Onsera3
Thank you so much for this info!
Sounds like Guys hospital were pretty good, fast treatment! I hope they are the same with me!
So if they do give me treatment it sounds like '3 cycles of IUI or one full round of IVF' I assume they offer same number free cycles to all.
Is all now going well in your pregnancy?

star1980 Mon 18-Apr-16 14:52:22

Hi LondonBerry, I live in Southwark and was referred to King's after 11 months TTC, aged 35. My GP started tests at 8 months. The wait for IVF is just one month at King's once you get going. We haven't yet as we have male factor infertility and agreed to try supplements for 4 months first. However, our ivf appointment is in 3 weeks and I understand we will have to wait 1 month from that point. I haven't had the appointment yet though so not 100% sure.

Given you've been pregnant twice in a short space of time, I suspect that your consultant will put your mcs down to egg quality (and age) and so IVF is probably a good option. As RebeccaNoodles says, they can have a go at picking out a good quality embryo which plays the odds in your favour.

Good luck and very sorry about the MCs.

star1980 Mon 18-Apr-16 14:55:46

Oh, I should add that once I was referred, King's re-did all my blood tests and my partner's SA. I also had two internal scans. Once they have all the results from those (which took 3 months), we had our first consultation. Sounds like Guys do it differently and you have the consultation first, but they may want to re-do all your bloods in their own lab. I didn't understand this in my case as my GP is across the road from King's and that's where you go for your blood tests. Anyway.

LondonBerry Mon 18-Apr-16 15:46:33

What is the criteria for getting offered IVF?

From my googling it seems to be these factors:

have to be over age 35 (I'm 38)

been trying for at least 6 months (I've been trying 8 months)

any medical condition that makes it difficult to conceive (I had radiotherapy for cancer 3 years ago)

RebeccaNoodles Mon 18-Apr-16 16:28:53

Hi LB, yes that all sounds right, as in those are the guidelines. I think (but could be wrong) the only variable is what waiting lists/budgets are like at your particular place but it sounds like Guy's is a great place to be from that PoV. I'm sure they will offer you IVF, I can't see why they wouldn't. When is your appointment?

We've been trying 16 months and I have pretty bad endometriosis. So the hospital (Homerton) recommended IVF v early on. They offer 3 rounds under 40 so we should be able to fit in at least two.

I am sorry to hear of your cancer and really glad your treatment was successful. It sucks that you should have had mcs after going through all that. I can identify a tiny, tiny bit because I was in hospital for 8 weeks having major surgery for endo in 2014 and was really very seriously ill, so I felt all calm and perspective-y after I got out but that didn't last forever! However I hope 2016 brings better times for you.x

LondonBerry Mon 18-Apr-16 16:50:39

Thanks RebeccaNoodles for your kind message.

My appointment is on Wednesday!

I hope the IVF goes well for you X

EleanorofCastile Mon 18-Apr-16 22:46:37

Hello, I had my first fertility appointment at Guy's last October aged 36. In order to be referred, my GP said we had to have the sperm analysis done first. Do you know when you'll get the results back, will you have them in time for Weds? It was certainly helpful to have them at the appointment. As my partner's SA and my bloods (FSH, LH, progesterone) were all ok, the doctor advised the only other investigation they would do is a hycosy which checks the fallopian tubes. The doctor explains their approach to investigations for infertility which seemed quite basic; there was either a problem with ovulation, a problem with the sperm or the problem with tubes blocking egg from meeting sperm. If they they could rule all those out, there was no identified cause for infertility and we'd have to wait til we had completed the requisite 3 years of TTC required by Southwark CCG to be eligible for any IVF treatment. If a cause was found which meant we would not get pregnant naturally then we could have started imminently.

After the consultation, I had a blood test for AMH, a swab and then I had to go to the 11th floor to book a date for the hycosy.

Fortunately, I got pregnant naturally 3 months after the hycosy. They actually found a fibroid in my womb when they did the hysosy and thought this could be causing problems, so it was recommended that I have the fibroid removed but I got pregnant whilst still considering whether to go ahead with this or not.

Your situation is a bit different with a history of chemical/ early MC so they might advise something different, but I hope my experience helps prepare you for what to expect to some extent.
I asked about further tests - even if we had to pay for them - and the doctor said there really wasn't anything else they would recommend and if there was another test that they considered useful they'd offer it on the NHS. I think I'd spent so long down the online conception/infertility rabbit hole that I was a bit disappointed with this, but I guess also reassured that we had a plan and that she saw things so simply, as to some extent the more I read online about different tests, treatments and theories, to some extent the more confusing I found it. In the meantime I took supplements (ubiquinol/vitamin d/ conception vits) and started accupuncture as it felt like I was doing something rather than just waiting!
Best of luck.

EleanorofCastile Mon 18-Apr-16 22:48:35

Oh and to answer another one of your questions, the antral follicle count was done at the hycosy.

LondonBerry Tue 19-Apr-16 09:52:05

Thanks eleanorofcastille for all this information.

It really helps to have as much info as possible before appointment.

I hope your pregnancy is going well!

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