Advice on secondary infertility please!

[JMo]

Been TTC for nearly 3 years, we already have a DD. Had lap, tubes clear, Clomid didn't work - DH & I all fine on paper, but still no baby. Any advice welcome!

have you tried holistic therapies? what has your consultant said?

Thanks, anniemac - nice to know there's others in the same boat. Everyone around me seems to be having babies! Clomid works for loads of people - give it a go, think I'm just very unlucky!

Can't really afford IVF, no NHS help if you have a child already :-(

Will look into nutritionist idea...

Hi Lissielou - haven't looked into holistic therapies. Worth a look I guess!

Consultant says, "if you knock on the door long enough, someone is bound to answer" !! At mo, he is recommending ovulation induction injections - I do actually ovulate already but he says it's possible this method might work. Holding off this for a couple of months, just for a sanity break cos it's getting me down.

I am seriously pissed off, so maybe I'll join you there soon!

Thanks for the tip! :-)

i think its very important to try to take the odd month off. ftc is very draining.

see you in the hut!

Hi again anniemac.

Fsh fine. Consultant said I might have a blocked tube, had lap and he flushed tubes out - both are fine. But had lap nearly a year ago and still no baby...

Tried clomid, wasn't convinced it was right drug for me as a Ov already - but tried it anyway. After a few months, I stopped ov altogether! App, there's only a very slight of this happening...just my look!

Clomid should be out of my system this month, so hoping Ov back to normal now...

Thanks Lissielou - see you there!

We tried to conceive #2 for 36 cycles before we eventually went to IVF - the NHS were absolutely crap, they wouldn't even pay for the most basic testing so the whole thing was unbelievably expensive. We never got a diagnosis beyond unexplained secondary infertility - my ovaries are cystic (as in PCOS) but I ovulate every month, dh's sperm morphology is borderline but his count & motility are really high so it shouldn't be a problem.

We thought we were lucky when we conceived on the first IVF go but we lost our daughter in the second trimester. I went on to do a injectable cycle (ovulation induction even though I was ovulating), out of desperation really. It was really low dose but is worked & #2 is now with us.

We're now trying for number 3 and are 10 months in with nothing to show for it other than increasing desperation. It sucks, we don't have any more money for treatment.

wanted to add that I really feel for you it is just crappy. We haven't used any contraception for 10 years, we have well timed, regular sex and nothing seems to be wrong with us ... the frustration that we've managed to conceive only 3* times during that period (and only once 'naturally') is immense. It has really screwed with my head, I feel like a completely failure most of the time.

(*believe me I know it's worse for those dealing with primary IF)

Anniemac, there is certainly basis in what you say. A lot of people are given this so called diagnosis frankly becasue they have not been adequately investigated.

Unexplained infertility is actually no diagnosis at all - all this means is that the docs have failed to find out what is wrong.

The most common tests that tend to be omitted are:-

Adequate x-rays of the uterus which may show abnormalities not otherwise seen at laparoscopy.

Hysteroscopy - telescope inspection of the inside of the uterus which may occasionally show abnormalities not seen otherwise

Repeated sperm counts over several weeks and months to make sure there is no subtle abnormality

Testing the sperm in special media such as swim up testsvelocity testing. However, when they are done, they often uncover a hidden cause for the suppposed unexplained problem

Thorough hormone tests to detect abnormalities of male hormone or early falls in progesterone

Scanning of the ovaries to see if follicles really are developing and there are no sign of polycystic ovaries.

JMo I would ensure that all the above tests have been carried out, if not ask as to why.

HTH

We never got a diagnosis beyond unexplained secondary infertility - my ovaries are cystic (as in PCOS) but I ovulate every month, dh's sperm morphology is borderline but his count & motility are really high so it shouldn't be a problem.

Minster

Am really sorry to read what happened to your first child.

You do actually have diagnoses - you have PCOS and DH's morphology is borderline. Morphology is just as important if not more so than count alone.

May I ask how you actually know that you ovulate monthly - I only ask as I have PCOS and I know for a fact that I do not ovulate (its a rare occurence at best). It is possible also to have periods without actually ovulating.

Hi Attila, I had six cycles of follicle tracking (mid cycle scan & 7dpo progesterone levels - always over 35nmol/L), my cycle are always 29 or 30 days long I get a +ve OPK on day 16 (with a peak on the fertility monitor) then a temperature shift on day 18. Apart from when I've been breastfeeding my cycles have been pretty much exactly the same for 10 years. No one will diagnose me with PCOS because I'm ovulatory, my LH is raised compared to my FSH but less than double (most recent ones were FSH 3.7 & LH 5.4). My oestradiol is on the very borderline of acceptability - my clinic likes it below 200, mine is always in the 190s on day 3. I've read that oestrogen dominance can cause problems but my progesterone is always okay ....

DH's last SA (3 months ago) was fairly typical - 3ml, 120million/ml, 65% motile, progression 3, 20% normal forms. The morphology varies between 15-25% normal. What worries me is that a lot of the abnormal forms are head abnormalities which can interfere with fertilisation.

I've had an HSG & hysteroscopy, clotting, karyoptyping, immune testing, repeated hormones levels & DH has had multiple SA. I haven't had a post coital test or a laparoscopy though.

Hi Minster,

Would not actually take too much note of the OPK particularly if PCOS is present as these can be particularly misleading. The temp shift can be misleading as you can get a rise in temp in the second half of your cycle when an egg has not been shed. Not suggesting you stop doing either but wish to point out the various problems associated with such things. OPK's measure LH; usage of these kits also assume only one rise in LH which is followed by ovulation (not true). I note that your LH is not twice as high as FSH but that actually does not matter; the fact that LH is raised anyway compared to FSH is one indicator of PCOS. I do know of women with PCOS who do have more ovulatory cycles than non ovulatory ones. Its not common but certainly not unknown.

Has your DH been checked to see if there is a varicocele or some such problem by a urologist or even an andrologist?. Has he ever been seen by either person?. I would be concerned like you are about the morphology of the sperms. Think your DH would need more specialist advice.

A lap is done is endometriosis is suspected, do not have surgery unless you need it.

HTH a bit and good luck.

Attila, Minster, Annie, Lissie - thank you so much for all your advice!

When surrounded by pregnant tums and babies, it feels like you're the only one these problems happen to - it's a help to know that's not true. All your advice has been very helpful and has given me a lot to think about.

Attila, thanks! I think we need more specialist advice on the sperm issue. Unfortnately since we have no more money for private treatment/investigation and nothing is 'wrong enough' for ths NHS to be interested in us I doubt it is going to happen.

We just keep hearing everything is normal over & over again. The only thing that really increases the pregnancy rate in unexplaind IF is IVF which is absolutely out of the question at the moment.

There's a PCOS doc that a friend saw privately (I can't for the life of me remember is name though ), who is excellent I'd really like to see him because I would love to know what is really going on.

JMo - I hope you have some good news soon.

Hi, can i please crash this board?! I have just had my first TVscan on CD12, I've been through clomid and told just to try and now finally done the scanning and i was told that my eggs are too small and the uterine lining too thin to sustain a pregnancy.
Does that mean that this is a one off or is something wrong hormonally?

bump.

Hi JMo.

I would strongly recomend you look into holistic therapies. Therapies such as acupunture and reflexology can be increadibly successful.

There is a directory called The Maternity Network which are all holistic therapist. www.thematernitynetwork.co.uk
Im not sure what area you live in but even if these therapist are not in your area they may be able to recomend someone for you.

I hope that this is helpful.

Good luck with everything my heart goes out to you.

JMo - secondary infertiilty is very common so you are by no means alone. The majority of secondary infertility problems are due to either (a) hormonal changes in the woman, often causing luteal phase defect or (b) reduced sperm count/motility/morphology. Things often change after a first baby in both these regards. Many men are told their sperm is fine by GP or consultant and in fact it is not. For some strange reason doctors seem v reluctant to tell men there is a problem. And this is a shame since many sperm problems can be easily corrected with dietary / supplement / lifestyle changes. I would second the advice to see a nutritionist but would also suggest charting your cycle for just one or two months to see whether luteal phase defect is an issue and look again at your husband's semen analysis. If it was me I would steer clear of the clomid if you already ovulate - it can make conceiving harder not easier sometimes because it dries up fertile cervical fluid.

Take care.

"And this is a shame since many sperm problems can be easily corrected with dietary / supplement / lifestyle changes".

I wish this were indeed the case but some problems cannot always be fixed by such methods. Sperms are complicated things and there is much about them that is not understood.