Over 40 IVF due to Blocked Fallopian tubes

[CyclingMumKent]

Hi, i ll be 41 soon and i m lucky to already have 2 kids, but we feel like our family isnt complete and have been trying for a baby since end of 2019.
I have been diagnosed with blocked fallopian tubes last week and recommended IVF.
Does anyone know if tubes can be unblocked with surgery?
IVF seems quite invasive and i m scared about the increased risk of cancer.
Also i m worried that due to being 41, my chances will be very low and i should just enjoy what i have, without putting my health at risk
Any over 40 like me who had a succesful IVF with own eggs?
Any experiences similar to mine?

Hi OP, sorry to hear about your troubles. Not exactly the same issue as my infertility was unexplained and my tubes were fine, but I did have own egg IVF at age 40 and now have 21mo twins, and am currently 20 weeks pregnant with a frozen embryo from the same round of IVF. I would say be prepared for it to take more than one cycle, especially at our age. The second cycle was the charm for me. Do you know what your AMH level is as that would be a good indicator for how you'll respond to the IVF drugs. Are you worried about an increased risk of ovarian cancer? I think those risks are miniscule tbh, especially if you're only planning on doing a few cycles. I went to my GP with ovary pain last year worried about ovarian cancer due to IVF and she didn't even seem to be aware that it was a thing. She did send me for a scan to be sure and all was fine 😊.

Oh how reassuring.
Congratulations on the twins and your current pregnancy!
Does it mean that your 2nd round of IVF produced 3 good embryos?
That's amazing. Did you implant 2 embryos also on the 1st and 3rd cycle?
Do you know what might have made the first attempt unsuccesful?

That s a fantastic story that brings hope! Such a great outcome!
I m quite a healthy eater. Low carb, no sugar, definitely mediterranean diet and i keep active. Hopefully that will help!
AMH is 7.9 and AFC follicle count 11.
Where you on long protocol or short or mild IVF, if you dont mind me asking?
I m reading that a milder protocol might help with better quality eggs rather than quantity.
I have my appointment on Thursday and will find out more. I m with CARE Fertility.
If I were in London, i would go with CREATE, as they have 29% success rate with mild IVF for over 40s.
Another open question for me is whether to try the ICSI procedure. Any experience with this?

Have a lovely evening and thanks for sharing such a positive story⚘💐

Hi OP, I'll try to answer all your questions!

My AMH was 10.4 and AFC 12. First round I stimulated very fast and had EC after 8 days of stims. Got 6 eggs, 4 made it to day 5 blasts. 2 were good enough to transfer but not top quality, had both transferred - BFN. No frosties.

Second cycle was 3 months later. In those 3 months I had regular fertility acupuncture, hoped my protein intake (I'm a vegetarian), took ubiquinol and reduced my work stress massively. For the cycle they changed my meds a little to try to slow down my stim phase as stimming too fast lowers the egg quality. We also added testosterone gel which can help with egg quality, and I had the endo scratch. I ended up with 9 days of stims and we got 12 eggs, 7 day 5 blasts, 2 top quality hatching blasts transferred which resulted in my twins. 2 more very good blasts frozen. One of those didn't stick but the second transfer was successful and 20 week scan yesterday showed that everything is good so far. So yes, 3 good embryos from that one round of IVF. I also ended up with OHSS but it was worth it!

Both cycles were short protocol, standard IVF, no ICSI and we had 100% fertilisation each time with my DH's average quality sperm. Whether or not you need ICSI should be advised by your clinic based on your DH's SA results though.

I don't know much about mild IVF but believe it is mostly useful where the woman has very low AMH and isn't likely to produce many eggs anyway. I'm not sure which would be more beneficial when you have decent AMH as you do, because you will likely get more eggs to choose from which might give you better odds IYSWIM? Maybe someone who knows more about mild IVF will be along soon to give you better advice on that 🤞

I was given 15-20% change of success of a single baby! Feel free to ask if you have any other questions and good luck!

Thank you so much! Songlsd to hear your scan went well! Not long to go🥰
I am a bit scared of OHSS as someone i know had it after the 2 embryos successfully implanted and she ended up in hospital for a couple of weeks.
Did you have OHSS when the twins were conceived?
Was it very bad? My fear is that i wouldnt be able to look after my 2 little ones (both under 4).
If you dont mind me asking, did you implant 2 embryos for baby nr 3 and only one implanted?
My appointment is tomorrow and one questions i will have is whether to consider inplanting 2 embryos (provided i ll be lucky enough to have at least 2 viable embryos) or just try with one each time, as I hear twins pregnancy are risky.
Thanks for mentioning testosterone gel, will look it up 👌
I am around 26 BMI, i hear it helps to stay fit and i m eating very clean and lots of antioxidants.
Fingers crossed it makes even a tiny difference🤞
Last question, i promise☺ when you say 15% chance of success, is that per each egg collection? Or per each implantation?
Thanks so much, it help a lot to speak to you and your wonderful outcome gives me hope.
All the best with your pregnancy💐⚘🌻

@CyclingMumKent I hope your appointment went well today. Most clinics will give you the option to have a double transfer if you're over 40 because success rates are so low. However during covid I think the HFEA has made this more difficult for them to do because they have a duty to reduce the amount of extra pressure they place on the NHS, and multiple pregnancies obviously use more NHS resources. My clinic weren't willing to do a second double transfer because I'd had a successful double transfer previously and the embryos were very good quality so they said the risk of more twins was too high (and I definitely didn't want another twin pregnancy as we all 3 almost died at the end of the first one). My first transfer didn't stick, but the second one did.
To answer your question, yes my OHSS was due to the double implantation. OHSS is quite rare at our age as we just don't produce enough follicles, but if multiple embryos implant then the hormone surge can cause it anyway. Mine was moderate, not severe enough to be hospitalised but it was still pretty awful. I won't lie, I wouldn't have been able to look after my little ones had I had any back then. I could barely stand, had to crawl up the stairs on my hands and knees, and couldn't eat for weeks.
In terms of the success rate, this varies by clinic. Many were offering 9% chances so I was lucky to find one with a 15 to 20% success rate for my circumstances. At the time that was the figure given for a cycle and I didn't understand enough to question further, e.g. If it would be the same for all embryos created in that cycle or overall so I can't answer that one sorry.

Hi @SamoyedFan123 thank you so much for your reply.
So scary to read that the 3 of you almost died at the end of the pregnancy. What happened, if you dont mind me asking?
My clinic is not keen on transferring 2 embryos.
Our meeting went well and i ll have a short protocol in April. We got my husband results and i m told they look average so sperm at least shouldn't be a problem. I attach the results in case you or someone has more knowledge about reading semen results?
I m also in 2 minds about PGD/ dna testing any embryos as i m scared of not getting any viable back and so missing out, as the test might be inaccurate?
Clinic also said they are not against DHEA supplements and they said I m free to try and get some if i wanted to. So I ordered the micronised 25 ngr on dhea.com.
I m very cautious though, as CARE wont check my current DHEA levels, so i ll probably only take 25 ngr once a day, instead of the usual dhea approach of taking 3x 25ngr a day.
I m scared too much testosterone might mess up my cycle.
Thanks so much again for replying. Your beautiful story gives me hope. Hope you are having a lovely weekend!⚘

@CyclingMumKent I'm glad your meeting went well. I'm sorry to say I can't be of much help with the results - I trusted our clinic when they told us that DH's sperm was all average and normal so never bothered looking into it any further. We got 100% fertilisation without ICSI on both cycles so I guess it was fine.
My clinic didn't test testosterone levels either, just prescribed the gel for 3 weeks prior to our second egg collection. I'm pretty sure it helped, but you're not allowed to stay out on it very long as it's very strong - much stronger than DHEA which has to be used for nearly 3 months to have any effect. Any side effects are completely reversible once you come off it though.
I'm not surprised your clinic isn't keen on a double transfer at the moment tbh. They're not that keen at the best of times and right now they're really under pressure to not put extra strain on the NHS, at twin pregnancies really do. Even if there are no other complications there are still a lot of extra scans and appointments, and the high chance of c section being necessary. In my case I had a complete abruption of one of the placentas at 34 weeks. I lost 4.5 litres of blood very quickly and the only reason we survived was because by a complete fluke I happened to have been kept in hospital overnight on that night for something completely unrelated - just on the lucky hunch of a consultant who felt I should have a steroid injection just incase of an early delivery because of some dodgy blood test results. It was nothing that would normally have warranted an overnight admission but because it was quite late when I got the injection they said I might as well stay. Very glad I did!

Omg that s terrifying
Such a coincidence that you were alreasy in hospital.
Hope this pregnancy is going great for you.
May I ask how did you get testosterone gel?
Was it prescribed by the clinic or by GP?
I will ask them, it seems like you had a wonderful cycle by using it, with 3 babies!
Take care and thanks a million for giving us all hope

My understanding is that the gel can only be prescribed by a fertility clinic as it's only licensed for use in this country in an active IVF cycle. The clinic weren't allowed to prescribe it for use trying naturally which I did ask them about when our FET got cancelled the first time due to the first covid lock down.

Thanks so much @SamoyedFan123 very helpful.
I got my egg collection booked for the 19th of April on my 41st birthday. Feeling a bit old but very grateful i have already 2 little ones
Hope your pregnancy is going great snd the twins are behaving!
💐

Great news @CyclingMumKent - are you doing a short protocol then? Did they give you the testogel? You're not old - I'm 23 weeks pregnant now at 43 and feeling great 😊

Dear @SamoyedFan123
You are an inspiration!
Is your egg from when you were 40 or 41?
Short protocol. Perid expected on 5th of April. Then 450 iu Menopur.
I have a call today to discuss a potential testosterone patch although it seems a bit late if egg collection is on the 19th of April?
💐
Will you need a new car with 3 child seats for when baby arrives?
X

@CyclingMumKent my egg collection was done 3 months before I turned 41. I'm not sure about patches, but the testogel was only used for 3 weeks leading up to EC so did like you still have time.
Yes need lockdown to end so we can go car shopping!

@samoyedFan123 you might have changed my life with your post!
My doctor finally sent me a Tostran testosteron gel prescription in the post. But there s no info about dosage and when to start.
My DHEA also just arrived in the post but i guess i wont touch them since testosterone gel is so much stronger?

Period is expected around 3rd of April and egg collection booked for the 19th of April.

You say you only took the gel for 3 weeks prior to egg collection? so it might be too early to start gel today if my EC is in 31 days..

Hope you are doing great, i just saw an old message of yours about your failed cycle in September and how tought it was to having to stop breatfeeding the twins. What a tough journey with a great outcome for you

Hi @CyclingMumKent, yes I had a lot of guilt last year about stopping BFing the twins for an FET thad was initially cancelled because of Covid, and then failed once we finally had it. Hadn't expected any success with the second transfer as the embryo was not quite as good quality as the first one, so was feeling a bit down about it all in September, but here we are!

Not sure about life changing, but I'm glad my posts have been helpful 😊 I personally would definitely not take the dhea as well as the testogel. Can you call your clinic and ask for instructions for the gel? I can't remember the exact cycle day i started it, but pretty sure I stopped it day before EC and used it for around 3 weeks. I only stim for 8/9 days though so this could have been longer if I'd had a normal stim phase so I doubt they'd be any harm in starting it in the next few days if your EC is 19th april. I used to rub it into my tummy every morning. Dosage i can't remember how many pumps it was each day so best to check with your clinic.