Advice on fertility clinic (LONG STORY)

[Ginge12]

Hi all,

We were referred to the fertility clinic around 1 year ago. We had our first appointment in January which found my DH sperm count is fine and initial investigations said I have PCOS.

From there they did some cycle tracking and found that I ovulated with a 22cm follicle late in my cycle.

My cycle was 28 days after coming off the pill in July 17 and then became irregular from Feb 18 with the longest being 54 days and shortest 27.

We went back to see the consultant on Tuesday, ive been told numerous times I need to lose weight - my bmi has risen to 28 over the last 6 months before that I was normal weight. I asked if there was treatment for my PCOS to be told again to lose weight which I said didn't match with my cycles becoming irregular and therefore not the root cause. They declined me Clomifene because I'm ovulating and Metformin saying the gp needs to check for diabetes.

Now we have been told because it's 2 years and I have never been pregnant that IVF is our next option. We have an appointment with the research nurse on 1st July.

Long story sorry. Is this correct information or should they be investigating my luteal phase in more depth? Personally I think that's where the problem is.

TIA

[Persipan]

Why do you think the problem is your luteal phase?

[itwasalovelydreamwhileitlasted]

To be honest doesn't sound like a luteul phase problem? Luteul phase defects happen when there is less than 10 days between ovulation and the start of your next period.

I would say the issues are a combination of PCOS and BMI - be aware though that if your BMI goes over 30 the NHS won't give you IVF

[Loopytiles]

Don’t quite understand your post, but PCOS seems the most likely explanation.

[AttilaTheMeerkat]

Is this clinic NHS or private?. Regardless of that answer I would actually now attend another clinic; this lot have and are giving you as a couple the runaround. Its substandard service you have received from this place to date.

I would also be wary of a place that is already suggesting IVF; IVF and PCOS are very uneasy bedfellows and this should only be tried after all other treatment options have been exhausted thoroughly. It may well be that you do not need IVF at all.

Some gynaes see LPD as a problem whereas others do not. I would think that your fertility problems are primarily due to PCOS in itself rather than a LPD. BTW also, weight should not be a barrier in itself to getting treatment.

[Teddybear45]

Most women with PCOS can get pregnant naturally when they lose weight. The fact that you are ovulating suggests if you lost weight your egg quality may improve (remember that an overweight BMI can be the equivalent of an obese one for PCOS). The women who need IVF tend to be those who have never been on the pill as they tend not to be able to ovulate due to scarring / cysts.

I’m assuming you have had other testing of course. Sometimes it might not be PCOS affecting you ability to get pregnant at all — a lot of women with PCOS, according to my IVF consultant, tend to have clotting disorders and thyroid issues too which can impact implantation. So you should be tested for those too.

But I agree with others. I have PCOS (with other conditions) and wouldn’t recommend IVF until you have tried to lose weight first and ttc naturally as it’s not a magic fix it.

[Ginge12]

I had lost weight, I was a healthy weight when we started trying but I've put a stone on in the last year and they are saying that is the cause which is untrue. It has been gradual too.

They haven't tested me for any clotting disorders and when I refer to my luteal phase that's what I'm saying. I feel the problem is in relation to implanting or the fertilised egg not being fully implanted. I have never had a positive pregnancy test despite sex at the right times every month for 2 years - we don't just have sex during ovulation week either.

I appreciate that weight has an impact but it hasn't always been the problem therefore can't be the root cause. When I asked if investigations could be done into this she offered IVF.

I feel very lost and unsupported in the whole process if I'm honest.

[lamadra]

What days are you having sex ? If your cycles are varying in length it must be hard to know when.

The tracked cycles when was ovulation and how long was the cycle?

What I have found through trial and error and taking those clear blue mega expensive ovulation tests, is that I need to have sex a few days before ovulation to get pregnant. Also that my ovulation is earlier than apps typically suggest.

[LilyWasThere]

With regards the weight - my IVF consultant said it wouldnt cause a problem the BMI was nudging 35 & that the NHS stipulate it only as it's part of their mantra in a healthy lifestyle - understandable, and obviously more ideal to be lighter generally, but don't get caught up on it. He said it was far more important to reduce the stress levels than the weight. I was BMI 31 with both my IVF babies.

[Teddybear45]

You need to speak with someone who knows about PCOS. Being overweight impacts egg quality by affecting insulin resistance - the egg itself develops issues. Mine became really thick so even IVF couldn’t be done it had to be ICSI. However when I went down to just under BMI 25, my egg quality started to improve dramatically. I still needed a bit of extra help via Metformin and Inosutol / but I got my BFP from the eggs collected when I had my lowest BMI.

Suggest you reach out to Bupa and search for the names of gaenes or obstetricians who specialise in endocrine conditions and try a private consultation. They might be able to refer you for further testing on the NHS. If at that point IVF is your only option then you can believe it; but you definitely need more support.

[Ginge12]

@LilyWasThere I ovulated around day 21 I think and had a period 14 days after. We had sex every day and just after and I was sure it would happen but it didn't. I've been using ovulation tests and have had the mega expensive ones but still nothing ☹️

@Teddybear45 All they have told me is that my egg quality is 'normal', I'm at BMI 28 at the moment and only need to lose around 9lb to be within a better region which I'm hoping I can do in the next 4 weeks. My husband can get private healthcare at work so we're going to look into that

[Persipan]

"They haven't tested me for any clotting disorders and when I refer to my luteal phase that's what I'm saying. I feel the problem is in relation to implanting or the fertilised egg not being fully implanted."

OK, but that's not really about your luteal phase, then. And also, I can see why you're concerned about this, but you don't actually know that fertilisation is occurring - you know that you're ovulating at least some of the time, and that you haven't got pregnant, but you don't specifically know that there's been implantation failure.

In this respect, IVF can sometimes be helpful in a diagnostic sense as well as a TTC sense - because fertilisation is happening in the lab, you get more information about where things are going awry.

[hoping2018]

Bear in mind 1 in 5 couples who need ivf don’t have a reason for being infertile - you may never know why you’re not getting pregnant (my two rounds of ivf taught me there is A LOT they don’t know about fertility still!!). One thing is very well documented though - BMI of 23 is the most fertile BMI, Fertility related to PCOS improves with weight loss (regardless of starting BMI) and ivf is more likely to work with a normal BMI and the pregnancy is likely to be healthier. So I would persevere with that 9lbs weight loss and follow consultants advice. I know someone who got pregnant with 35-55 day cycles so don’t lose hope in the meantime (note it still took them 10 cycles still). Good luck x