2nd cycle advice please

[Vivkim]

Hi all

First time posting but I’ve followed lots of your stories and advice for many months now which has helped me tremendously.

We have had one failed IVF cycle so far. I am 37 and my husband 43, both with unexplained infertility.

Our first round was a short course. Meds to regulate start of period, stims for approx 9 days in total with intermittent scans to check progress. We achieved 8 follicles, 7 were viable. 3 fertilised but only two made it to day 3 (cell division slowed) so both were transferred on day 3. Lining thickness was 14mm. We waited until day 14 after transfer to take the pregnancy test but unfortunately got a BFN.

Our follow up was last week. We were told for the second round, we will have a longer protocol- 2 weeks of down regs, 2 weeks of stims and the strength of stims will be doubled to 300. They will also perform ICSI this time although in the last round my husbands sperm had good mobility.

When we asked the reason for the changes we were told it was to hopefully produce approx 12 follicles to give us better odds.

We meet with our nurse on the 12th Nov to go through treatment plan (NHS). Are there any questions I should ask?

Eggs produced in the first cycle we described as ‘reasonable quality.’ Sperm was described as ‘excellent.’ I’m taking all necessary supplements recommended in ‘It starts with the egg’ text. When we discussed these with the specialist, we were told they ‘can do no harm, but question the benefits.’

As this is our last NHS cycle, we want to do everything we can so advice is welcomed.

We had a few challenges in the last cycle….key dates tended to fall on weekends and bank holidays which left us feeling ‘rushed’ when at clinic as we were often the only ones there. We were supplied with progesterone pessaries early in the process but weren’t told when to administer them, just that they would be explained later in the process. The day after egg transfer, I called the clinic to ask about the pessaries who said I should have taken them the evening of transfer day and that morning (I’d missed both of these). They then called me back and advised me to take the pessaries 3 times a day not twice as previously stated. I felt this was because of the error made. They say the first cycle is a ‘learning curve’ which it was and I understand errors can be made.

We are in a position to pay for extra tests but I haven’t discussed anything with the clinic to date.

I stupidly watched the movie ‘Knocked up’ yesterday and the closing scenes had me in floods of tears. This outburst came from no where and shocked me. I think I want this more than I’m letting myself believe.

Sorry for the essay 😂

[Ranchu90]

The good bit is that you have a completely new protocol which is amazing, never go with the same protocol if it didn't work last time. Sperm can be excellent after "washing" as only good ones are left but ICSI will offer you a great chance for a better fertilization rate. Also sperm can look perfect but lots of men are suffering from high DNA fragmentation that is not visible only under a special microscope where they can be selected. High DNA fragmentation results in poor fertilisation rate or BFN. Hope is not your case, just want to mention it to you FYI. Regarding your progesterone pessaries I am a bit surprised but each clinic has it own protocols/rules and I am not a specialist. In my case I always been advised to take progesterone the night after my eggs where collected. Progesterone is very important before embryo transfer, it is preparing your lining for your little embryos to snuggle there. Hope everything will go smooth on your next cycle. Take care 💕🤗

[Vivkim in reply to Ranchu90]

Thanks for the reply Ranchu90 🥰

I will ask about the DNA fragmentation you mentioned. Does using ICSI override this issue as they might see it under the microscope and only select the ‘fit’ sperm or should I ask for this to be tested? Sorry for the questions.

I will also ask if I can take pessaries after egg collection this time. I worried last time that I’d missed the opportunity to keep the lining in optimum condition as I started them later than I should have. I try not to ask Google too often but I wished I had on that occasion.

If you have had a long protocol previously, can you tell me if this is more ‘traumatic?’

I had very few symptoms during the first attempt aside from a little bloating and constipation. I’m anxious that the changes will hit me hard. The last cycle was during the summer hols but this time I’ll be working through it with the added pressure of school inspections.

We’ll also need to decide if we start before Xmas when we next speak to the nurse. Not sure of dates yet but I’m dreading things coinciding with holidays again…but I also don’t want to wait until January 🤪 I don’t mind the interruption, it’s just the worry of clinics operating on skeleton staff etc. Daft I know! I need to trust in the process more.

Thanks again for the reply.

[Ranchu90 in reply to Vivkim]

ICSI will not help to solve DNA fragmentation but definitely will have better outcome than IVF. Other methods in solving this issue like IMSI as far as I am aware are not available on NHS but I might be wrong. Also DNA fragmentation not all NHS clinics are offering it but you can go private to have it done and is not cheap in UK. I was on long protocol 3 times and I wouldn't say is more traumatic but is longer than antagonist. When I was on Buserelin injections I didn't enjoy them at all because of the side effects but when I was on birth control pills it was absolutely fine, so depends what they will put you on. Ask them thousand questions and try to be informed as much as possible. I was always challenging my consultants 🤦😃 if you have more questions feel free to ask 😊

[Vivkim]

Thank you again for sharing. Our problem is, we don’t know enough about the process to know what questions to ask 🤪 I guess that’s a fortunate position to be in in some ways. We’ll have to trust in the process and keep everything crossed.

Once we’ve met with the nurse I might get back to you with more information.

Thanks again.