IVF - May

[TheSnufflet]

Couldn't see a thread for May so I thought I'd start one!

Anyone else doing their cycle in May? I just got my calendar through and all the injections look extremely Not Fun (this is my first time doing it) 😕

Hi @TheSnufflet I’m hopefully going to be doing a FET cycle from mid-May, I’m doing a mock cycle with ERA EMMA ALICE right now, so I will need to finish that, have a natural cycle and then hopefully I should be ready for a transfer after that.

What’s your story been so far?

I'm planning a FET in May.

4 failed IUI attempted.

First IVF attempt in Feb/March, had a terrible egg collection - 7 good size follicules on scan but eggs didn't mature, only 4 eggs could be collected, 2 fertilised. Transfered 5AA embryo in March and period started 4dp5dt.

Second embryo is a 4AA and will be transfered in the May FET, so keeping fingers crossed.

Actually have consultation today about drug regime for FET since I started period so early last time.

@TheSnufflet the injections really aren't bad, but I'd watch out for the hormonal rollercoaster! I found it fine until egg collection, when it all became really emotionally taxing

@Gardenlady543 I've heard of ERAs but what are EMMA and ALICE? And under what circumstances do they do mock transfers? Good luck with your FET - is this your first go or not?

@2mumlife oh wow you've been through a lot already! Were you recommended to go for IUI before going to IVF? And was the first attempt a fresh cycle? How awful about the ER - I suppose it's good that you got 2 good quality embryos out of it, but I would have a billion questions for them in your shoes! Good to know that the injections aren't so bad - my husband has volunteered to do them

As for me, I'm 34, no kids, about to turn 35 at the end of the month and we've been TTC nearly 4 years - so far no explanation other than shitty sperm morphology. Haven't had too many invasive tests like other people, the system just seemed to fast track us to IVF ICSI (although it's taken bloody ages to get to this point). This is our first NHS-funded go and it'll be a fresh cycle (we get two fresh and two frozen in our CCG).

Hi,

I’m Jess. I will hopefully to be starting IVF first time in May. I have a consultation with a Nurse mid April and I believe I’ll probably start taking stims at the beginning of the next cycle which will be May. Excited and nervous at the same time. It will be my first time doing IVF after trying naturally since October 2019.

@TheSnufflet they take an endometrial biopsy for the ERA, the same biopsy is used for the EMMA and ALICE, they look at the levels of good and bad bacteria, the bacteria flora is really important for implantation and pregnancy. My friend had these tests as she has a low AMH and has a limited about of embryos after embryo banking but in most circumstances they don’t tend to consider them until around 3-4 unsuccessful transfers of good quality embryos. In my case I ended up with 9 blastocytes in my fresh cycle, I just had my remaining embryos PGT-A tested and there is a high rate of euploid (normal) embryos. So after 12 months of trying naturally and never getting a BFP and 2 unsuccessful transfers we decided to do implantation failure tests.

@JesHope345 that’s when me and DH started trying naturally as well. How has it gone for you, did you get any positive results trying naturally? I found it so difficult month and month of negatives

Hi all,
After trying to conceive for over 3 years we are about to start out first round of IVF/ICSI due to MF issues. Recieved my schedule this week and egg collection is currently booked for 13th May. Starting down reg next week so it's all starting to feel a bit real now 😬.

@TheSnufflet We're a same sex couple so originally started this journey only needing fertility treatment because of using donor sperm, and I had no indications of any issues which is why we did the IUI (it's a lot cheaper and our success rates should have been very good). We moved to IVF when that wasn't working. Since we're same sex we aren't eligible for any NHS funded treatment until we have self-funded 6 pregnancy attempts with donor sperm. It's been a long and very expensive journey, that hasn't gone at all as expected.

Yeah last go was a fresh. Consultant is really happy as we only had 2 mature eggs which both fertilised (not using ICSI) and progressed to perfect 5 day embryos, so progression rate there is really good. But they've decided I'm a poor responder despite normal AMH score, and my body just seems to respond in unexpected ways to fertility treatment. It's frustrating. We have 1 vial of donor sperm left and signed up for an IVF financial package that will give us 1 more egg collection attempt and transfer for all frozen embryos from that as well, so whilst I'm hoping this time works, we still have some more chances hopefully, and consultant has proposed a lot of changes if we need another fresh cycle (retest AMH and move to a Flare protocol, potentially delayed egg collection as eggs weren't mature last time).

My FET is being done with hormone replacement rather than a natural cycle to try give is best chance they can, and I'm on progesterone injections as well as cyclogest this time around so we'll see.

You're lucky you get so many funded cycles, though it must be tough having tried for so many years. At least private means we've had very little wait, other than when the clinic stoped seeing patients last year during the initial lockdown which delayed our IUI attempts.

@JesHope345 Best if luck with your cycle!

@Georgie87B Are you on a protocol where you need to bleed after downregulation? It's makes a weird change hoping for a bleed to hurry up so you can get going with stims!

@Gardenlady543 Interesting to hear more about implantation failure tests. How long do you need to wait for results, and are there things they can do if tests suggest things are not optimal?

@2mumlife these are the tests I had:

1. PGT-A testing of embryos, so I know I’m only transferring euploid embryos.

1. Level 1 recurrent implantation blood tests, -I was tested for autoantibodies (if positive I would have been put on steroids)- luckily these were fine.

• A thrombophilia screen (if positive for aspirin and heparin), they found 1 abnormal PAI gene- so I’ve been told to take aspirin and after the transfer I’ll be on heparin. I think this is quite controversial from my reading, but I don’t think there is a high risk so I’m happy to try it.
• Test for MTHFR mutation, I have one abnormal gene, this means there is an issue with an enzyme involved with folic acid metabolism. It’s is quite common. I’m taking methylfolate 5mg a day now.

1. ERA/EMMA/ALICE

The ERA will give a personalized regime for the progesterone course length in my FET. Some women have a shift in their implantation window, they need to take progesterone for less/more time. The EMMA and ALICE look at good and bad bacteria. Too much bad and it’s antibiotics and not enough good and it’s probiotics.

So all the tests can lead to changes in the treatment. They usually hold off until 3-4 abnormal transfers, I can see why, it’s been really stressful, I was surprised when things have been flagged up, but I guess a lot of women will have some abnormal results if they had all these tests.

@2mumlife the blood tests and PGT-A both took 2 weeks. The ERA I’m on day 9 at the moment, they should take the biopsy on day 21 and then it will be 2-4 weeks for the result. So lots of waiting around and worrying!

@Gardenlady543 Lots of testing, wow! Though it's really good news so many of your embryos came back euploid (they're currently saying biggest likelihood of my fresh transfer failure is embryo abnormalities). My consultant has started asking me about miscarriages running in my family, autoimmune disorders and things though, so I think they may be starting to consider if I need more tests to see why nothing ever works...

@2mumlife yeah I’m lucky on the embryo side, I think the issue for most people with unsuccessful cycles is the embryo, it’s harder to overcome implantation issues which is annoying. That’s interesting that you have a normal AMH but only got the 2 eggs on EC, what’s your AFC? Hopefully this transfer works for you (it only takes one) but it’s good that your specialist is considering other options for a higher yield if it doesn’t.

How old are you out of interest?

Also with that early bleed you should ask (insist) on a progesterone level the day before transfer. I bled from 8dp5dt in my fresh transfer, a specialist said this is normal as this is the equivalent of 13dpo but bleeding 4 days after the transfer seems really early. You should have been producing some progesterone naturally in your fresh cycle, but you won’t in a FET, so it’s really important they get the progesterone dose right.

Hi everyone, can I join? I have an ivf consultation on Thursday - we have one fresh round via the nhs.

It's been a long and heartbreaking journey to get here. We started ttc in November 2017 and started fertility investigations after a year but miraculously conceived after 16 months, but I had a MMC. We were allowed to continue with investigations and have gone onto conceive naturally 3 more times but have lost each one. I've had standard nhs recurrent miscarriage tests and found no reasons and just told to keep going, but there's been a pattern with 3 of our losses.

I've been diagnosed privately with an overactive immune system, which my specialist feels is the cause of both my recurrent losses and our subfertility.
I've been following an immune protocol since November last year to help calm it down but we've not conceived. I'm actually in my tww from doing a medicated cycle with letrozole and trigger, but fully expecting to be starting our ivf soon. My specialist has given me a medication plan to share with the clinic, but I'm a bit anxious that as it's nhs funded they might not be keen to let me do it alongside (I'm currently on hydroxychloroquine, intralipid infusions, prednisolone and cyclogest and he wants to add in fragmin for ivf).

We were due to start last August but I conceived after my baseline scan, but they were going to put me on mild stims. I've also since been diagnosed with adenomyosis, which I've read long down reg can be more beneficial.

Sorry, that's a long intro! Looking forward to following your journeys xx

Can I join you ladies?

Should have been starting this month but due to a delay with husbands sperm analysis and GP being hopeless with our screening bloods, I've come on my period so this month is now 😔

I've done 4 IVF cycles previously and got my DD on the last frozen cycle. Started trying in 2016 and had her last summer.

Will be doing a freeze all as that's what gave us our BFP but I'm concerned that they take forever and I'm 38 this year. I also don't get many eggs so feeling very nervous as I'm a few years older than my last EC.

Must be bonkers for putting myself through this again...

@Gardenlady543 I'll be 32 in June. Normal weight, normal lifestyle, no medical conditions, AMH was 18 point something which was in normal range for age (not sure they ever did a AFC but all pre-treatment investigations normal) and expected to have a normal response to stims. They only stimmed me for 6 days because my leading follicles were large and estrogen levels were right range, had 7 follicles they expected eggs from, but at retrieval they wouldn't separate from follicular wall (still immature) hence considering delaying time between trigger and retrieval or trying a different trigger. I took a long time to bleed after downregulation (prostap) so they think flare protocol would be better. Been told despite bleeding 4dp5dt they don't think we missed implantation window. Our FET cycle they have us lined up for 6 days of progesterone injections to supplement luteal phase in addition to cyclogest and estrogen, but they've no plans to test progesterone levels I don't think. All my IUI attempts I bled before the end of the 2ww but only couple days before (we did medicated IUI with controlled ovulation). My natural cycle length is more variable and normally on the longer side of things

@2mumlife they should know your AFC from the scans, it’s just the numbers of follicles they can count on your ovaries, but presumedly that was ok as you had a few follicles that looked to be responding. 6 days of stims is really short, I only needed 8 but I have a huge AFC of 34. An early bleed can be a sign that the progesterone isn’t high enough to support a pregnancy, I insisted on a progesterone level in my FET, it was a bit lower than my specialist wanted it to be so she asked me to increase the dose. With the longer cycles do they think there’s any chance of PCOS?

@2mumlife Yea I will be on down regs for 2 weeks then have a bleed before starting stim injections.
Just reading through the messages and you have been through alot! I really hope the IVF works for you this time around. We have also gone down the private route as where we live are currently suspending NHS funded cycles due to Covid. So decided on a multicyle programme with access fertility.

@VenusStarr welcome! Wow you have been through a long journey just getting to this point. I am all pretty new to all the different protocols. Etc as we only started our IVF journey at the start of this year so trying to read up on as much as I can 😂📖. I really hope that the medication and protocol they put you on helps x

@VenusStarr Must be really tough having a history of MMC, hopefully IVF does the trick. Are you going down the genetic testing route with embryos?

@Georgie87B Hope you're not waiting around for your down regulation bleed, I just found it ridiculous irony to be wanting bleed to come! We went Access Fertility too - we only had 2 vials of sperm left so just took the 2 cycle package. I keep thinking this is going to all have been a very expensive and emotional journey just to end up with a Fertility problem at the end....

@Gardenlady543 I've had more vaginal scans than I can count at this point and a lot of follicule monitoring during cycle anyway so that doesn't seem to be an issue. I reliably recruited 2 folliculws with light Letrozole during IUIs. I had a lot of follicules maturing on IVF scan but just not that many big ones, but I half think it might be due to having too much flat after downreg, hence talking about moving to flare protocol to get my body to contribute to the work and with a lower dosage to try get more follicules to mature and not just end up with a couple big ones. Interestingly my consultant seemed to think varying luteal phase support wouldn't make much difference to stopping me bleeding early, but I'll see what they say about testing progesterone levels.

@FingersXssd83 Congratulations on your previous success. I've heard FET can actually have better success than fresh now :)

Thank you @Georgie87B I'm definitely ready to let the professionals take over now, being on the hope roller-coaster is exhausting.

@2mumlife we had our last baby tested and he was chromosomally normal, so we're not looking at pgs testing at the moment. Our specialist in reproductive immunology says that less than 5% of recurrent losses are due to chromosomal factors. I've only had one chemical loss and I do feel that one was likely to have been related to that, but the others all stopped growing in week 6. X

@VenusStarr That must have been really difficult. I hope they're able to give you some answers, hope, and success

@Gardenlady543 Heard back from clinic about progesterone testing - was interesting, response was that trials are inconclusive and there isn't an agreed level on what should be aimed for, but sounded confident adding progesterone injections should mean we're covered. Meant to say re: PCOS I got a scan done in my 20s due to period issues and was told I had ovaries with a polycystic appearance but didn't take it any further and never had a PCOS diagnosis (you can have polycystic appearance of ovaries without PCOS). Had a Mirena coil inserted in my 20s to help with things and since that was removed a good few years ago I've had a cycle and nothing during initial tests with the clinic has been suggestive of PCOS.

Hope everyone had a good Easter

@2mumlife yeah it’s felt that once progesterone reaches a certain threshold it triggers events leading to endometrial receptivity, but there is no agreed level for when this might occur, my specialist uses a level of >50 but others might use over 20 or 30. Hopefully the progesterone regime will prevent an early bleed in your next cycle.

Yes the diagnostic criteria for PCOS involves assessing for:

• A high AFC
• Clinical Hyperandrogenism
• Oligomenorrhea (Less Than 6-9 Menses per Year

The diagnostic criteria differ depending on which criteria is used but generally 2 out of 3 results in a diagnosis, I have a very high AFC of 34 but none of the other criteria. I ended up with a good result from EC but I’ve seen others on here get huge amount of eggs but very few blastocytes.

@Gardenlady543 I've heard of others getting progesterone tested as well. My clinic doesn't do the endometrial scratch or assisted hatching for instance either because the mixed evidence-base. Ive got a science background so do my own reading of research paper as well when I've got questions about treatment plans, but in the end have to trust my consultants ultimately!