Advice on next steps: FET or a fresh IVF cycle?

[Esme78]

Dear HealthUnlocked community

I am writing to ask your advice.

I've recently turned 39 and have no children. I had PCOS but no longer have the full syndrome, 'only' the polycystic ovaries. I lead a healthy and active life. My hormonal profile is within 'normal' range. We've only just missed on the NHS funding for IVF and had to self-fund our first round (short protocol) last summer. We were unsuccessful in getting pregnant but have a top-grade frozen embryo.

We always felt that the natural way forward would be to have a frozen embryo transfer but have been asked to consider having a fresh cycle of IVF (long protocol) first because of my age and the impact this may have on the quality of my eggs, alongside the impact of polycystic ovaries. It seems that there is a notion that delaying a fresh cycle (i.e. after an unsuccessful frozen embryo transfer) by several months could impact on my egg quality, given my age.

I am yet to decide what to do and I am aware I have to do it rather quickly. I wonder if you might have come across a similar scenario or what you would recommend in such circumstances. I am a little anxious about the long protocol but feel I have another round of IVF 'in me'.

Thank you!

[Lizzielizzielizzie]

You'll get through long protocol fine, it's not as long as it sounds!

Personally I'd go with the fresh cycle if you can afford it. Having more options is always a good thing (and if it works, you still have your Frostie for a potential sibling...)

[Esme78 in reply to Lizzielizzielizzie]

Thank you for your advice Lizzie. Will get in touch if I decide to go down that path. x

[Lynnr54]

Egg quality does deteriorate with age. Not sure if a few months makes a difference, but it's based on age at fresh IVF treatment as opposed to frozen. It's worth asking the direct question if that helps you make up your mind.

One thing to potentially consider. If you have FET and it is successful would you like a sibling for your LO? If you would then you are likely to be at least a year older before you have that round of IVF and I can see that your egg quality can deteriorate in a year. So in that scenario if you're going to have a fresh round at some point anyway then one now would probably give you a better chance.

Just out of interest, do you know why they're switching you to long protocol? Is it just to try something different or did they not like the way you responded to short protocol? Reason I ask is that I was under the impression that if you had polycystic ovaries they always went short protocol to reduce risk of OHSS.

Good luck with whatever you decide!

[Esme78 in reply to Lynnr54]

Dear Lynn, thanks for your message.

No, I am not fully certain why they are suggesting to switch to the long protocol but will ask.

I'll keep you posted.

[7AVA]

Hi Esme78, I’m sorry to hear your first round wasn’t successful. I was in a similar position last April but with an NHS round. I floated the idea of doing fresh before my one frozen embryo but was advised by medical professionals to go frozen first. However, I still see the benefits of doing another fresh cycle first and it’s good your health professionals are discussing this option with you. We were in a different position because I was concerned we might lose funding if we went for a fresh cycle (which we would have had to fund privately) and thought it would complicate matters. I would also question why long protocol now as you were fairly successful with embryos from last round (apparently only 1 in 7 get a frozen embryo). Good luck with your decision, it’s a tricky one and I wish you every success in your next round xxx

[Esme78 in reply to 7AVA]

Thank you 7AVA, I'll be asking a question about switching to a long protocol at this stage first before making my mind up.

[Se99]

Hi, I chose to do another fresh cycle instead of using my frozen, I’m only 33 but have a low AMH. I now have 4 in the freezer and think it was the right decision to do it sooner x

[Esme78 in reply to Se99]

Hi Se99. My AMH is 22.7 but egg quality in my first and only cycle was mixed - I was told it could be my age, PCO or a mixture of both. I'll ask my consultant more questions to aid my decision and let you know how I get on.

Did you get pregnant with any of your cycles?

Are you hoping to use your frozen embryos soon?

[Se99 in reply to Esme78]

Good idea, they should be able to offer advice, but do what is best for you!

I did get pregnant with both my cycles but lost at 22 weeks and then 11 weeks. I’m transferring my first frozen embryo next Friday, hoping this is the one!x

[Esme78 in reply to Se99]

Will be thinking of your on Friday - good luck with your FET. Are you doing it the 'natural' way?

[Se99 in reply to Esme78]

Thank you! Very close now! I’m medicated. Have you had anymore thoughts on what to do?x

[Esme78 in reply to Se99]

Hi Se99, yes, it is getting close. Keeping my fingers crossed for you.

I'm still waiting to hear from my Dr as I have a few questions for clarification, but feel inclined to do FET. If that does not work out, we will consider a fresh cycle in early 2018. I read that it's not advisable to do a fresh cycle at the end of calendar year and much better to do it in the spring when everything is waking up to new life...

[Se99 in reply to Esme78]

It’s good you have a plan in place, hopefully you can get going soon! I agree timings are difficult over the Christmas break x

[Se99 in reply to Esme78]

You amh is good though, that’s positive!!! Maybe talk to them about anything you can do for quality? I found my second cycle much more successful, same number of eggs collected but 4 blasto (2 on my first round). I started prep 4 months before, healthy diet, lots of water, acupuncture etc x

[Esme78 in reply to Se99]

Thank you. I do hope that either the FET or the fresh cycle will be a success! I too follow a very healthy diet, have good water intake, acupuncture etc.

[SConnor]

I can't really give much advice, just my experience with the long protocol as I have endometriosis and that's what they recommended. It is certainly not that long and I had an endometrio scratch in between. This may be of help too perhaps?