Ivf. Doctor seemed overly negative.

[mikkyr]

So husband and I have had 3 failed ivf cycles in the last 2 years. I am 41 and husband has had a vasectomy (previously married). Given the time constraints we decided that a testes biopsy was the best route to go instead of a vasectomy reversal which may not be successful and then still need to do a sperm extraction via biopsy at a later stage.

My last cycle failed completely whereas before I have had two early miscarriages. Without going into all the medical jargon I retrieved a fair amount of eggs for my age, they were reasonable quality, the embryos were not A grade but also not the worst. Everything seemed pretty average.

My appt with doc yesterday was terrible. I went in feeling so full of hope that we would be able to do another egg retrieval, ICSI and transfer before Christmas. But the doctor was so negative. He didn’t have anything hopeful to say. Basically I’m old my eggs have aged. My husbands sperm is less than great because it’s been extracted via biopsy and a vasectomy after 10 years rescues the quality. Our embryos are poor. The chances of genetic abnormalities are high. Our track record of 3 failed cycles leaves such a small percentage of success in the future. It’s costly.

We told him that money was not an issue (that sounds pretentious but we have enough to do another few cycles)

I’m just so disappointed in his atttitude. It’s like he doesn’t want me to do another cycle. I thought this whole process was about hope and that these doctors would be able to try and try. 3 cycles seems very little compared to what I’ve read and I’m surely not the only 41 year old who is seeking fertility help when there are 41 year olds falling pregnant naturally?

I don’t know what to do.

I think it is good that they are honest. My friend was taken through endless cycles in her early 40s which were unsuccessful due to poor quality eggs.

My female Gynaecologist had told me that her advice for any woman over 40 with a history of failed IVF should go straight for donor eggs ( I wasn't being nosy she asked me to ask mine if she would take her as a client when she got married age 40). She didn't want donor eggs. It was 5 years after my conversation with my gynaecologist and £50,000 later that her eggs were finally used up.

It was very sad and I think downright dishonest.

It's devastating

but I would trust an honest and ethical doctor a lot more than someone making false promises and boosting your hopes up unrealistically.

You are keeping in mind the most extreme scenario ( There are women with one ovary, cancer, endometriosis etc whose doctors persist. )

It sounds like you REALLY needed to be told basic facts and truths, as hurtful as they might be. It doesn't sound like it, but it's in your own interest.

@CovidAnni

It sounds like a crushing experience. Is it worth revisiting using donor eggs and sperm and unpicking why you don’t feel it’s an option?

I don’t want to unpick it honestly. It’s just something my DH and I agreed on from the start. No adoption and no donors. It’s probably a bit of an immature unexplored mindset but it was one of the limitations we set ourselves beforehand and probably why I’m so devastated that this may be the end of the road.

In fairness the NHS doesn’t cover PGS testing except where there’s a known genetic fault, and wouldn’t cover your IVF at 41 or as a result of vasectomy. Most people would be paying for it here out of pocket.

It adds about £500 per embryo to the cost here so not cheap but emotionally preferable to failed transfers (I think).

@jcurve

In fairness the NHS doesn’t cover PGS testing except where there’s a known genetic fault, and wouldn’t cover your IVF at 41 or as a result of vasectomy. Most people would be paying for it here out of pocket.

It adds about £500 per embryo to the cost here so not cheap but emotionally preferable to failed transfers (I think).

I’m not in the UK so none of this is NHS funded and financially we can afford a few more goes.

Yes, but you were commenting previously that you were in a country where IVF wasn’t supported by the state - I was pointing out your circumstances wouldn’t be covered here either.

@jcurve

Yes, but you were commenting previously that you were in a country where IVF wasn’t supported by the state - I was pointing out your circumstances wouldn’t be covered here either.

Ok got it. Thanks.

Your op wasn’t clear at all. I agree you should not give up now. You obviously had a lot of eggs with the one cycle and your embryos survived the defrosting process well.

I presume your dh had a vasectomy more than 5 years ago, it looks like only 30% of reversals are effective after that point. Perhaps that would help with better grade embryos but you’re also running out of time fertility wise. So probably best to stick with plan A unless you can get it done quickly.

If you try again then get poor quality embryos from the second cycle and no pregnancy, perhaps this should be the point to think again.

As for how your consultant spoke to you, I think he needed to be Frank to manage your expectations. If he was upbeat and you had more failures, you’d feel cheated and probably far more upset than you are now. It can become an obsession and while doing ivf, I met someone on cycle 12. I do wonder if she was ever successful.

I’m surprised you got 5 decent embryos to be honest. Do you know the quality? I would read up about this because the doctor is now saying you are not getting good quality embryos. In that case it is pointless to freeze them and proceed with further attempts.

@Circusoflove

I’m surprised you got 5 decent embryos to be honest. Do you know the quality? I would read up about this because the doctor is now saying you are not getting good quality embryos. In that case it is pointless to freeze them and proceed with further attempts.

Exactly! I don’t know the exact grades but both the 3 day frozen cycles got to 9 and 8 cells and then 10 and 9 cells respectively. I understand that an odd number isn’t good. In terms of grading they were not grade 1s ie the best but they were not the worst either.

He also told me there is nothing you can do to improve egg quality... is this true?

Op, your doctor was being honest and realistic. Your chances are slim.

HOWEVER, your body, your life, your rules
You can afford to do more rounds. Are you and DH emotionally and mentally strong enough to keep going? Have you talked about when enough is enough, when you will accept its not going to happen and your life will be one just the two of you?

There is nothing stopping you from doing as many rounds as you like, your doctor doesn't have to be your cheerleader but does have to be honest and realistic.

You can afford to keep going, and you are you husband seem to be in agreement to do so, so I cannot really see the issue you have with your doctor.

I also to do ivf. My last round failed in jan 2019. We hadn't been able to afford to go again. If I had been able, I would have. Despite the failure.

All my expectations are very average too, with average outcome, yet I still failed. I am in mid 30s. Ivf is just always one huge gamble, im afraid our bodies work against us.

Would a clinic change make you feel any better?.

I just always thought your doctor would be the one providing it through confidence. Possibly even give us some good news stories.
What would be the point? He's being honest with you; you not wanting to hear it is by the by, it doesn't change a thing.
It's the fair thing to do.

I would advise you to look into the best surgeon for a vasectomy reversal for your husband (my husband has had 2 reversals) so you can try naturally between cycles if it works. Even if he has a low sperm count afterwards you can then collect sperm for icsi. Good luck, I would say 41 is too young to give up.

Does your husband already have children?

@mcmooberry

I would advise you to look into the best surgeon for a vasectomy reversal for your husband (my husband has had 2 reversals) so you can try naturally between cycles if it works. Even if he has a low sperm count afterwards you can then collect sperm for icsi. Good luck, I would say 41 is too young to give up.

My DH had such a terrible reaction post surgery after the biopsy. Infection and testicle scar tissue bonding (I don’t know the complete medical terms!) I don’t think I could voluntarily put him through another procedure on his precious jewels!

@diddl

Does your husband already have children?

Yes two in their teens

We had two tries at IVF. The first try they didn't retrieve any eggs from me at all - completely empty sacs. DH sperm were mobile so that was fine.

We went back to our clinic thinking they'd say donor eggs. The female doctor who saw us said she had had her twins by ICSI at the clinic herself and had a similar low egg production. She left it to us but said we could try one more time as the first try nearly always set the bench mark. Many don't conceive first time with IVF.

We thought about it and decided one more go. We'd always said just two tries at IVF as I do believe you can become obsessed and, like many things, it can take over your life. Setting an exit plan at the beginning allows you to step away, in my opinion. Anyway we set ours at two tries.

When we went the next time DH's sperm were swimming in circles so the decision was made to do ICSI. I produced three eggs. That's all.

Miraculously all three fertilised and they implanted all three.

One took. He's currently on his playstation as it's half term. He's now 13 years old. I was 44 when I had him.

Yes, you do need to be realistic - getting no eggs the first time round was devastating for us. But having that limit of two cycles in our head allowed us to go into the final round with a 'what will be' attitude. We were both, to be honest, going through the motions at that point. Feeling that we'd give it a shot but making plans for the future without children in it.

I don't know where you are in the country but we used the Lister Clinic in London.

@LondonJax

We had two tries at IVF. The first try they didn't retrieve any eggs from me at all - completely empty sacs. DH sperm were mobile so that was fine.

We went back to our clinic thinking they'd say donor eggs. The female doctor who saw us said she had had her twins by ICSI at the clinic herself and had a similar low egg production. She left it to us but said we could try one more time as the first try nearly always set the bench mark. Many don't conceive first time with IVF.

We thought about it and decided one more go. We'd always said just two tries at IVF as I do believe you can become obsessed and, like many things, it can take over your life. Setting an exit plan at the beginning allows you to step away, in my opinion. Anyway we set ours at two tries.

When we went the next time DH's sperm were swimming in circles so the decision was made to do ICSI. I produced three eggs. That's all.

Miraculously all three fertilised and they implanted all three.

One took. He's currently on his playstation as it's half term. He's now 13 years old. I was 44 when I had him.

Yes, you do need to be realistic - getting no eggs the first time round was devastating for us. But having that limit of two cycles in our head allowed us to go into the final round with a 'what will be' attitude. We were both, to be honest, going through the motions at that point. Feeling that we'd give it a shot but making plans for the future without children in it.

I don't know where you are in the country but we used the Lister Clinic in London.

Thank you for your story. I am not in the UK. Our exit plan was this next round that I was so hopeful for. Just didn’t expect my doctor to be so negative about it. He knew this was my plan... another egg retrieval and husbands frozen sperm. I understand that people have to be realistic. And I get that I can change doctors although we don’t have many REs here and it would mean a LONG travel. I guess I’m just disappointed.

So sorry OP - that sounds so incredibly hard.

We have decided that donor eggs or sperm is not an option for us.

Is your mind 100% made up about this? Perhaps it could be the way forward!

OP its crushing hearing this kind of news.
But he could tell you what you want to hear and keep taking your money - he was trying to just be honest about your chances.

i would be more concerned that if it did work there would be a problem given your eggs and the losses so far - and for that reason would explore donation.

IVF worked for me.....my DC was born after my 13th cycle!!!!! but i was 35 - and considered a 'geriatric pregnancy'. If it helps you to know dc was the last little embryo in the freezer, poor quality and not exected to survive the defrost - the last two did, both implanted but I lost one baby and had DC.....who was worth the journey.

i also parent a disabled child - through adoption - and for that reason say explore donated eggs. just read up on it....in IVF you have to keep continually pushing your own boundaries x

Yes, I was wondering about that as only higher grade embryos are usually selected for freezing and defrosting.

It's advisable to be aware of the statistical odds, but honestly you have had one cycle and you a) got embryos and b) got embryos that survived defrosting and implanted in two cases. I know little to nothing abotu vasectomies, but I would not be giving up with those results from one cycle.

And I don’t think many people can understand the brevity of being at a cross roads in your life. One path with children in it and one without. I just hadn’t considered the prospects of having to come to terms of a life without children so soon in this journey. I knew that the day may come but just didn’t expect it now when I thought it was still a while to go.

He also told me there is nothing you can do to improve egg quality... is this true?

I'm sure you've already read it, but the supplements outlined in the book 'it starts with the egg' may help with egg quality - it's worth a try anyway. Also check out Yoga Yin on YouTube for fertility yoga - which again may help but won't do any harm if not. Sorry you had such an awful experience. On one hand the doctor may have been being realistic, but on the other hand unless he is an acknowledged expert in his field, it could be worth getting a second opinion at least. Wishing you lots of luck - you clearly aren't ready to give up on your quest for motherhood.

If you had one cycle with multiple transfers then I would try again. I had 2 cycles with a total of 5 transfers, all great quality and 2 stuck (one ended in tfmr). The doctor is probably correct statiscally but I'd give it two more full cycles before you give up. You don't know which statistic you are. I'd get a quick move on though, don't wait at your age. I was 38 during my first egg retrieval which ended in 4 embryo's and 40 during the second and only ended with 1 embryo.

You could try reasearching other clinics in your country. I chose to travel further and go to the clinic with the highest success rate. Really happy that I did.

Can I just be a little bit envious of all the women who get anesthetics for the egg retrieval? I hit the roof with the pain of it. It was awful. Also not UK.