Independent infertility investigations

[Sierra26]

Hi all. Unexplained infertility over here. We’re due first IVF consult this week for our one and only nhs funded cycle, which we want to go through with, but I can’t stop thinking about all the investigations we haven’t had yet.

We went private for all the usual blood tests, and HyCoSy, multiple scans, and had a few letrozole rounds on nhs (which I had to ask for as they wanted to refer straight to ivf).

I’m otherwise fit and healthy. I’m sad that we may never know what the problem is. That I’ve not had the chance to make any lifestyle changes that might help. And worried that IVF might not work as it won’t be well enough tailored to whatever my problem is.

Can anyone recommend an independent fertility investigation clinic or consultant in London? From research I think they are all more IVF clinics, so push you for treatment, rather than focusing on root cause and working on that. I don’t really know what I’m looking for or if such a thing exists.

Hi @Sierra26 you could try Fertility Solutions in London or Beaconsfield. They technically specialise in male infertility but they very much believe unexplained is not a valid diagnosis and advocate for more rigorous testing - for example, if you haven’t had one already I would definitely recommend a sperm dna fragmentation test, as high dna frag can cause ivf / ICSI to fail, and men can have normal sperm parameters everywhere else and so it goes undetected. One study said it accounts for 80% of unexplained infertility! That wasn’t actually the source of our problems but the clinic recommended further tests for my husband (eg semen culture) and they recommended I see Dr Lynne Chapman who is meant to be very hands on and thorough (I’ve got my first appointment on Monday so will let you know how it goes). Do you have any symptoms of endometriosis? A Lap could be an option? I completely know what you mean though about fertility clinics really being ivf clinics - given the relatively low success rates ivf should not be the be all and end all!

out of interest how did you persuade the nhs to give you Letrozole if you are already unexplained? My original clinic told me because I am already ovulating I would have to do it privately, which would cost £750 a month (!!) I haven’t started because I am hesitant to drop that amount of money on something which may not actually solve the problem, but I didn’t realise the nhs was even an option?

@hopingforapeainapod we meet again :)

Thanks for the clinic recommendation, I’ll check them out. We’ve looked in to dna frag test but waiting lists are months long and we’ve got first ivf consult later today. So going to ask if they’d advise us doing that first, and waiting to start ivf until after.

i haven’t had a lap but have wondered about silent endo, and am curious about the EMMA and ALICE testing too (have started taking optibac supplements anyway in case). Going to ask today if there’s a possibility to add any of these on to our ivf package.

Re letrozole. At our first nhs fertility appt they didn’t do any clinical reasoning, we already had our private tests results (normal) so the doc looked at those and literally just said “so you have unexplained infertility, here are the ivf referral forms”. I was so shocked there had been no other discussion and we didn’t want to go straight to ivf. So I said as much, and (because I already knew about letrozole and clomid from on here and as I’ve had friends use it) I asked about ovulation induction and the doc said yes straight away. I don’t know why! I honestly think another doc might have said no, so I was just lucky (/unlucky as this doc has been terrible in every other way).

During later appts they started mentioning PCOS and, when I questioned that, said “yes that’s why you’re on letrozole”. I had to say “em no…. I ASKED for letrozole and we’ve never discussed pcos before”. That’s when talk of my high(ish) AMH came up. Honestly such a shambles from start to finish, with so many other issues in between.

If you’re already ovulating, you may not be missing out by not trying letrozole. Fortunately I live near the hospital but each month I’ve had to go in 3-4 times, they won’t prescribe the cycles in bulk so each prescription pickup needs two visits, they’re only open two days a week so getting a scan on the right days is almost impossible, and they never managed to get me a trigger shot. It’s been really stressful and if I had a less flexible job it would have been completely impossible.

@Sierra26 I am sorry to hear about your struggle

I find it odd that we are always pushed for IVF before doing the diagnostics properly and knowing what is causing infertility in the first place. Most of us don't have unlimited resources to throw at IVF cycle after cycle, and then spending more on tests AFTER the failures! Isn't it ridiculous that you won't be checked for implantation issues until good embryos have failed to implant at least three times? You are not getting those good embryos back!

So it's really good that you are doing tests before embarking on this journey, sometimes you have to push them. I regret not doing it earlier. Hope your consultation went well.

On the Letrozole, my GP suggested ovulation stimulation to me, but as you experienced, said we couldn’t do it on the NHS (she was very sympathetic but said very much that she couldn’t do anything for us). But when I mentioned that to our private clinician, she was surprised and said she’d prescribed ovulation stimulation for her NHS clients before with no issues. I think it is a bit of a lottery!

Also, OP @Sierra26 for male fertility you can consult Dr Jonathan Ramsay. We have been to Dr Ramsay and would recommend him.

Dr Hassan Shehata apparently is good for dealing with repeated implantation failure and miscarriages. But you don't know yet if you have that problem. We have not been to Dr Shehata, so can't give any personal recommendation.