How long TTC before considering IVF?

[Englishrose35]

I realise this is a really broad question and responses may vary but I'm trying to get some insights in anyone with a similar situation

I'm 35 and have only been TTC for 6-months (realise it's not long). There are a few issues on BOTH mine and DH sides:

• I have PCOS but I do ovulate I think and regular cycles every 29-32 days
• I am also awaiting repeat scan and maybe laparoscopy for ?endometriosis as my pelvic ultrasound showed a nodule which they suggested could be endometriosis but they are not sure
• DH has had 2 SA which have been quite borderline - one showing low volume and borderline motility and the other showing low motility and progressive motility but just a little below the normal range. He is going for a third SA soon

I suspect il need to wait until after the scan and possible laparoscopy but I'm just concerned that we already have a lot of things against us plus I'm approaching wrong side of 35 and would like more than 1 child if possible.

I know people can conceive with the above issues (there is nothing absolute which would prevent conception like no ovulation or complete lack of sperm) but in this situation how long do people try before considering IVF?

Thanks

Hello!

I'm 34 and my partner is 39. We went through IVF at the end of last year after about 2 years of TTC.

I'd say if there's a list for treatment to put yourselves down on for it then do it asap. The waiting list where we live for an initial fertility appointment is about 18 months at the minute. We ended up going private as luckily when we did our second lot of tests( we paid for them to check) everything was in the good range so we just went for it as we were too scared to wait.

We are in the 'unexplained category' so IVF was the only option for us really without just keeping on going which gets a bit unfun!

Thanks for the response and helpful information. I feel like private will be the way to go if we aren't successful due to waiting lists.

We are lucky that financially we can afford to go the private route. But I'm going to ask GP to refer to NHS fertility anyway after I've had my repeat ultrasound. I'm seeing a gynaecologist privately as the wait was going to be 8-months otherwise!

Are you classed as unexplained if everything totally normal?? - I feel like our tests are not drastically "abnormal" but definitely not normal if that makes sense. Don't know what is the better position to be in

I only waited 8 months before getting investigations for myself and my husband, we were hitting ovulation hard and getting nothing so I knew something was wrong. Glad I did, he has a varicocele and we'd never have conceived naturally as all his parameters were low. Tried to embolise it but that failed so went to IVF right away. Went private so happened quite fast though at the time every day was torturous with waiting!. From beginning to TTC to having our baby it was 2 years 2 months, 9 if that of course being pregnant.

Thank you. Waiting is torturous but my main concern is I feel there is already stuff known to be a problem - PCOS, this possible endometriosis and DH Sperm which is borderline. The Gynae consultant suggested we have an SA early because DH has a history of torsion as a child but now I feel it has just made us more stressed

I feel I just need to have "time frame" as to how long we should try before considering IVF. Do you think best to find out from my Gynae after the repeat scan?

Its very odd.. my AMH was very high and they did suspect PCOS but that got ruled out. They couldn't find any reason so we got chucked in the 'we don't knows pile!

If you can get in for a consultation with a clinic I'd say that wouldn't hurt. They can do their baseline testing and stuff and at least give you some options to consider without having to shell out for the full cost of IVF and you can then maybe weigh up waiting for NHS or going private. We went with Care Fertility in Liverpool and they were really lovely :) for a time frame idea, we had our initial consultation in July but then put off starting IVF straight away as we got married in August. Started tablets in September, egg collection in October and then had to postpone to December for a frozen transfer due to OHSS.

Thank you. That is odd! I would have thought they should have thought about PCOS in your case rather than just bouncing to the unexplained category

I have confirmed PCOS (scan findings, high AMH, acne and high testosterone) though I ovulate and am not overweight so at least that is a positive.

I will look into clinics. I'm aware il probably need to repeat some of the tests and will need to see what my repeat scan shows. It's so hard being surrounded by friends with children and babies knowing we may struggle.

@Englishrose35 In regards to what you should do I don’t know but I’ll share my experience incase it helps.

We started trying when I was 32 but after 9 months nothing was happening so we went to a fertility clinic for investigations. At the same time I had my first and only chemical pregnancy.
We were then at the 14 month mark by the time we decided to start trying treatment after some clear tests. I was then just turning 34. We ended up doing 4 iuis and one round of ivf - all unsuccessful. We know my partner has lower morphology but not terrible and I have lowish amh. All this to say we started the ball rolling 9 months in which prob seemed premature but now we are about 27 months later and still nowhere and I’m 35 😢 .. We’re starting second round of ivf in a week.

I guess my experience would lead me to think better to start sooner than later but then someone who’s been more lucky would most likely advise the opposite. It’s a tough one. I don’t think I’d have been mentally ready for ivf initially. Best of luck to you! ❤️

Hi @Englishrose35

Thought I'd give you my opinion and story :)

Firstly, my opinion is to go for IVF if you can. As you said, if you're financially lucky to do it then I would crack on. My husband and I have been TTC for 13 months now. We knew something was up 6 months in- he got tested and his sperm were terrible. The NHS kept saying, come back in 3 months and test, come back in 3 months and test.

In hindsight we should have gone to a urologist for my DH sperm straight away but we presumed it was because he was so stressed and hopefully thought his sperm would improve. Anyway, we started IVF abroad (much cheaper than UK) in October. Have had 2 failed rounds BUT my DH went to a urologist in November due to aches down there..... turns out he has a varicocele which we think is the culprit to all the struggle.

I would get as many tests done as possible now so you've 'ticked' off all areas and crack on with IVF :)

I also have a polyp which I will get removed but I wish DH and I knew all of this early on... hindsight is great but we all learn and I can pass on my advice to others.

GOOD LUCK!!

@Englishrose35 PS. When we told our family our IVF plans, I was worried they would all think we are jumping in far too soon (9 months in) but every single person thought we were doing the right thing by cracking on with IVF. Everyone said, if you can do it, then why wait 💜

Thank you so much for sharing and sorry to hear it has been a long struggle despite getting the ball rolling at 9-months. I think the NHS is really on its knees at the moment which makes waiting times more difficult.

Were there any other issues apart from low morphology and lowish AMH? - I think I'm just getting myself in a panic as we already have reasons why we might struggle and it's just the unknown of whether or not we will conceive/ how long it takes.

The gynaecology consultant says it can take up to a year for even healthy couples to conceive - which really irks me because then surely if there is a problem/ issues it can take even longer and one should be more proactive?! Especially with my age

Wishing you the very best of luck for second round xx

@FernaFrey

Thanks so much for sharing your story. That is great that you were so proactive. Can I ask how bad / low the SA results were?

• my DH has a total motility and progressive motility just below cut off and sperm count of 42mil

We are doing vitamins etc. We also thought maybe he was stressed with giving the sample. DH does have a history of torsion as a child so wonder if it might be worth seeing a urologist to see if anything else can be done...

I also have an endocervical polyp!! And a ?endo nodule. Waiting for repeat ultasound scan then may need a lap. All just feels like so many delays one after another ☹️
I guess I need to know about the above but will likely look into fertility clinics soon after outcome of this.

Best of luck with your journey. Did you look at private options in the UK as well??

Sorry to hear you're on this train. A few thoughts from me:

• fertility consultants often aren't too worried about motility if that is the only issue, so will be interesting to see what the 3rd SA shows.

• be aware private treatment in some areas invalidates future access for NHS treatment (even with no live children as a result of the private treatment). Similarly NHS may not regard private test results.

• you want to have multiple children and say you can afford the private route. With an average of 3 rounds of IVF for a live birth you could be looking at a £40-50k bill for two children (or more). Just worth considering, especially in the context of if you are successful for one. Your disposable income when trying for a second will be significantly less and savings can be eaten by mat leave etc. Of course you know your financial situation best, just thought worth highlighting.

• I personally wouldn't rush into IVF. Success rates are terrible, even at your age. You can waste a lot of time and money going down that route if it's not needed.

Robert Winston's The Essential Fertility Guide is an excellent, pragmatic, evidence based book that provides detailed info on navigating the world of infertility. I'd highly recommend reading it before making any decisions about next steps. All this said with the hindsight of a lot of IVF, successful and unsuccessful! Best of luck.

Well this is only personal experience but we had IVF for a second child after struggling to conceive for three years. The first cycle failed but the second worked and our family is now complete. We were unexplained and didn’t have a hint of a positive in three years of hitting the ovulation window every month. Our first IVF cycle was an early loss but it proved we could get pregnant again.

I don’t think we would ever have our second baby without IVF. In my opinion it gives you the best chance of success by far!

Good luck!

@SErunner
Thank you so much for this helpful and thoughtful response.

The 1st SA showed low volume with borderline motility - the count was OK and above normal range.
2nd SA was low motility and morphology but volume and count fine.
DH has a history of testicular torsion.

I definitely don't want to just jump to IVF without giving enough of a chance of conceiving naturally. I just feel like there are already several issues on both sides which is getting me down: PCOS (though ovulating I think), endo and then a less than idea SA. It's so hard when everyone seems to get pregnant easily. I also feel I don't have much time as I'm 35 so abit panicked about that. My AMH is high because of PCOS but who knows about egg quality and possible effects of endometriosis..

Your insights into IVF are really helpful thank you and I'm going to purchase that book as I would rather stick to facts and the HFEA website for realistic rates.

I have checked ICB guidelines for where we currently live. Only 1 NHS IVF round funded. From the guidelines I think I'll as long as no more than 1 rounds of private, it is OK. ICB says:
Patients who have previously had NHS-funded IVF/ICSI or patients who have had more than two full cycles of IVF/ICSI (if aged under 40) and more than one cycle (if over 40), whether privately or NHS-funded will not receive any further NHS-funded IVF/ICSI.

I really agree with you about the costs and wanting 2 children, which is why I don't want to jump to IVF unless I do really need to. But it is hard to know how long that should be. My plan is to ask my gynaecology consultant when I've had the repeat scan as probably if I need a laparoscopy that might delay things. I'm planning to go private for this if needed as the waiting list is awful.

I'm so sorry, there was a typo in my reply. I meant not too concerned if morphology is the only issue. It sounds like there are some challenges from your husbands perspective. There are some good threads on here about ways to improve sperm quality through diet and supplements from people who have had consults with Jonathan Ramsey, who is considered the best in this particular area.

We were similar with our NHS IVF provision in terms of it was very limited (1 collection 1 transfer). However, we only had my low AMH and AFC to contend with, for which there is no treatment. Bear in mind the NHS provision may cover things like the lap you mentioned, other surgery/imaging etc, and treatment for your husband if needed. IVF isn't going to solve those other issues and they may make a positive outcome less likely. You can quickly spend thousands on tests/surgeries etc just to optimise your chances for IVF. Not at all saying you should go private straight off the back (we did due to combo of crap NHS offer in our area and long waiting lists due to Covid), but good to make as informed a decision as possible (allowing for so much with fertility being uncertain). I understand the frustration of waiting, it is awful, and eventually you just have to do what feels right for you.

Glad you're ordering the book. I similarly stick to the HFEA guidance and very reputable doctors like Robert Winston. There are sadly far too many people praying on peoples vulnerabilities for financial gain. Robert Winston's website is also excellent (genesis research trust).

Hi all,

Saw my gynaecologist today. Repeat ultrasound just show polycystic ovaries and no polyps.

DH has now had 3 SA which all show low motility and some with a borderline count.

She basically advised to continue TTC for a further 6-months and if not successful than to go straight to IVF/ ICSI. She said that we can get referred now on NHS because of the male factor. Which is good I guess in terms of getting the referral in.

Annoyingly she wasn't able to say what our chances of natural conception would be so it all feels very uncertain. DH motility is around 30% and counts are between 16 - 21 million/ml so borderline.

She said that would not try IUI or ovulation induction (even though i have PCOS) because I ovulate and because of the male factor.

In some ways it feels good to have a plan but just never thought I'd be in this situation of likely needing IVF/ ICSI we can't conceive.