To change IVF clinics

[naomimn]

Question for those who have done IVF

I had my first round at this clinic, 13 eggs retrieved with only 8 mature... of them 2 made it to day 5 blastocyst. I tested PGTA non euploid and one ended in a miscarriage.

Round 2. Different protocol. Of 20 follicles only 7 eggs retrieved. Waiting to hear back on fertilisation and development.

I'm 29 so for my age should be better results.
It's a well known clinic in London, one of the big ones.

I had similar results in Manchester - almost identical for the first (13, 5, 2) and fewer for the second. Did your clinic change anything drug wise for the second? I had different drugs and my second frozen transfer worked.

I'm really sorry you're going through this. IVF is just grim. Have you had a full review with a Consultant?

I was 23 for my first cycle. All my cycles rendered differing results, finally gave birth when I was 28. What started off as MFI ended up being MFI & every gene mutation and blood condition for me! What's the reason for IVF?

@Latenightreader @CurbsideProphet yes I had a full review with the consultant in that they said "the result is bad, let's try you on different drugs" after the first, so my protocol was changed before the second.

@idrinkandknowthings unexplained infertility! Although every consultant that has ever seen DH's sperm results has said they're very very good so guessing it's a female issue.

Don't have experience in this area but didn't want to read and run. Wish you every bit of luck in your journey xx

I mean this kindly but you have only two rounds and you don't even know the outcome of the second round yet and they also changed the drugs from the first time.

Give it time and be kind to yourself.

It's a draining process and really individual to each person.

I know the reasons for my issues and I think it a lot of ways that makes it easier. When it's unexplained it's more difficult.

I really hope you get the outcome you want.

Okay, so the unexplained bit makes me think you should stick at it with the clinic. As shit as it is, IVF rarely works the first time and you don't actually know how this cycle has gone yet. The clinic have done a good thing in reviewing and changing things up - my consultant told me that the first cycle is to see how your body 'reacts'.

I totally get the impatience of it all, as though you have to take control of 'something' and I think that's what you're doing, I did the same. After my first 4 cycles I asked what other tests could be done and I was offered 'Chicago tests' and these uncovered what my issues were and my protocol was changed to match that, I had my little boy on the 6th go.

I know '6 cycles' isn't what you want to hear, and I'm not saying that you will need that or that this second cycle won't have worked, god I really really hope it does, but that IVF is a 'try and see approach' for everyone.

How long have you been trying with unexplained infertility? Your results don't sound that "bad" I think the problem is that most clinics are not particularly honest about expectations when it comes to IVF - they really only expect to get one blastocyst to transfer and maybe one to freeze at best they just don't want to tell you that when you are spending a lot of money/ going through the trauma of treatment.

What protocol were you on both times? What was your AMH? What size were your follicles when they did the trigger? That's all really important to understand if your result was as or worse than expected?

Also why did you PGTA at age 29 with only 2 blastocysts - also really unusual? Was that your request or did the clinic push that? Highly unusual unless you have a history of a LOT of miscarriages but even then PGTA isn't rated that highly by the HFEA

Have you discussed ICSI to try and increase the number of mature eggs developing to blastocyst? This worked for me, plus metformin during early pregnancy to reduce increased risk of miscarriage due to PCOS.

A good clinic will consider what areas can be worked on for the next round, though a lot is luck.

H I’ll e you get your miracle.

Thank you so much for a detailed response!!

How long have you been trying with unexplained infertility?
About a year before starting IVF. Since then two rounds with about 2 months in between them because I went travelling.

What protocol were you on both times?
Menopur and Gonal F low doses first time round (don't remember exact)
Menopur 450iu second time round

What was your AMH?
13

What size were your follicles when they did the trigger?
I don't know. Should I have asked? Please could you explain a little more about this?

Also why did you PGTA at age 29 with only 2 blastocysts - also really unusual? Was that your request or did the clinic push that?
I guess I really didn't want miscarriages or give myself false hope, would rather pay the fee for it than waste months and go through miscarriage. Clinic explained the option and I agreed to it.

I think what's making me sad about the second round is 20 follicles -> 7 eggs. Not even been told yet how many of them are mature, maybe none...
and then the first round losing 40% to being immature

Have you discussed ICSI to try and increase the number of mature eggs developing to blastocyst?

They said we didn't need it as the sperm sample was really really good both times... so presumably the infertility is somehow a female issue

@idrinkandknowthings yes makes sense what about say about being a wait and see approach... my consultant always says the same thing about ivf. But then the cynical part of me wonders if he only says that because he doesn't know what he's doing exactly 😄

Probably also worth noting that I have a nearly 3 year old child conceived naturally, first month

I never made it to ivf was just about to start and got pregnant so extremely lucky but l had strongly considered going abroad for treatment even my nurse in my Gp surgery went abroad after many failed attempts and got pregnant and really urged me to go abroad, when the clinic I was with found out I got pregnant naturally I was treated horribly I won't go into it but basically no care at all no advice even on medication they had prescribed if I were to fall pregnant naturally as they went making ivf money off of me. I remember sobbing down the phone asking them for a blood test to confirm and they all but hung up on me. (I'm not in the UK btw)

Have a look at (the wait ivf) on Instagram x

Hopefully this round will have better results for you. Sometimes a change of protocol can make the difference. I did 4 short and 1 long protocol. I think I got more eggs on my long protocol but sadly although most fertilised only 2 were suitable for day 3 transfer and that cycle didn’t work for me.

I ended up doing 6 cycles altogether as we had unexplained infertility and had been trying for 13 years. The first 4 were at our local hospital and for the remaining two we travelled to Glasgow as I felt that my local teaching hospital were quite set in their ways about IVF. I never got pregnant on the first 4 and they said that there was no correlation between high TSH and infertility (there is!). They also didn’t believe in immune issues. My GP phoned an endocrinologist at our local hospital who said I would never get pregnant with my TSH as high as it was (think it was 4.6 and it needs to be below 2.4).

We moved to a clinic in Glasgow and I started on levothyroxine and had a biopsy of my uterine lining and my NK cells were 6.5 and they should be below 5. I was put on steroids and had to inject myself every day with blood thinners after transfer. I got pregnant for the first time ever but my hcg numbers were low and was told that they would continue to drop then I’d miscarry which did happen. For my 6th attempt we went for donor eggs at the same clinic as I was 41 and I got pregnant again and now have a 6 year old.

I would say to stick where you are for now as this is only your second cycle (which may be successful) but if you feel that your not being listened to or they’re not willing to try something else then I’d say to move. Being in London you will have more of a choice on clinics. Wishing you all the best on this difficult journey xx

I needed ICSI because the sperm couldn’t get through my egg outer surface. There was nothing wrong with the sperm, my eggs just didn’t like letting sperm through. We went from 20% fertilised to 90% fertilised meaning we could take more to blastocyst to give us the best chance. ICSI can still be relevant for female issues.

A little update...
Of the 7 eggs retrieved, 1 was damaged (presumably during egg retrieval), 6 fertilised. Although 1 of the 6 looks like it might have dodgy fertilisation, they said we'll observe.

@JontyGentoo that's the thing, I've not had tests for NK cells, I've not had the Chicago tests which someone mentioned earlier. I'm sure there's a million other tests I've not had and haven't been offered. Presumably there's endless things we could test in theory so not even sure where to start. Hate it being unexplained.
@Worldgonecrazy ahh ok maybe ICSI still something to ask about. Although I think fertilisation rates seem ok?

I’d hold out for now, especially given you already have a child and are having IVF after a relatively short time TTC. Most people I know it’s taken a few rounds.

The Chicago tests are not routinely offered, they were an additional cost of about £2k and were sent over to Chicago for testing - although that was a few years ago so hopefully they have begun the same type of blood testing here.

Hmm so a few things I would say from your reply - at age 29 home AMH of 13 is pretty low - for context when i started IVF age around 34 my AMH was 13 and that was considered low for my age - that would explain you were on a pretty high dose of stims - 450 is the top dose.

Guessing this was also long protocol?

I'd question why a clinic would want to PGTA - its still not a proven science and most reputable clinics would only suggest it after lots of miscarriages (like in my case) rather than a young woman in their 20s with no obvious reasons for infertility

@amothersinstinct no it was short protocol. In all honesty I don't understand the difference in terms of when they'd suggest long over short

Long protocol - in the simplest terms is much longer duration of treatment. You take initial medication to switch off your ovaries - called down reg - then the clinic gives the go ahead to start stims - the idea being that all follicles grow at the same rate and apparently creates more follicles. But the process can be 6+ weeks long

Short protocol - your protocol - no down reg. start stims at a certain point in your cycle. Risk is follicles grow different rates

Some clinics don't do long protocol - like Create - their ethos is short low Dose stim cycles. Some clinics will only do long and then everyone else do a mixture of both

I would ask about ICSI but if the sperm is good quality there is no reason to do it

NK cells - again it's only really something you'd look at if you'd had a high number of chemical or early miscarriages

Have to say also....this is for a second child but you were "only" trying for a year. I know that feels like a long time when you are TTC - I've been there. But Statistically at your age it takes up to 24 months to conceive and you'd only just be in the window for when the NHS would refer you for testing had you not already had a child

I fear that your clinic may be taking advantage here - getting you to pay for PGTA etc - and most decent ethical clinics would have said try a few more months - 6 at least and come back rather than take your money for 2 cycles in quick succession

Oh and the follicle size - sorry forgot to reply on that - statistically you want follicles of 14mm and larger on trigger day for the best chance of getting a mature egg from it

I did 5 rounds of IVF....each follicle scan I would write down the follicle numbers and size. Control freak??! Yes but it helped me feel in control. I was then able to monitor growth over the stims - you want to see at least a 2mm growth every other day.

If they say told you you had 20 follicles but lots of them were below 14mm on trigger day that could explain why you only got 7 eggs?