ARGC or CRGH (or Lister)? Any recommendations

[NSC1982]

I’m trying to choose between the above two/three clinics and looking for any recommendations/advice as it feels like such a huge decision.

For context, I’m early 40s so very aware chances of success are low but previous fertility tests have shown my egg count to be good for my age (although my partner’s sperm count is on the low side) and I did conceive three times last year (one miscarriage, one ectopic, one missed miscarriage). Prior to this, we were trying for 18 months and I’m worried we’re now back at the stage where nothing is happening again - and I’m hurtling towards my 43rd birthday so feels like it might be now or never with ivf.

Any advice on the above three clinics - or ivf advice in general - would be very gratefully received.

Thank you.

At 42 you are likely to need more than one cycle in order to game the odds. Suggest going wherever it would be possible to do a multicycle package. Are you planning to fresh transfer or freeze and do genetic testing?

Do you know your AMH/ FSH/ AFC?

@sirensong thank you for the reply. That’s a good point on the multi cycle package - will look into it as couldn’t see it listed on the price lists of the ones I’ve already looked at. I was thinking given age and past miscarriages it would be better to freeze and do genetic testing…

My most recent AMH came in at 13.4 which i was told was reasonable for my age and my FSH was 6.62. Unsure on AFC.

I know the odds are very much against me but I ovulate mostly from my left ovary (my tubeless side since the ectopic) so I feel like if I did ivf I’d at least have a better shot than to keep hoping for the best each month… so much to think about though!

Ok these are numbers to work with. Your FSH level implies your ovaries are going to respond. Your AMH implies an AFC of anything from 10-20. It then comes down to quality, which can't be assessed by any measure other than actually going through a round.

Back to back collection cycles with PGTA testing is your best bet. Any other route risks time consuming miscarriages. ARGC and CRGH end up a lot more expensive than advertised because they charge for so many extras that some other clinics include for free (blood tests, advanced embryology etc).

You need to aim for around 5 or 6 embryos to have the statically average chance of a euploid. It can be more helpful to have this as the target rather than thinking of any % chances per round. Get a euploid and you are fully in the game.

Both ditch alcohol and get started on antioxidant prenatal supplements, Vitamin D, omega 3 and coenzyme q10.

I did 2 egg collections last year at the Lister Chelsea and have been happy with the clinic (I may be slightly biased as our 2nd FET there was successful) but I think the doctors are very good. My 1st EC wasn't so great and they had lots of ideas of how to amend for the 2nd EC. I also had issues when we got to FET time with thin lining and again they were willing to try new things and change up what wasn't working.

Downsides are it is a very busy clinic and pretty much all my scans ran about 30 minutes late, and quite long wait times to speak to nurses too, plus pharmacy wait times, so I was often there a long time during IVF stims cycles. Generally I found communication very good, only a couple of minor hiccups.

They do a 3 cycle package, and refund if you don't use the 3rd. Overall they're not the cheapest, and they're thorough so I did pay for a lot of tests but was also able to say no if I didn't want to do something or wasn't convinced it was worth it. They also do NK cell testing and various other extras that not all clinics do. We did pgta testing there as well. Hope that helps, happy to answer more questions!

I can’t tell you how helpful all this is - thanks so much for taking the time to look at my numbers.

ok, I’ll aim for back to back collection cycles with testing. My missed miscarriage dragged on just over three months (with two lots of surgery) so if testing can help avoid that then it’s definitely worth it.

I’ve cut down alcohol a lot but will ditch it completely and get my other half to do the same. I’ve been on all the vitamins you mention for a year now but my OH is just on a standard on a standard fertility one so will look into getting him on some of the others too. I’ve been having acupuncture since my missed miscarriage so will continue that too although unsure if that actually helps.

I’ve been putting off this decision for a few months now, hoping each month it would happen naturally but now I’ve decided i just want to get started.

Thanks so much for the invaluable advice - you’ve really helped x

@Orangewillow, Thanks for all the information and congratulations - so glad the second ET worked for you.
I’ve heard that the doctors at the Lister are really good. I couldn’t see it before but have just found the page where they list prices for multi-cycle package. With @sirensong’s advice I’m definitely going to go with the pgta testing.

That sounds really reassuring that they tweaked things for the second ET.
do you mind me asking which doctor you had or did you see more than one? Just looking on their website and it looks like you can choose between quite a few doctors for an initial consultation. Also, can I ask about timings - from when you first saw someone to when you got started, and also how long the pgta testing took? and how long between the first and the second ET? Just need to get my head around scheduling everything else around this - luckily I work from home so waiting for scans/appointments etc won’t be too much of a problem.

Thank you!

I saw Dr Thum and really like him, he's lovely and knowledgeable but also listens. I also liked Ben Jones who I saw a few times when he was the on call doctor. Dr thum does get quite booked up - he's a reproductive immunology specialist which is why I initially got sent via way, as well as IVF, so he's in demand!

We decided to do Ivf about a year ago, we were already with Dr Thum and had done some investigations so once we decided to go for it it was quick, and started on my next period in mid September. Did 2 egg collections back to back, and got pgta results about 10 days after each egg collection. The clinic closes over Christmas so we decided to have a short break at the end of last year and crack on with a FET in early Jan- had 1 cycle cancelled, then a failed FET, then I had a break to have a hysteroscopy and remove some scar tissue that they thought might have been why FET #1 didn't work. I've found things can move quickly with the Lister, i pushed to always be getting on with thr next thing in my next cycle without waiting around and that worked well.

During stims cycles, I was in the clinic probably twice a week at least, they do a fair amount of scanning and keep a close eye which is good but takes a lot of time!

Sorry when I said pgta results 10 days after egg collection, I meant after embryo development, so egg collection, 5/6 days to see what happens after that, and then they sent the blastocyst for testing and got results 10 days later

If you are planning to do PGTA testing it’s worth looking into the prices first. I believe the way CRGH do it is you pay a certain amount and can test up to 6 embryos, then pay for any extra. However if, like me, you only get 2 embryos a cycle then it doesn’t make financial sense to pay that much for just two embryos.

Having said that I have been very happy with CRGH. They are going through some issues at the minute because they have changed their online portal which has caused loads of problems but they are gradually resolving it.

It does feel a bit like a conveyer belt because when u go to the clinic and are in the waiting room they have the team of phlebotomists who will call u in for bloods, then the team of so sonographers who call you in for scans and the team of nurses who then call you in for consultations. It is not often I see the same staff member more than once. However in a way it is efficient.

We have big issues with sperm and we chose them for their embryology team and the consultant urologist they use. I have found all the egg collections and embryo transfers very efficient and as pleasant as can be. I do think the doctors are also very good.

I’ve heard positive things about lister but never used them myself

Oh also, from what I have gathered being with CRGH, they tend to use a lot more medications than some other clinics! For example after embryo transfer they like your progesterone levels to be very high and if it’s not over 100 (think it was 100) they will give u more. From the threads I’ve been in with other ladies I haven’t seen other clinics like this.

I don’t have much to compare with but apparently they are more expensive than other clinics too.

Worth bearing in mind u will need to pay for screening before u start and this can be very expensive too. I think all clinics require this though. Get as many screening tests done with your GP if you can and as long as they are within 3 months they should be fine for the clinic to use.

Also tip for sperm…. Proxceed, Lycopene, no tight pants or cycling, no hot baths. Nothing that will heat the testicles basically. Sperm is very important in the development of the embryos from day 4 onwards, so if you can improve it, it’s worth it.

Hi, jumping in here too. Husband and I are early 40s too and have had initial tests done at the Lister Chelsea so its reassuring to read positive things about the clinic in this post too. We have decided (just today!!! after our call with Dr Parikh at Lister clinic) to go down the IVF route to not waste any more time, to maximise our chances (seeing as both mine and husbands numbers arent great) and just as importantly to do the genetic testing to avoid any miscarriages (we were going to explore the IUI route first but decided against it). So far, we've made a few trips to the clinic (which i must admit is a bit a faff for us to get to) but all visits have been quick and efficient so far (touch wood!). I didnt know about the multicycle packages, thanks to a PP for sharing that as I will look into it as well. Sorry, im not adding much value in my post, im just happy to read about women my age and in London exploring IVF like me!

@Orangewillow, I had been looking at Ben Jones as he’s got so many exceptional reviews online - looks like he has an appointment available on 5 September but I’ll have a look at Dr Thum too and see what his availability is too. That’s reassuring that it was all quick once you got things in motion. Ideally, if period dates work out I’d like to start September/October. I’m a bit worried about any lasting damage from two lots of miscarriage surgery last year (first time it didn’t work due) plus the ectopic surgery… so will be good to get all the thorough checks for scar tissue etc.

Sounds like it can be quite time consuming which is probably why lister would be best for me as it’s easiest to get to. I was feeling so scared and on the fence about ivf so very glad I posted on here as this has really helped to reassure me. Thank you so much for all the advice.

that makes sense. I was worried it might all take longer than that!

@Mrsplants thanks so much for your comments. I’m just trying to do a spreadsheet of all the prices, extras etc to get my head around it all. Are you doing a multi cycle option? I had been leaning towards CRGH although with conversations above now starting to think Lister might be better for me. I can see though that CRGh have an open evening on Thursday so going to go to that to get an idea of what they’re like. From what you’ve said they do sound very efficient. Choosing a clinic feels like such a big decision but all this advice and first-hand experience is so helpful.

@Mrsplants, sorry - just saw this second part of your message. That’s really good to know re progesterone levels. When I had my missed miscarriage I was on progesterone from five weeks as they saw bleeding at five week-scan - but didn’t really get any information about levels etc. It’s going to be a bit of a financial nightmare wherever we go but if I’m spending such a huge amount of money anyway then I’d rather spend that bit more if it means more chance of success.
My gp has been really supportive so will take your advice and get as much screening done as possible by them.

thank you for the tip on lycopene etc too. I do think we need some help in the sperm department so ordering that right now!

Hi @Seashells24 , so good to hear from someone in similar position - I’ve seen some negativity in other posts towards people in our age bracket so was nervous to post but this thread has been so positive and made me feel so much better about it all.
i’m certainly leaning towards Lister now but going to do a CRGH open evening so I can compare.
Did you book consultant appointment before initial tests? Just trying to navigate their website and work out which consultant to go with for an initial discussion. Wasn’t sure if i could book tests in meantime to avoid any delays/ have my most recent numbers to discuss with them. Good to hear the visits have been quick and efficient so far.

just one more quick question from me. Wondering about lifestyle changes and if there’s anything extra I could be doing now? I eat very healthily (all the recommended ‘fertility boosting’ foods), take prenatal supplements plus coenzyme q10. My OH takes a fertility supplement and fish oil but I do need to get him to reduce/cut out alcohol!

I asked my Dr about this when we started ivf, as we had just been on holiday and I'd been drinking (although not loads) and wondered if there was merit in waiting 3 months to really focus on healthy lifestyle and then start. He said no and that unless I'd been drinking really a lot, it wasn't worth delaying. I think holistic practitioners put a lot more store in lifestyle to be honest, and it's absolutely important, but doctors probably focus more on the drugs and getting on with it esp when age is a factor.

I did a few microbiome tests throughout mt ttc 'journey' and that might be something to consider doing to rule out anything there, I did invivo (through a practitioner) and Daye which was quick, screen me is meant to be very good and thorough but takes a while to get results, and I found it held things up a bit when wanting to do a transfer, so just mentioning it now as something you might consider.

It sounds like you're doing all the right lifestyle things anyway and are probably already in a pretty good position there!

@NSC1982 just keep active and do also try to make sure he is eating well/ limiting drinking. You could consider a Total Blood Count to make sure nothing is out of range.

One of the consultants at CRGH told us they are looking to change the pricing of PGTA testing to make it more cost effective for people with a smaller number of embryos.

@Orangewillow, that’s really helpful - thank you. I guess we’ll just do what we can between now and it all starting as really just want to get going with it now (also just saw a post about clinics closing over Christmas etc so need to start soon as possible really).

I actually did the Daye microbiome test a few weeks - was actually a bit surprised that all came back all good as wondered if I might have a problem there! All the healthy eating must have paid off!

@sirensong, thank you - will do so on the healthy eating and no alcohol. Feeling really positive now and ready to get started. I did total blood count via GP at start of year and everything was within range but might get a repeat now to make sure. Have had concerns over my TSH as it has fluctuated between 2.8 and 4.8 in the four times I have had it tested. Everything online says it needs to be under 2.5 when ttc/in early pregnancy but I’ve tried three different GPs and all are adamant that it’s fine because it’s under 5. Frustrating but hopefully something the private clinic can advise on.

@lilacrab , that’s interesting! I’m going to an open evening there this week so will ask about that as well (especially as I would anticipate having a smaller number of embryos)…

@lilacraboh that’s really good to know actually. Hopefully they do change it so you can pay per embryo.@NSC1982let us know if you find out any more.