Infertility investigations/IVF in Scotland - thread 3

[itsmschanandlerbong]

A thread for those of us undergoing infertility investigations or treatment in Scotland.

Thread 1 - www.mumsnet.com/Talk/infertility/3742246-infertility-investigations-ivf-in-scotland

Thread 2 - www.mumsnet.com/Talk/infertility/4138992-Infertility-investigations-IVF-in-Scotland-thread-2

Thanks for your good wishes ladies, we got two eggs yesterday and we just got the call to say that we had 100% fertilisation!! So I am delighted with that. Still a way to go of course, but this is a great start. We had a bit of drama yesterday as my blood pressure was low and heart rate really low both before, during and after the procedure (even at discharge my heart rate was only 45) so I'll need to get that checked out when I get back to Edinburgh in case I have a thyroid problem. I had my thyroid levels checked as part of my NHS fertility checks back in January and they said they were "fine", so I'm not sure if something has changed since then. Hopefully my GP will be able to help find out if there's anything that needs to be treated.

@2mumlife I hope egg collection doesn't fall on your sisters wedding! But covid symptoms/waiting for test results could be a reasonable explanation. I always said that GCRM should be more proactive on scanning and checking how stims are going, I bet if they increased my meds at the beginning, or checked my baseline follicle count they would have increased my meds from the beginning!
@Kitekat81 That's awesome!! Congrats on 2 out of 2! And yeah, definetley get that checked out!

We are waiting for AF, to call the GCRM and get the bloods appts for FET...not much going on here! Last week of work before one week of holidays, which will feel good!

@Kitekat81 That's great news - so pleased for you. Worth keeping an eye on, my resting heart rate dropping is how I know I need to increase my thyroid meds, but could be unrelated and just one of those things.

@GemmTryTTC and @2mumlife I also agree with wishing GCRM scanned more often, I also wish they'd check progesterone levels around transfer. I guess they follow the way they think is right and it's in their interests for all of us to have successful cycles but sometimes these things niggle at the back of my mind.

@Kamiros Yes! I have been reading online (bad habit! can't help it) and I am wondering why they are not offering progesterone by default for FETs? They will give a shot of ovitrelle I think when the transfer is done, and that's it... I wonder if taking progesterone would help, and if that's something I could ask them? My periods are extremely light (lasts 4 days, with two normal and the rest very light), so I am wondering if that would help!

@GemmTryTTC I do it all the time - so glad I'm not the only one, but yeah probably doesn't help me relax much. That's exactly what I got for the flare protocol. I asked about it after because I bled at 8dp5dt and it didn't seem right to me. I was quite firmly told that the Ovitrelle would make my ovaries produce enough progesterone to top up what was already there in the natural cycle and that I didn't need it. I'd ask if it's bothering you though.

@Kitekat81 Thats great news to have both eggs fertilised. Are you due an update on day 3? I know my blood pressure goes funky in medical settings, could it just be that?

@GemmTryTTC Did GCRM make you wait a month between your freeze-all and FET? Just thinking when might be the earliest we can transfer. I reckon they'll do the egg collection day before the wedding, as I always stim for very few days (one of the things that never made sense to me when they said I was a poor responder, as I always respond quickly to stims, just that I don't seem to recruit many eggs...).

@Kamiros @GemmTryTTC I've worried abotu progesterone levels too. I've bled before the end of the 2WW on every cycle other than my chemical. I started bleeding 4dp5dt on my fresh transfer and was told similar to @Kamiros that the Ovitrelle and cyclogest support would have been enough progesterone. I still don't feel I ever got a sufficient explanation for why I bled so early that transfer, and I still feel that transfer never had any possibility of success as my lining must have been starting to shed at the time implantation would have taken place, so I feel implantation was never possible that cycle. Its the one reason I'm embracing having to have a freeze-all and not another fresh transfer as I don't want to waste a precious embryo and go through an early bleed again.

I had a medicated FET @GemmTryTTC so had progesterone - they gave me Lubion injections as well as utrogestan for that transfer, and I'm convinced the Lubion injections made a difference as thats the only BFP I've ever had, even if it did in in a chemical, and I didn't bleed until I stopped the progesterone support. I also normally have very light periods and a longer cycle length.

@2mumlife Yes, they made me wait withdrawal bleed, a normal cycle and then we will do transfer - currently waiting for AF. Depending on how long your cycles are the wait may be longer, my withdrawal bleed was a few days after egg collection (like 4 days after I think?) and my period came 33 days after that, usually my cycles are 27-28 days like clockword, so not much longer really.

I may speak to my partner and ask GCRM if they recommed progesterone, and if not, why, what are the pros/cons and if there's no cons, ask if I can have the pessaries for 12 weeks, if it can't hurt then maybe I will ask, but I am not sure yet. We are doing a natural FET, my cycles are ok and I don't have PCOS, light periods but regular, regular ovulation... they don't check lining either at the GCRM, which makes me nervous!

@GemmTryTTC Was going to ask if bleed came quick after egg collection. My cycles are normally in the 33-36 day range, but my first natural cycle after my left IVF was like 45 days, so we'll just need to see I guess. GCRM do the lining check for medicated FET. Maybe see about the progesterone, it can't hurt anything as far as I understand, and the suppositories are really cheap compared to everything else. I preferred Utrogestan to cyclogest, even though Utrogestan is 3 times a day rather than the 2 times a day for cyclogest

Thanks @2mumlife I sent them a portal message yesterday evening, I’ll see what they say! If it can’t harm and they say they would prescribe it we may take them, I’d rather try everything to be honest and not wonder after! And yep, my withdrawal bleed was super, super fast!

Hi all, how is everyone? I've booked in for an acupuncture appointment following all the positive feedback - well, it's more a initial consultation, at natural fertility centre in Edinburgh, think it's a kind of holistic approach.

@Kitekat81 have you heard anything about your fertilised eggs yet? I'm interested in create although going with gcrm just now, is it a nightmare travelling? Do you drive up and down?

I've seen quite a few people talk about baseline scans here, and think one of you mentioned gcrm don't do this? I feel its very functional and wish they'd explain things more, including why they don't do things . I've also seen on other forums people talk about their FSH levels. I've no clue at all what mine is, gcrm haven't even mentioned it. Is this normal?

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@LouScot yeah GCRM doesn’t do baseline scans as far as I know - at least not with antagonist protocol. They don’t measure FSH either, only AMH, and as much as I do trust them, they don’t explain a lot of things, I think you need to ask them a lot for them to explain this things, don’t be shy!

@Kitekat81 great news, fingers crossed for continued positive updates!

Question - does anyone have any experience with thyroid issues and fertility/fertility treatment? I get mine checked every year as a few years ago a test picked up thyroid antibodies. My TSH is within normal range (called GP today to get Feb results and it was 1.9) but I'm now reading the presence of antibodies even when TSH is normal, can results in increased implantation failure and miscarriage rate. Worrying now ahead of first FET.

Does anyones clinic test the thyroid? I've messaged GCRM to raise my concerns and ask. I did put the fact that I get my thyroid tested every year and presence of antibodies on my initial patient registration form but they've never mentioned it to me.

It seems to be quite an important factor in fertility/infertility but have never had it mentioned which is a bit annoying. Unless it's another thing they do maybe do in the background but then never tell you about it!!

@ally99101 GCRM did make me test my thyroid and give them the result before starting IVF- my result was normal so I’m not sure about the rest, sorry!

Thanks Gemma, that's useful and interesting, never mentioned it to me so perhaps they've checked my existing results from the GP or something and not been concerned. It can so confusing sometimes! Guess I'll find out when they get back to me anyway.

@LouScot I hope you enjoy it. They give you a full acupuncture session in your initial consultation. There's usually heat lamps and stuff too so wear something cool.

@ally99101 I have hashimotos (very high antibodies) and underactive thyroid. I take levothyroxine and have got TSH down from 8 to 1. I went to see a private endocrinologist a couple of months back and she said that as long as TSH, T3 and T4 were ok the antibodies shouldn't effect anything. However this has been on my mind recently as I've read what you've read and that some people find a steroid after transfer and for the first 12 weeks helps. I haven't asked GCRM about it, I'd be interested to see their response. My endo said that issues aren't caused by thyroid antibodies but that an auto immune issue with one thing means you're likely to have more hidden auto immune issues which could include NK cells- something else they don't test for unless you have recurrent miscarriage. It's been on my mind the last week so really interesting you bring it up- not sure I've been any help though as I've no idea what to do about it myself.

@ally99101 I have thyroid issues too. My thyroid hormone levels are completely normal, but my TSH was above 2.5 (still in the normal range though) and I have autoantibodies which mean I'll almost certainly go on to develop hypothyroidism in time (interestingly, it runs in my family). I was put on low dose levothyroxine to bring my TSH below 2.5 (above 2.5 can impact upon fertility). But, I was also told by a clinic that the autoantibodies themselves can affect implantation and cause miscarriage - they said there wasn't anything they could do about it though. A different clinic said it wasn't an issue, however, so long as the TSH level was below 2.5 and hormone levels were normal. I think it's something that's not particularly well understood - maybe some of the immunological reproductive specialists down south might know more? My plan was that if my cycle this summer had been unsuccessful I would have booked a consultation with one of them to discuss.

Thank you @Kamiros and @Scirocco for that insight, that's really useful.

Yes certainly does seem to be smething that's perhaps not well understood!

I will certainly share any info I get from GCRM @Kamiros. Would you mind sharing who you have spoken to on the endo side please as I may go down that route myself (feel free to pm me if you'd rather). I guess good that they've said you should be ok if TSH, T3 and T4 are all good.

I also read that about other autoimmune issues, that it may not necessarily be the thyroid antibodies causing issues, but the presence of them suggests the presence of other autoimmune issues and perhaps it's more likely those autoimmune issues that cause the fertility issues.

The main thing that baffles me really is just the lack of any mention of thyroid whatsoever from the clinic. If it might have even a small impact and is maybe not something people are regularly tested for (unless there are specific concerns/symptoms etc) why not make sure it's tested and levels are ok before proceeding with fertility treatment. It's a simple blood test after all.

@ally9901 Totally agree, not sure why it's not routinely checked. It was a woman at Spire Murrayfield, I'll find and send you the exact details. A lot of endos really only specialise in diabetes but she has a lot of thyroid experience and was really good. I've just booked in another private blood test tomorrow before I start my norethisterone, want to be sure of my levels before I start stims just in case.

@LouScot as @GemmTryTTC said GCRM don't do baselines or FSH levels. I've got a lot better at pushing them for information. You need to treat fertility treatment a bit like having another job, as I find you really need to be on top of things and pushing for things and asking questions and keeping an eye on protocols, agreed drug dosage etc etc

@ally99101 I did have TSH levels tested by GCRM last year as part of intial testing, but I had to ask to have the results put on the portal after I asked about this after chemical (mine result was normal last year)

@GemmTryTTC Will be really interested to see what their resonse is

@Kamiros Exciting you're starting norethisterone!

@2mumlife Yes I want to get excited but I feel like I'm getting ready to ovulate so I' sent a portal message yesterday asking if it's ok to still go ahead and haven't had any response. I've also tried calling but no answer as usual. I think it's probably ok but I'm due to take the first tablet in the morning so I want to be sure.

@2mumlife I just had an answer from Marco, that if cycles and hormone profiles are normal they don't prescribe progesterone as there have been studies (he cited it, I'd need to find it) that link ASD in males with progesterone (50% of male pregnancies with progesterone had ASD) so in our case as I ovulate regularly we'd rather not take it if they think we don't have to, we will trust them. If you want the study name/his exact answer I can send it to you through pm.

@Kamiros Sounds like your cycles have been giving you issues for awhile, but hopefully the tablets will override your body cycle even if it is a bit out of whack and get your cycle under control by the clinic :)

@GemmTryTTC That's really interesting - I'd appreciate the study name if you can find it (I work in academia so I might also be able to access the full paper for you if its not in an open journal), would be curious if thats just for natural cycles, or applies to medicated FETs too

@2mumlife I was going to message you but maybe somebody else is interested. To be honest I think it’s a grey area this one, I found other potential studies with low progesterone being related to ASD, but for us it was a good decision maker to try without, full natural FET. The study he cited was Davidovitch et al, 2018.

@LouScot that's great - enjoy the acupuncture! If anything, it makes me feel relaxed, so that's a plus.

@ally99101 I think I had my thyroid tested during the initial testing and was told it's fine, don't remember it being tested since.

@GemmTryTTC that's interesting! I wonder how reliable that link is. I'll have a look if I can get access to it.

First stims scan tomorrow, will be day 8 of stims. Feeling quite anxious about it! I don't have the same blissful ignorance as round 1!

@2mumlife yeh the low blood pressure could have been situational. I don't cope well when I'm hungry and I think I was also dehydrated, plus of course being in the clinic about to have egg collection is not a stress-free situation!

@LouScot yep it is a bit of a nightmare getting treatment in Manchester! I'm making it work because I basically have nothing else going on in my life at the moment, and I have spent hours on trains and "working from home" in hotel rooms. I'm happy with the clinic and still think that mild ivf was the right choice for me, so I'm going to stick with it to the end, but it's certainly not easy!

@ally99101 I'm interested in the thyroid question as well, I'm getting mine checked by my GP on Monday.

So an update on our two embryos - we had our day 3 phone call this morning and it wasn't great news. They both don't have the number of cells you would expect on day 3, they are still at the day 2 stage, so freezing today wasn't an option. They are going to continue observing them until day 5 or 6 to see if they have developed into blastocysts by then. I guess if there was no hope they would be binning them now, but still it's not looking great.