Fertility appointment - ? Ovulation induction before IVF

[Englishrose35]

Hi everyone,

We have our fertility appointment next week to make a plan after all the tests.
I'm 35 with PCOS (confirmed on scan, high testosterone and somewhat regular cycles). Also MFI with low motility 30% and borderline/ low morphology. My Hycosy showed clear tubes. When we previously saw consultant privately - they advised next step would be IVF/ICSI due to the male factor. In January, they said to consider IVF of no pregnancy in 4-6months which came as a bit of a shock.

Our appointment next week is with same consultant but in the NHS service. We are entitled to 1 round of IVF in our region.

I'm really not sure whether I am ovulating - periods very light (just 2 days with spotting for a day or two either side), previous progesterone was borderline and my Clearblue peak very late on in the cycle (I know not that reliable for PCOS).

I would like to try follicle tracking and letrozole/ clomid whilst we wait for IVF - but when I had previously mentioned this they said no because of the male factor issue. Do you think it's worth mentioning to the consultant again to see if possible?? - I just think if it's an ovulation issue it would be worth pursuing that first. But also understand with my age 35 and the male factor - IVF ICSI might be the next best step. This is all now NHS by the way. We are pursuing this before considering private route.

Thanks all

Hi Op

I did letrozole and OI before IVF as our infertility was "unexplained". I did get pregnant twice with this over a year but miscarried both times.
Then we had more testing and turned out to have MFI, low motility and morphology and sperm DNA frag high. Went on to have icsi and now 38 weeks.

When I look back I do wonder was there any point wth the letrozole and did we need the icsi due to the MFI as they ended up miscarriages. I'm sure if I didn't miscarry I would think differently. But in hindsight we added two years to our infertility journey with holding out for the OI.

If you have a date for IVF and want to try in the meantime seems fair enough as you won't be putting it off as long as we did. Also now after everything I've put my body through and the emotions of trying to get pregnant are at bay I've been looking at the risks associated with the medications of the fertility process aswell. And I do wish I hadn't done so long in letrozole and OI. But would i do it all again if it meant I would get a baby? Probably yes.

Generally with MFI icsi gives the best outcome.

Don't know if that helps at all. Just my thoughts on my own personal process.

Good luck with whatever you decide.

Personally, and I’m not an expert at all so just purely telling you what I’d do - I’d go ahead with the IVF with ICSI. Egg quality goes down quite sharply over the age of 35 so I wouldn’t want to delay it and run the risk of then having egg quality to deal with too, which can’t be corrected. So yeah, I’d just say get on with IVF as quickly as possible.

Your partners sperm results aren’t actually that bad tbh either, as an aside! 🙂

@Halsi

Thank you for your helpful response and sharing. I agree, I definitely don't want it to delay IVF ICSI - we don't yet have a date for starting so I need to find out how long approximately the waiting list will be. I guess part of me hopes that if OI letrozole worked, it would save the hassle of IVF but agree that for male issues ICSI is recommended.

Sorry to hear about your miscarriages.

Can I ask: how low was the motility and morphology for your partner?
We haven't yet done a sperm DNA fragmentation test but I don't think it will likely change recommendation for proceed to IVF based on what we have been told so far.

And congrats on your pregnancy.

It is difficult to know but I guess it also may depend on female age. How old are you? I'm 35 so probably that is a factor aswell.

@HopefulllHolly

Thanks. I think this is also what the consultant was thinking. And that best outcomes would be with IVF ICSI and also lower female age.

We have now been trying for 9 or 10 months so it isn't really that long at all. But I think because we know there are two issues at play, it is harder and may take longer.

Yes exactly, his results are a little bit below normal. Which then makes me think maybe it's more an ovulation issue and would OI work without having to pursue IVF. But perhaps it is a combo of age/ sperm results/ PCOS which is why they suggested IVF.

Thankyou @Englishrose35
I am 35- I also have lower amh for my age at 34 which was 7 (this halfed from 14 at 32), egg quality likely could be an issue for us aswell
DNA frag was 27
Motility was 28%
Morphology 3

So like your partner not awful.

Wishing you well with your decisions, I found it very hard to make the decisions each time

Btw we didn't get amazing results from Icsi, one day 5 blast, not a great grade (3BC); and day 6 blasts 1xbb 2 xcb. Very thankful for this one. I do wish we did icsi earlier

@Halsi
Thanks - it is hard knowing what to do
Sounds like sperm results quite similar to yours. My AMH is OK but I think that is because of PCOS - so it's always higher than normal but who knows about egg quality

When you say you wish you'd started ICSI sooner - how long were you TTC for? (Or how long TTC before you started OI?)
I feel like we haven't been trying that long but if we know there is an issue might be best to crack on

It's very hard to take the next step each time.

We TTC for a year, then investigations for a year, then OI for a year but because we were pregnant and miscarried twice with that it really took say 18months. Then about six months between appointments and ICSI starting so It was four years by the time we did ICSI. I do sometimes think shud we have done the IVF after year two but mentally I wasn't ready and can't change that obvs. But realistically we may have gotten more embryos being the two years younger.

I do understand how hard it is to take that next step. It's so much money doing it privately aswell.