IVF and vaginismus - City Fertility or CRGH?

[cannonball8726]

Hello, we have been told we need IVF for male factor and are paying privately until NHS referrals go through. To complicate matters, I have vaginismus and whilst I have made lots of progress with dilators, I'm still getting used to invasive procedures and don't find them easy. I wondered if anyone has experience of either of these clinics. Both are pretty much the same distance from my workplace and are closer than other clinics. My impression so far is that CRGH is busier, appears to have better success rates but more expensive. Whereas City Fertility doesn't seem super busy, Dr A is really kind and understanding (he has done my transvaginal ultrasound and HyCoSy - it wasn't easy given my condition but he was really patient and gentle). Prices seem lower at City Fertility but I'm feeling apprehensive about their success rates not being as good. My worry about CRGH is that it's often described as a conveyor belt type place and I'm afraid they might not have the time to take my vaginismus into consideration. I'm hoping the progress I've made continues and I will keep working at it so have some hope that things will ultimately become easier - but need to be handled with some sensitivity!

Would be really grateful to hear about people's general experiences at these clinics. If anyone else has vaginismus and has had to have IVF, I'd love to hear about how you got on and what helped you get through it.

Thanks so much

[RubyBoots7]

Can't comment on the vaginismus, but can on CRGH.
It is a busy clinic, so i can see why it could feel like there's a constant stream of people in and out. But it's popular for a reason, because of its success rates. Our experience of the appointments themselves were that every clinician was incredibly friendly, considerate and human.
For me, without vaginismus (though with other things that made it stressful like travelling and blood tests) I'd rather a slightly more business like setting but with the possibility of having to do the whole process fewer times.

But you will potentially have to have a lot of internal scans (alternate days during stimming) as well as other procedures. Egg collection and e transfer are a bit undignifying as there are so many people in the room (necessarily), but you won't actually be awake for the collection part. It's a lot of probing and stirrups.o lying you can decide what is going to help you most with managing the vaginismus on top of an already pretty stressful journey.

Good luck x

[RubyBoots7]

• Only you can decide

[JeNeBaguetteRien]

Hi Cannonball, no experience of either but I think you won't be able to decide for sure unless you have a consultation at CRGH (not sure if your impressions are from reading or visiting the clinic).

I have a condition that involved internal scans from a youngish age and the consultant used to ask if I wanted to insert the probe myself and then she would take over. It sounds a bit random but might help you. Good luck wherever you decide, do choose a clinic where you'll feel at ease because the whole IVF process can be stressful at times.

[cannonball8726]

Thanks so much, Ruby and JeNeBaguetteRien (great name!). You are both right. I think I would prefer to go to CRGH based on the rates and need to go and see it for myself and have a consultation there. Thank you.

[cannonball8726]

Sorry, bit of a specific CRGH question Ruby! Trying to get a feel for how much time off work I'm going to need. Did you have to take many days off for IVF at CRGH? Are scans relatively early in morning so I can get to work at decent time? Thanks so much.

[RubyBoots7]

I think it might depend on your protocol to an extent. I broke it down in my head in to three phases as I was on long protocol. Some people's would look very different to this. They tend to give you a personalised time table with your dates on for when things are likely to happen.

1. Down reg, which was a month for me and involves a few/couple of clinic visits but is fairly low key. You're basically resetting your hormones with something like norithisterone, so your cycle starts at a certain time.

1. Stimming (to make your body produce lots of eggs). This was the intense bit. It starts a certain time after the period that you get when you've stopped with the down reg. Once you start stimming (I had hormones and steroids), they scan you regularly and take bloods to check your hormone levels and how your eggs are responding to the drugs (number/size). We went for the earliest scan appointments so we were in there for 8am. If you work in London and start at 9am, you can probably just come in to work a bit late. A scan and bloods usually takes 30/45 mins. Sometimes it's quicker. It depends if you can give blood easily (so do it with HCA in scan room or have to see phlebotomist afterwards) and if you have to see a nurse for additional drug supplies etc. (They tend to only give you what you need and top you up regularly. We were NHS, but If you're paying, they can't take drugs back so don't want to give you extras that cost you money if you don't need them).

We had to be scanned/bloods every other day over about a week and a half/two week period. I took leave for some of this because it was pretty exhausting, but it depends where you work and what you do.

So our routine would be 8am scan and bloods. Clinic then called us late afternoon with blood results and instructions on what dose meds to take that night on the basis of the results. Then you do the meds injections/tablets. If dose stayed same, you went back in two days and repeated until the end of this bit. If the dose changed, they can call you back in for a blood test on your 'off day' to recheck levels. This happened to us a couple of times and I wasn't expecting it so had to rapidly rearrange work committments (that was cycle one, for cycle two which was our successful one, I'd learned and just took annual leave to give myself a break).

This phase culminates in egg collection which is a surgical procedure under heavy sedation (similar to GA) and means def having that day off work. And you'll need someone to accompany you home. You won't know exactly what day EC will be in advance as they wait for most eggs to be a certain size and then react quite quickly. They usually give you a rough idea but it could be within a few days give or take.
Once the eggs are collected, your partner gives their sperm sample (at same time) and the lab gets to work mixing it all up (either via IVF or ICSI). They monitor the embryos to see what fertilised and then grow them to hopefully a stage of division called a blastocyst (within a few days). The embryologists tend to give you a call regularly to update you on what's happening. The embryos then either go back in as a fresh transfer or they freeze them (multiple reasons for both). During this time you're taking different meds but not necessarily at the clinic much. You just have to wait for the calls

1. Embryo transfer. If it's fresh then this might be a few days after egg collection. If it's frozen then this could be weeks or months later depending on how you're doing stuff (if frozen you have to do some prep drugs again). They then put the embryo/s in. It's a really easy procedure that they tend to do sometime in the afternoon. You are advised to take it a bit easy for rest of day but I can't imagine feeling off from this. The worst bit is you have to drink lots of water and have a full bladder! Then depending on your protocol, you may take a bunch of progesterone drugs (we had various ones for the first trimester roughly). They get you back for a blood test to check your progesterone levels at some point early on, in case you need to change dose. Otherwise you wait to test around two weeks after transfer. Then if you get a BFP, you have a couple of scans at around 6/7 and 9 weeks. If all okay, they discharge you to regular maternity care.

There is so much info to take in that the first go will prob seem like a whirlwind. If you end up having further cycles, it's a whole lot easier as you have a much better idea what to expect!

Good luck with it all! :)

[RubyBoots7]

Sorry my paragraphs for that huge blurb have gone to crap! :)

[RefuseTheLies]

I had an incredibly difficult embryo transfer at CRGH due to my cervix being most uncooperative! What should have taken 15 mins tops took almost two hours. It was hideous and uncomfortable but not once did I feel as though I was under any sort of pressure and my consultant was patient, calm and totally unflustered. I can’t imagine any of the staff carrying out any of the invasive procedures would be anything other than compassionate and understanding.

[cannonball8726]

Wow, Ruby. That is amazingly helpful! Thank you so much :)

RefuseTheLies thank you, that's very reassuring to hear.