IVF clinic thoughts

[kennetrose]

We've been TTC a bit over a year. My LP is naturally about 7 days. I went to the NHS fairly early on and got referred to the local fertility clinic because my cd21 tests showed I wasn't ovulating. Once the clinic confirmed I was ovulating they said they wouldn't do anything for me and encouraged me to go private, and come back for IVF before my 35th birthday if I needed it (I'm 33).

So I've been getting treated for LP defect privately. The doctor recommended six cycles before IVF and we've finished number 5, about to start number 6. My hopes are low so I've started looking at IVF clinics. I want to be ready to move to that next step if/when this cycle fails. But part of me feels like an imposter. On the one hand my doctor said if six medicated cycles (with 2+ follicles a time) don't work then we should move to IVF. But the NHS says we're not eligible for nearly another year...so do I deserve it? We can afford one cycle privately and I don't want to wait. It feels reckless but the alternative seems worse.

I've also had a polyp the last few cycles. Initially my doctor said he wasn't worried and now he's telling me to get it removed, but I have to sort that out myself. I feel like our chances are futile while I have it anyway.

And then choosing and IVF clinic....how do I do that? I want a clinic that listens to me and my concerns, that will let me do things if I really push for them (I would like an ERA even though I know it's not advised until after a failed transfer). I am convinced there is something wrong with my lining and so I want all the tests possible to ensure it's okay for transfer. I also want a clinic that will be flexible - e.g. I'd rather go into it not paying for ICSI, but if it looks like it's in our interests after ER then I'd like them to switch. I have LP defect and I absolutely need luteal phase support.

So I've put together a shortlist of clinics:

• Fertility Plus. My current clinic. Pros: doctor knows me. I know he is a problem solver and creative with treatment. Cons: they are expensive AF. Would be a minimum of about £10k per cycle. It's in London (long commute from home).
• CRGH. Pros: Better value for money. Good reviews. Success rates almost suspiciously high (~60% for women

Are you under Mr Gudi at fertility plus? My friend was under him and has had the most individualized care I've heard of. He did the ERA EMMA ALICE and a HSG before a transfer. I would stick there if I were you.

If I were in your position I would be pursuing IVF, but I would be arranging a hysteroscopy to investigate/ treat the polyp in the first instance. Even if your specialist can't do the hysteroscopy they can write a referral to a clinician that can.

@Gardenlady543 Thank you, reassuring to hear about your friend. Was she successful? Yes I am with Mr Gudi. I've contacted a local private gynaecologist (who is also the Director of Thames Valley) and am waiting to hear back re polyp removal. I did ask him if I could do ERA EMMA ALICE a while ago. I didn't need the ERA at the time as I wasn't doing IVF, I just wanted the EMMA and ALICE to check my lining as, rational or not, I am worried there is something wrong because of infections in the past. But maybe if I do IVF with him he'll agree to do it then pre-transfer.

My main concern with Fertility Plus is just the price. They have a flat fee for IVF including medication, which I think is good if you need a lot of meds but a disadvantage if you have a shorter protocol and I don't know what I'd need until after a consultation. They don't do multicycle packages as far as I can tell either. If the first cycle failed then I'm not sure we could afford a second.

I meant I asked Mr Gudi if I could do ERA EMMA ALICE not the private gynae...

Yes, my friend got her positive in August. I'm not able to keep contact with her now, as it's too hard for me in my situation. I know a lot about Mr Gudi though from her journey, she has DOR, so she went through embryo banking and the 2nd transfer was successful. I know he is expensive but if I was close geographically I would want treatment with him. He works pretty much all the time, she was able to contact him at all hours over WhatsApp. It's very much one on one care, he did all her scans etc. I honestly don't think you will find better treatment elsewhere. And yeah the cost is high, but the cost everywhere in London is high.

He does the ERA EMMA ALICE a lot, and I've not heard of any specialist doing them more in the UK. So I'm sure he'll give the go ahead for it.

Also you don't get individualised care at Care, it's got multiple locations and it's very much a one size fits everyone approach. They take on a lot of patients and you will have your treatment adjusted so that it fits their availability.

I'm sure there are people that have good things to say about all clinics, but these are usually the people that got success at an early point. It's more important to listen to those with complicated cases because if your situation isn't straight forward you would wish you were at a clinic where they know what they're doing.

Thanks @Gardenlady543. This is exactly why I asked here. The attraction of Care is that there is a local-ish clinic that I could drive to. I am concerned about travelling to London clinics. In your experience do you think having to take public transport to most appointments is a big problem? I'm worried about getting Covid (even though I'm double vaxxed) but train is quicker than driving. Plus I have anxiety about motorway driving.

Mr Gudi and Fertility Plus definitely seem to take a tailored approach which is very appealing. Have you seen his YouTube channel? He really gives the impression of a problem solver who perseveres with his patients (at a cost obviously...). If other clinics are led by nurses and not individual doctors it makes sense why Fertility Plus is pricier. CRGH does seem slightly cheaper on the face of it, but without a consultation it's hard to compare accurately.

I guess the main issue with Care is you won't get one to one attention. You may if you're lucky have the same specialist, but they will mostly set up your treatment protocol and then you are in the nurse led service. They have a daily meeting to discuss cases but there's a rota for this so it will be different doctors that is involved daily, procures are also done on a rota, so of my 6 procedures (egg collection, 3x transfers, 2x biopsies) just one of those was done by my specialist.

In addition having a different nurse scan me every day means that I never know what my lining is doing, as there is a variation in how everyone measures.

The doctors are clearly not given long enough for appointments, this meant that on my original ultrasound my lining was very thin at 5.4mm but as the scan was done by a nurse my doctor then missed it, it wasn't until my second unsuccessful transfer when I asked for an unmedicated FET, that she looked back and realized I had thin lining, being confronted with such a significant issue for the first time when it should have been known months before and after several months of treatment was awful.

I definitely relate to the driving issues. I have driving anxiety and have trouble with long journeys too. I was having treatment for this which then got put on hold due to the pandemic and I mean it's hardly the right time for me to pursue treatment right now. If Mr Gudi was round the corner then I would be having treatment there. Location definitely plays a part in the decision. Public transport is really up to how much risk your willing to take during your treatment cycles. You could wear a FFP3 mask for extra protection, I did this during a treatment cycle when I needed to get medications etc and people were no longer wearing masks. I wouldn't advise public transport on egg collection day, I found this to be a tough day as my ovaries were so big and after the sedation, I just needed to get home. But I guess arranging a list with someone on one day isn't that difficult to achieve.

I haven't watched the videos but I know he lectures a lot. And I just know that he is an expert as her case was complicated. My friend also asked Mr Gudi questions about me. I know we've chatted in the past about my microflora coming back at 0.00% lactobacillus, there were no cases in the evidence base this bad and my specialist was astounded. However as Mr Gudi does a lot of EMMA ALICE tests he was able to tell my friend he'd seen 2 patients with this level of lactobacillus and that both only needed the one course of treatment.

I think you have some big decisions to make, if you want to make the decision based on location then it sounds like the answer is Care, they would probably have an issue doing the ERA EMMA ALICE before a transfer, you could ask though. If you want to make the decision based on 1 to 1 care and having your treatment with someone who is an expert then I think you know the answer is Mr Gudi. But you'll have to work out how this will work from a practical perspective with the journey.

Thank you. This is all really, really helpful. You have definitely put me off Care! I'm sorry you learnt about all that the hard way. You've reminded me what I'd be paying for if we went with Fertility Plus. Re driving, my husband would drive on ER day and it's an option for other appointments, it just might not be practical all the time so would have to see how it went. FFP3 mask is a good idea.

You've given me a lot of ideas for questions I'll ask too, both at Fertility Plus and if we have any other consultations.

Thames Valley Fertility is the other local clinic to me. Their director will probably be the person who removes my polyp so I can ask some questions when I see him about it, informed by what you've said. I do really want to stay with Fertility Plus but do want a bit more information on the alternatives, so even if I end up staying with them I'll be 100% confident in my decision. Thank you!

Well it sounds like you'll be able to form an opinion of the other specialist when you have treatment with them.

Don't feel pressured to jump to a decision, as you have to get the polyp sorted you have time. There are lots of things to think about.

Just thought I would pipe up... I have cycled in Reprofit, Brno, CZ and got my beautiful daughter first try abroad. The clinic are wham bam but they get the job done. However I am just starting my 3rd fresh cycle for my 3rd baby and am with Gennet, Prague (moved clinics as easier to get to than brno)... They have been amazing so far. They really pay attention to what u need... My last cycle only produced 3 mature eggs with 7 immature and they have amended my protocol as such for which I am really excited. My coordinator and I email daily and her English is great... She organises everything between u and the doctor. I am just leaving Prague now (currently at airport) after having had a hysteroscopy which they insisted on due to having had 2 c sections... They want to maximise my chances. The process went incredibly smooth... The cost is lower than UK... U don't pay extra for ICSI... They have great success rates. The flights to Prague are currently around £19 return. Would highly recommend. Lots of luck x

Oh and their technology is just as good if not better than UK x

Hi @firefly37 I have been toying with the idea. I'm worried about monitoring, how they would adjust meds if necessary, and the hassle of doing things here like getting meds and scans...how have you found it? How long did you spend overseas at any one time?

I went with Argc. They are in London. How I got round it was renting a flat for two weeks of treatment. Their results are very good and they throw the kitchen sink at you so wouldn’t care what you asked them to do. A lot of people don’t find it individualised ( as so busy) but I had dor and I found they monitored me very closely and optimised my output! The only issue is the head guy makes the decisions and you don’t see him , but you can discuss with his doctors and nurses and they check with him and let you know.
I liked it there , although expensive, it got results

With me, I sent all my previous ivf paperwork to Gennet which the doctor reviewed and then we had a free Skype consultation where she made her observations on our position and recommendations. They identified my issue around immature eggs and provided a treatment plan with that in mind. They identified a need for a hysteroscopy based on two previous c sections... U have to put ur trust in them to know what they are doing I believe. Any questions I have are answered promptly.
The longest u stay is for final follicle scan, collection and transfer so about 7 to 8 days. The doctor likes u to have ur final follicle scan with her so she can assess things for herself and extend stimms if required but u have ur first follicle scan in the UK and usually they will know by then how things are going. Scans in the UK are easy with Ultrasound Direct... They have a clinic open everyday, u just may need to travel to different ones depending on day required. Bloods are easy via Medichecks (I always get the blood drawn at a local hospital) and medication, I used Fertility2u. This time though, I went to clinic for my hysteroscopy so have come home with my meds all ready to go. It may not be for everyone, but I have all positive experiences of going to Czech for ivf. Flight is 1.5hrs and fares are cheap so not really a hassle... I also find it quite nice to get away to be honest.

Hi @Dreamsupreme just piping up a bit late here! Wondering how much you paid for argc ivf? They have great success rates but I expect very expensive! And glad you for results! X