1st NHS appt tomorrow - guidance please

[HM2024]

We've been TTC for over a year. We have a wonderful 3 year old who was conceived quite quickly. I'm 38 and DH is 41.

We have an appointment at the NHS fertility clinic tomorrow and I'm trying to do my research and go in prepared. I'm worried about being fobbed off / told to go for ivf so want to be armed with questions/requests as I feel that we haven't tried everything first (and honestly I don't think we can face the mental strain of ivf).

My periods are pretty regular though I think short. Usually 25 days with spotting a few days before. I think they are probably on the 'light' side. Through ovulation tests, I think I ovulate about day 15 or 16 so have wondered if I have a short luteal phase.

I've had blood tests and everything looked ok apart from my testosterone was 0.2 (normal range noted as 0.3-1.7 nmol/L). 0.2 nmol/L translates to 5.77 ng/dL). I've been reading It Starts With the Egg and she notes that normal range is 8-60 ng/dL and optimal is 25-45 so I'm much lower than that. Wonder if DHEA could be considered and if it something used in the UK by the NHS?

DH sperm results just came back as normal.

We are both talking loads of supplements as recommended in It Starts With The Egg for about a month now.

Just wondering if I've missed anything? Any suggestions appreciated!

Hi, I didn’t want to read and run. I think that it’s very unlikely you’d be offered funded IVF on the NHS for a second child anyway. The policy is different in each area but I don’t believe any NHS trust offers to fund IVF for a second child. What might be useful is asking for a HyCoSy to check everything looks normal, no blocked tubes, scaring in the uterus etc. plus research shows the few months after a HyCoSy have slightly higher conception rates due to everything being cleared out! Also, if your tests so far didn’t already include it, you might want to get an AMH & AFC test to understand what your ovarian reserve looks like. Good luck!

Thanks so much for taking the time to reply :)

Yes, we wouldn't be eligible for funded IVF, so it would be self funded.

Thank you for the suggestions. My blood tests didn't include AMH or AFC so I'll ask about those.

Is a HyCoSy more/less useful than an HSG? I phoned to ask what the appt involved and they said maybe a transvaginal ultrasound so wonder if that's an HyCoSy...

Hi, HSG and HyCoSy are very similar. HSG is done under xray whereas HyCoSy is by ultrasound. If they said they would do a transvaginal ultrasound I would imagine this is just a standard U/S rather than a HyCoSy procedure for which I’d expect you’d need a referral. The standard U/S I’ve had usually checks the womb and ovaries for any obvious lesions etc. but cannot check the tubes for example. They might check your AFC for you as well though while they are doing it. Good luck!

Hi OP,

My only advice, from painful experience, is try not to write off IVF so quickly.

We went through 4 years of unsuccessful fertility treatments, supplements, advice, various interventions, doctors, IUI etc. Nothing worked.

But then, the very first round of IVF we did, it worked.

I won't lie, the IVF obviously wasn't easy - but trying to avoid it, the stress of drawing it all out, the emotional turmoil of that, was a lot harder. Not to mention the amount of money we spent and we ended up with IVF anyway.

IUI works about 10% of the time for your age group - less if you have any kind of fertility issues (& it sounds like you might). You could end up doing it over and over and over again, spending money and time, and having no success. 10% is low.

A round of IVF can be over and done with in a couple of months.

I'm not saying to completely write off other approaches - I'm just saying don't waste loads of time before doing IVF, because it really is the most likely way you will have success, and with your age, you probably want it to happen sooner rather than later.

Take care and good luck whatever you decide.

Thanks for all the info and guidance Zypig. Has standard U/S and have been put on the list for an HSG.

Thanks so much for taking the time to reply.

Can I ask what other fertility treatments you had before IUI? Curious as nothing except IVF was mentioned today.

Your take on it is really useful. The low success rates for IVF feels like such a gamble. The money is one thing but the emotional turmoil is more my concern. And when do you stop.

Also, what point do you decide that it is time to stop trying naturally and go down the IVF route.

We had a couple of rounds of ICSI with my partner's sperm first, before moving to IUI with a donor.

ICSI is IVF really, the only difference is they inject the sperm directly into the egg to give it a little extra help. It didn't work for us because our issues are male factor and it became clear that my partner's sperm was never going to work, so we switched to a donor before trying IUI. We did quite a lot of IUI in the hope to avoid having to do IVF again.

The other things we tried were various supplements that were meant to help my partner's sperm (sometimes for mild cases, people just need to get a bit healthier etc), and antibiotics to clear a couple of infections he had, but it became clear that nothing like that was going to do the job for us and we would need a donor.

The 'when do you stop' question is a very difficult one, but really I don't know that it's all that helpful to worry about it before you've even started. You might get pregnant on the first round and then you wouldn't need to worry about it - you just don't know what will happen.

For us, doing so much IUI only added to the emotional turmoil because it didn't work and it dragged everything out for so much longer. Doing repeated IUI's is harder than IVF emotionally, because it's just relentless month after month, scans, ovulation tests and pregnancy tests, ups and downs. IVF is physically harder, but at least it has different stages to it and you can get a break at times.

Really I think infertility is just emotionally difficult whatever you do, and the cause of that is more to do with wanting to be pregnant than the specific treatment you choose. You'll have to deal with some difficult emotional stuff either way, unfortunately.

If I could go back in time, I'd do the thing that would get me pregnant the quickest, which was IVF with donor sperm. Of course, at the time I didn't know it, but I really wish I was more strongly advised against doing so much IUI.

Did your appointment help you reach any conclusions at all or make you feel any better? Hope you are doing OK, this is a really difficult place to be xx

What a journey you went through. Where are you on it now? If only there was a crystal ball at the start of it 🔮

Hmm the appointment yesterday - I suppose it was helpful to rule out anything obvious. And I felt listened to, and he took time to answer my questions. Obviously age isn't on our side but the internal U/S seemed to show good follicles so that's good. And next I will get the HSG.

It is an awful place to be in and now I'm much more aware of it, I've heard of so many people who have struggled in one way or another. Really seems that a lot more research and funding is required.

I'm OK sometimes and really upset sometimes. It just takes up your mind (which is probably the least helpful thing to 'relax'!). I have a friend who started trying months after we did and due her baby any day now. I'm finding that hard.

@HM2024 Well I'm actually pregnant now after the very first round of IVF with donor sperm (after 9 x IUI's) so that is partly why I'm encouraging you to consider IVF rather than the IUI route - or at least don't do too much IUI before switching.

I'm really glad to hear you felt listened to in your appointment - we've had a range of experiences from excellent to absolutely appalling and dismissive. One appointment with a gynaecologist actually made me cry because I felt so patronised and unheard by him. Getting a professional who listens is a great start.

And yes, it's really hard when friends/ family members get pregnant. We had so many people announcing pregnancies over the long years it took us to get here, and it got more and more painful over the years. Quite a lot of people who started trying after us now have 2/ 3/ 4 year old children. That's tough.

Do you have a good support network or counsellor to talk to? That can be really helpful. You really need to prioritise looking after yourself in this process x

Congratulations! Sounds like you went through so much so that's great news for you.

It does feel like a lottery for which medical staff you speak to. From GP visits, I had one who was like 'it's fiineee just keep trying' (and I'm pretty sure I know more about fertility than she does now) to one who listened, took pity and ordered all the tests and referral.

I've got a few people I will speak to about things but honestly I'm quite guarded as now know from experience that it's really hard/awkward when someone that knows we're trying gets pregnant.

Any advice on how to navigate the friends getting pregnant? My best friend is going to be trying for #2 soon and I love her too much to distance myself for self preservation.

Any advice on how to navigate the friends getting pregnant?

I think an outlet of some kind is really important, where you can feel properly seen and heard. It's hard when your friends get pregnant because you really want to be happy for them (and on some level, you are), but also, you have this indescribable pain of your own - so it's quite a conflict. I think it's important to be able to talk about that.

If you're not happy sharing with too many people you know then a counsellor would help you to have a space just for you.

Swallowing that emotion is really very hard. Being able to express how fucking horrible it is to hear the 7th pregnancy announcement of the year, and have that heard and acknowledged, can help you to mask that to some level around your friend and be happy for her (and realise that you actually truly are happy for her at the same time).

Really though, it just is really hard :( I really hope that it happens for you as soon as possible.