IVF or Natural / Natural Modified

[Sian7919]

Hi everyone, unfortunately I just had a failed round of IVF. I had 7 AF and only 3 eggs collected, AMH 3.12. I was hoping for more and previously had a much higher AF count of 14 on a previous scan, so not sure if I just had a lower number that month and it may be higher on another month. I was on Menapur 450IU and Cetrotide. 1 egg fertilised but the shell was damaged and it was not viable. Now we will have to pay and are in the Manchester area.

Does anyone have any advice on whether we should try again with the same regime or try natural IVF. I've heard Create do a package with egg collection and embryo freezing x 3 for approx £10200 for natural modified. We have a consultation next Thurs with St Marys to discuss next steps, but worried they might be too slow and not enough monitoring if we go with them again, as two of my eggs went over before collection.

Any advice, I feel really confused?

@Sian7919

Just replied to you on the other thread

My 3 cycle package with Create including ICSI and all drugs was £13.4k - it worked for me as pregnant with twins. We banked blastocysts from the cycles and then Creates embryologist team reviewed all the time lapse footage and picked the two which best complemented each other. I'm convinced this made all the difference compared to just popping back in the one which made it to blastocyst first

(I actually put in a day 5 5BA and a day 6 4BB - I still have a day 5 4AA and a day 5 3BB which many clinics would have chosen ahead of what Create decided on as on the face of it they are graded higher and some clinics consider day 6 inferior - but Creates way has given me my twins)

Hi @ivfbeenbusy thanks so much for the info. Is this Create Manchester? Would you mind sharing your age, baseline AFC and AMH? And was it natural modified you did? I have an appointment with St Mary’s on Thurs and can ask the dr if they think I’ll respond to natural modified. I’d hate to start it and then realise I do actually need full dose stims. Would they change/up the doses if they think I need it? Sorry for so many questions... but

How often did you have scans and bloods? What drug regime did you have?

My partner and I are so disappointed with this first round failing and the one egg that fertilized being cracked, that I really don’t think putting all our money into one cycle is going to do it. I don’t think my partner will want to pay for another after, so I’m trying to go for one that is multiple rounds.

Also I realise this is a little naive but on this failed cycle I started stims on day 3, then had one scan only on day 10/then trigger that night... then IVF with sperm. Is it the same cycle timeline for natural modified? Do they do the ICSI or IVF after each EC and then freeze (hopefully) the embryos? They’re not just freezing the eggs?

What are the staff like, is there a dr you can recommend?

Thanks so much for your reply and massive congratulations on having twins 💜 that is the dream xxx

@Sian7919

Heya I'll try and work through your questions in sequence so I don't miss any!

I was with Create Birmingham

Age - 36 when I did my first cycle of IVF.
AFC - around 10-15 depending on month plus I've had 2 ruptured ectopics so surgery near my ovaries often led to reduced AFC in the months after
AMH - 12.9 so a little low for my age. Only tested once as it doesn't really tell them
Much and AFC is a better indicator

Most other clinics can be a bit "snooty" about natural modified IVF as they very much set their stall by getting as many eggs from you as possible. They consider it a numbers game. Whereas Create has a totally different ethos. Numbers isn't as important to them as quality hence why they will go forward to egg collection even if there is only 1 follicle whereas most other clinics say there has to be a minimum of 3 otherwise they abort the whole cycle and they'll pump you full of the highest dose drugs to get them

Most clinics will tweak the dose of drugs part way through the cycle if it didn't look like you were responding. But they can only do that if they are monitoring you closely - it's no use if you only have one scan?!

With both short protocol and natural modified I would have a first scan and blood test on cycle day 4 or 5 or 6 depending on how the weekend fell and then every other day. Nearing trigger time it might be a scan and bloods two days in a row

Short protocol IVF my drug regime both times was
225ml Bemfola daily from cycle day 2
Cetrotide as required to prevent ovulation
Trigger single or double depending on hormone levels

Natural modified IVF drug regime was
Tamoxifen tablets 20mg I think from cycle dab 3
150ml of Bemfola every OTHER day

The second natural modified cycle they tweaked it a bit and reduced the Bemfola to 75ml daily from cycle day 3 and added 75ml luveris for a couple of days
Cetrotide as required
Trigger single or double spending on hormones

I'm surprised you had so little monitoring with your cycle was this an NHS one??? I have to say that i wouldn't stay with the same clinic if I didn't trust them and felt that they had failed in some way with a previous cycle - there is no excuse for lack of monitoring and losing 2 of your follicles. I stayed with Create for 5 rounds because it wasn't through lack of trying on their part that the first 2 rounds didn't work As it was clear that my egg quality was really rubbish for my age and given the amount of supplements I'd been on.

I would recommend the 3 cycle package - it really took the pressure off and enabled Create to tweak things each month to get the best results.

They will do ICSI after each egg collection as normal and culture to either day 3 or day 5

Create has a policy of freezing at least one fertilised embryo on day 3. So the first round we froze our best quality on day 3 and let the other go to blastocyst (ended up being day 6) and then was frozen (these two actually ended up being my twins as the day 3 was thawed and cultured to day 5 and transferred with the day 6)
On the second round Create let them all go to day 5 and we froze another 2.
I did both these rounds back to back ie no break in between.
Cycle 3 was during lockdown and a complete bust as my hormones were out of whack and after 5 rounds in 18 months I think my body had had enough and also tamoxifen makes my lining too thick so I couldn't take it and we reverted back to more of a short protocol IVF and unsurprisingly my egg quality went back to rubbish so instead of doing a fresh transfer as we had Planned we thawed the 2 from January

I really loved the staff at Create Birmingham- very friendly and felt like they cared (they were almost in tears when I had the twins confirmed)
I met some of the anaesthetists from Manchester once as they were covering Birmingham and they were lovely.

Create also really looked after me when I fell pregnant naturally in-between IVF cycles and did everything they could to try and prevent a miscarriage. Also when i had an ectopic last year and was fobbed off by my hospital (I knew what it was as I nearly died from one before but they wouldn't take it seriously) I rang Create in a panic they scanned me within 1/2 an hour and called an ambulance and I was In theatre within hours

Hope all that makes sense!!!

@ivfbeenbusy thanks so much for the detailed info, super helpful. Yes my round one and only funded was NhS and only had one scan at day 10. I also made a boo boo and injected double dose Menapur 450 (so 900) one day and when I rang the clinic I asked if a dr could call me but the nurse fobbed me off and I received no call from the hospital. Anyway when I went for my 10 day scan, two follicles were big and these were the ones that were lost and only managed to collect 3 others, 1 wasn’t mature. I like the sound of Create but will need to see what the consultant at the NHS clinic thinks and whether they think I will respond to natural modified. My AMH was only 3.12 and unfortunately I have a completed medical history and take two medications :(

I’m so happy you’ve had a successful outcome. I’m 41 so really feel my time is running out x

Hi @Sian7919 I would definitely ask create if natural modified works with a poor response. I think if I recall correctly @ivfbeenbusy always got plenty of eggs but they dropped off. This is different to if you get v few eggs on high Stims and those eggs get nowhere. I’m wondering same myself as I am a poor responder and never get many eggs so wonder if I need max dose of Stims to get what I do.

@Racinglikeapronow yes I wonder that too, I don’t know the answer to that. Hopefully I will on Thurs x

I’d be interested to hear how you get on if you don’t mind reporting back. Good luck with the meeting.

@Sian7919 bear in mind your NHS consultant is unlikely to know in detail if a natural modified approach could work for you, nobody knows until they try unfortunately but Create do seem to specialise in this. (I've never gone to Create, just from what I read here, they have free webinars where you can find out more).

How are they supposed to know how you're responding or tweak response if you only get one scan?!
To be honest with my NHS round the consultant was very conservative, they stick to the same protocol, very much one size fits all and at the end of the day the CCG keeps paying them. They do private treatment but I'd never recommend anyone to go to that clinic if they were paying.

When you double injected they may have considered giving you a dose of Cetrotide or something to try to prevent ovulation.
In any case good luck for next steps.

Following with interest! May need to make this decision soon.

Have any of you used funding packages - i.e. 50% refund if no baby after 3 cycles, etc?

Manchester Fertility apparently offers that for age 38-39, but I don't know the full details yet.

@Sian7919 and @Racinglikeapronow I attended the create free webinar (it's definitely worth attending as you can ask questions at the end of the webinar as well) and they say they really recommend natural/natural IVF specifically to poor responders. The webinar is every Monday so definitely sign up to it if you can!

All the best @Sian7919

Sorry I don't know why my reply shows in bold above d'oh!

I attended a Create webinar recently and agree with @BrandyM, they recommend that. I was really impressed with how caring they were, and they focus on quality over quantity.

I was all set to go to them even though it would be a real trek each way, when I received very unexpected funding. If my NHS round fails, I would seriously consider going to Create. I liked them a lot and everything they said made sense to me.

Hi everyone, thanks for your replies. Yes I will update you after the consultation tomorrow. I have a complicated medical history so I need whoever is looking after me to liaise with my relevant medical specialities. I feel this hasn’t been given enough attention up to the present. I am still swaying towards Create, as I like the idea of banking for three months. It would be the dream to be successful and also to have one or two frozen embryos for future goes. That as I say is the dream, not sure if it will ever be reality. I have felt really down about things the last few days, I am hoping to be due on my period in the next few days so hopefully it’s just PMS as I always feel blue before my period. Thanks again for all of your replies. It’s so nice to have some moral support x

So it was not the best. They said that id I tried again with IVF my chance is 3%, with ICSI 5%! I asked about natural modified but the consultant didn't seem to know much about it and said I would likely not get enough eggs, the embryologist also didn't sound positive towards it. The consultant said it wouldn't have made a difference if they'd have scanned me earlier as wouldn't give a trigger before day 10... My partner is devastated as am I. I'm very much go and get what I want and I'm happy to throw lots of money and time at it, my partners works with numbers and thinks it's game over. I feel very sad. I've got an appointment with Manchester Fertility next week, so I think I will have that, see how I feel... potentially have one more regular cycle and then if that doesn't work try the natural modified approach. I am starting to feel now that I may never have children. It feels even worse because my sister in law is newly pregnant and will be sharing scans etc with the family soon enough. I haven't told family... just a few of my friends. Feeling sad. Feeling overwhelmed. Just want a break. I've had so much shit over these last few years, I genuinely can't even begin to tell you. Not sure if that's helpful to any of you, but I did say I would update you x

@Sian7919 - Really sorry to hear what a tough time you've been having.

To be clear, have you only dealt with NHS so far?

If so, you should definitely get opinions from a couple of private clinics, to help you make a decision (or simply to feel you've tried everything).

To share my latest update...

I was referred to the NHS Fertility team (even though I can't get IVF on the NHS, due to having a child already).

Had my consultation and they said that while I don't appear to have any other problems, my high FSH (which usually correlates with low AMH) means I wouldn't be a great candidate for IVF - which is what I suspected. I'm nearly 39.

However, they said it's important to discuss it with a private clinic, as they're the experts and deal with lots of people with low ovarian reserve.

We have an appointment with Manchester Fertility next week, after tests with them a few weeks ago (will discover AMH then). After that, we intend to speak to the Manchester branch of Create.

Have you been referred to MF by the NHS, with results from that?

Hi @CC81 we had the final appointment yesterday with St Mary’s. We have an appointment with Manchester Fertility on Mon and have requested all my results etc but already have some so have forwarded these. We’ve also booked a free consultation with Reprofit, Czech on Sun. I called Create But was put off that I would have to pay £350 for another scan, despite having just had a recent one and also the St Mary’s Consultant and Embryologist didn’t seem keen/positive towards it. I haven’t ruled them out but thought I would compare these two first. I have a horrible feeling that I might not be successful here so I wanted to see about Czech because my understanding is that it is cheaper and I think they might do banking like Create, which I also like the sound of. That’s if I can even grow an embryo. Feeling quite despondent as i mentioned have some other health issues which make me even less straightforward. I’ve decided that I’ll do quite a few rounds tho before giving up as you can’t take money with you when you die. Pls will you let me know if you end up having a consult with Create how it goes? X

@Sian7919 - Our apt with Manchester Fertility is on Tuesday, the day after yours (booked 6 weeks ago - it's been an anxious wait!).

So we should compare notes afterwards!

Are they looking at tests you've done at other clinics / NHS? Rather than tests with them directly?

I've never been quite sure about how it works, with test results - I guess every clinic has a different approach. We're going to ask MF for a copy of all our results (hopefully that won't be a problem).

You're doing the right thing by looking into all the options. You need to feel like you've done everything you possibly can.

I suspect MF will tell us that standard IVF is unlikely to succeed, with my results. But also that we won't know unless we try.

If we're eligible for MF's 50% refund scheme, that might sway it. But if not, I'll probably be more inclined to try natural modified with Create (as they're the experts and the process may be less intense).

But we haven't yet enquired with Create - we'll approach them once the MF apt is over.

We're still trying naturally at the mo, as there's nothing medical standing in the way of that. The only thing left to check is that my tubes are clear (but the NHS waiting list for that may be quite lengthy).

Like you, I feel time is short... but I don't want to rush into the wrong thing.

Yes let’s compare notes. I have a consultation with MF and Reprofit in Czech. Will see how they compare... have not ruled out Create either x

Hi does anyone have proof natural modified produces better quality than normal ivf - I can find no scientific evidence anywhere ! I’ve asked create to show me evidence , I’m calling back Monday as missed call last week. Did they produce any evidence ? My clinic said it’s a marketing ploy . The more eggs you get , especially with low amh the better chance to get 1 good one they said x

@Sunshinelove8 - I think it's just different medical hypotheses - i.e. different theories based on lab experiences, etc. Not easily quantifiable.

Statistical evidence has to be quantifiable and produced under very specific conditions, so doesn't fit too well with this type of issue.

My GP (who specialises in this) said that the matter of 'evidence' is generally very difficult with fertility, as there are so many unknowns. Lots of people have 'unexplained infertility', even though on paper there's nothing wrong with their reproductive system.

Even test results don't provide evidence of much, as while things like low AMH/AFC can be an indication of low ovarian reserve, they don't actually know for sure. That's why some 'poor candidates' do well with IVF, while some 'good candidates' don't.

From what I understand, some specialists hold the view that eggs encouraged to mature more naturally are more likely to be good-quality, instead of the false push to maturity that standard IVF gives (i.e. eggs that otherwise may not have made the grade - so are more likely to fail). But as every egg is different and every person is different, it's not easily quantifiable.

Also, some people don't react well to heavy doses of drugs - so the stress impact on their body may lead to reduced quality/success. But again, I imagine it's just a theory.

I really do wish there were more certainties!

Why don’t they do a mass experiment getting the same women with a mix of low and good amh etc to do ivf and then natural modified? I don’t know why there aren’t more experiments :-) yes it’s a minefield to get the right procedure and not spend precious money and time doing the wrong things ! X

@Sunshinelove8 - Yeah I know! It's so tough.

I think despite all the experiments already done (and more they could do), they'll never know for sure which factor has made the difference in each woman they study.

There are so many factors! My head is spinning from all the reading I've done in recent months...

@Sunshinelove8 I think I may have contributed on a different thread however I don't have evidence but my experience is that I got MORE eggs on natural modified than I did with regular IVF. The approaches are very different - I started stimulation drugs on day 2 with regular whereas with natural modified I started on day 5. Different drugs and vastly different doses as well.

I think really the only way to know which is best for you is to actually do a round of each and see which one you respond better to. Try one and if that doesn't work well, try the other. It is is all a bit of an experiment to see how you as an individual responds as what works for me may not work for you and vice versa xx

Thanks both and @Weswoo how are you getting on now? X

@Sunshinelove8 just waiting for AF to show up so I can do another collection and transfer my frozen embryo