Private IVF or not....

[spinduffy]

I'm 38, husband 42. TTC for 14 months.

I had a previous missed miscarriage in a previous relationship and had an ERPC. Since then my periods have been lighter.

We have been seen at the Royal fertility clinic and were put on the waiting list for IVF (1 month ago) and I'm get a hysteroscopy.

Our tests were normally, with the exception of my uterine lining, which was 4.2mm on day 27 at first appt and 6.2mm on day 11 at next appt (thin, but improved). AMH was 15.2.

Another month and another period and I can't help feeling that I should go to to a local private hospital (much better results) for a cycle, whilst awaiting NHS (NHS consultant had said she didn't think we should go private whilst awaiting NHS cycle). The private clinic stats are much better for my age and I can't her feeling really panicky when I look At our local nhs success rates (16% v's 32% live births for 38-39 year old).

We can afford to go privately, but wonder are we jumping and not giving ourselves long enough trying naturally?

I would really appreciate others opinions on what they would advise!x

We opted for a private IVF whilst we were waiting for our NHS try to come up, it didn't work but I'm glad we did it as IVF can answer questions, in my case I didn't respond to the drugs and I only grew 3/4 follicles despite drugs being trebled. So when my NHS chance came up, they already knew I needed more drugs which again I only grew 2 follicles, the NHS go would have been abandoned due to lack of follicles however my consultant knew that I got fertilisation on my 1st private go and went ahead with the cycle, the result was a heathy DS. If you can afford it I would go now.

Honestly? Private.

You have a little bit of time so don't panic. But the NHS is very one-size-fits-all IMHO and if you can afford to go private I would, in your position.

Good luck OP

Private. If you can afford it, time is of the essence and like Grittzio said, you find out so much info from different rounds.

I'd go private to see if anything can be done to improve your lining. It sounds like that is likely to be the problem, and it may be that it can be improved without resorting to IVF.

I have had persistent uterine lining problems

If you've had an ERPC then I would bet any money the lining issues are to do with Ashermans - which a hysteroscopy will diagnose

I would strongly advise against doing any embryo transfers until you've got the uterine environment sorted - adhesions can be treated with a surgical hysteroscopy but may need a coil inserted for a while to help the endometrium heal and stop it sticking together

If it's NOT ashermans, then it may be worth trying a few monitored natural cycles with lining support before rushing to IVF - as if the problem is the lining, it may be that solving this might enable you to conceive naturally. My Dr said we could add in oestrogen to build up my lining (it never got above 5mm on a natural cycle) but we'd have to do monitored cycles to ensure we didn't block ovulation, and to assess the response to the oestrogen

I was told that oestrogen may work to thicken the lining, but that it would take 6 months and we should not try and conceive in that time. At my age, this sounds too long.....

Also gynaecologist thought ashermanns was unlikely as ERPC was done by suction, not curettage

Up to you whether you want to rush to IVF in that case - but regardless, I wouldn't put anything back until you've had the uterine cavity checked out via hysteroscopy

Adhesions are less likely with a suction curette but still possible

Does the Dr have any other suggestions as to why your previously OK lining is now thinner and your periods are lighter since the ERPC?

I say this as someone who's has persistent thin lining (due to non responsive oestrogen receptors in my endometrium) and one miscarriage of a chromosomally normal embryo that was likely due to my thin lining

Two months of oestrogen exposure seem to have upregulated the oestrogen receptors as my lining thickened up to 11.1mm all by itself in my current fresh cycle, when it's never got above 7mm without oestrogen before

We aren't doing an embryo transfer until I've menstruated properly and my lining has had a chance to properly shed and regenerate - this is all purely personal to me and my situation, and doesn't mean any of this is applicable to you

Just purely intended to say that IVF in and of itself won't solve a thin lining and that the issue needs to be addressed as part of the solution

No other suggestions as to why it's thin. The doctor wasn't at all concerned by day 11 thickness of 6.2, as it was trilaminar, and said she would transfer to that thickness. I'm not so convinced. I'm taking baby aspirin, raspberry leaf, vit E, among other supplements. Also attending acupuncture. When I asked NHS doctor about oestrogen to thicken it, she felt that this was not necessary. My thoughts are that it may well be!

Have they checked the uterine blood flow?

Have you had a saline ultrasound to check for adhesions or are they just waiting for the hysteroscopy?

My Dr said his absolute minimum for transfer was 7mm, but that was pushing it and he preferred 8mm+, ideally 9mm+

Dr Sher writes a lot about thin lining and says anything below 8mm is suboptimal

My Dr said he has had pregnancies below 7mm on ovulation induction cycles but no way would he risk transferring a good quality embryo in an IVF cycle into a suboptimal endometrium

I tried everything to improve my lining in a natural cycle : red raspberry leaf tea, acupuncture, vitamin E, baby aspirin, pomegranate juice, heat packs, vaginal viagra. Didnt get above 4.5mm

Because all of those are designed to improve uterine blood flow

My consultant checked my uterine blood flow with the doppler ultrasound and it was spectacular

So blood flow wasn't my problem

My lining simply wasn't responsive to oestrogen and needed additional oestrogen to thicken up

In cases of ashermans all the oestrogen in the world won't make any difference unless the adhesions are dealt with

Following the miscarriage my Dr says we absolutely will not transfer until we are absolutely confident in the quality of the endometrium

Thanks for the update.

My miscarriage was a missed miscarriage and doctor felt that this was unlikely to relate to uterine lining, again I'm not so sure.

How did you get uterine blood flow checked?

Hysteroscopy on Monday, so hopefully I will know better then.

I was a little reassured that lining was 6.2 on day 11, as I didn't ovulate until day 15, so hoped it would probably have been thicker by that stage.

Sorry lovely wasn't suggesting your mc was due to uterine lining issues - just that as you've only had lighter periods since the ERPC that is suggestive that something has changed since then, and that it's a really important factor in both getting and staying pregnant, so especially if you're going to go through IVF, important that Drs take it seriously

I'm so sorry for your loss - mine was a MMC too, 3 months ago

My Dr checks my uterine blood flow when doing a normal pelvic ultrasound

Good luck for your hysteroscopy on Mon.

I would go private of you want to proceed quickly. I'm due in two weeks after my first round of IVF on the NHS and was treated really well. Didn't have to wait long between appointments etc but I know this depends on the area.

My lining was usually around 8/9. I had 2 mc via IUI on the usual gonalF.

With private IVF it increased to 12 because of the drugs I was on - fostimon & merional.

Some women at my clinic were given clomid and viagra as well and some saw their lining increase from 4 to 13.

This is why it's useful to go private, they can increase your lining without any waiting around.

I was at ARGC in London - a 4 hour round trip. It wasn't easy but am due to give birth in 3 weeks time so very, very worth it.

Good luck.

If you can afford, then go private. I would also consider best (for your age group) overseas clinics, that will be probably cheaper. I know a few ladies who have undergone ivf at overseas clinics and have been happy with service and price. Some fell pregnant on the first cycle in Poland. All the best

Hi spin, are you in N.I.? Just wondered as you'd mentioned Royal Fertility Clinic.

If so, I've done NHS cycle there and am just about to start my private cycle, if you have any questions please ask away (or p/m me).