Conflicting advice from fertility consultants!!

[LouLou7864]

Hi all,
It’s my first time posting, so please bear with me!
I’m 36, my partner is 41 and we’ve just had a failed 3rd round of ivf, where we got no embryos 😢 I’ve got stage 4 endo (which we only discovered last year after our second ivf ended in an ectopic) and I’ve got low AMH for my age (5.3 at last test). My partner has had a few sperm samples come back with low morphology (1%) over the 3 years we’ve been ttc, but the last couple of times have been fine, so no one seems overly worried about him.

Our NHS round was a bit of a disaster - I didn’t respond to stims and only got 2 eggs. Luckily one made it and we had a “good quality” day 5 embryo which unfortunately didn’t stick. We changed clinics for our second go and in the meantime I’d bought the book “it starts with the egg” and was hammering the supplements in preparation for our second round 😂 However our consultant at that time was horrified by the amount of supplements I was taking and told me and my partner to just take Impryl which we both did. We managed to get 5 eggs that time, 2 were still going on day 5 but were only early blasts, so had both transferred back. This then ended with our ectopic. We then discovered my endometriosis when we were due to start our 3rd go and I had pretty major surgery in Jan this year to remove it. Unfortunately, one small endometrioma has grown back in one of my ovaries, so my surgeon recommended we see Mr Salim at the Lister clinic.
During our first consultation he gave the complete opposite advice of our previous consultant, said Impryl was overrated and gave us both a long list of supplements we should be taking. So I’ve been on pregnacare, extra folic acid, coq10, melatonin, omega 3s, spermidine, iron (I’m veggie) and high dose vitamin d for the last 3 months. I feel like I’m rattling! Obviously this has all come at a cost on top of our actual ivf costs, but I’m willingly to do it if it will help. However, our last round actually turned out to be our worst. We got 8 eggs, but only 3 fertilised. One then continued until day 6 but then stopped growing, so for the first time we got nothing.
Mr Salim has now said my egg quality is poor which caused our embryos ran out of energy by day 3 (first time we’ve heard that, before it was all about needing to get more eggs and our embryos previously have been top quality on day 3, then began to drop off between days 3-5). So he said to continue with the supplements, have one more go with my eggs (using icsi and HGH this time) and if that doesn’t work, to go down the road of egg donation.
Sorry for the essay, but I’m wondering if anyone has been in a similar situation? Can my egg quality have changed that much in a year? Would you continue with all the supplements even though this round ended so badly? Is there anything else we should look into? When my partners morphology came back low previously, our last consultant mentioned sperm DNA fragmentation, is that worth looking into?
Thanks everyone and well done if you made it to the end of my ramblings 😂

@LouLou7864 Made it to the end of your rambling haha. Sorry I wont ve much help though as I havent started my cycle yet. We have our nurses appointment on the 27th to sign paperwork etc il be having the short protocol. I take coq10 Zita West : vital dha, vitamin boost 1, vitafem and folate. Our consultant didn't really recommend anything apart from a normal multivitamin. But im taking these and hoping they help. I'm 33. AMH 17.4 (they say lower end of normal) and my OH results came back borderline for everything the second sample he had analysed so we need to do ICSI. I hope you can find someone with some advice. I just thought id message. X

Hi @LouLou7864 , I took a lot of supplements for egg quality in the run up to stims. I was advised by a nutritionist and was taking 16 different supplements every day. I was seeing a consultant for recurrent miscarriage, who was sceptical about their value, but he didn’t have any specific concerns, just thought it was a waste of time and money I think. My husbands Andrologist and our IVF consultant were both supportive of the supplements. My husband took Impryl for high DNA fragmentation, and his sperm improved a lot. It was expensive, taking all the supplements (worked out about £200 per month for both of us) but this is nothing compared to what we were spending on IVF so I was willing to do it to give us the best chance.

I think it’s definitely worth having the sperm DNA fragmentation test. My husbands basic semen analysis was fine, but he was then found to have a high level of DNA fragmentation which was almost certainly a cause of our recurrent miscarriages. If DNA fragmentation is found, there’s a lot you can do to improve it.

Re. egg quality, I think it can vary hugely from year to year or even cycle to cycle. I got very different results over 4 cycles in the same year.

I have heard/ read that embryos that arrest on days 1-3 are more likely to be due to egg quality, and from days 3-5 are more likely due to sperm quality. You could ask to talk to the embryology team about this? Ultimately though I think there’s a lot you can do to improve egg and sperm quality (though so much of it is chance too - it’s so hard!).

Hi Loulou:

I am in a very similar situation, including ectopic, endo, and egg quality. I was just wondering how soon after the ectopic did you have your IVF round? 3 months after the ectopic I had a round with no embryos but in 6 months after surgery I have done better in terms of embryo numbers. I am 37 yo for reference. I have had to have a subsequent surgery in addition to ectopic and overall noticed that all of my health indicators (like thyroid health, AMH nosedived after each of the surgeries but then recovered).

Hope it works for you soon! (and me).

@Sherr33 Thank you for your reply. I really hope it all works out for you x

@sweetpea2000 wow, 16 different supplements?? Did you feel like it helped? Like you said, I’m more than happy to spend money on supplements if it’s going to have a positive impact. I just keep thinking about my old consultant, as she told us they could possibly do more harm than good and now we’ve had a failed round, it makes me worry about it more. Trouble is you worry about everything when you’re going through ivf don’t you!
Thanks for your advice about the fragmentation test - I’m definitely going to speak to our current consultant about a DNA fragmentation test. Even if it comes back ok, I want to know we’ve done everything we can.

@Lisa12345678910 I’m sorry that you’re having to go through all this, I hope it works for you too! So our ectopic was in May last year, then we were going to start ivf again in November. But the nurse found large endometriomas on my ovaries during my baseline scan, so that led to me having endo surgery in January. It was mad because I had no idea I even had endometriosis before then! My surgeon was confident that the endo was our main problem and to try naturally for 6 months once I’d recovered, but no joy so we just did our 3rd round of ivf, the one that ended with no embryos. Even though we didn’t get pregnant naturally, I was really hopeful my surgery would’ve made a difference to our ivf results, but actually seems to have gotten worse 😔

I can't comment on the endo aspect but there is no conclusive evidence of any supplements improving egg quality. Same for diet modifications and interestingly giving up caffeine and alcohol despite these being common practice for those TTC. Your GP should be able to do a set of bloods and unless you're deficient in anything, supplementation beyond folic acid (recommended for everyone TTC) is not necessary. I personally do take vitamin D and ubiquinol. Vitamin D because there is good evidence of it's benefit in a wide range of areas outside fertility, and many people are deficient. Ubiquinol because I feel good on it and my hair and skin are good on it too. I first started taking it to try and help with egg quality but as above now highly doubt it has any meaningful effect. I enjoy the other effects of it though!

I’ll never know if it helped, as there’s no way of measuring egg quality, but there was a marked improvement in my husband’s sperm. However that could also be attributed to other changes he made (like looser underwear, less cycling etc), as well as diet and supplements.

I felt like the amount of supplements I was recommended was overkill at the start and had my consultant check and okay the list, which gave me peace of mind. I think there’s some controversy around the use of DHEA but apart from that I’m not sure how the supplements you’re taking would do more harm than good.

You could ask your current consultant what they think, for reassurance?

I know results can vary so much between cycles anyway.

Wishing you all the best with your next round.