Beginning our journey . . .

[PurpleCrocus]

Hello all!

We're very much looking at the beginning of our IVF journey, and are feeling a little nervous and overwhelmed right now.

I'm 36 and my partner is 38. We have been trying for a few years, with increasing 'focus' on the actual trying; from just not being careful, to more active cycle tracking, etc. We've been investigated on the NHS (bloods, USS, HyCoSy, semen analysis). The good news is that everything so far seems ok (apart from borderline low sperm morphology), but it leaves us with "unexplained infertility" and we've been advised to start IVF. This would be private as our local area deems us too old for funding.

There are still some lifestyle bits that we can work on. We've reduced alcohol and caffeine, but we could actually cut down further. Our diet is pretty good already, but we've optimised the supplements a bit; thanks for all those who've posted on here previously. And we're really trying our best to think about reducing stress and having better sleep etc (not QUITE so easy, but we'll try).

We're probably thinking we could start the actual process around September time. We feel like this would give us a bit of 'optimisation time', and also I can hopefully reduce my hours at work as of September.

We just have a few questions and were wondering what your thoughts were . . .

1) When you first approach a private clinic, roughly how long is it before you START the actual IVF process? So we know when to start actually contacting places.

2) Will they need to repeat the various blood tests and scans I've already had? My first blood tests were in June last year, and my HyCoSy was only last week.

3) When we actually START, like from the time I have to start taking medications, how often will I need to visit the clinic for scans/bloods/whatever? What is a typical schedule like? I'm just not sure how to coordinate this with work.

Thank you all so much! 😊

[HollyT7]

So it totally depends on the clinic and if they need to request information, carry out any additional tests, where you are in your cycle, when they can book your initial consultation, delivery of meds etc. You just need to call them and go from there, they used to do open days or you can check the hefa websites for details on %s. For recent things, they may be ok just using those results, I think anymore over a year or maybe even 6 months for bloods, they may request new, you’ll be able to ask your chosen clinic all of this at your consultation.

When you need to be free for apts etc depends on your specific protocol. I’ll look for mine and see if I can send it over, might not make much sense at this point though.

Actually found this too about repeating things etc

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[HollyT7 in reply to HollyT7]

here was my frozen protocol, much easier and a lot less visits than fresh

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[HollyT7 in reply to HollyT7]

can’t find my fresh cycle but I’ll have another look later x

[PurpleCrocus in reply to HollyT7]

Thanks so much Holly, that's really helpful! It's just really helpful to get a rough guide, as I need to decide by the end of April how many shifts I want to do as of September - argh!

Thanks again! 😊

[JA-fnuk Partner Nurse Fertility Network UK]

Have a look at the following website Human Fertilisation & Embryology Authority [Fertility Regulator for fertility clinics in the UK] hfea.gov.uk for accurate information about all aspects of fertility treatment etc - also has Find a clinic near me just enter your postcode -how far prepared to travel to see info about clinic - treatments available - costings etc Also take a look at" Preparing for IVF" for info about 1st appt etc Good luck when you start treatment - it should be explained to you on a day to day basis

Take care

Janet

[PurpleCrocus in reply to JA-fnuk]

Thanks Janet! We had a look at the HFEA website, it was just all a bit vague regarding what actual visit schedules might look like. And taking time off work is really hard for me , so I have to commit somewhat in advance, which is a bit stressful.

But thanks so much. I think the next step really is choosing a clinic - eek!

[HedgehogMad]

Hi lovely, I would probably start contacting a clinic soon. We had initial testing done in the January, follow up testing in March and had our cycle in May. So worth getting all the initial tests and admin done so you can start when you are ready xx

[PurpleCrocus in reply to HedgehogMad]

Thanks for that advice. We just weren't sure how quickly things would move, but I guess it makes sense to start now and then be all prepared for starting in September (if that's what we decide to do). And then we avoid any additional delays as far as possible too! Thanks again! 😊

[Twiglet2]

I would contact them now as there is a bit of paperwork and likely some more blood tests etc. even with a clinic we have been with for years to start again private we contacted July time and didn’t get started on a cycle until November. For your protocol and timings it really depends on what treatment plan your consultant recommends and this will be one of your first steps with the clinic to have a consultation. If short protocol things pretty quickly from your period date you start taking injections and you will have scans and bloods every few days until your follicles are ready (usually about 7-14 days later) then egg collection 36 hours after that then transfer either 3 or 5 days later (if you go for fresh transfer). I hope that helps a bit and lots of luck to you both xx

[PurpleCrocus in reply to Twiglet2]

Thanks Twiglet! Yes, I guess getting sorted sooner rather than later in case there are more tests and delays etc (which is always a problem with scheduling around work too!).

And that is helpful thanks. I know it's all quite individualised, but just knowing roughly how often I'll be expected to make it to clinic is helpful. I need to decide how many hours to work per week as of September, and it's just quite tricky knowing what I'll be able to juggle if we start IVF.

Thanks again! 😊

[Twiglet2 in reply to PurpleCrocus]

I stayed at full time (and more 🙈) during it all and only took off egg collection really or a few days holiday after transfers sometimes. For the bloods and scans appointments they were usually quite good at giving early appointments before work or I just nipped away for them and made the time back. You should check if your work has any policy to cover IVF treatment as you might find they do and you can nip away for appointments paid 🤗 xx

[PurpleCrocus in reply to Twiglet2]

I didn't even consider the possibility of work having an IVF policy, but this is a really good thought!

[DreamingOfTwo79]

Hello! Like the ladies before me said, it cannot hurt to get everything lined up as soon as possible, you may also need to factor in some lead time for your chosen consultant's next availability for your initial consultation (I had to wait six weeks from phoning the clinic to actually having our first consultation). Our investigations took about two months to complete (bear in mind that for some tests you will need to wait for a certain day in your next cycle). And you may have summer holidays booked that interfere with timing for investigations. For my egg collections I would typically have scans on Cycle Day 3, 6, 9, 11,12, then you'd collect around Cycle Day 14 in theatre and you may want to take a couple of days off work for recovery. I also chose to do a mock cycle with further uterine and immunology investigations ahead of my frozen transfer cycle which mimics the steps for the actual transfer cycle except you'd have a biopsy around CD 16-20 instead of the transfer. For this and because of the nature of the FET (modified natural) I would go in for scans quite frequently, Cycle Day 3, 7, 8, 9, (possibly up to 12), then another scan to confirm ovulation and then the actual transfer day. If your protocol includes intralipid infusions then this will be at least one more appointment at the clinic ahead of transfer. Scans are usually less than 10 min, longer if you need your blood taken separately, and you may want to see a nurse afterwards, for me it was the commute to and from the clinic that added to the overall "away from my desk" time per appointment. I am very fortunate in that my manager is fully supportive of our quest even though my company does not have an IVF policy so would expect me to take leave for my appointments or as unpaid time, however my manager views these as regular medical appointments so I try to make up the time as best as I can in the evening. What I found more stressful than the actual time spent at the clinic is the time between appointments, IVF can often seem like a never ending game of waiting and waiting some more until you may progress to the next hurdle. I have found it all quite mentally and physically draining and I have often wished I had reduced my hours to part-time for a period of let's say 6 months as juggling full-time work and life with a pre-schooler alongside IVF can get tricky to navigate.

You may be familiar with this website already, when I first embarked on this rollercoaster I found this site extremely helpful. It is very well researched (with a first hand account of living through IVF) and presented in plain English with a lovely sense of humour:

theduff.co.uk/

Wishing you the best of luck and a smooth experience! x

[PurpleCrocus in reply to DreamingOfTwo79]

Thank you so much! I guess knowing that I might have to have scans that often makes me feel more convinced that reducing my hours for a while might be the right thing to do. Like you said, it's not just the scan but the travelling to and from that is a problem.

And thanks for the website recommendation, I hadn't seen it before but have just binge-read lots of it! 😊

[DreamingOfTwo79 in reply to PurpleCrocus]

I’m so pleased you’re finding the info on the website useful! It had me in stitches after all the seriousness of injections and multitude of scans and the constant worrying. Hope all goes well for September and you’ll get your dream! X

[soccerkt6]

Hi lovely

You've gotten some good advice from others about timing and clinic tests, etc so I won't duplicate that, but I did just want to pop in with some other advice. We had the same diagnosis when we started - 'unexplained' with all tests good on my end and my husband's semen analysis good except for slightly low morphology (2-3%). Long story short (you can read my profile if you want the long version!), my husband ended up having high sperm DNA fragmentation which was the root cause of all of our issues conceiving. We had one failed IVF cycle before we found out about it, and two further failed cycles after we found out but before we were able to find and treat the root cause of it on his end. Since fixing his varicocele last year, we've conceived naturally and I'm now 12 weeks pregnant. Since you're not planning on starting a cycle until September, I would HIGHLY recommend having your partner do a sperm DNA frag test. Most IVF clinics offer it. It can take 4-5 weeks to get results back so if you do it soon and the results come back abnormal, you'll still have time to start working on improving his numbers before you start IVF.

Best of luck! xxx

[PurpleCrocus in reply to soccerkt6]

Oh wow. I've heard of DNA fragmentation but I hadn't read anything about it. Sounds like it would definitely be worth us getting this checked ASAP.

Can I ask for your advice . . . If we find that my other half has high sperm DNA fragmentation, what is the best way to pursue this getting looked into? Do the IVF clinics have an in-house urologist, or do you seek out a private urologist some other way? And how do you push to get this looked into/addressed? Sounds like it might be worth trying to get things sorted sooner rather than later!

Thanks again! Very much appreciated! 😊

[soccerkt6 in reply to PurpleCrocus]

Of course, happy to share what I've learned! If his numbers come back high, you should seek out a private urologist who specialises in male fertility - Dr Jonathan Ramsay being the most renowned. I don't think most clinics have in-house urologists (ours in oxfordshire certainly didn't) but I know that Dr Ramsay does some procedures at The Lister Clinic in London, so there are probably a few private London clinics that have affiliations with urologists.

When my husband's numbers came back high, our IVF clinic gave us some pretty underwhelming advice -- try to eat well, no smoking, minimal drinking, take a fertility supplement etc etc. Pretty much all the bog standard advice for men. But once we saw Dr Ramsay he tested my husband for the most common causes of high DNA frag (infections in the urinary tract, hormone imbalances, varicoceles) and in general just gave us a tonne of really helpful feedback and set out next steps. I can't recommend him enough if you end up needing to go down that route.

As for how to get the test ordered - I would just contact your IVF clinic and ask if they offer a sperm DNA fragmentation test. It's not covered by the NHS so you'll have to pay for it. The most common one is called the Comet test and it costs around £500 at my clinic. There is a strange pervasive myth among lots of fertility doctors that there's nothing much to be done to improve male factor infertility and that high DNA frag can't be fixed, so you might encounter pushback from your clinic that the test isn't worthwhile to do, but just ignore that! DNA frag can absolutely be improved once you figure out what the underlying cause is.

Best of luck, and happy to answer any other questions you may have! xx

[PurpleCrocus in reply to soccerkt6]

I was worried about getting that kind of advice you mention, especially as we're already trying all of that now, so I'm not sure ANOTHER x-months of that is going to miraculously solve anything!

We just need to pick a clinic, and then I think we will definitely push for the DNA fragmentation test first thing so we get results ASAP. The more I've read about it (in the past couple of days), the more it seems like an obvious thing to look in to! So thanks for pointing us in that direction!

Thanks for the Dr Ramsay recommendation too - we're also Oxfordshire, so he's not too far away and if he's the man for the job then we will definitely consider seeing him!

Once again, thanks so much for taking the time to reply! It's so very much appreciated 😊