Strange experience at 1st fertility consultation

[tak1ngchances]

DH and I had our first appt at Guys Hospital yesterday.
History: 2 yrs TTC, no BFP. I have endometriosis but am ovulating with good hormone levels as of tests in January, and laparoscopy shows tubes are clear. DH semen analysis was v good with ? on motility.

Consultant said, ok you have unexplained fertility, keep trying another 9-12 months and then you can go on the list for IVF.

No further tests, no other options.

I asked if I could have the AMH blood test and if DH semen analysis could be repeated as he's only had 1. She said, Oh ummm yes and gave us the forms. Then I asked about IUI and she said, Yes you can do it but success rate is 10%.

Was that normal? I thought we would do a much more in-depth consultation and tests before discussing IVF and also it seems v hard to have to keep trying another year before going on a waiting list...

I fail to see how they can class you as unexplained given the gynae history for yourself and the semen analysis (one semen analysis is by no means conclusive). Also "unexplained" is actually no diagnosis at all; all that means is that they have failed to find out what is wrong. Sometimes it is said to people when they as a couple have not been adequately investigated.

It makes me think she suggested IVF due to possible male factor issues.

Think you need to seek a second opinion from another hospital; not all gynaes are up to speed and this one in particular you saw sounds frankly poor.

I agree Attilla. I might pay for a private consultation. .

Private is certainly an option yes but the same caveats apply; do your researches thoroughly before parting with your hard earned cash. Some private treatment is poor as well as expensive.

That's weird - I'm really surprised they didn't either run more tests (when did your DH have his semen analysis? Those results can change over a period of 3 months) or give you more info/ a different diagnosis based on your history.

We also have the unexplained infertility diagnosis, but batteries of tests have shown no issues with me and DH has really crappy sperm, so the 'unexplained' refers to that in our case, as various tests have failed to pinpoint a cause for his duff swimmers.

We're having IVF (ICSI) at Guys and have found them to be incredibly thorough (to the point of frustration when we're running test after test if needed!) - we are private though, so I guess they're getting paid!

Who is your consultant there?

Bear in mind that it is the business of most private fertility clinics to sell treatments such as IUI and IVF, so consultations will often be geared towards this.

Your experience isn't that different to mine, although Mr euro did give a couple of samples and I just had a HSG rather than a lap. But we got given the unexplained label and referred on for IVF. It seems that the view is "whatever the question, IVF is probably the answer" so rather than investigate properly, they just refer you on

Good point Euro.

OP, what tests did you GP run to lead to the referral?

They fobbed me of for IVF for 7 years!!! Just kept getting told to keep trying. I started trying when I was 25 I have endo and my H has low morphology. I had 3 lap and dyes and H had 2 SA. They tried me on chlomid when I was 32 didn't work. Finally got referred for IVF at 33. I am now pregnant 9 weeks. But wish I had been offered IVF sooner it would have avoided a lot if heartache.

Gp did day 2 & 21 tests for me and one SA for Mr euro.

Fertility clinic did ultrasound, rubella check, HSG and a second SA.

After that, they gave me an "unexplained" "diagnosis" and they referred me on to the IVF clinic.

I would get a private appointment for a second opinion

Tests I have had are:
2 x laparoscopy and dye
Hormone profile, thyroid etc

DH has had 1 x semen analysis

Extra tests we are now having with Guy's are AMH for me and another SA for DH

We had our 1st fertility consultation last week after 17m of trying. Pre the appointment I'd had day 2 and 21 tests, rubella immunity, up to date smear and chlamydia test. All fine. DH had sperm analysis, fine.

The Dr is now sending me for another blood test for AMH, and I will be having a HyCoSy, but he said if they both come back fine then they won't do any further tests, we will just have to keep trying until 3 years is up. 3 yrs trying is our PCT's referral criteria for IVF if we have a diagnosis of unexplained. I'm guessing your PCT is the same hence the further wait :-(

RE the sperm - reading the new NICE guidelines this week it does say that while SA should be repeated if results are bad, if they come back good there is generally no need to repeat them.

Working in medical research myself I'm surprised there's so little research being done into the "unexplained" camp. When you look at fertility journals it is all about maximising IVF results rather than looking at the causes of the problems in the first place. My line manager used to work in the area 20 years ago - did a big piece of work on the female cycle - and he told me that there's not been much done in that area since then now that they have a "cure-all" of IVF. (I told him all our TTC woes the other week... somewhat surprised me, since he's 63, no kids, and not exactly my typical confidante! But he was so sympathetic about it!)

Forgive me tak1ingchances as I don't know much about endo, but would that be enough to stop you conceiving in your situation? If everything else is OK perhaps the odds of you conceiving naturally are still better than with IVF?

If not, I'd book a private appointment - I agree with Atilla though and recommend you research into the best clinic for you and your situation. We chose Guys because they do a lot of work in the area of male infertility among other reasons.

At my first fertility appointment I was booked in for bloodtests, ultrasound and HSG. And a sperm test for DH. This was at Birmingham Womens Hospital, aged 23 after 4 years ttc.

have u tried clomid?