First Fertility Clinic Appointment Tomorrow

[dogmam]

Me and my partner have our first appointment with our fertility clinic tomorrow!

We went to the GP after a year of TTC and after 21 day bloods and partners SA, we were referred straight away to the fertility clinic. GP tests were in October/November so it's moved along quite quickly so far.

Feeling slightly nervous but also excited to hopefully get some help! My partners SA showed low motility and morphology so I assume that will be discussed..
What else should i expect from this first appointment? Is there anything I should be asking?

Thanks in advance! I'll update this after the appointment tomorrow as I know there are a few others on here who are in a similar position and might find it useful.

@paintfairy I’d recommend a listen to that last link I shared especially. We just finished it after starting last night and it’s really interesting and goes into detail about IVF and ICSI and how many people only seek help from a urologist after failed cycles.

It also talks about the history of CCGs offering one round vs more rounds and why like @Juno231 mentioned, and the success rates being based on 3 cycles.

I only found about about Dr Ramsay because of mumsnet and now I’m listening to his greatest hits lol

Good luck dogmam.

I wrote a huge long post and closed the page by accident 😭

@thislittlebird yes if you could send me the information that would be great.
I assumed, but could be wrong, that with ICSI, the embryologist does pick out the 'best ones', rather than just picking any from the entire sample. I thought they could do that in the same way they are able to do/see what each reading of the analysis is, I thought the benefit of ICSI is that they are able to select the best ones giving the best chance of creating a good embryo.
Not sure how I would feel about going back to IVF, now that ICSI has been offered, even if the SA was improved. I feel like ICSI does the extra job of creating the embryo which is one less thing to leave to nature (as seen as that's failed us!). But I get what you are saying about natural selection with IVF, although I think when it comes to both IVF and ICSI, in my mind I group them both together in the 'down to science' approach oppose to conceiving naturally. Also whether it's natural vs ivf vs icsi, the embryo will probably be different every time.

No change with my partner between first and second SA, other than taking wellman after the first results in a hope to improve them!

I haven't listed to the links/podcast you have sent but plan to today. Dr Ramsay though I have come across before on the Big Fat Negative podcast, there's a whole interview with him.
Interestingly, when we had our consultation this week, we mentioned my partner has a spermacidle cyst and a small varicocele (which he was told about a year or two before ttc but told by the urologist it's nothing to worry about (he also had torsion reversed and a varicocele removed when he was a child)), anyway we asked the consultant if whilst we are waiting for treatment to start if he should go back to the urologist via the gp, and the consultant said unless it's causing pain and discomfort, not to bother as at this point it won't make any difference to the outcome of needing treatment. It can take 2 years to start seeing improvements and they can only be minor.

@dogmam to add to the above - my main thought about improving OH's swimmers is that if MFI is your main problem and it can be improved then you might not end up needing ivf if you get your BFP in the mean time? "end of summer" is potentially another 5 months away and then god knows if there are any other delays. Plus if you want more than one child it would be good to know whether it can be improved and therefore skip IVF for DC#2?

@paintfairy yes it's nuts how many people need help to conceive nowadays - it also makes me think about how the C section stats are rising like mad as well. Apparently it's because all the women with narrow hips that would have died in childbirth back in the day have now had daughters and granddaughters that also require c sections to deliver.

@Juno231 definitely don't think I have the hips problem. 🤣 But I know that's true of some breeds of dog though too. Us interfering too much with nature is bonkers really.

@dogmam interesting that he has a small varicocele. I’d say definitely have a listen. The couple on the podcast had ICSI and it worked first time but they talk a lot about how they’re the exception and not the norm, and it has low success rates that don’t get mentioned when you’re sent for it etc so I guess it’s good to kind of help the sperm along the way a bit as well as what @Juno231 said. Get them in the best shape possible because when they pick one that they think is good it still may not fertilise.

Science is doing the work but scientists are imperfect, I guess, so doing as much work to help them ourselves in the meantime could help the science? That’s the layman’s version from me anyway Lolol

There’s an interesting part of the podcast where Dr Ramsay talks about IVF needing a multidisciplinary team approach of Gynaecologists, urologists, REs, embryologists etc to take a holistic approach and I wish they’d hurry up and do that because driving everyone down the gynaecologist route is ignoring so many issues.

@paintfairy we really love to interfere

I didn’t know this c section thing @Juno231 but that’s pretty crazy. I don’t know what my hips are, pretty average I guess.

Yeah I completely get where you are coming from, and we will still be ttc in the next 5 month's in the hope we don't need treatment but we have got a bit of shock at how low the latest SA and feel a little bit hopeless and maybe a bit reliant on IVF/ICSI. Possibly too reliant. But that said we have ordered 5 months worth of wellman (currently £5.70 on Amazon!) but considering to ditch the opks but still actively trying. Thing is, other than take vitimans and remain a healthy balanced diet, avoid baths etc etc which we will continue to do, what else can we do? Aside from pay for private tests but what will they tell us what we don't already know. I would be happy to pay if someone could 'fix' the problem but if it's just more investigating then I'm not sure if it's worth it. I don't know. Such a shit situation.

Here is the dr ramsey BFN podcast episode open.spotify.com/episode/2b5DqdFReZen9XjFc7VduI?si=5D6p5-VvQF61jXXHULW7lw&utm_source=copy-link

Hello Ladies! I did pop in to introduce myself a few weeks ago, but I have since been slowly reading through the whole thread... and I finally completed it. It has been a big learning curve - thank you ladies!

I also feel like I know you all really well now, haha, but you don't know me. So here is my blurb:

I'm 35 (36 in July) and OH is 38 (39 in July).
I came off the pill end of May 2020 and started properly trying in August. I have had a total of 8 cycles in 10 months and only 6 of those were ovulatory.
I have been using B-Complex to extend LP and have tried Soy Iso. This cycle (cycle 9) I'm just using Conceive + Ferility support and Ovulation support, and OH has started taking the Motility support (I think he has started to think about his sperm health now that he will have to do a SA!).

I got impatient and self referred myself (private) to Exeter Fertility Clinic and our first appointment is on May 6th.

I'm hoping they can do something to encourage ovulation (as my body seems to have repeated failed attempts within a cycle before sometimes squeezing an egg out) and I suspect I have shitty progesterone levels too.

17th Dec 2020 tests (day 3):

• TSH 1.96
• FSH 4.3
• LH 4.8
• Testosterone - 0.5

Huge congrats to @Flutterby8!!

@Juno231 I had a look at the NICE guidelines and it says the success rate after three cycles of ivf is 45-53%?

www.nice.org.uk/news/blog/the-importance-of-3-full-cycles-of-ivf

@Kitekat81 that could vary greatly though? You could have only 6 eggs from 3 cycles or 30 eggs! So a person having one cycle and getting 9 eggs (who can go on to have them transferred later) is not really any more worse off than someone who struggles egg wise and only manages 2 good ones per cycle, over 3 cycles. So there's still a massive scope for inconsistencies figures wise.

As for percent- I think the percent is a bit like with natural pregnancy. If everything is right it works first go. If it isn't, it won't. The useless people (like me) are the ones that bring the stats down. I have loads of friends who got pregnant first time trying each time.

@Kitekat81 that’s what the doctor on the podcast I was listening to said too. He said 50% + and the nhs not offering three is just pushing people towards the private sector essentially.

I’ll send you the stuff via dm @dogmam and you can read it. I guess the argument is just find out if there’s anything to fix before you get too far down the line and I get it, I want science to do it for me too, but I’m scared it won’t work and only then will I have to investigate why, £25k down the line 😭

I’ll check out the podcast, thanks. He seems very informative and helpful, I think we’re going to book with him since we’re in London anyway.

Have a think over the next few weeks how you feel about it all, but I know it feels hopefully, we just don’t know how it’ll be for any of us until we try which sucks.

Hi @Kay00! We will all get you know you soon!

How do you know your cycles were anovulatory by the way? Temping? When are you getting your progesterone tested?

I didn’t know there were motility support vits, I’ll have to google them.

Congrats to @Flutterby8!

@thislittlebird Hi

Yes, Conceive+ do a Motility support which includes CoQ10 and Ashwagandha and lots of zinc. I hadn't read much about it, so wonder if its new? He's only just started them so probably won't have much of an effect on and SA done off the back of our first appointment.

Yes, I temp, do OPKs etc. My temperatures are always pretty low, including in LP, which makes me wonder if my hormones are a bit rubbish. I also did a private progesterone test 6 days into my LP and my numbers were pretty boarder line, although maybe I should have waited an extra day. I haven't had any other tests, but I just have a feeling progesterone is an issue for me.... we'll see!

I am also undergoing other tests at the moment to get to the bottom of some inflammation issues I have been having. I usually get inflammation in my joints and the flare ups can last 6 months+, this time it has been in my stomach and bowels and I am 5 months in.

Interestingly whilst at the peak of my inflammation I didn't ovulate for 2 x cycles. Once I got my inflammation under control (through strict FOMAP diet) I ovulated again! However despite the coincidence, my Gastroentoroloist doesn't think they are related (I do!)

I feel my symptoms are improving now so i'm feeling hopeful for ovulation this cycle. I had an ultrasound yesterday on my whole abdomen, and all was good . I have a colonoscopy and gastroscopy next week on Weds (eek!!)

@Kitekat81 You're looking at an old report from 2014, the newer stats say a third chance with each cycle and cumulatively 80-85% with 3 rounds. I can't find the original study now (although it was so easy to google for the other day, fml) but they mention it in this article:

www.theguardian.com/society/2020/jun/30/uks-ivf-success-rate-has-tripled-in-last-20-years

“Whilst the Nice [National Institute for Health and Care Excellence] guidance states that all eligible couples should be entitled to three full cycles (including the use of frozen embryos) and we know, using latest statistics, that this will give them an 80-85% chance of having a baby – and indeed many will not require the full three cycles, with on average 30% conceiving with one cycle (and in the best cases maybe 40-45%) – IVF is seen to be an easy target."

What year are those new figures from? @Juno231

@thislittlebird 2018 it looks like - based on this survey:
www.hfea.gov.uk/about-us/publications/research-and-data/fertility-treatment-2018-trends-and-figures/#birthrates2

Brilliant thanks @Juno231!

That’s handy to know! @Juno231

I was listening to that podcast chat about low ICSI success rates and I’m too nervous to google what they are lol. I’ll just take hope from this for now.

@Juno231 feeling slightly more hopeful with my one solitary round of ivf allowed. 🤣 If absolutely necessary we might be able to afford one privately after that. But no more.

Listener to the dr ramsay podcast, very interesting and really does motivate me to perhaps do something to improve things before the end of the summer.. but what?
@thislittlebird it will be very interesting having an appointment with him. On the podcast link I sent, one of the hosts actually books an appointment with him after interviewing him as she also had MFI and was due to start ICSI (which was successful first go) and I think a few episodes later goes through how the appointment went, so will be worth a listen to know what to expect!
Also the original podcast where he is giving lower stats, I think is from a fair few years ago do maybe things have changed. It's just so interesting how confident he feels about the ease of bring able to improve sperm. How?! What is the magic he speaks of?! Deffinetly motivated me to continue to ttc whilst waiting.

@kay00 welcome, hope you find it useful!

@dogmam I think I was the same as you a few days ago and thought “ok we need to leave this to them” or whatever (this was after his last SA) and then my other half said “what about me?”. It really resonated because I thought ‘well yes, why does no one seem interested in him?’ And then I posted on the infertility sub and someone replied suggesting we investigate pre ICSI before going on to DM me more info. Initially I thought I don’t get the point but then I came round to thinking it makes sense. Maybe the tests and consult will cost £1k but that’s about the same as one FET for us, and maybe it’ll save us a few FETs in the long run if we can improve his sperm quality.

Yeah the podcast was from 2017 I think so more recent data must be available.

Totally agree. I felt motivated by him too, I suppose. Because he clearly believes it’s not fruitless and more time should be spent on the men. For me I’m interested in the DNA fragmentation test especially. Because if we know he’s got severely fragmented sperm there’s the option to retrieve it surgically at some point, rather than try in the normal fashion each time. I’ll send you that DM soon, I’m a few gins in so it’s risky right now 😂

I’ve just sent a letter about my experience to date to PALS. Probably isn’t perfect but it’s done.

Hi, just an update from me. Received my next appointment letters, 2nd June for implications and 3rd June for signing consent.

letter also confirmed what we were told at our consultation last week;
AMH 34.1 pmol/L
TSH 1.46
AFC 32
Motility and morphology both 2%

Hope everyone's ok