Confused about assisted conception, next steps?

[Celen]

Hi all.

I'm wondering if anyone can help direct me in next steps?

I'm 39. Been ttc-ing dc2 for 2 years with no luck. Had an mc and an mmc but not got pregnant for 10 months since. Had hormone, rubella, chlamydia tests and ultrasound via nhs which have come back all normal.

So what can we do next? GP has told me nhs cannot offer any fertility treatment & anything else will have to be private. But we're not sure what next steps are? Is it a lap & dye and/or hycosy procedure? Can we get those via a path towards IUI or IVF? Would private consultants advise those before the actual fertility treatment themselves? I don't really want to try clomid as my pmt is off the charts already, so not keen on anything that might make me more hormonal.

I'm so confused and bewildered by it all so if anyone can help point me in the right direction, I'd really appreciate it!

Thank you

I'm so sorry for your losses OP.

If it was me I'd probably go ahead and contact the private clinics you're interested in and have an initial consultation. You might well need to have a lap / dye or hycosy, but unless there are suggestions of endo or other reason for you struggling, and if the GP is saying you'd have to go private for IVF anyway, then I'm not sure whether they would be keen on pursuing it on the NHS. But I genuinely have no idea and hopefully someone else might be much more knowledgable. Given that you have DC1 and that you have got pregnant twice relatively recently, then perhaps they would be happy to proceed without lap and dye / hycosy. I'd hope not though. I don't think the procedures are horribly expensive privately, but you'd be looking at several thousand I'd think. AFAIK if you have health insurance you might be able to claim on it as long as it's listed as for gynae not fertility reasons.

I had no ill effects from Clomid (other than a ridiculous number of follicles) nor for that matter from the IVF drugs generally, though my guess is you might struggle if you need to down reg (it basically induces a sort of temporary menopause).

The HFEA website is probably a good starting point for looking at private clinics. Whereabouts are you?

Not sure whether this will have helped at all. And hopefully someone more useful will be along soon!

Thank you so much for your reply cheapredwine

My DH and I are completely at a loss of what to do next, to be honest, so I shall take a look at the website and start there.

Thanks again for taking the time to reply

You're welcome Celen I'm sorry I wasn't much help! Fertility Friends is also a terrific site but there's huge amounts of detail on there and it can be a bit overwhelming! It's completely just my opinion, but if I were you, and you think you want to pursue treatment, I'd consider throwing everything at it because as tedious as it is, so much of it comes down to age unfortunately. If you're London based (or near enough) then you're very lucky, unsurprisingly the top UK clinics are basically there. Some have pretty long waiting lists for initial appointments so I'd make enquiries sooner rather than later... Wishing you all the very best!

Hopeful bump?

I'd be inclined to go direct to a fertility clinic too. They will do investigations , and if you ultimately need treatment, you will already have had tests with them and you'll know who you are dealing with. Even if you don't need fertility treatment, they will be able to spot any problems that can be resolved so you can try naturally.

Tests a clinic will probably do are:

Ovarian reserve - tests of your LH, FSH and AMH levels and a scan to count your antral follicles
Hycosy / hysteroscopy to check the plumbing and your uterus. If you have IVF later , it is sensible to have checked the environment into which you are putting any embryos. I had a hysteroscopy in my recent IVF and they used it as an opportunity to do a scratch (which might aid implantation) so it was a two for one!

Tests they might do include vitamin D levels, swabs for infection, tests for clotting disorders (which can lead to miscarriage).

Don't worry about the fertility drugs, I found I actually felt great during stimulation (large doses of clomid like drugs) if a little bloated. It was fine generally.

When choosing a clinic, someone told me to pick the one with the best IVF success rates that I could afford. I did so, it was eye-watering and I got a BFN, but I think going somewhere cheaper with lower success rates might have been a false economy (ie I'd end up doing more cycles, spending more money and still no BFP!). I did end up with blastocysts in the freezer which at my age (40) is good, and I give some of the credit for that for the excellent embryologists at my clinic. Another thing to consider is whether you might want preimplantation genetic testing. This screens out abnormal embryos in an IVF cycle so you can lower your risk of miscarriage and not all clinics do it, so it might be relevant to your decision.

Best of luck whatever you decide.

Hi Celen, we are starting our first ivf round in June. The clinic needed a referral letter from our gp before they could see us, even though we are private. So you may need the same. We had hormone tests, std tests, rubella, spermatogenesis analysis done before our initial consult. Clinic carried out all other tests, and insisted on repeating some we had already done as they check in more detail. I would call your chosen clinic and ask what they need for you to proceed.

Good luck

I have no idea what spermatogenesis is! Just meant to write sperm!

Hello. Sorry to hear about your losses.

In terms of next steps, go direct to your fertility clinic of choice (investigate a few before choosing). They will want to do their own investigations anyway and they will be able to tell you what those are and how much they cost. They will then recommend treatment based on their own investigations of both of you.

I had ICSI at Create - they scanned me and did various blood tests, then DH had a sperm analysis and then we sat down with one of the Drs re what to do next. All of that happened very fast.

Many private clinics will simply allow you to self-refer, which is what we did with Create.

Good luck!

Thanks for all these great replies!

drinkyourmilk, if you don't mind, please can you tell me how much the initial consultation was? After that, was a procedure recommended to you OR you just decided to go for IVF?

We are at the Nuffield, Woking. They needed my AMH blood test done at the clinic before initial consult (47.00), same with Semen analysis (145.00). Initial consult (includes implications counselling and treatment planning with a nurse at a late date) was 275.00. I also needed a pelvic assessment scan (140.00) which can be done either before or after initial scan depending on where you are on your cycle.
We knew before we went that we needed ivf, but the consultant confirmed this at the appointment.