I had 2 consultations with probably the best london clinics and struggling to choose which one to go for as they have said 2 very different things. I have very low amh 5.1 (june 2020), afc 5-6, and poor responder to drugs.
Clinic 1 - said to do a fresh transfer, and that freezing was not suitable for me given old egg quality and very few eggs. Hence batching was also not preferable in their view. Also said icsi not required because we had 2 natural miscarriages before and good feetilisation rates on 2 ivf cycles. This clinic would do daily blood tests during monitoring and seems very intense.
This clinic said fostimon and meriofert and will confirm closer to the time if high or mold stim, but likely high as my fsh is 6.7.
Requested test: chromosomal testing and immunes test. She didnt think there was an issue with hubbies sperm but said he could do dna fragmentation for peace of mind
Clinic 2 - suggested 3 cycle embryo batching (i only got 2 eggs retrieved from my last 2 cycles). They said opposite to clinic 1, to use icsi for best sperm selection and freeze all embryosto do pgt-a.
This clinic said to use meriofert alone and mild stim.
Requested tests: dna fragmentation and thrombophilia; immune tests / chicago before fet.
Im so confused, these are 2 top clinics but have 2 very different views on fresh or frozen transfer and requirement for icsi.
Any advice or views here would be much appreciated. Desperate to start my treatment.
Many thanks in advance for any responses.
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joey81
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Gosh that's such a hard decision. What I have found helpful with my clinic is that we make a plan, and see how it goes but it's always flexible.... If it was me, I would probably choose the clinic that I liked the most, had the best feeling about - start with their protocol and see how it goes. If clinic 1 are suggesting genetic testing - is that for you or the embryos (or both)? If it is the embryos they have to freeze them while they wait for the results so that seems odd that they would say not to freeze. Fragmentation test should tell them if they should use ICSI instead of IVF?
I would definitely have immunology done
Do you have a gut feeling somewhere deep down that one protocol makes you feel slightly more comfortable? xx
Hello, thank you for your response. Clinic 1 said fresh and clinic 2 said frozen (batching and pgta). I had a strong gut feel to clinic 1 but then after having the consultation with the 2nd clinic i think i prefee their protocol as takes a more long term view for siblings etc.
I just dont know what to do.
If i went with clinic 1 probably cost me £10-15k for that 1 cycle. Clinic 2 will be about £30k with 3 cycles, inc all the add-ons.
I think I know which clinic number 1 is And I think they do get good results.However, if I'd known that our IVF wasn't going to work first time (as I expected) I would have invested straight away in an ERA test, PGS Testing and Immunology - we've just learned as we've gone along and to be honest spent way more than we would have done... But that is just my take on it. Everyone is very individual! x
Yes i wanted to do all the tests at the start but again its all very controversial. Some say karyotype is pointless to do but clinic 1 said to do it. We probably will do the dna frag to be on safe side.And definitely the immunes. I cant get started on tests until i choose the clinic.
Hey, I know how important it is to find a clinic you are happy with and a doctor you trust so just wanted to wish you the best of luck.
I don’t have much experience in terms of amh and fsh as we have a chromosomal issue, but we have had 3 cycles at a top London clinic, 1 in Spain and 1 at a London hospital, we’ve also spoken to several other doctors along the way.
Clinic 1 seems to be offering you a personal approach, not wanting to give you an exact plan until they see what is best in your individual case.
Daily monitoring is costly, and can seem unnecessary but in my personal experience, it allowed for dose adjustments and resulted in more follicles.
As for icsi, normally fertilisation rate is expected to be 70% so if your fertilisation in previous ivf is in this range and the sperm quality is good then it’s not necessary. All my cycles (5) have been icsi, in London we had 13 out of 18 eggs fertilise, in Spain we had 1 out of 12 .. so my personal experience is icsi has more room for human error.
I don’t understand the need for embryo batching. It’s just forcing you into 3 cycles.
Fresh cycles and frozen embryo transfer have equal success rates, and multiple embryo transfer doesn’t really improve your success rate. Your only benefit I believe would be in terms of the pgt-a testing, it would cost less to test all embryos at the same time rather than per cycle.
As for pgt-a - this is also known as pgs. From our personal experience we did karyotyping and found we have a chromosomal translocation.
We had 2 embryos tested in Spain pgs (pgt-a) and 1 had our translocation and the other had a different chromosomal issue that neither my partner or i have, we weren’t able to transfer either.
In a different cycle, we didn’t have testing and I miscarried at 9weeks. We tested the tissue and found a chromosomal issue that neither my Partner or I have. This might seem like the best option to prevent the heartache of another miscarriage is pgt-a.
We were advised against this by a top genetics doctor. This is the information we were given, baring in mind embryo genetics is still a developing field.
We were told to do pgd testing for the specific translocation we have because that is a known factor. We know we have this problem and there is a very real possibility it may transfer to an embryo and it won’t go away. However, pgt-a testing is not recommended as sometimes there may be very small chromosomal issues that are picked up that may later correct themselves - thereby you have to dispose of what could have been a good embryo. There’s lots of debate about this but for me, we are struggling to get a good embryo so I personally can’t risk not using a good embryo even if there is a possibility it won’t work out.
Personally, I know it would cause delay but I would do karyotyping for yourself and your partner before deciding on your next step just so you are fully informed of your position.
Salsa, many thanks for sharing your experience... what a journey so far! I hope its gets easier for you. I was quite against pgta because i get such few eggs and didnt want to take the risk. Also as im older (age 40), i think its best to bank as many embryos as possible. But clinic 1 seemed to think my embryo would be so fragile at my age that they did not recommend it.
I’m not sure about the time scale of the banked collections in relation to say 3 fresh cycles, I agree you probably don’t want to delay egg collections as your egg quality is likely to be better now.
In our case we’ve always had fresh transfers (except this one!) as only ended up with 1 embryo or the others haven’t been good enough to freeze so I can see what the clinic is saying but you may get some great quality embryos that freeze perfectly.
It’s a hard one, but I’m sure you’ll make the best choice! Xx
How confusing! I am by no means an expert but the thing that I immediately thought of was about the freezing.. have you had enough embryos to freeze on day 5 before? I have been accused of having old eggs and in 6 cycles have never had more than 3 on day 5 and never enough to freeze .. so the thing that stood out to me if it was me making this decision was the batching/freeze cycles are great if you have anything to freeze at the end of them but my clinic always went with fresh cycles for me (as early as day 2 transfer) for fear of ending up with nothing.
They also told me PGS testing was only a good idea when you had loads of embryos.
I don't know enough about batching cycles though.. Maybe they freeze on earlier days? x
Hi Daisy, many thanks for responding. Fic is aware that i wont get more than 2 embryos per cycle so hence she suggested do 3 cycles, aim for 6 embryos in total then pgs them. They would freeze on day 3 after each cycle for fear they will not get to day 5. Then after the 3rd cycle, they would thaw them all and pgs them in one batch.
My docs in the US are world leaders in treating older woman. And I did tons of research. They are 100% into fresh day 3 transfer in someone with 2eggs. The also recommend ICSI and hatching when there are very few eggs, even with normal sperm. But I’m sure they would do ICSI if you ask. Anyhow I would still do standard IVF fresh versus batching. Absolutely not a good idea to culture to blastocyst and PGA test. You may never get an embryo. We do monitoring every 2 days in the beginning and daily when it gets closer. Do early retrieval, lead follicle between 16-18 for better quality embryos. You may also want to look into PRP done in other countries to improve embryos, doesn’t work for everybody but works to some.
I know you said you want more kids and batching sounds appealing, but the reality infortunately is that you will be lucky to have one...
I think it’s valid to do all the testing both clinics propose, especially immune and trombophilia. Good luck!
Thanks BBHHH, yes i am erring on doing all the tests except not sure about the karyotype test. I want to batch due to my age 40 and low amh already! But like you say if this is a recipe for disaster then ide rather go fresh and have atleast one child.
Exactly because of your age, AMH and poor responder is that the approach of the first with fresh is more indicated. I do think batching could be a disaster... follow your instincts but that is what has more science support. Best
Hi joey, I'm aslo a poor responder with extremely low AMH. From my research, I understand that for us low stims or mild, natural IVF cycles with embryo batching work best. Poor responders usually don't respond to stims well if at all, and in my case, I felt like it fried my eggs and worsened quality. You will probably need more than one cycle to find a viable embryo, so 3 cycle option seems to make more sense. DNA fragmentation test is always a good idea, thyroid panel as well. Good luck!
Thank you Marisa... its so much harder for us isnt it. The 3 cycle package isnt discounted or anything, its just that the doc thought i would need 3 cycles to get 6 embryos in total (judging from my track record of only getting 2 embryos per cycle).Its just confusing given both are 2 top clinics in the Uk!
It that case, I guess you may have to go with few fresh cycles back to back. I only ever got 1 embryo from cycles and it was not good enough blast to be pga tested, so they just put it back in untested. It ended in BFN but I could just keep trying right after. The only thing that may delay the process is early MC etc. I switched from IVF to unmedicated IUIs and got a BFP on the first go but MC at 5 weeks. That set me back by 2 cycles, until I could try again. Got pregnant naturally 3 months later though. It's an uphill climb for us poor responders but somewhere in there we still have a good egg. We just have to catch it coming out. Fingers crossed 🤞 your good one is coming up soon.
With regard to the 1 cycle or 3 cycles package, what I can say is that I have actually worked out myself what clinic 1 said to you.
I have been proposed the 3 cycles package by my clinic and was about to go for it. However, I am over 40 do not produce much (we are now trying mild ivf) so I thought the 3 cycles package would not really work for us.
I will not produce much and don't want to take the risk of losing what I may produce just because it's not good enough to be frozen or strong enough to survive the thawing process. Also, the fact that they transfer blastocysts as opposed to a day 2 or 3 embryo, is not a guarantee of success.
Someone on this forum who had a successful IVF preg at the age of 45 (with healthy baby born at the age of 46) , asked to freeze her embryo and she was told that the embryo was not good enough to be frozen.
Hope this will help and will not make you feel more confused.
Thank you Miracola... yes this forum gives me so much hope... probably motivates me to keep on going at the rate that i am. Camt wait for this ttc journey is over though... ide have so much time (and money) on my hands!
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