Would you try again?

[twinkledag]

My history:

IVF 1 on NHS - failed fresh; successful FET
IVF 2 at Boston Place - failed fresh and FET
IVF 3 at Serum - MC fresh and failed FET
IVF 4 with PGS testing at Reprofit - nothing suitable for transfer
IVF 5 at The Evewell - failed fresh, none suitable to be frozen

😞

Went for our follow up at Evewell. Doctor says he would try something different next time (long instead of short protocol). That we're still young. I have lots of follicles.

I'm 40 with an AMH of 10.7.

Would you try again?

Yes, I would. Are you taking DHEA and CoEnzyme Q10?

What sort of numbers did you get from each cycle in terms of how many retrieved, fertilised, what day transfer, etc?

How come you've switched clinic each time? The first round of IVF often tells a clinic a lot about how they might proceed differently with a subsequent cycle, so doing a second cycle with the same clinic is potentially a plus in that respect.

What additional testing have you had along the way? Are there more tests that might help identify what's going on?

I personally would probably be thinking hard about donor eggs (assuming there's no known sperm issue, in which case I'd be thinking about that side of things, too). But that's quite a big step, so I can absolutely appreciate if you don't feel that's something you'd want to consider at present.

From the looks of it you are getting 1-2 blasts suitable for transfer on each cycle which depending on how many you started out with could indicate poor egg quality. Long protocol is known to produce lots of eggs but not necessarily good quality so wouldn't go that route

Other than long protocol what else have they suggested? Any additional medications?

At your age I'd probably go back to basics and try a round of natural IVF - so collect just the one egg your body naturally selected that month and have that one collected and cultures to day 5 and transferred

I don’t know whether I would go again. Similar to @Persipan ‘s questions and also,

What’s the time line between the first (successful) cycle and now?

On the 4th one with the PGS, how many eggs did you get? How many fertilised and how many were tested?

Sadly I think only you can make that decision, guided by what your clinic can advise. Some people have the finance and emotional ability to continue multiple times. We are only on our first round, but I already know there is going to be a limit to how many times we can do this before I go totally mad and that life will need to move on

Would you consider switching to donor eggs?

Depends on how many eggs and embryos you are getting and the reason behind your infertility. If you are airing on not trying again then I would consider DE or surrogacy. Wishing you peace whatever decision you make ❤️ x x

@HavelockVetinari - why would you try again? What would be the deciding factor for you?

ps I am taking coq10 and have done for over a year. No to DHEA.

@Persipan -

IVF 1 - over odd eggs collected; 18 fertilised, 2 blastocysts. 5 day transfer. Successful FET.

IVF 2 - 18 collected; 14 fertilised; 2 blasto. 5 days transfer. Fresh and fet failed.

IVF 3 - 10 collected, 5 fertilised, 5 blastos. Miscarriage fresh. Failed FET.

IVF 4 - 7 collected; 6 fertilised. 1 6-day blasto tested. Not suitable for transfer.

IVF 5 - 8 collected. 5 fertilised. 1 early blasto at day 5 transferred and failed.

The reason why we switched clinics so often is the first private clinic was the run by the same person who gave us DS so we went back to him. Second time was to save money but all that flying to and from Athens was madness. Third time was to save money. And the last time was because if recommendations from here about the Evewell. We also looked at ARGC.

I've had the usual tubes flushed etc. Has the Greek hidden tests from serum. All come back fine, I always get told I'm in good nick! What other tests would you recommend?

There was an MFI issue but over the years with supplements, lifestyle changes, etc the morphology which was always low is up to 4 - the minimum needed and the numbers are good, I think the highest tested was 84 million.

I have started to think about donor eggs but I just failed this recent cycle 2 weeks ago so it's early days.

@itwasalovelydreamwhileitlasted - why would you recommend natural IVF?

@EarlGreyT - I first had IVF in 2013.

The PGS cycle - only 1 was suitable for testing.

Thank you @Anaesthetist83 and @FingersXssd83 💐

@AliceAbsolum at the very start of considering donor eggs as my last cycle only failed 2 weeks ago.

Honestly yes. My plan going into IVF was to do it as many times as it took as it is a numbers game. But while I am also close to 40, I have treatable conditions and an ovulation disorder that (managed well) can result in more eggs and therefore more blastocysts. That’s where your individual cycles aren’t working well - the end blastocyst number. (I had 6 blastocysts from 2 cycles). If you have higher folicles and so low egg reserve isn’t a problem then maybe ask for the maximum dose protocol possible and see what happens then. In your position I would focus on multiple egg collections to build a reserve of frozen blastocysts and only do FETs.

Hi Op, your amh levels are good, but your sadly your age can affect egg quality. I highl, highly recommend taking Dhea if your hormone levels are in the normal range! They dont work for everyone but worked for me! Good luck. X

Thanks @Teddybear45 - the consultant said that they put me on a low dose in my last cycle. There was a lot of follicles but they weren't getting up to the correct size quick enough!

Just don't know if I should close the door and focus on DS.

😫

@Smiler88 where can I get dhea?

I would try the high dose as I got my BFP when my consultant ignored my PCOS and just gave me the max stimulation drugs he could approve. If it results in more blastocysts then it would be worth it. If the high dose doesn’t work then at least you know you tried everything.

Hi i think its called micronized dhea, it has to be shipped from america. I just got it online. I would also get your dose increased if you were on a lower dose.

DHEA may also reduce egg quality in some situations. Best not to take it without talking it over with your consultant. Mine didn’t want me to take it as it can sometimes influence testosterone levels in women with PCOS.

Hi @twinkledag - if I were you, I would - but I'd want to be on every additional med going. Prednisone in case of high NK cell activation, aspirin, inhixa/clexane injections etc. All the stuff that they don't know for sure increases the chance of successful implantation but won't do any harm. I threw everything at it on my 4th cycle and it was the only one that worked. Could have been coincidence, though!

Also, I'd consider donor eggs. You're ending up with a small number of transferable blasts each time (except for your third cycle - that was a good result!) - which may be declining egg quality due to age (I'm 40 too and had to use donor eggs as I never produced any of my own).

But it all comes down to how badly you want it, and how resilient you are, and the impact it's having on your life. Only you know for sure whether you should. Personally, I'd have kept going for as long as we could afford to . . .

@RedPandaFluff - funnily enough my 3rd cycle I was on all in your list - pred, clexane, etc, and a high protein, low carb diet...

@RedPandaFluff what is also skewing my thinking is I already have DS, I already have someone calling me mummy. But I wanted a bigger family so badly 😞

@twinkledag
Because IVF stimulation doesn't work for everyone......the body is its own best judge and natural selector of the best egg to put forward above all the others each month to mature and be released? Why force the body to produce loads of eggs which it would never have selected for maturation anyway? I suspect this is true of a lot of people who only get 1 or 2 blasts from a cycle - that the number of bad eggs far outnumber the good - so let nature decide (with a little help!)