ICSI / FET or fresh

[IVFninja]

Desperately seeking some advice please and general “what would you do if you were me” thoughts after two days of none stop crying.

I’m now 35, been TTC for 2.5 years and it hasn’t happened due to male factor infertility. We were approved to commence a funded cycle with ICSI at the end of 2019 and then the pandemic hit so this was understandably halted. My AMH in January 2020 was 12.5 and I’ve not had one since.

At the end of December 2020 I started my stim drugs and had my eggs harvested last week. I had 9 collected, 5 fertilised and 2 went to the “good” blastocyst stage. This is when things take a horrible downturn. The night following my egg harvest, I woke up in the middle of the night in agony which I’m told can be quite normal. I woke needed them bathroom but I think I sat up too quickly/placing too much pressure on my poor abdomen and I passed out in pain, consequentially wetting the bed.

DH took me to a&e as he was concerned and they noted that I’d need to see a neurologist to rule out epilepsy (!!!) despite them barely conducting any tests themselves. They also spoke to my fertility consultant who is part of the hospital too who confirmed my treatment could still go ahead as planned. I then spoke to the embryologist and nurses who updated me about my planned transfer and how my eggs were progressing etc.

I turned up for my embryo transfer, led to the treatment room only for the consultant on that day to tell me she didn’t want to progress my treatment until I’ve had the appointment with the neurologist, so consider my fresh transfer cancelled and I can have a frozen one in a few months.

I am beyond devastated, not only do I feel this has been so poorly managed from a communication perspective but I feel robbed of my fresh transfer which I know carries far higher success rates for my age.

So here’s the question... what would tot do if you were me? Continue with the FET at this incompetent clinic with one of my frozen blastocysts knowing it’s likely to fail and cost me valuable time or start initiating the private route for a fresh transfer? Or am I being overly negative? This was my first round of treatment, my head is a bit blown with statistics etc.

Any thoughts welcomed, I’m feeling very lost and hopeless at the mo xxx

Also forgot to mention is it worth getting another AMH as it’s been a year since my last one?

Hi OP, I'm sorry you've had a rough time, I hope you're feeling physically better now though at least. I'm not sure why you think that a FET is more likely to fail? The general consensus now is that FETs carry a slightly higher success rate than fresh transfers, because all of the nasty simulation hormones are out of your system. Medicated cycle FETs are even more successful than natural cycle ones. If you have good quality blasts there's no reason to think that your chances of success will be lower. I believe that lower quality blasts are more likely to be poorer quality after they are thawed though. Good luck xxx

It’s totally understandable how you feel and the stress of IVF in itself on top of what you’ve been through I’m not surprised you feel mind blown. I can’t imagine how it feels to prepare yourself for transfer day for it not to happen at the last minute. Have you talked through why it happened that way with the clinic? And although it doesn’t sound the best communication wise, would it have changed the outcome if they’d made the decision sooner, re the fresh one being cancelled?

Re AMH my impression is it isn’t the greatest indicator of your chances of success on its own. My AMH was 7.9 and I still got 12 eggs.

To try and give some reassurance, I’ve read the FET seems to be a bit more successful than fresh transfers. I was 33 during IVF so similar to you, my fresh transfer failed, I had to wait a month (a cycle) for my ovaries to calm down and then had FET which worked.

Wishing you well xx

I should add that I'm older than you, and have had a successful pregnancy from a fresh transfer, and am now nearly 16 weeks pregnant with a frozen embryo from the same IVF cycle. The fresh transfer was 2 5AA embryos, and this frozen one was a 4AB (5AB) by the time it was thawed and transferred so even a poorer quality frozen embryo resulted in a viable pregnancy.

Thank you so much for your kind words, you have no idea how much comfort both posts have provided me. I’ve spent the last two days pouring over statistics and sending myself further into the dark clouds, I promised myself I’ll pull myself together tomorrow.

I think what’s hit me the hardest was the shock - I went from sitting on the chair preparing for the transfer to it being pulled away by a stand in consultant flippantly glancing at my notes and making an extreme decision. I was SO excited too - very aware of the potential for it to not work - but still excited. I feel they just took that away so callously and needlessly - there was little to no empathy whatsoever we really are just a cog in the wheel at these places.

I think factoring in what you’ve both said I’ll progress with a FET next and use one of my blastocysts. Fingers crossed for a better experience next time. Out of interest, what meds do you have to take ahead of a FET? Is it buselerin and Meriofert again? Xx

If you do a Medicated FET cycle then the meds are exactly the same a for a fresh cycle, except you won't have the ovarian stimulation drugs but will have oestrogen instead to build up womb lining.

Hi @IVFninja I’m sorry things got cancelled for you at the last minute.

It sounds to be like the emergency doctor was concerned because you lost consciousness and you were incontinent they wanted to rule out a seizure, hence the neurology appointment. I’m a doctor myself but I obviously haven’t assessed you and don’t have all the information, so I can’t comment on whether that’s the right decision or not.

It sounds like the doctor doing the transfer found out that you were awaiting a neurology appointment to rule out epilepsy and they didn’t want to go ahead. I think that based on the information they received that would be a fair decision, they need to ensure that a person is well enough to have transfer and become pregnant. If someone could have epilepsy (and I’m not saying that’s your case at all), then medications need to be started and adjusted, and a lot of antiepileptics cause adverse pregnancy outcomes.

I had a fresh cycle in November and I understand how difficult what you’ve experienced is, I developed a suspected allergy to progesterone the night before the transfer, my specialist said we had to cancel everything and in the end we agreed to transfer the least viable embryo and it was unsuccessful. When my specialist was explaining it to me, she said she didn’t want to “waste” a really good embryo knowing I could have to stop the progesterone, as the embryo would then definitely die. She told me how she had to make sure the conditions were perfect and that she will even insist on cancelling a cycle if a patient has a cold on the transfer day. She wanted to give the embryo the best chance possible. I was really disappointed too, especially when it was then unsuccessful and it’s prolonged the journey which is always hard.

I suspect that you’re worried because you’ve seen some incorrect statistics, to my knowledge fresh and frozen cycles have pretty similar success rates and as mentioned already, frozen can be more beneficial. Honestly I felt horrendous after all those stims so I can see why the body would be in a better state with a frozen transfer.

I think the best option would be for you to discuss this situation with your assigned doctor and make sure there is a proper plan in place which all the specialists are aware of and agree on moving forward. It’s difficult now the ball is rolling with the neurology appointment, it may take some time before you’re reviewed by them. Also, you could speak with your GP and see what their opinion is on the situation?