IVF or investigations first?

[Lemms]

Hello

At the beginning of May we were seen at the local infertility clinic. They advised lap & dye due to a lifetime of severe period pain (suspected endometriosis), 6 months of clomid, then IVF. At that appt blood was taken for an AMH test.

A couple of weeks later I got a call to say my AMH had come back low for my age (4.2 and I’m age 30). They asked for it to be repeated and it came back as 6.9 the second time. The IVF criteria is a minimum of 5.4. They cancelled my lap & dye and wanted to see me in clinic.

I had the appt this week and it didn’t go too well. The consultant was dismissive about my AMH and couldn’t understand why I was worried about it now it’s within the IVF criteria.

He said I could either go straight for IVF, or still have some investigations done first. Either lap & dye or just the dye test.

Am so confused and very stressed. I don’t know whether to go ahead with the lap & dye in the hope that we may conceive naturally, or in the case that we don’t, to make sure everything is as good as it can be ready for IVF.

Or am I being short sighted not to just go straight to IVF? Would an IVF clinic want these investigations to have been done first?

Am also worried that the lap could further worsen my AMH levels.

Has anyone been in a similar situation or have words of advice please?

Thank you.

[XOXO13]

Hey, I guess it depends on how long you’ve been trying naturally for and what tests you’ve already had to identify what may be preventing you from conceiving naturally? If they’re offering you clomid, does that mean you’re not ovulating on your own?

Before we were referred to our fertility specialist, we were under the care of a gynaecologist who ran lots of test including hormone panel, recurrent miscarriage panel (I had suffered one but it had taken years to get to a positive test) and a sperm analysis on my husband (at first they said it wasn’t needed but it was this test that led us down the path of IVF ICSI). We moved quite quickly from there as we knew at that point that whilst we could conceive naturally, it could a long time with a less than 5% chance each year and mentally I couldn’t cope with that. I’m now in my forth TWW after a IVF ICSI transfer and had many additional tests along the way incl. a hysteroscopy and a HyCoSy.

IVF is physically tough, so I would first try to rule out as much as possible with tests before jumping into it if you’re able to. But if there is an underlying reason that you know of already that means IVF is your best chance then I would go for it.

Hope that helps xx

[Lemms in reply to XOXO13]

Thank you for your reply. The tests I’ve had so far are bloods and an ultrasound scan. My partner has had SA. I don’t really understand why clomid is being offered, I’ve had two blood tests showing a good progesterone level a week after ovulation. I also do ovulation tests and always get my period 13/14 days after that. The first half of my cycle is quite variable though, they can be 21-29 days long but the variation is always in the first half, before ovulation.

I’d definitely prefer to avoid ivf if possible, but I’m being told that time is of the essence due to my low AMH.

Wishing you the best of luck in your TWW.

[McQueeny]

It’s tough to know what’s the right thing to do. I don’t have direct experience of the specific things you’re discussing , so can’t really advise … we were never offered clomid, but did do a HyCosy - we then went straight to IVF. But as has been said IVF is tough (physically, emotionally and financially) so if there’s a chance you can avoid needing it that’s always a good thing? That said, it depends on your age and your patience …. And how you’d feel with more delays… hope you work it out and good luck x

[Lemms in reply to McQueeny]

Thanks for your message. Do you mind me asking how you found the HyCosy in terms of pain?

I’m not in a rush in terms of my emotions, but the low AMH means if I don’t go for NHS treatment in the near future, I may not be eligible once the AMH has dropped further.

[soccerkt6]

Hi lovely, I would 100% go for investigations first. I can't speak to the risk of the lap affecting your AMH levels though, so I would speak with your consultant about that more.

As others have said, IVF is no walk in the park and I wouldn't jump into it lightly. Additionally, once you start IVF it's difficult (mentally) to step away from it, so I would say do as many investigations as possible beforehand. And don't forget to make sure your partner has investigations done as well. Just because you know you have low AMH and possible endometriosis doesn't mean that he might not have something going on as well!

Good luck xx

[Lemms in reply to soccerkt6]

Hello, thank you for your reply. Good point about the other half, thankfully his SA results came back fine. I feel very guilty that my body is causing us these issues though. There’s info online saying that removing cysts via lap affects AMH but I don’t know what would be the case in my situation if they’re just looking inside and only doing minor treatment.

[soccerkt6 in reply to Lemms]

Ah, I totally get it but try not to let yourself feel guilty. It's completely out of your control and honestly, struggling to conceive is plenty hard enough without adding guilt to the mix xx

[Crazy_girl]

It always helps to get the investigations done and with that you can be sure of what’s going on. Looking back, I also feel that should I have stepped into the IVF earlier than I did because the investigations, trying naturally also takes up sometime and if you are already ready to take care of a baby mentally, the delay kind of gets annoying and by that time we are also growing older and body is definitely going to respond differently. At that point, uncertainty sets in too and that also adds up and causes stress and impacts on the results of IVF.

IVF definitely is no joke. It’s very very difficult to be on this journey and definitely, if your results from investigations indicate it’s better to try naturally, nothing like it.

Before you make any decision, it’s always worth weighing out the options.

May be you can approach an IVF clinic, get all the investigations there and they could probably give you the best way forward for your case.

All the best 👍

[Marisa32]

Can you get on the waiting list with NHS for IVF and in the meantime do as many tests as possible? Time is of the essence with low AMH plus whatever else may come up, at the same time, you don't want to begin such invasive treatment without proper investigation first. If it's going to take them forever to do these tests, I would probably do egg collection asap while your AMH is decent. Once it goes down, not only you won't get a free round but also stimming won't give you many eggs and you are looking at many rounds down the road.

[Lemms in reply to Marisa32]

Thanks for your reply Marisa. I think I have to choose between an IVF referral now, or investigations and the referral after those are done. Today they have offered a date for lap & dye on 18th August so about 6 weeks away. Or they could do HSG about a month sooner than that.

I would definitely then request that I want a referral straight after the investigations are done, instead of trying clomid.

Still really struggling to decide.

[Marisa32 in reply to Lemms]

I see. I'm assuming you can't have the tests done faster privately or anything. Or even get the eggs out, make embryos, freeze all and investigate any issues prior to transfer. 6 weeks probably isn't that big of a deal but I would definitely not hang around on Clomid for 6 months knowing my egg reserve is low to begin with.

[soccerkt6 in reply to Lemms]

Marisa's suggestion is really interesting.

Since the lap & dye is only a 6-week wait time, I would go for that rather than the HSG. Depending on what the doctor says about the risk to your AMH with the lap, maybe just tell them that you only want a diagnosis from the lap for now - no surgical removal of cysts. If they find cysts, you could then (as Marisa suggests), first undergo an IVF egg collection and freeze your embryos, and then go back in to have the cysts dealt with, and then have embryo transfer once the endo is dealt with.

[Bernie150781]

If I hadn't had the CT scan and dye test they would not have known my tubes weren't working and could have ended up with ectopic if I had got pregnant with IVF, I needed both falopian tubes removed before having IVF and I am now 33 weeks pregnant, they can get alot of info from just the dye test, it might be worth thinking about X

[KLADY123]

Hi Lemms

I think it best to have all the information you can before going into an IVF round. I took everything the NHS could offer before going for the IVF and only when I knew it was the best option did I ask for the referral. I never had clomid as I was ovulating normally and they found out I had tubal factor infertility.

All our blood/sperm test came back normal so we then had a hsg which showed a blocked tube, I then went for a lap in which the removed the tube (if they hadn't and I went direct to ivf the fluid could have leaked and ivf could have been unsuccessful).

The other thing to consider is the procedures will be free on the NHS, if you go straight to IVF and it is not successful the first time then you may have to go private and then if you wanted to have extra tests you would need to finance yourself, I am assuming here that you only have 1 round on the NHS as that's what mine is but if you have 3 this may not be relevant.

Best wishes x

[KLADY123]

One other thing with my appointments I kept calling for cancellations and they did manage to get my in quicker for my lap so might be worth trying if you do decide to go ahead x

[Jess1981]

I was offered the same choice 4 years ago- now I had lots of symptoms and pain that no dr could explain and our fertility was unexplained. I chose a lap and dye and low and behold the fertility specialist found and treated endometriosis! Finally I had an explanation for 6 years of infertility and 3 years of cycle issues with lots of pain and symptoms. I literally had every symptom you can have with endometriosis but yet no GP or any gynae had made the connection 😒 Anyway we got our positive test after my first surgery, sadly it was a chemical pregnancy. After our first chemical pregnancy the endo re grew ( some was left on my bowel) I had 2 more surgeries last being July 2018 and 2 months later conceived our 2 year old daughter Francesca. We decided to try again when she was 1 but lost a pregnancy at 20 weeks with our daughter Amelia in November , had another chemical in January, another loss at 6.5 weeks in March , got referred to a miscarriage specialist who couldn't find a reason for our losses. Currently 7 weeks 3 days hoping this is our rainbow baby. It's been a long hard journey but getting the diagnosis and treatment of my endometriosis was the turning point in our journey. I'll also add I'm not that young 39! To me it seems sensible to rule out or treat endometriosis . If just to know the IVF has the best chance of working. Obviously this a decision you have to make that is right for you. Xx