older mums and fertility treatment - info for mears' sister

[mears]

My sister is 43 years old and is about to embark on fertility treatment.

She is not sure that she is getting the best advice (she is a research scientist and has scoured all the papers).

She has been advised to attempt super ovulation and IUI, but sh efeels that she might be better opting for IVF. She is concerned that if she produces more than 3 eggs theywill defer treatment where she would prefer they harvest eggs and attempt IVF. In the literature she has read, no woman of her age has had a multiple pregnancy even when more than 3 eggs have been implanted (huge trial in USA).

Does anyone have experience of fertility treatment over the age of 42 years?

Hello mears. I am 42 and currently having clomid treatment (only) on NHS. It isn't working and I am about to see my consultant for further discussions. I have no clue as to the best option, but I feel that private treatment is the next stage. IUI is the next stage usually offered if clomid alone doesn't work. I can't offer any other information, but may have more details after my appointment next week.

Hi Gingerbear - my DS (sister) is seeing a fertility specialist privately - she cannot get treatment on NHS apparently. She has had her ovaries scanned and a cyst was seen so she has to have that treated first. She is ovulating but her eggs are not good quality she has been told. She has also been told that after 44yrs, no woman has coceived with their own eggs with fertility treatment and that she will need donor eggs. She really want to maximise her chances of conception and thinks that IVF might be the way to go.

I feel the same way. Time is running out - maybe IVF is better. Has she seen this website?
Attilathemeerkat is usually a mind of information on these matters. Perhaps we should bump for her tomorrow morning.

Thanks for that - I have sent her a link top that site. We can bumpthis thread tomorrow. Thanks for your help.

bump

Your sister is wise to be wary.

IVF may well be the way to go here but she needs a second opinion before going down that route as well. I take it as read that her man has both been tested and there are no male factor problems.
I presume by super ovulation they mean clomid. However, clomid is ideally only used for women who are not ovulating.

At the very least your sister should seek out a second opinion from another gynae specialist. Some private clinics as well as being expensive actually offer quite poor treatment.

thank you attila.

Mears
She may already know about this, but a new, private fertility clinic will be opening up in Glasgow.

Not cheap, but can help women who are no longer eligible for treatment on the NHS.

\linknews.scotsman.com/health.cfm?id=1033642006\fertilityclinic}

sorry, it's here:

fertilityclinic

Thanks for replies. Expat, thanks for the link but she lives in Bristol.
AttilaTheMeerkat - I didn't clarify whether it was clomid or not - I assumed it wasn't (don't know why).
Her DH is fine and she is ovulating but says her eggs are pathetic!

any other experiences?

bump

Hi

I'm mear's sister and new to this site. At 43 I'm about to start fertility treatment. My fertility problem is due to my age and the poor egg quality older women have. Luckily my husband is much younger and his little swimmers are very good :-)

I've concerns over the advice I have been given. Because we conceived naturally a year ago, but had a miscarriage, we have been advised to do super ovulation and IUI. I was told that they would aim to get 3-4 eggs, if I got too many they would cancel the IUI.

My problem with the advice is that they say I only have a 4% chance of it working but then say the risk of multiple birth is too great so the number of eggs needs to be limited. This contradicts the research that states that fertility treatment success rates are directly related to the number of eggs produced by a women regardless of her age. For research I have read it appears British clinics fail women over 42 because they do not go for the max number of eggs possible. The treatment strategy I want is:

• find out how many follicles I have
• use the long ovulation protocol to get max eggs. Clomid is a no no for women over 40
• do IUI if up to 10 eggs available, if more than 10 convert to IVF in order to be able to pick 3 good embryos. There is no technical need to go to IVF as I was able to get pregnant before.

But I know the clinic will frown on this approach. Research from the US, that does not have restrictions on the number of embryos used have conclusively shown that women over 42 are only at risk of having twins. The approach I've outlined would be risky for women who are 40 or 41.

I only have a chance of three cycles as I'll be 44 in January and have to put my name down on the waiting list for a donor egg. So I want to have the most 'aggressive' treatment approach possible.

I wonder if anyone out there has had any experiences on this subject and should I go to the top performing clinics in London?

A friend of mine will be 42 later this year and has at this point had 3 unsuccessful IUI's. Her doctor has recommended IVF as she (the dr.) believes that they are having problems getting "good eggs" and would be able to do further testing with IVF.

I conceived at 42 after the 4th attempt using IUI (and clomid), and went on to have my lovely dd.

My clinic was very focussed on FSH levels, and that was the information around which my treatment seemed to pivot. When dd was conceived, my levels were in the high single digits. At 44, when I tried for a sibling, my FSH levels were consistently much higher and I was advised that IVF, instead of IUI, would be necessary. It amazed me what a difference those few years could make - but it really matters at that age.

Has your clinic tested for FSH levels? I was advised that most clinics want to see a 12 or lower before commencing treatment, though my clinic was willing to work with anything under a 15. Their philosophy was that anything over 15 had such a miniscule chance of success that it was better to wait for a "lower" month - better for the body (not pumping useless fertility drugs in), better for the wallet (those drugs are eye-wateringly expensive), and better for the emotions (fertility treatment is such a roller coaster).

Ultimately, treatment did not work for me. FWIW, I was told that transferring 2 embryos was the IVF policy, unless there were special circumstances (in my case, age) that would allow for a third embryo.

Best of luck with it all. Will keep an eye out for your progress.

Hello mears.
I conceived using IUI and clomid at 38 and again at 41. If you need some good medical advice I strongly recommend seeing Melanie Davies. She works out of the EGA at UCH and also has a private clinic working out of the same hospital. She's a leader in her field and a tremendously empathic woman - she'll be very straight about chances and the best route to choose. Shrr also has a very high success rate, 2nd in UK I think, or it was when I was there a couple of years ago.
All the best to your sister

I had IUI cancelled because I produced 3 eggs but I subsequently found out that most clinics would proceed with this number as the likelhood of triplets is very small. That being said, the percentages success of IVF are much greater than IUI but obviously the actual procedure etc is very much more invasive/psychologically challenging (we've just been through it).

Earlybird is right about FSH level too - they are one of the most important factors when it comes to success.

Welshmum, I am currently trying to decide which clinic to go to (nearly 43 but very low FSH at 3.5) and I may take your advice and go to UCH. My obstetrician is pushing for London Bridge clinic but I know he has a friend who works there so I am a bit wary that this may be the reason. UCH clinic looks good on the website. Anyone else got any further thoughts?

I've been looking at a few sites and it appears that IUI is not that successful. Because of my age I only have time to do three cycles of fertility treatment. When I next see my consultant I think I will ask if I can do IVF. I will hopefully get an idea of how many follicles I have. I would rather try for three good embryos than be limited to producing three eggs of unknown quality. So far my FSH levels have been very good.

The UCH sounds like a good clinic. The other clinic I may go to for a second opinion is The London Fertility Centre. Prof Ian Craft recommends that women over 38 with good tubes go for GIFT. Because it is not licenced by the HFEA (yet!) he is putting back more than 3 eggs (so has better results than IVF) and have been getting a 20% birth rate for 43 year old women.

Katierocket - I've no idea what it must be like to have a cycle cancelled because a centre deem you to have too many eggs. It just sounds like madness, they are following an HFEA guideline to the letter without taking into account the individuals circumstances. If you are over 42 there are no reports of triplets with fertility treatment and I'd be upset if they didn't want me to have twins as I'm a twin myself!

Hi,

I've not had IUI but have had loads of IVF/ICSI (male factor). Just a few thoughts. I'm at UCH and am very pleased with the tx we have received there. (Have lovely 2yr old DS). They also have good success rates with GIFT though how willing they are to replace multiple embryos I don't know. Prof Craft may be more willing to push on this one than Mr Serhal at UCH. Worth a consult with both though. I beleive waiting lists for both are quite short - you should get an appoitnment withing a few weeks.

Also consider the Lister - they have a good rep with 40+ age group and are not hung up on the need for FSH to be below 10 like some other clinics are. (though age rather than FSH is the overriding factor). Do you know what your CD3 FSH is? Clinics use this as a guide to how you will respond to ovarian stimulation. UCH do an Ovarian Stress Test on CD3 and 4 that they use to indicate the level of stimms required. Have you had any injectibles? Any idea of how you respond?

Another thought. The issue you face is getting a chromosomally normal egg. That's what they mean by poor egg quality but few spit it out. There are lots of studies of aneupoidy by age and ,iirc, at age 43 at least 75% of all eggs will be chromosomally abnormal. (Study last year suggested that even at age 30, on average 40% of all eggs abnormal) So it may be worhtwhile going to a clinic experienced in doing PGD/PGS. PGD/PGS good outcome for advanced maternal age. There are only a handful of clincs. UCH vv good in this area (they do it in-house at the UCL genetics dept rather than send cells to US) and also the Lister. Anecdotally, I would avoid The Bridge with a barge pole. I'm currently stimming for a IVF/ICSI/PGS cycle (am 40).

Other thoughts. If you end up down the DE route, going to Europe, Spain especially will reduce your wait. Check out ivfconnections.com as there are sections on their boards on age/PGD/IUI etc etc. Also the message board of fertilityfriends.co.uk a really good UK site but it has been down for a while.

FWIW, I think it may be worthwhile you doing a cycle of inj/IUI just to see how you respond. You could do this while you are waiting for IVF clinic appointments.

Hope this has helped. Sorry it's a bit garbled.

Thanks for all that info. I have just recived the info brochure from UCH and I think I will will go for it there now. I plan to make an appt next week (waiting for AF due in about a week but will make appt now and can cancel if things chnage). My FSH was 3.5 early in cycle and 8 mid-cycle.

Deax - many thanks for the posting. You have really done your homework. I will check out UCH as the next appointment for the London Fertility Clinic is the 22nd of September! I hope to do at least an IUI cycle with my local clinic, I really want to get an idea of how many eggs I'm capable of producing. Even at 43 if you are able to produce more than 5 egg/embryos your chances of success are so much higher than the 4 - 8% quoted.

Hi Evansg01

It is a dilemna for you but iui involving fertility drugs is very controlled. They'd probably start you on a low dose to ensure the follicles don't grow too quickly and to hopefully ensure that you don't produce too many either. It's still invasive but not as much as ivf I imagine. If you're ovulating ok this may be the reason they suggusted iui. ivf is prob for people who don't ovulate and/or have blocked tubes. fwiw, I had an fsh of about 13 I think. Had 5 lots of iui (needed loads of drugs though) 3 pregnancies and now have dd who is 15 mths. Good luck

oh and i'm 40 btw