Failed round follow up appointment - Fertility Network UK

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Failed round follow up appointment

Ariel24 profile image
25 Replies

Hi, what sorts of things should we be asking at our follow up appointment tomorrow please?

1st round - no fertilisation following egg collection

2nd round (ICSI) - 2BB transferred, BFN

3rd round (ICSI) - 5AA transferred, BFN

After both transfers I started bleeding on day 9 so I’ve thought perhaps asking to increase my progesterone dosage 🤷🏻‍♀️

We’re staying with the nhs clinic, we had to pay for round 2 and 3 but we really like the clinic and I feel comfortable there so would like to stay.

Your knowledge and experience would be appreciated 🙏🏻 thank you!

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Ariel24 profile image
Ariel24
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25 Replies
Marisa32 profile image
Marisa32

Not sure what tests you have already done, given the fact you went through 3 cycles. I would recommend DNA fragmentation test on sperm and if all good there, then maybe PGA testing on embryos to see if the problem are embryos or something entirely different. Also make sure your TSH is below 2, ideally at 1.

Ariel24 profile image
Ariel24 in reply to Marisa32

Thank you! Not had any of those - possible TSH levels at the start but I can’t remember. Thank u!

Carelia profile image
Carelia

Hi There, not sure if this reply comes too late but this is what I would explore with the clinic:

Based on our cycles to-date, what are our learnings:

Preparation in the cycle before treatment - One way to optimise your IVF cycle is to take Progynova or Norethisterone from day 14 or day 21 of your previous cycle. This effectively puts your body a sleep so there are no renege follicles taking a march before their time.

Baseline scan - Some clinics do a baseline scan on day 2 or day 3 of you IVF cycle to count the number of follicles present in that cycle - the starting point for the number of follicles. This is helpful/ reassuring to ensure that you know there are enough. The number of follicles present in a cycle can fluctuate month to month and it is a bit of luck how many will be available on the given IVF cycle month. The baseline scan can be a good way to ensure that you are starting a treatment with follicles and not waisting your money on drugs and then discover it part way through. The number of follicles is very personal so have a look at your stats from previous 3 cycles (at the start of scanning cycle), and see what the average is.

Medication - have we used one type of drug only? With NHS they are often limited to the type of drugs they offer, but you may respond better to another family of drugs. There are 3 types of drug families as far as I have figured it out in the UK 1) Follitropin Alfa (Benfola, Gonal-F), Follitropin Beta (Menopur, Puregon) and Follitropin Delta (Rekovelle). Personally (and this is different to everyone), I responded poorly to Alfa (to both Gonal F and Benfola) and so-so to Beta (menopur), but like wine....quality of eggs improved massively with Delta (Rekovelle). If you repeat the same as before and expect different results....well that is not a good clinic. The clinic needs to be working hard for you after each cycle to determine what could be optimised.

Medication 2 - Are they giving you the supporting medication Luteinising Hormone (Luveris etc). Particularly with NHS they don't start the supporting meds on the same day as the main drug (wait until day 6 or 7 until the follicles are at a certain size), this can make things worse and starting them at the same time can make a difference. Talk about what learnings you have made across the 3 cycles and if there have been no changes, why not?

Stimulation length - Do you know what date your natural ovulation is? I get a peak at day 10-12 and when we extended the stimulation to day 10 and collected on day 12, again the quantity of eggs got better. I.e. did they take the eggs out at the optimal date? Have they been trying to optimise the collection date from one cycle to the next? Have there been any changes and if not, why not?

Trigger medication - this is an area I know very little about but they can have an impact too, so if you are picking up follicles but they are not mature, the reasons is most likely that they have collected too early but also, things can be improved with a change of trigger meds?

Vitamins - I am sure you have gone through all of this but I thought I was a veteran in IVF only to discover now that I should be taking CoQ10 supplements, anything from 200mg - 600 mg a day. These can be bought on amazon etc and not expensive. There is research that is coming out (China) that it can have an impact on egg quality. I am only doing my next cycle with this 'as my new component' so I can't tell myself as yet. Of course - then there is the whole thing of no coffee, etc, but I assume you know this already :)

Progesterone - this is all to improve the lining of your womb and in the previous cycles they should have been measuring your lining development in each scan. Have they and what was it? It needs to be in range 8-12 at time of transfer. You can take injections and you can take pessaries. You can also take both. Talk about what combo would be most useful for you?

Timing of collection - with NHS clinics they often don't do weekends and your collection may be brough forward to Friday or pushed to Monday when the ideal time to collect is Saturday. Look at the timing of collection and judge when the ideal time should have been.

ICSI - Your note above does not say if you guys did ICSI but this made a huge difference to us in terms of fertilisation rate going from 40% to 90% of all mature eggs. Definitely worth a try even if the sperm analysis is borderline ok. Fragmentation test is ok too but all you are going to get is ICSI..so you could just go for it anyway and give it a go.

PGA testing - my comment here could be controversial vs other comments but I am only staying this based on data that is now well established. PGA etc testing is very expensive and most importantly, it has not yet proven to be effective (despite years in the market). -> You can look at UK regulator who monitors results fo PGA testing and who have published research on this. Private clinics make a lot of money with this, it is one of their key income earners, so hence they push hard on it. Also, as we know embryos can correct themselves, and if you only get 1-3 blastocysts per cycle....it is not worthwhile given the error rate with PGA testing (results can show a red flag when it should not). If you get lots of blastocysts and you have the money, I would say worth a try. If not, your body is likely to reject and you save the money (can be as much as one cycle basic treatment) to do another round.

Day 3 or Day 5 transfer - Have you explored day 3 transfer. Clinics don't like to say this but the body can be a better incubator than the lab and so it is worth a try. It has worked for me (pregnancy) while day 5 transfers have not. Clinics may say, we only know which embryos are best on day 5 but if you are doing a package, such as Access fertility where transfers are all included and they don't cost you extra, it is worth trying day 3. Older women (38+years) are also shown to have better results with day 3. If you end up putting in embryos that were not the best, you then have the best to freeze. The optimal result for you and one which "gives every embryo the chance - not those that look like they will boost the clinic's stats"...which is unfortunately something that is going on with clinics at the moment as they are very preoccupied with maximising their own stats vs. maximising transfers to you.

No exercise after transfer & generally don't stress - I am sure you know this too :)

Finally, ask the clinic to give you paper/email copies of:

IVD treatment summary - which shows which medications were taken when, on which cycle date, and the size and number of follicles in a given round - separate for each of your IVF cycles

Laboratory sheet - they should also have for each cycle a lab sheet which shows how many follicles were collected, how many were mature, how many fertilised, how many made to day 3 and at what grade, and how many made it to day 5 (or 6) and at what grade? It should also give your partner's sperm stats. You need these for your own records and so that you can have a proper conversation (as above) with the clinic.

The reality today is that the clinics don't really provide you customised care. They don't look at your previous data (except if you push at the consultation meeting and at the scans) and they simply treat you with averages. To get each cycle to work hard for you, you need to keep an eye on all of the possible elements that could be tweaked. Also, clinics often (when you change clinics) change 'everything' and that is not idea either as you can't tell what in the new protocol is working vs what is not working. New clinics also don't properly read your historical data either, even if you give it to them. The only way is for you to have individualised care is for you to be familiar with what is working for you and what is not, and what your key challenges are, and then use the historical data in each of your consultation appointments and scan appointments to help you and the clinic to anticipate and course correct.

Hope this gives you some ideas :)

Ariel24 profile image
Ariel24 in reply to Carelia

This is absolutely amazing, thank you so much! Our appointments not until this afternoon so I can digest all of this this morning, thank you 🙏🏻🙏🏻🙏🏻🙏🏻

Carelia profile image
Carelia in reply to Ariel24

HI Ariel, apologies I had not read your own bio before responding. Given you are 'so young', I would recommend to explore a package with Access Fertility or Assured Fertility. Why? They do great 'money back' guarantee packages for people under 40 years and you can then budget with certainty. I have used them (and have no association with them) and have saved quite a bit of money by using their packages. The clinics they have pre-vetted are also usually better than the average. You might even find your existing clinic on their list.💫

Gemstar20 profile image
Gemstar20 in reply to Carelia

I was just reading this thread and there is some great information here, lots of things I hadn’t thought of which I will do so going forward. Thank you for sharing this xxx

Ariel24 profile image
Ariel24 in reply to Gemstar20

It’s great isn’t it! So much information

DianeArnold profile image
DianeArnoldPartnerNurseFertility Network UK

Hi Ariel. I do have a list of questions I could email you in confidence, for you to have a look through before seeing your specialist again. You will need to email me at support@fertilitynetworkuk.org if you want them. good luck! Diane

Ariel24 profile image
Ariel24 in reply to DianeArnold

Thank you, I’ll email you now - thank you!

Ladybugluck profile image
Ladybugluck

Have you done an ERA? Sounds like your bleeding early, transfer timing could be off.

Ariel24 profile image
Ariel24 in reply to Ladybugluck

No- I didn’t even know that was a thing, had to Google it 🙈

Running79 profile image
Running79 in reply to Ariel24

ERA was recommended as a possible test by our consultant, it’s about £2000 but is can assist with your window of receptivity - as all the clinic normally does is book you in and give you a time.

Although our consultant spoke about ERA she suggested to us using Canesflor pessaries prior to transfers, to ensure the flora in the uterus was a nice environment

Ariel24 profile image
Ariel24 in reply to Running79

Thank you!

Aussie83 profile image
Aussie83 in reply to Running79

Hi sorry to jump in here but can I ask what dose they put on with the canesflor pessaries? I’ve not heard of this before..I’m interested!

Running79 profile image
Running79 in reply to Aussie83

I don’t know what the dose is, just nought them over the counter at a chemist. You use one a day for 6 days then it’s once a week or once a month after that - think there’s 10 pessaries in the packet

Aussie83 profile image
Aussie83 in reply to Running79

Oh cool thanks for that!

Ladybugluck profile image
Ladybugluck

Get this checked!! I know multiple people who swear this is what finally made it work. My clinic and many others start with the ERA as the first test they recommend if a transfer doesn’t work because 1 in 4 women need the timing of the transfer adjusted. One in 4!!! Why they don’t test this for everyone is beyond me. My wife had this done and now we have a son, so when it was my turn I had the test done before any transfers because I was so convinced of its importance. The fertility journey is so stressful and hard, mostly because you have to work so hard to do your own research and be your own advocate, but if there was one piece of advise I’d give someone going through IVF it would be to do an ERA!

Also, I’m sorry for what you are going through. My heart breaks for you. Keep at it, the fact that you are getting embryos is a good sign.

Oh and I also agree with others that low progesterone could be contributing.

Running79 profile image
Running79 in reply to Ladybugluck

Good call re progesterone, when I did our final round which was a donor egg round they found during a medicated monitored cycle (dummy run) that cyclogest pessaries weren’t enough so put me on prontogest injections as well!!

I’m pretty sure thats why our 1st round 1st transfers ended in MC before the 7 week scan - but like everything they didn’t check HCG levels before or after transfer so you’ll never prove it

Ariel24 profile image
Ariel24 in reply to Running79

I don’t know why but I have had a feeling the progesterone wasn’t enough - not based on anything really apart from the early bleeding but they’ve agreed for the next cycle to monitor, increase the dose and include injections as well 🙏🏻

Running79 profile image
Running79 in reply to Ariel24

Apparently the oil based ones are the best, I was on prontogest - the only drawback with this one is you need to inject into the muscle at the top of the backside! 😖 - but if I can do it for 12 odd weeks you can 👍 - I hate needles

Ariel24 profile image
Ariel24 in reply to Running79

O wow, thanks for the heads up! Does this mean your partner has to do it or can u manage yourself? I haven’t trusted my husband with any of the injections yet lol

Running79 profile image
Running79 in reply to Ariel24

There is no way you could do it yourself as the whole needle needs to go in, you need to drawback slightly to check you haven’t hit a blood vessel - if you do you need to take it out and stick it in again. You would end up injuring yourself if you did it.

My sister is an ex nurse, so did the first one to demonstrate to my husband, after that he was well away and is now sad he can’t jab me in the backside, as we’ve had the 12 week scan and finished the last injection yesterday These injections are also cheaper then other brands, hence why I opted for them, I figured we’d spent enough as it was

Ariel24 profile image
Ariel24 in reply to Running79

Aww congratulations 🥰 at hitting such a milestone that you’re able to stop them!

Ariel24 profile image
Ariel24 in reply to Ladybugluck

Thank you for your advice, it’s brilliant! Feel so much more informed having people on here give advice!

Ariel24 profile image
Ariel24

Thank you everyone! No idea how much easier you’ve made the research process and therefore kept the stress levels down 🙏🏻 we both thank you so much!

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