Choosing a clinic for 1st IVF round?

[Confusedddddddd]

Trying to decide what to do, there's a clinic 10mins away from me, but they are within a nhs hospital so don't offer anything beyond a bog-standard IVF round. They are cheap, but no finance packages. We can probably do without that but was hoping for a 50% refund package maybe if it doesn't work. HFEA success rates are pretty much the same as England average.

Other options are slightly better and would have things like PGT testing but more expensive and an hours drive, or I could go to one of the London ones - 2 hours drive.

Issues: I'll be 39 in 3 months so age isn't really on my side, I only have one accessible ovary, one tube, large cyst on inaccessible ovary, bulky uterus, bmi 35, prolactinoma (been treated 10 yrs so not too worried about this), AMH 11, AFC 9 - possibly more, but 7 were on my accessible ovary. Sperm testing came back fine.
I've been pregnant twice before - 1 live birth at 36, took 6 cycles, one ectopic pregnancy at 37 - 1st try.
DH thinks IVF should work fine as we've been pregnant twice relatively easily,the tube we lost was to my good ovary and we thing due to the cyst the remaining tube isn't picking up the eggs from the good ovary. We had all our testing with our local clinic but I'm not sure they are the best for our case - they just seemed to say that age is my main issue, keep trying another 6 months, nothing about the other issues. I'm thinking we should shop around but we're a bit limited by bmi, and I don't want to spend a fortune on consultations.

I also know I need to lose weight and I'm working on it, but last time I was at a normal <25 bmi my cycles stopped, and restarted when I gained again - I think the prolactinoma had something to do with this. I also don't want to waste time losing weight as my age is a bigger factor at this stage.

Do you think it's best to stay local for 1st round then change clinics if it fails? Or spend more on 1st round in the hope that it's successful?

Not an easy one as you have a few issues potentially to consider in terms of treatment.

What I would say though is to consider your commitments / flexibility at work etc. IVF involves a lot of very short appointments. So particularly when they're monitoring your response to stims, you could have a 10-15min appointment every other day for 6 days. Do you have the time / flexibility in your life to be spending 4 hours of your day driving, for a 10min scan and blood test if you went with a London clinic?

You might also want to consider waiting times at the various clinics you're considering.

The sad reality is that age generally is the biggest factor for most people. As you've said you've conceived naturally easily before, so whilst age and the blocked tube are against you, you do have a good previous fertility. How long have you been TTC? Is there any particular reason you're wanting PGT testing?

I think have a consultation with the clinic thats an hour away, see what they say and if you think they are offering anything more, and get a quote for how much a refund package would be with them. And then sit down and consider the 10min away and 1hr away option of pros and cons.

Agree with the poster above, I would think about wait times and how easily accessible the clinic is as you’ll spend a lot of time there during treatment.

I was in a very similar situation to you. Started at 39, now 41 and still going through it.
Often it can be a longer process than think think so I would do a consultation asap.
I had a dermoid cyst on the my ovary and the clinic wouldn’t do ivf until I had it removed which delayed starting treatment by 6 months.

Wishing you all the best.

@2mumlife thanks, we've been trying how 15 cycles since the ectopic. I think we wouldn't go for PGT testing on the first cycle but would if that one fails, it's just an option I'd like to have available but I guess we can just change clinics if we need to.
I guess it makes sense to book an appt with the one an hour even just to get a second opinion.

@AmberEagle thanks too, out of interest how big was your cyst? Mine is about 4cm (though I'm worried it's grown in the last few days as has been painful), they said removing it prior to starting is an option but as I only had 2 visible follicles on that side they said they simply would leave it alone. I'm wary of removing it as I had it previously removed at the same time as the ectopic and it grew straight back. They didn't know what type of cyst it was or why it grew back It was blood filled but not endometrioma.
How many rounds have you had now?

Mine was 5.5cm so bigger than yours. That’s good they are happy to leave it, my clinic wouldn’t do the stims until it was gone. So sounds like yours is different to mine which is great.

I am just about to start round 5 with my last frozen embryo. I’ve had 4 rounds with varying results. First was a BFN, second was a pregnancy that resulted in miscarriage, third was a pregnancy that resulted in TFMR. Fourth cycle was BFN.
However please don’t let my experience dishearten you. I have been extremely unlucky and it only takes one good embryo x