3 Ectopics (other MC too) - No Tubes. What questions do we ask at IVF consultant?

[Pregnant4456]

I have had 3 ectopics confirmed resulting in all my tubes being removed via surgery (last occurred only last month). 1 confirmed miscarriage and 3 other early losses but no location of the pregnancy confirmed. So either 6 or 7 losses in total.

I have one living child who is nearly 3.

We have a call with our clinic tomorrow due to chat about how our protocol may change now I have lost my last remaining tube. We were always anticipating starting IVF in the new year to freeze embryos as have been concerned that my egg equality wasn’t very good. But after my last ectopic, IVF is our only option.

I am 36 - AMH is 12.5 with 20 Follicles located on my ovaries during my scan a couple of months ago. No issues with husbands sperm test but that was done nearly 4 years ago. No issues with getting pregnant, has always been loosing the pregnancies.

These are the questions I have written down. Does anyone else have anything I have missed? We are doing it at Kings in South London.

• Since we last met I have obviously had more losses. I have lost 6 pregnancies with a potential seventh. 1 was a confirmed miscarriage and I have had 3 confirmed ectopics. Given I am clearly at risk of ectopic pregnancy, what is the likelihood that at least one of those further 2/3 pregnancies being also an ectopic.
• If you think that is a potential, does that change the advice on doing PGT testing as it could mean that I have better embryos than I had originally thought but they just stopped growing due to being in the wrong place.
• Do we need a sperm test again. We are not concerned about this due to getting pregnant not being a problem for us.
• Can they explain a bit more about why the medical protocol has been chosen and how it has been selected given my medical findings
• We are not sure if and how many embryos we would want to send off for PGT testing. Can we decide how many to send off once we know how many blastocysts we have got.
• We were told that a fresh transfer would probably not be recommended due to the risk I may experience ovarian stimulation. Does that mean we would not have the option at all. For example, if I did react to the medication more favourably, would you be able to change your mind and say it was an option available to us.
• How soon can we start. We are not sure on timelines on when we would want to put embryo back in but we are keen to collect embryos as soon as possible seeing as I am only getting older.
• If we were to do embryo collection and then freeze and/or PGT testing, what is the timeline on booking the frozen transfer in.

Thanks!

xx

Hiya,

I'm sorry to hear about your losses, so devastating. I'm with King's and did PGT-A can answer some of the questions you posed.

• If you think that is a potential, does that change the advice on doing PGT testing as it could mean that I have better embryos than I had originally thought but they just stopped growing due to being in the wrong place. - I would definitely PGT-A test as the reasons for your miscarriages weren't just ectopic. I've said this a couple of times on the forum, we had 1/7 come back as euploid and the way I look at it, the PGT-A test saved me from 6 certain miscarriages
• Do we need a sperm test again. We are not concerned about this due to getting pregnant not being a problem for us. - They do a sperm test as standard when they do your first scan
• We are not sure if and how many embryos we would want to send off for PGT testing. Can we decide how many to send off once we know how many blastocysts we have got. - Yes, you absolutely can. They make you pay for 4 (£1800) before you even go through the egg collection, and then if you have less than 4 they refund you. If you have more than 4, you tell them how many you want to test. We had 14 day 5 blastos but only tested 7, the rest are frozen.
• How soon can we start. We are not sure on timelines on when we would want to put embryo back in but we are keen to collect embryos as soon as possible seeing as I am only getting older. - My experience was that the delays were mostly with getting all the admin appointments booked in. You need to book in a baseline scan, then speak to a doctor to give you a suggestion of the protocol you'll be on, then you need an appointment with the nurse (these always took the longest, probably 3-4 weeks on average), and then you also need another baseline scan before you can start stimulation drugs, which has to be in a certain period of your cycle, and it has to be after the nurse's appointment, so depending on your cycle this can definitely drag out. They start booking you in immediately, it just takes time to get available slots. A lot of the ladies here are with King's, they seem to be very busy!
• If we were to do embryo collection and then freeze and/or PGT testing, what is the timeline on booking the frozen transfer in. - I can only comment on how it went for me - I asked the same question and the answer was "depending on your cycle". My timeline is below:
• end of August - egg collection
• PGT-A results - 3 weeks from Day 5 post fertilisation
• nurses appointment was a month after I got my PGT-A results
• transfer 2nd December

so a total timeline of 3 months from EC to FET. I think there are some girls that it was closer to 2 months for, but it definitely depends on how your cycle aligns. I think they like to see 2 proper bleeds before they go through with it - I had a bleed mid October, and then the one mid November was the one they called me in for a scan on day 11 and said FET would be early Dec.

Hope that helps!

@Pregnant4456 I am at King's and have identical AMH and AFC to you. I've done several banking rounds and each time got between 20 and 28 eggs. To reassure, I never got OHSS.

• "We were told that a fresh transfer would probably not be recommended due to the risk I may experience ovarian stimulation. Does that mean we would not have the option at all. For example, if I did react to the medication more favourably, would you be able to change your mind and say it was an option available to us."

It is responsing robustly to the injected FSH which would mean you weren't a good candidate for fresh transfer. It's actually responding less well which would open it up as an option - it depends whether your AFC or AMH is more accurate for you personally, as 12.5 AMH usually has a lower AFC. The reason is how high oestrogen gets with a lot of maturing follicles.

I think your list of questions is good. Ask about any visible scar tissue when they do your scan. You could also double check what supplements they suggest for you. They're quite conservative leaning so may only say vitamin D and folic acid. I also take omega 3 and coenzyme Q10, and so does my partner.

If the semen analysis you have is recent they may accept it for your file rather than testing again - call or email admin to ask.

At 36 with tubal factor I think you have a very good chance. Good luck!

Hey no advice as new to IVF but also have lost both my tubes to ectopics. No living children. 3 ectopics & 2 miscarriages ( however with ex partner and we’re both smokers and unhealthy with bmi of 16 - unplanned pregnancy’s) my 3 ectopics are with my current partner, had sperm test which was all good and my AMH is 22.5, im 32 years old.
i’m unsure about PGA testing as have been told 2 different answers by 2 different doctors.

As for the ectopic risk they have both reassured me the risk is very low as they will implant it in the womb but agree to ask about womb scaring. They did advise me to wait 3 months since last surgery to give my body chance to recover so you maybe told that too. good luck xxx

I just wanted to say thank you for all of your advice and suggestions.

We had our second consultation with the clinic yesterday and they were very helpful.

We have then paid all of our monies and are now booked into start in January. Going to go down the route of either doing a fresh transfer (if we can) and freezing the rest with PGT testing OR we will just test all of the embryos we get and will then do a frozen transfer later on in the year.

Trying to go with the flow on the whole process which is not what me or my husband are to typically like, so it will be a challenge!

Thank you again and best of luck in your own journeys. Xx