Next steps, what to ask on review appointment? + Birmingham IVF clinic recommendations (Please DM)

[Hopewhite]

Hi all , i hope you're well and keeping hopeful and strong at whatever stage you are in your journeys.

I just had another BFN this Monday, and trying to put together a plan for our next steps and what to ask for on the review appointment, and would like to get some of your experience on what changes have been helpful for you, even if it's just as reassurance. Doing the same all over again like the clinic has suggested in the past, doesn't sound promiseful !!

as background,

DH was diagnosed with oligozoospermia: low morphology (1%) and low count, this was main reason to send us to ICSI. No other further studies made on the MF. I was told I have PCO but no PCOS (regular periods and ovulation) . AMH 31.1 a year ago.

12 eggs collected, 9 mature, 9 fertilised (ICSI), 3 high rated blastocysts (not pgt-a tested) , 6 others made it to day 6 but were not considered of good enough quality to freeze.

1 Fresh transfer: MMC at viability scan (close to wk 8 after hematoma and heartbeat found at wk 6)

2 FET: BFN

3 FET: BFN (very faint second line, BFN on second test a day later).

I'm considering the following options:

1. DNA fragmentation test/varicocele assessment - other ladies in here have advised this given DH results.

2. Warwick implantation clinic tests for me? - consultant said last time that he didn't see anything that would suggest i needed those, but he said it was personal choice if i wanted to discard other causes, but that I should bear in mind these are experimental. Has this been useful for you?

3. PGt-a tests on fresh cycle: consultant main guess was egg quality because I'm 39 and suggested pgt-a tests on next fresh cycle.

4. Anticoagulants: I see a lot of ladies in here get prescribed anticoagulants like clexane, aspirin etc? - this was not suggested to me on my 2 FET. -

5. Supplements - what would you recommend for fresh cycle to try to improve egg quality and how long to prepare the body for? for this FET I did proceive + magnesium. Would probiotics be helpful?

We now have to do a fresh cycle, and considering whether we should change clinics, as they didn't change anything for the past transfers. I'd also would love to hear your DM recommendations for private clinics in Birmingham, it would be helpful if your clinic offers natural modified ivf.

Sorry about the length of this letter, I don't expect anyone to respond to all of this, but if you'd like to share advise on any of the above or any other points that have helped you, I'll be very grateful for it!

Thank you very much, sending you all loads of good luck and strength xx

[MiniCeeCee]

hi Hopewhite , so sorry to hear the journey you’ve been on so far hasn’t got you where you want to be. It’s a tough old road isn’t it, and I really hope there is success ahead for you. I don’t have advice per se, but I’m just connecting as have a similar situation in some areas. My partner has 1% morphology, and I’ve in some scans been told I have PCO but not PCOS (as I seem to ovulate regularly, just have very light periods and they noticed a PCO pattern on overaries in early scans). We had a failed fresh transfer in November last year, and just gearing up for an FET next month. We have 3 blastocysts in the freezer (4 collected in total). I’ve started acupuncture recently and trying to be healthy diet wise. A friend of mine who has been through IVF and is also a doctor, told me to ask my clinic about adding Clexane to the next cycle - as there is evidence it can improve implantation rates and is used in the first cycle in lots of clinics. She also has told me to ask about progesterone injections as well as pesseries just to ensure levels are high enough. So could be worth asking about those two things? Sending lots of love and hope for you xx

[Hopewhite in reply to MiniCeeCee]

hi MiniCeeCee thank you for your kind words and good wishes. It is a rollercoaster indeed ! I’m sorry about your negative FET in November, I hope this next one is the lucky one for you xx thank you for recommending the anticoagulant , I’ll definitely raise this one , I’ve read some ladies have just used aspirin . I did have Lubion added this time as my progesterone was low , but not sure if my body responded to that or not as I didn’t get a second test afterwards. I was doing 2 Cyclogest + 1 Lubion jab, but seen other ladies in here have been advised more than that. I’ll let you know what the consultant says about the DNA fragmentation test x

Sending you lots of hope and good luck for the upcoming transfer xx

[HedgehogMad]

Hi lovelyI think the evidence is patchy for most of the above apart from PGTA testing in improving outcomes. We have recurrent implantation failure and our clinic advised PGTA as the majority of causes of implantation failure/miscarriage is problems with the embryos and even perfectly graded embryos can still be chromosomally normal. We felt better knowing that we were only transferring chromosomally normal embryos. I'd perhaps also suggest a 3D ultrasound as this will fairly confidently exclude any potential problems with the womb (adenomyosis, septum etc)

But still the likely issue is that you just haven't found the right embryo yet. wishing you luck for the next cycle xxx

[Hopewhite in reply to HedgehogMad]

Hi HedgehogMad thank you very much for sharing this advice, I’m sorry about your tough journey , I wish you all the best of luck for your next steps xx I hope your dream comes true very soon, you absolutely deserve it xx

We were advised to do pgta testing but only if we get a good number out of the next fresh cycle , I did ask for this after the first MMC , I only had 2 embryos and the consultant said it wasn’t worth it, so only advised to do FET. I’ll ask if they can do the 3D scan at my current clinic , I had not heard about this one , thank you for sharing It’s very helpful x

[Chel91]

Hi hun, so sorry to hear about your BFN. Sending love! From what I know / my opinion Sperm DNA is maybe not the best use of money, will it change anything depending on the results? Is there a variocele? Evidence seem inconclusive about variocele surgery if already doing ICSI, but may be worth it for a long term improvement on chances.

PGT-A is generally a waste unless you have a history or miscarriage or more than say 5-6 blastocysts. It is not recommended and studies find it lowers success rates for most.

High dose vitamin D (like 3000-4000iu daily) is the only supplement I've seen much agreement about. CoQ10, fish oil, and a multi are fairly safe options.

I personally think clexane is helpful to a fair number of women, but it's up to you if you want to take it. I got horrible rashes from it, but I was also diagnosed with obstetric APS by my miscarriage specialist, so maybe I wouldn't have had success without it. xx

[Natasha2012 in reply to Chel91]

Can you recommend a vitamin d supplement? I’m taking the zita west oral spray currently x

[Chel91 in reply to Natasha2012]

I just buy whatever is cheapest. Just make sure it's D3 (cholecalciferol) xx

[Hopewhite in reply to Chel91]

hi Chel I hope you’re well, thank you very much for taking the time to share your knowledge. There were no further analysis made on the MF, other ladies in here with similar case have advised on dna fragmentation being useful before seeing a urologist. Pgt-a got recommended by our consultant if we did a fresh cycle and got more blastocyst than last time, I’m also unsure of this one by the things I’ve read and it’s also fairly expensive.

Thanks for the supplement recommendation, I’ll check again my vitamin D levels and increase the dosage on those, I have to do more research on coq10 as I’ve only taken than as part of multivitamin.

Thanks for sharing your experience with clexane I’ll raise this with the consultant on Monday. Hopefully he’ll consider this for next try.

many thanks again , sending good luck your way xx

[Natasha2012]

I’m in the same situation. 9 mature eggs , 37, one embryo left then will be looking at another collection . I feel very alone with what to do to improve my chances . My clinic like so many others seem to feel like it’s a numbers game and finding the right “one “ . Xx

[Hopewhite in reply to Natasha2012]

Hi Natasha, I hope you’re well. That’s exactly it , I know we definitely need to find the right embryo but can’t help to think what if there’s something else we have ignored because we don’t know about it. I know there are not guarantees but cannot help to think what if ! Sending you all the best of luck I hope your last embryo is your strong one xx