Assisted Conception (and the bits in between) Volume 6

[rowingboat]

Hi all,
I just went to post on the old thread and noticed it had been locked, so here is a new one!
Come on in!

vallinnapod my health insurance doesnt cover fertility issues... but it does cover for investigations into multiple (3 or more and not nec successive) miscariages... I am with the Pru btw... so, i have managed to get some of my stuff covered to date. I had to read through my policy very carefully and then fight through about 3 call centre people before I got the answer I wanted... will try and do the same for the Chicago test...

Hi all,
wow busy on here, a flurry!

LAW and Vallin I hope the insurance does cover you, that would be amazing. There doesn't seem to be a lot of help for people with fertility problems, so anything is a bonus.

I have an appointment with our local infertility clinic on Friday, not quite sure what to expect. Does anyone have any top tips re questions and that kind of thing?
Have had another appointment with a specialist for completely unrelated issue and am now feeling I didn't ask the right questions. Of course I am signed-off now so would have to referred again via my GP, months and months....

hi rowing I always write down my questions before going to see any type of consultant. Before i went on Tuesday to ARGC my OH and i wrote a combined list. I always write down the answers too as it means that I take it in better and I also have a chance to ask again if i didnt 'get it' first time around.

I like to know what 'next steps' are... ie at the conclusion of the meeting... what is going to happen next and who has to do what (how long will the wait be, tests etc).. also who do i contact if i have anymore questions...

i hate walking out thinking...ok... but now what?

oh and i am a control freak too

BagofHolly and late--I received the information pack from ARGC. The price for IVF+ICSI is £3500. I figure with drugs and the consultation fees that will add about £1000. My GP has agreed to do all the bloods, which saves us quite a few pounds, am I missing something? The initial charges include all the ultrasound scans, theatre charges, anaesthetic charges and doctor's fees. All in all, it's still less than a single cycle at The Bridge, and with the higher success rates and your information, I'm sold!

Lissy - I was told by the Bridge a cycle is £3300 which includes most things plus 7 scans and 7 blood tests. Drugs are £1500-£2000 and then extra scans and bloods (BOUND to happen!!) So we were thinking £6000 absoulte max...am I being naive

costs at argc.... as i reach into my ever growing pile of clinic paperwork...

initial visit- £150 plus sperm analysis (at that visit £50

monitoring cycle...

Hormone profile 90
Oestradiol 30
ultrasound 110
oestradiol 30 (no idea why 2...)

Immunes 780
IgA 25

so... to get to end of first bit £1265

then... depends on outcome of Immunes...

IVF

2500
blood tests... during stims, min 1 x every day for 14 days... max 6 per day... so... min of 14 X 30= £420 and max of £2520

drugs for between 11-16 days..
given the list, i think at least avergage of 2000..

so 1265 + 2500 + 840 (average 2 blood per day?) + 2000 = £6605

but that doesnt include any drugs for the results of the immunes... and is a real finger in the air for bloods and other tests...

you also need to get HIV etc done too.

so I do think 5-7 in minimum and with immunes closer to 8-10...

hth..

oh and they also sometimes ask for a hysteroscopy... which is 1160...

and for us they have asked for karyotyping which is another 200

Italian - much amused by your Tampax Tea!!

BOH - Thank you for the info about ARGC, although I don't think it'll be very convenient for me as I live half way between Manchester & Leeds!!!

Val - I think we may be the same person, my 12 yrs on Dianette hid my PCOS and some of my scho0l year now have children old enough to appear on the X-Factor....

Okay, I'm off to pack for a weekend in London with DH to celebrate my birthday (another year - no baby....). I've been promised a romantic walk through Hyde Park on a crisp Autumn morning followed by a nice latte and lots of nice pressies! Staying with the in-laws so lots of being looked after and yummy food as well!!

Bye-ee!! xxx

Thanks for all the information, girls!

I've already eliminated the need to spend for the blood tests. Spoke to GP, and he printed up the paperwork for all of them: HIV, Hep B and C, oestradiol, AMH, FSH, Prolactin, etc. I figure I can get them done when my next AF comes, and I'll have the results by the time my consultation rolls around.

Husband had TESE in May 2009, and I have the results of his sperm analysis already. That's also information that The Bridge has, and on my follow-up I'll ask for them to release any information to the next clinic.

Doing everything I can to save a pound, but I'm prepared for the costs, and so is DH.

I figure I'll pay for the registration fee to get an initial consultation, and then go to my follow up appointment at The Bridge and then an open evening at CRGH. Then I'll compare and contrast.

That's my plan and I'm sticking to it!

Hugs and kisses to all, have a great weekend!

Ah Lissy, I see how you've arrived at those figures. However, on top of the initial bloods which you're right, your GP can sort, ARGC do daily bloods to monitor how you're responding to the stimulation drugs. These are between £40-£80 a day, and you have them done at the HCA lab at the back of ARGC's clinic, at 7.30am and they get the results back by about 11am. They then call you later that day to tell you how much of your drugs to take that night. They do scans every couple of days early on in stims, then daily and then for the last few days of stims, they'll take bloods both first thing in the morning and again at lunch so that they know exactly when to trigger your ovaries. That's how they're able to get so many eggs, even from people who have responded poorly at other clinics. They also avoid ovarian hyperstimulation by doing this too. So that's how the cost leaps up. I kept a spreadsheet [geek] which you're welcome to see! Hope that explains a bit!

Hi all,

LAW thank you for the tips! It is helpful to hear your approach, I will have a bit of a think about what I should be asking.
For a minute I didn't 'get' the bit about you writing down answers. I realise now, that you mean you write down what the doctors give as an answer, but initially, I thought you meant you wrote down answers to your own questions, which made me smile.
I had an image of the doctor answering your question and you saying, 'yes doctor, but this is actually the answer I wanted' then reading them what you think they should have said, from your notepad.
I bet they would love that kind of input.

Iscream, that sounds like a lovely birthday. I hope you get a nice crispy day. Don't forget to eat crisps, to add to the crispiness! Have a lovely weekend!

Italian, what's this about herbal teabags? Not that kind Shola wotsername does?

Lissy that's the spirit, get everything done at the GP! I'm surprised they still let me in round at the surgery 'OK, what do you want now?'

Bagofholly Thanks for the info. I can't quite imagine that level of checking. I'm amazed at the cost but delighted it worked for you. So are you now finished with fertility treatment, have you got two children? Are you trying for more? Don't answer if this is too many questions.

I couldn't fine the page at www.epsom-sthelier.nhs.uk/news/news-archive%20/2010/february-2010/miracle-baby-arrives-after-18-%20miscarriages/ said page not found.

Unfortunately, we can't change clinic (well not unfortunately as we are happy with them) but we will get our donor via them and so we will need to stick with them.

My husband is not convinced about the Chicago test, he found this on the Internet www.hfea.gov.uk/fertility-treatment-options-reproductive-immunology.html and also he points out that I have only had one miscarriage not repeated ones so it is not likely to affect us.

Latetowork that is great that you have frozen eggs (eggs or embryos?). All the best.

Latetowork and Vallin good luck with the getting things on health insurance (we have none so no point me checking!).

BB Why are you taking steroids? We were told if we did not need steroids and took them it would not help and might even hinder. But I have no idea for your situation. I said to consultant at clinic that if there was not risk to me then I would take whatever. I am asthmatic (mildly) so I do take steroids occasionally (when prescribed by the doctor) and also take inhaler in the winter and that has steroids in it.

Rowing am I confused? Are you seeing a UK clinic or one overseas? Is this for FET or donor embryos or something else? Re questions - well, you?ve done all this before so I would ask all the stuff you asked before. I personally like to know what the chances are for people in my situation, how long the wait is and of course the cost (full costs of everything you will need to pay) and I guess if you would like to see the counsellor or whatever you could find out what extra freebees there are (I have found seeing the counsellor quite helpful).

Lateatwork you sound like me! Yes, I write it all down, if I remember. You sound so organised. (In a good way!).

Iscream are you happy with your clinic? Enjoy your London trip. We are off to Dorset to see a relative. Maybe you should send me an email next time you are down south! I always imagine meeting up with Mumsnetters and it does feel kind of weird telling you guys so much and not knowing what you all look like or anything!

Lissy all the best with all tests/checking etc I am sure you will make the right choice. When we went on our open evening at our clinic we were late and got locked out!!!!!!!!!!!

By the way, is anyone going to the fertility show? I would not necessarily recommend it but I did go last year.

Mojangles are you still around?

Love and waves and chocolate boobs to all

Rowing cross posted, not sure who Shola wotsername?

The teas are Pukka www.pukkaherbs.com/file/4ab81aeddaa96c4978e904447ad307f6/herbal-teas.html?gclid=CIKH4brQ56QCFWf-2AodFR9g2g

The blue detox aniseed, fennel and cardamom one is the best (if you like the liquorice taste - on the website it says liquorice but on my box it says aniseed, fennel and cardamom!).

hi lissy i thought the same as you re hormones etc and had them done on the nhs for the cycle before my appt.. i was advised that i needed to get them 'redone' as they wanted to do their own scan (which also i have already had done at the lister...) and they wanted the bloods and scan from the same cycle... i am totally sure it is possible. i just took the easy path this time

boh wow. you sound super organised with the costs. think i might start spreadsheet too as it all adds up... am really pleased things worked out for you there as it makes my decision about which clinic a little easier..

rowing i used to answer my own questions with the dr (or at least cross examine...) so you arent far wrong- nightmare patient-.. but have given up on Dr Google now as i get far too worried about it all. am trying to reduce my stress levels...

italian i have eggs frozen.

BagofHolly--A spreadsheet? God, you are so organized. I understand now how it totally adds up. It sounds intense. But you know what? I would rather spend ££ now and have it work. That way, when my NHS cycle comes up, I'll have a choice. Plus, we do have one frozen embie at The Bridge as a back-up plan.

Late--I'll see how everything goes. First thing's first. Fill out registration form and get an appointment!

Italian, sorry about that link, you're right, it seems to have disappeared, but if you google Shehata and Miscarriage there are loads of articles about his work.
Here's another:
www.timesonline.co.uk/tol/news/article1049620.ece

I can understand your husband's reticence in relation to the HFEA post about immunes. I work as a lay-advisor to the HFEA and all I can say is that as an official regulator, the HFEA is mandated only to endorse clinically accepted treatments. Unfortunatly because of a) the nature of the patient group and b) the type of drugs used in the treatment, this whole therapeutic area suffers from a lack of widely accepted evidence at the moment. That being said, there are plenty of clinical papers published in esteemed journals highlighting the role of the immune system in miscarriage, it's just that it hasn't all been written up into an accepted treatment protocol. More and more clinicians are moving towards treating the immune system, sometimes prophalactically, on the basis that it can't do any harm.

The way I look at it is, if you carry on doing what you're doing, you'll carry on getting what you're getting. So a change in the direction of treatment is a good thing, especially if it can be proven to show improved results and also if it can be shown that it does no harm. From everything I've read (and I got a bit obsessive about it) there appears to be only limited risk to the patient and an increased liklihood of success.

In my own case, I never had a miscarriage. My NK cells were so high that implantation would have been pretty much impossible. I had a regular cycle but appeared to be producing antibodies to my own progesterone, and there were many occassions where I felt as though 'this was the month' - lots of symptoms, implantation bleed etc and then the day BEFORE my period was due, I'd have an absolutely massive bleed.

When I eventually went for IVF, on the official test day, (10 days after 2 5 day blasts were returned) my beta HCG was only 29. Anything below 25 is a negative so it was really really low and I was already bleeding. ARGC called me straight back in and gave me a mahoosive dose of dexamethasone and told me to come back the following day. The next day it had jumped to 45, and a day later, to 145. It continued to rise very sharply and the result of all this is currently in the next room, reading a book with his Grandma. I have no doubt whatsoever that the steroids are what stopped my crappy immune system from rejecting the embryo. My boy is 19 months now, and in May of this year I went back for a second cycle at ARCG. They gave me the steroids earlier in the treatment protocol this time, and I got 19 eggs, 14 of which fertilised. We had two put back and I'm currently 26 weeks pregnant with twin boys. Again when my NKs were tested, one perameter came back high and that was carefully controlled with steroids again.

You don't have to change clinics to be treated in this way - Gorgy and Shehata (but more so Gorgy) will treat patients alongside any other clinic as far as I know.

(Sorry, I've rambled on a bit!)

Lissy, I filled in the spreadsheet on my phone every day on the way home on the train, just as a way of keeping tabs on what we were spending. I think I got a bit punchdrunk with it really - the numbers started to mean less and less as the treatment went on, but at least it meant we had a clear idea of what we spent. I didn't do this the first time, and my husband complained bitterly (he's Mr. Home Finance!) so I did it to keep him quiet!

Italian, I haven't forgotten to email you, this week has been rather odd though, which I'll explain when I get a minute! V sorry! x

Hey Italian - your blue rinse tea sounds refreshing! Are you on facebook? If so I may send you a little e-mail so that you have my name and we can become "friends" (there's only one of me on facebook) - it'd be interesting to see if we look like what each of imagines! I imagine that you are tallish with brown wavy hair (and I think that BagofHolly has very curly hair!!!). I've had a nice day in London but got a little bit sad this afternoon when we went to the park with DH's sister and her children and there were quite a few mummies & daddies with little ones. It gets chuffing freezing hanging around a park though - maybe I'm not cut out to be a mummy after all cos I'd rather have been in Starbucks with a latte and a copy of the Saurday Times!!!

Laters! xx

Hi all,

Iscream, so it was a bit too crispy today then! Yes you will need to invest in a waterproof puffa jacket with a hood for little iscreams.

Italian, I have been referred by my GP to the local IVF clinic for further checks. I hope they will run some tests to see if there is anything underlying my lack of success in conceiving baby number 2.
This appointment is really just because I asked my GP about immune tests when I was arranging the bloods and smear for the embryo adoption abroad. It's just because I am interested, not because it is required by the IVF clinic we are dealing with.
Shola wotsit is Oslo. I didn't want to type her name for fear of being spammed. She advertised all over the internet and if you ever reply, you receive emails for the following two years on a daily basis.
She does a kind of tea-soaked tampon up your wotsit as part of a detox.

LAW I had forgotten about the frozen eggs. What is the next step for you?

I'm on CD7 (I think) so plan to order the prescription for oestrogen and prednisolone (sp?) soon/ book time off (nightmare short staffed chaos)
Not managing to eat less than one swiss roll a day, but have managed to clamber onto my exercise bike at least every other day and I do feel much more toned. I actually ran up a (small) hill the other day and didn't need to be resuscitated at the top. Impressive!

morning!

scream glad you had a good day in london.. nice day for it! am just looking out the window now and think we might go find a nice pub somewhere and have a nice lunch...

rowing we are going to do the monitoring cycle at argc and take it from there... the dr i saw there said he would be happy to use frozen eggs but tbh the clinic has no experience of this so if we go that way, we will probably go to MFC (who are the only UK clinic who have had live births from frozen eggs..)

boh i am getting a little nervous about the tests and drugs at argc.... but am putting off my nerves until the result of the immunes for me...

Talking on another thread about red clover. Rowing were there some problems with red clover? Did it make your period disappear or longer??? Any side effects? Would anyone recommend the red clover tablets or the tea?
Rowing the tea bags are just me drinking tea, trying to get healthy. I read a lot about health in the book Inconceivable. Shola wotsername was about immunology.

Iscream don?t think wanting to be warm and not cold and to drink coffee qualifies you as a potentially bad mother or a bad potential mother. Hang on in there, your day will come. I really hope. Yes, send me an email. I imagine you as petite/short and dark but that is just my thinking, with dark hair and riding a rocket. I imagine bag of Holly as tall and slim and blonde but have just read she is 26 weeks pregnant so maybe not so slim!

latetowork excellent that you have frozen eggs. Can I ask (ignore me if it is too personal) but why did you freeze eggs and not embryos, was it before you met DP/DH? Nosy, nosy Italian!

Bagofholly thanks for your long and detailed information. I am just not sure. I mean I have only had one miscarriage and I am not getting pregnant naturally because I don?t have any eggs/eggs left. I am a bit scared about taking steroids if I don?t need them as the consultant I saw seemed to think they would be detrimental if I did not need them. I can see that there probably are a lot of drugs and treatments that do work and are not harmful and maybe have not been used because there is no actuate data on them and not because they don?t work or are dangerous. We are with Care, they have a lot of clinics, about a dozen or so, and I wonder if any of them have done any pioneer work on this as I think (I could be wrong) that they have done lots of ground breaking work in the past!

Bagofholly sorry to keep picking your brain. Is there any evidence on the Internet that I can find that taking steroid does NOT damage your chances/health if you do not have raised killer cells? I am guessing the USA is the place where more experimentation into this has been done and so I guess they know more.

Googled as suggested and found a site for Mr Hassan Shehata. On it there is mention of possible side effects for Aspirin, Prednisolone and Clexane. Do you know more about why these may or may not be used? I know you are not an expert so anything you say I would appreciate any suggestion and I will continue my investigations.

Rowing just looked at Shola Wotsits's page and there is a gross picture of something on there, it is like something you find at the bottom of the sea! (It is a subserosal fibroid apparently!) Just when I thought it could not get any worse than the subserosal fibroid I read about the tea-soaked tampon!

Rowing very impressed with your running. I?ve been walking a friend dog on the lead and because I think the poor lassie needs more excise I break into the most pathetic little run for about 5 seconds every 15 minutes or so! Still want a dog but think a rabbit would do. Mostly want a baby but even that desire is slipping into the past somewhat!

MM are you still around and reading us. Sending hugs.

BB how goes it? Thinking of you.

Arrow prayers for us all to get what we want, please God.

My period has totally utterly gone missing.

I did a test today and again BFN. So I now convinced! I did not cry or get sad or shout why, God, why. I just stuffed the test in the bin and carried on with my day.

Rosemary Conley, I am a bit behind. I must confess I have fallen off the wagon. I?ve fallen off the wagon and I am now being dragged behind the wagon eating buns!

Love and waves and chocolate boobs to all

Italian, just popping in briefly, got to be up at 5am so please excuse brevity. I really don't know about if there's any evidence that would show that steroids do no harm if you don't need them, but I think it's unlikely that you'd find published evidence as explicit as that because it's unlikely to be the primary endpoint of a trial and it's also trying to prove a negative. Essentially in this arena they're used "off label" at the prescriber's discretion so he would be the one to ask, but one of the reasons for immune testing including Chicago tests is to identify which patients actually need them and therefore mitigate the risk of problems in patients who didn't need them anyway.

Sorry, pressed post too soon! I'm surprised your CARE consultant hasn't mentioned George Ndwuke at CARE Nottingham. He's v experienced in this arena and I've only heard good things about him.
As for the clexane/steroids/aspirin cocktail my understanding is that the steroids supress the immune system, and the clexane and aspirin thin the blood at different points in the clotting process so that if the immunes flare up again and try to put a clot (in the placenta usually) then the thinners make this more tricky. Alan Beer explains it rather better than me!

Bagofholly It's interesting that you mention massive bleeds. Sometime in tehe past I used to get a massive bleed about once every third cycle. I mean (sorry if this is too much information)but I bled through my sanitary protection and onto my jeans on occasions. I am not sure exactly when this was but I think it was around the time we had come off the pill and were trying and before we started the IUI treatment that led to our daughter.