Advice on treatment next steps (before IVF)

[CarlottaD27]

Hello,

I’m relatively early in my treatment journey but already thinking about next steps, so it would be great to hear from anyone who has been on a journey.

I’m on round three of a medicated cycle (letrozole +HCG shot + cyclogest pessaries) to treat a luteal phase defect.

My husband has normal sperm and I am 33 with no other known fertility issues, other than the luteal defect and a low AMH (6.2), which I’m told shouldn’t impact natural conception but may make IVF stimulation more challenging.

So far, the medicated cycle regims has successfully lengthened my luteal phase and round 2 of treatment resulted in a biochemical pregnancy, which was very emotional for me as it coincided with the day I stopped taking cyclogest and left me feeling guilty. However, the nurses reassured me this was likely not caused by me and noted the positive was that it demonstrated that my body is capable of getting so far along in a pregnancy. I too feel encouraged that this treatment regime is in effect giving me a "normal" cycle and potential to concieve as any other person without fertility issues would.

However, my Dr has recommended just another 2 or so rounds of this medicated regime before IVF. He also thinks IUI is of little additional benefit given the sperm don’t need the boost.

Since that will only be c.5 medicated cycles (with one biochemical), the thought of moving to IVF that soon made me quite uncomfortable. The sceptic in me also thinks that since I’m paying privately to see a specialist, there may be a financial aspect to the advice too!

I was wondering if :

-People have experience of less invasive treatment options available before IVF? Or if some Drs will allow medicated protocols for more than the 5 I am being allowed?

- Actually, based on past experiences, you agree with the Dr and can see moving to IVF sooner rather than later as the best option?

Many thanks for any thoughts on this. I appreciate there are three more rounds to go and I should be hoping for a positive outcome there, rather than planning for the worst. I sometimes find the anxiety related to all the unknowns in this journey overwhelming, therefore having a bit of a game plan helps with that.

Sending huge admiration and support to the many people on here who are further along on this journey xxx

[soccerkt6]

Hi lovely,

I would tend to agree with your doctor's recommendation that five medicated cycles is probably the max worth doing. Assuming no fertility issues, a couple has - on average - a 20% chance of conceiving each month. So if you've done 5 cycles where ovulation has been confirmed and you're making sure to time intercourse, you should, in theory, be able to conceive. From your doctor's standpoint, if you haven't had success by then it's possible that there's something else going on besides the low AMH/ luteal phase defect, and they're just looking at the odds and making the recommendation that they think will have the best chance at success. Of course, it does sometimes take couples without fertility issues longer than 5 months to conceive, so I understand your reticence to jump straight to IVF after that. If you want to continue trying naturally for a bit longer before going down the IVF route, I would suggest just asking your doctor to prescribe you cyclogest to use for another 3-4 months while you continue to try. The letrozole and trigger are really just to ensure ovulation, so if your issue is only a luteal phase defect but you seem to be ovulating on your own, you don't really need the other two medications. I would also agree with the doctor that there's little difference between IUI and the medicated cycles you're doing if your partner's sperm is good.

As for when to move on to IVF - that's a hard one to advise other people on, but I think a lot of women on here would advise starting sooner rather than later. Your egg quality is likely still very good at 33 but, in my experience at least, as you start to approach your mid 30's you become hyper-aware of the statistics around egg quality starting to drop around 35 and then time suddenly starts disappearing in front of your eyes. I don't mean to freak you out but I think women are often given really unhelpful fertility advice in their early 30's of "don't worry, you have loads of time", and then it seems to switch overnight in your mid 30's and advice is suddenly that time is of the essence, your most fertile years are behind you and and you really need to get things moving asap. 😒 Personally, when that started happening to me I felt frustrated for 'frittering away' some really valuable years and wished people hadn't kept telling me that I had plenty of time.

Good luck! I really hope the next three medicated cycles do the trick for you! xxx

[CarlottaD27 in reply to soccerkt6]

Hello,

Thank you so much for the detailed and honest reply, it’s such a minefield!

I see what you mean about the 5 chances being a decent amount of time to concieve. Having had a chemical pregnancy there’s part of me that hopes that wasn’t the one time out of five it would have worked and therefore am keen for a few more goes.

I like the suggestion of asking for cyclogest as that’s definitely the one key part of the treatment I need for the Luteal defect… I hope the clinic would be happy to prescribe it, but I think i would chose a clinic close to home if I need IVF, so I’m not sure how keen they’ll be to keep prescribing it if I have plans to leave them!

Thank you for sharing that advice on age, as I’m definitely now thinking that if I need IVF, collecting eggs before I ready 35 will be better than leading it too late. Although I think the fact I have low AMH makes me particularly anxious and reticent about IVF and can see from some of the stories in here that it can be a long old journey.

I feel so negative planning for worst case scenarios, I will try and be hopefully for my next three rounds.

Thank you very much for the well wishes! I just read your bio and what a lovely, happy surprise to your story - goes to show how quickly things can change! Xxx