Three failed ivf - what to do next?

[LouLou7864]

Hi everyone,
I’m really hoping someone might have some advice for me. I’m 36, my husband is 42 and we’ve just had our 3rd failed round of ivf.
Our first one was an nhs round at care in bath in 2021. Before starting they found my amh was really low for my age (3.4 pmol) but said my antral follicle count was good. Went on a long protocol with 225 Ovaleap and had two very dominant follicles from the beginning. Got 2 eggs, both fertilised, both grade 1 on day 3 and got 1 “good” quality day 5 blast. Fresh transfer but BFN.
Second round was private. She repeated my AMH and it had gone up to 11 pmol?! She still thought I’d benefit from max dose of menopur. Again 2 follicles were dominant. That time we got 5 eggs, 4 mature, 3 fertilised. We had 2 top quality embryos on day 3, but they were only early blasts by day 5. She advised have both put back, got a BFP, but ended up being ectopic.
While getting ready for our 3rd round we found I had stage 4 endometriosis and had major surgery (had to have part of my bowel removed it was that bad!)
We were then pointed in the direction of the lister Portland clinic in London as my AMH had dropped to 5.5. We didn’t have the best experience - got sent away with the wrong dose of meds twice (one pharmacy error, one consultant error) However things seemed to be going well and got 8 eggs (I was on 300gonal, 150 menopur and had a double trigger). 6 were mature, but only 3 fertilised. None made it to blast or to be biopsied (one struggled on until day 7, then stopped growing). Had a follow up with our consultant and he basically said it shows my eggs are terrible quality. He’s suggesting one more go with pergovis, human growth hormone and ICSI (husbands sperm is decent, he said it would help my eggs?) If that doesn’t work he said our only option will be donor eggs. I was upset and said no one had mentioned egg quality before and we have always made blasts. He said the fact it hasn’t worked for us so far and that we had an ectopic proves poor egg quality and said we will need PGTA testing again if we do make any future blasts.
Has anyone been in a similar situation? Does it sound like our problem has been egg quality all along? It’d cost a small fortune to do this new protocol and I’m just not sure. Part of me wants to look into mild ivf as some believe it can help with egg quality, but also don’t know if it helps to keep changing clinics! If anyone has any advice, I’d be so grateful!

@LouLou7864 sorry to hear you've had a tough ride so far! I have stage 3 endo, had excision surgery and then about a year later had our first IVF round on the NHS, this equalled such a poor round on Ovaleap and the short protocol - got 9 eggs but all bad quality and none made it to blasts. We did have 2 transferred on day 5 but the quality wasn't great, failed round.

I then decided after some research to go on ubiquinol for at least 3 months to improve egg quality. Long story short, we moved clinics to BCRM in Bristol (amazing clinic), they put me on the long protocol and I ended up with 17 eggs! (Pmol was 11 on this round, 15 pmol on first round). Ended up with 7 top quality embryos, one transferred and I'm currently 18 weeks pregnant with 6 embryos in the freezer. Two completely different cycles, it could be coincidence but I would definitely look into improving egg quality before your next round! Good luck 💖

Hi lou, Sorry to hear you have had a tough journey so far, but honestly dont give up.

What supplements are you taking?
I highly recommend the book, it starts with a egg, the supplements she mentions works wonders.

Coq10(ubiquinol) is a very good supplement to add for egg quality, another one is dhea but you will need to check with your clinic first. MY clinic has advised me on both.

But remember it takes 3 months of taking good supplements for egg quality.

@AnnaRose85 @wtawtaw
Thank you both for your replies! I’ve been using Ubiquinol for over 3 months now. I also take proceive, vitamin d, omega 3, a probiotic and I was taking melatonin during stims but stopped after my egg collection. I’m not sure I can do much else as my current consultant hasn’t recommended DHEA.

I'm sorry you've had a hard journey OP and could have almost written this myself! It can be draining at times! We TTC 13yrs, lost 3 and 2 rounds of IVF. My AMH was above average though, and the only cause for sub-fertility found was 'my old eggs' (according to 1 consultant!)

Was the ectopic prior to starting IVF or as a result of it? I always thought ectopics were more likely from damaged tubes from inflammation/infection and not to do with egg quality! I'm afraid I'm not familiar with pergovis or that regime. If all the eggs collected so far have not been great, why would mild IVF, where only 1 egg is collected be any better? Have you read actual medical literature/evidence that this could improve outcomes?

After my 2nd IVF, I actually had a consultant explain things to me. I asked about PGS (as it was then) but she said that unless the embryos get to blast stage- there is nothing to test and it can be damaged by the process. From memory, she also said that the cell taken out for testing might be fine, but others may not and vice versa. This was Guys in London, and she said that they didn't even offer PGS, because the evidence that it is beneficial was negligible. She did say that private clinics would take your money and give it a try! This was nearly 3yrs ago, so maybe there is more evidence or better techniques now.

The consultant also asked whether I'd considered donor eggs. Well NO- I'd never considered it because she was the 1st Dr/person to ever mentioned it in 13yrs!!! In hindsight, I guess that is an obvious next step, but unless you are told that your own eggs are no good, it was something I always thought 'other' women needed.

I did start looking into donor eggs. The difference between choosing a British donor vs say a Spanish clinic. I could have tried a 3rd round of IVF or tried donor eggs. By that stage, I was nearing 43, DH was 47, and in the end, we decided to leave it. I have a very happy life, just a different one to what I'd always assumed.

I'm afraid I can't offer much advice, but feel free to ask anything. x

Hi Op not same situation other than my egg quality was the presumed issue as I'm 40 and had reoccurant mc. AMH and follicle count fine for my age. I was offered Pergoveris after my first round as they thought I was a poor responder. (I did the blood test and wasn't so I did menopur and was successful). I followed the book it starts with the egg max programme and did fertility accupuncture for my second round. I think it helped me as my embryos were much higher quality second round. People have mixed opinions on DHEA I think but I know someone who had very low AMH and AFC took it for 3 months and was successful in her second round after taking it and in addition to following the book I did it for 1 month before but was nervous so did a lower dose. Probably didn't make a difference for me in that time but hard to tell as I threw the kitchen sink at it! X

So sorry you have to go through all this!💔

I would recommend trying ICSI for next time and also pgta testing your embryos. We too had no sperm issues but it helped get better embryos.

I have always had a decent number of follicles (34 eggs total from 3 cycles, 8 blastocysts, and only 1 normal embryo that we are yet to transfer).

I think having these two procedures will help to understand what else might be going wrong with your body and eliminate the egg quality question.

best wishes ❤️

So sorry to hear of your experience, you don't actually realise the hurdles to get over at the beginning, our first round on NHS I got 13 eggs, zero fertilisation, second round I got 14 eggs and with icsi 10 fertilised but only one made it and unfortunately it did not implant. Recent third round 17 eggs with isci 10 fertilised but not one made it. My partners sperm is good and like you this was the first time my egg quality was mentioned to not being the best but everything else seems OK. They have said going forward about pergoveris which I've never had with picsi, macs and mentioned dna fragmentation and that was czech republic we went to last round, others northern ireland. Don't think I could do it again. I was taking the best supplements money could buy and honestly I wouldn't waste your money, I was told just take your folic acid and vitamin d unless of course there's something you need medically