Looking for a new IVF clinic - please recommend?

[agesandages111]

I am 34 (35 in a few months' time) with a 35 yo husband. Our nutshell history is we started TTC in December 2019 and were successful by ourselves in three months, but unfortunately had a 9w loss. After that, nothing. I had a hysteroscopy/HSG during this time which showed no concerns on those counts.

Moved to IVF at a Care location in the Midlands in March of this year. I have now done two cycles with them - the first yielded 14 eggs, 8 fert, 2 embryos, one of which was a failed fresh transfer and the other tested aneuploid. Second cycle yielded 21 eggs, 15 fert. I am waiting on the Day 5 results, but the reason I am writing now is because - just like our first cycle - all of the embryos are suffering from fragmentation, and much worse fragmentation grades than the first cycle (the two that made it to blast were Grade 2 frag, this time there aren't any at Grade 2 - all worse!), so again, I am expecting very, very few blasts which will likely be of poor quality, perhaps even none.

My protocol was changed between the first and second cycle, and I was also diagnosed with PCOS (currently on metformin). Husband has had SA and some other tests on him, and nothing seems to be of concern on his side.

We were on a two cycle package with Care so I'm now done with being tied in financially, and depending if there is anything for transfer, I am wanting to move on to a different clinic. I feel like Care gets results for some people, but they are not very good at individualising patient treatment which I feel is what I need. I feel like I was the driving force to try a protocol change between first/second cycle, and practically had to guide them to conduct some more bloodwork on me to confirm PCOS. The only thing they have really done to help is prescribe me metformin, but even then, they have given me this without actually checking to see if I am insulin resistant so... Anyway, I can clearly produce eggs, and my husband can fertilise them, but the quality of the embryos is not good.

I know that the best clinics in terms of success rates seem to be in London, but this would be a real PITA for me as I would need to completely decamp down there for the period of stims etc. I am not completely ruling it out, but I am also hoping to avoid if I can.

Clinics I am currently considering are P4 Fertility (i.e. the Priory in Birmingham) and Herts and Essex Fertility Centre (down London way, but not central, so a bit easier to manage even though I would still need to decamp).

Can anyone offer comment on P4/Herts & Essex or provide strong testimony for any other clinics? I do not want to use Care or Create locations.

So create Birmingham's location would be no good for you? I did 2 cycles of short protocol with similar crap result and rubbish grades on day 3 and then changed to natural modified IVF with create on a 3 cycle package- my grades all jumped to grade 1 and I have twins plus 2 more top quality blastocysts frozen

@ivfgottwins Hi there, thank you for taking the time to reply. I've seen your update on some other threads and that's wonderful you got success.

I am not personally against considering 'mild' or 'natural modified' IVF, but I have a contact at a very respected London clinic who I had an informal conversation with a few days ago when I first learnt about the total fragmentation, and they (as most of the scientific literature) do not really support the claims of clinics like Create in terms of lower stims helping egg quality, higher stims having the inverse effect. That isn't to say that Create customers won't have success as there are anecdotal stories out there to support every single scenario you can think of, but I would like anything I do to be scientifically backed in the main.

They (my contact) even recommended at that stage that I possibly consider a long protocol (i.e. down regging) which I have seen other PCOS individuals use, but would never be considered by a clinic like Care, because as soon as you are badged as PCOS, the worry about OHSS overrides everything else.

I will be speaking to my contact more once I have the Day 5 results from this cycle, but I just wondered if anyone else had some recommendations they could share in the meantime. Ideally I'm looking for clinics with a highly personalised, very scientific approach.

Hi @agesandages111 have you had a DNA frag test done for your DH? Do your embryos tend to drop off toward latter end of days or at start? Have you had your testosterone checked to see if it’s low?

Re clinics I have moved clinics a few times and I recommend that you pay for the consults for each clinic you are interested in and see what they are like ie which consultant seeks more proactive - what protocol do they recommend and why. For me I did 3 consults with a clear winner and I’m v happy with the approach of our new clinic (although not pregnant yet)

I’d be wary of taking peoples own recommendations here as obviously people tend to recommend the clinic where they got pregnant but that’s not necessarily the mark of a good clinic.

Best example is Ive done multiple rounds of ivf - 1st clinic no embryos one round. 2nd clinic no embryos one round, 2 embryos 1 BFN on the next round. 3rd clinic new protocol, huge success with 3 top quality blasts however we froze them and wanted to do another round of banking - exact same protocol yielded a cancelled cycle two months later. Now if I’d done a fresh transfer and gotten pregnant I would be saying 3rd clinic is amazing with new protocol high blasts and pregnancy and my other clinics were no good etc and I wouldn’t have experienced the disastrous next round.

All I would say is that most clinics business model and marketing is premised on getting the maximum number of eggs from a patient in the hope of getting that one good one.....they don't really want to admit that "less is more" as it would go against their entire ethos? there is just as much scientific literature which supports lower dose stims improving egg quality.....if the likes of Create had the science "wrong" they wouldn't have as good if not better success rates than all the other clinics who only do long protocol and high dose stims? As much as I like Create I would still have gone elsewhere to try something different if I hadn't had a successful round on my last one - before we gave up I wanted to make sure I tried everything - if that meant trying short protocol, natural modified and long protocol then I'd do it - as it was we found natural modified was the key to my egg quality. I agree in that you ought to look to a different clinic and new approach but don't write off low dose protocols just yet

If you are after a more individualised approach then ARGC is probably the only clinic but it routinely costs £25k for a single round and I know plenty of women for who it has still failed despite the boot camp approach with daily blood tests and tweaks to medication

@alwayswithhope My husband has had two SA and an oxidative stress test (considered a precursor for DNA frag) - all of which were normal. I believe treatment for DNA frag is primarily ICSI and reduced abstinence period, in addition to some at home supplements that can be taken. In other countries there are also some microfluidic assessments that can be applied to sperm, but these are very uncommon in the UK.

My testosterone level is 'towards the high end of normal' according to Care - this was one of the tests I pushed for including thyroid when I was with Care. I believe the exact number for testosterone was 1.9nmol, and my thyroid was 'normal' (they did not supply the figure at that stage).

In terms of the fragmentation - the embryos start to fragment around Day 2/3, with my first cycle the majority of them arresting around Day 3. I will find out my Day 5 results tomorrow, but with the grade of fragmentation being much worse than my first cycle, I am again expecting to hear that all of them arrested, or that I perhaps ended up with one or two poor quality blasts like in my first cycle.

Agree with your point around most advice on here with be highly anecdotal - it is so hard to know what is a legit source to trust. I know you can compare HFEA numbers, but their website is not easy to use unless you are willing to trawl through lots of data and make your own Excel! For example, the 'compare' functionality, which you would think would be used to compare meaningful stats like live births per embryo transfer only compares info like what services a clinic offers.

Similarly I would not disagree with you that probably the best way to do this is to arrange the consults with the clinics I have already identified and see what feel I get.

@ivfgottwins Definitely - every clinic has to have its own niche and push that, and those niches will work for certain people otherwise we would all be going to same clinics! You are absolutely right in that for someone who has DOR, the same result will likely be achieved with high dose stims vs. lower stims (reduced to a certain point), so definitely, for certain individuals, I can see why such regimes as espoused by Create may be successful.

I didn't mention in my first post, but I did not have a great experience with Create Bham. When I was considering IVF back in September 2020, I had consults with them and Care which also included an u/s with Create (PCO was never mentioned to me). In January 2021, I had decided I might want to try a cycle of IUI prior to going to IVF, and so reached out to Create to see if I could organise this. They told me that my old scan had 'expired' (it was perhaps a week over the three month deadline they impose) and that I would need to pay another £300ish. I also had awful trouble trying to actually reach someone at Createto book in the first consult and then seek clarity on the second - I understand that this is a common thing with Create in that you have to go through the awful phone centre prior to joining up and being assigned a clinic/contact, but it did not put the best taste in my mouth.

In the end, I decided that I'd rather take the more traditional IVF route and just went with Care who moved quite swiftly (with encouragement from myself) meaning that I underwent initial tests in February and started treatment in March.

I am familiar with ARGC, but it sounds positively nightmarish to me, plus the extreme costs it attracts with the bloods/immunes that they force everyone to do. I also believe (and have seen other threads indicating this) that their success rates are not as impressive as they make seem on their website when compared with the data on HFEA.

@alwayswithhope Sorry forgot to say, that's wonderful you've had such great results with your third cycle! I'm sorry you haven't been able to bank any more yet, but fingers crossed if you do any more cycles you'll be able to replicate the success of the third, or if you are moving to transfer, that you have a live birth of one (or more!) in there with your three frozen.

Yes the call centre does put a lot of people off - once you are a patient though you get the patient coordinators direct mobile for the Bham clinic so once I started I never had to go through the call centre again - I don't know if due to covid etc though that they are making more use of the call centre due to receptionists working from home etc?

If you go through the call centre they are much less flexible when it comes to things like making you pay for treatment

I think my experience with them is so different because I stuck with them through all 5 cycles in 18 months and so got to know everyone really well so i had a lot of free scans thrown in etc

Just curious if you ended up going with Herts & Essex? Thanks :)