Need advice

beth0874

Hi ladies.  Jumping over from 3T.  I need some advice.  I am on my third IVF and it seems to have failed again.  I'm a mess to say the least but I am trying to keep my sanity by thinking ahead.

My RE did not do much in the form of testing for both me and DH.  The real basics.  DH only had motility and volume tested. I only had hormone levels tested.  Progesterone, Estrogen and FSH.  I think that was it.

There is just so much more to this picture that I feel there should be a lot more testing done.  Does anyone have a list of what testing should be done?  Or can point me in a direction to get some more info?

I also have a fibroid that concerns me but RE says it is in a place that we don't need to worry.  Well I worried now.

And if there is any Mass girls here, can you recommend a new clinic?

TIA! 

MAbride0808

What clinic are you using now?

We are at Boston IVF and we like them.   You do need to be a little proactive, but I think that comes from any clinic.

steveandkim2

I am so sorry you're going through this again.  I would definitely push for more testing after your 3rd failure.  Have they given you any indications in follow up appointments about what went wrong (embryo quality, hormone issues, ute issues).

Other things to ask about:

1.  Hysteroscope - if you haven't had one to rule out uterine issues

2.  Immunological Testing (natural killer cells, APA, etc).  Different REs have different thoughts on this topic, so you may get some pushback.

3.  PGD/CGH on your embryos

4.  Sperm fragmentaton test on your DH?

I've only done # 1, but if this FET fails, I'm pursuing 2-4 on the list.

You may also want to set up a phone consult with CCRM or SIRM  - their REs are so knowledgeable.

Best of luck!

beth0874

MAbride0808:

What clinic are you using now?

We are at Boston IVF and we like them.   You do need to be a little proactive, but I think that comes from any clinic.

I'm using Woman and Infants in Providence, RI right now.  (They are also affiliated with Tufts).

Edwina.McDunnough

Advanced Fertility has a whole section on diagnostic testing. In addition, after my third failed IVF I had a hysteroscopy, a clotting panel, NK screen, OGTT, DQ-alpha comparison. We had done the genetic aspect of RPL testing as a pre-conception workup, and AMH/MIS at the start of treatment. We also considered SCSA and other RPL tests.

Are you sure that you have not had more comprehensive testing done?

beth0874

steveandkim2:

I am so sorry you're going through this again.  I would definitely push for more testing after your 3rd failure.  Have they given you any indications in follow up appointments about what went wrong (embryo quality, hormone issues, ute issues).

Other things to ask about:

1.  Hysteroscope - if you haven't had one to rule out uterine issues

2.  Immunological Testing (natural killer cells, APA, etc).  Different REs have different thoughts on this topic, so you may get some pushback.

3.  PGD/CGH on your embryos

4.  Sperm fragmentaton test on your DH?

I've only done # 1, but if this FET fails, I'm pursuing 2-4 on the list.

You may also want to set up a phone consult with CCRM or SIRM  - their REs are so knowledgeable.

Best of luck!

Thank you.  So regarding your list, I asked about all of these and this is what I got:

1)  No need

2)  Wouldn't make a difference in protocol so not worth it

3)  I don't make enough eggs to chance losing more with this.

4)  DH is perfect.  He has enough sperm to fertilize Boston.

And yes the answers were exactly like that.

One minute he says my quality is good the next he says not really.  I can't get a clear picture.

 

beth0874

Edwina.McDunnough:

Advanced Fertility has a whole section on diagnostic testing. In addition, after my third failed IVF I had a hysteroscopy, a clotting panel, NK screen, OGTT, DQ-alpha comparison. We had done the genetic aspect of RPL testing as a pre-conception workup, and AMH/MIS at the start of treatment. We also considered SCSA and other RPL tests.

Are you sure that you have not had more comprehensive testing done?

Thank you.  That helps.  Yes I'm sure.  He didn't think it was necessary because it would not change the way he would want to do things.  I knew I should have pushed more but I put my trust in him.  Now I wish I stuck to my gut.

JM1977

I'm so sorry for what you have been through.

I agree with the others that I would want more information from your current RE before getting a second opinion.  Has your protocol been changed for each cycle?  What is your RE's opinion of the reason for your unsuccessful IVF cycles?  How many embryos have you had, and what were the quality ratings?  I saw you mentioned high FSH/DOR - I'm wondering how severe this is (and have you had AMH and antral follicle count measured?).

I wish you all the best moving forward!

beth0874

JM1977:

I'm so sorry for what you have been through.

I agree with the others that I would want more information from your current RE before getting a second opinion.  Has your protocol been changed for each cycle?  What is your RE's opinion of the reason for your unsuccessful IVF cycles?  How many embryos have you had, and what were the quality ratings?  I saw you mentioned high FSH/DOR - I'm wondering how severe this is (and have you had AMH and antral follicle count measured?).

I wish you all the best moving forward!

The first two times were Long Lupron.  7 eggs retrieved each time.  6 fertlized the first time and all 7 the second.  We still have one frozen embie from the first try. Put 2 embryos back each time.  This time it was antagonist.  5 eggs retrieved.  All 5 fertilized.  Put 4 embryos back.

They don't tell me the quality rating so I don't know.  They just tell the cell count.  They are 3dt.  The highest cell count was 7 and the lowest 4 at transfer.  RE thinks the embryos are arresting but he does not know why.  He said possibly a gene mutation.

AMH and antral follicle count was never measured.  I just now my FSH was 12 at one point but he does not want to test it again because he is afraid the insurance won't cover it.

JM1977

Wow - that really does seem like you are getting very little testing and information based on having been through 3 IVF cycles.  It sounds like a second opinion is definitely in order.  Some people choose to do consults with top clinics like CCRM (they do phone consults) or Cornell, but it sounds like for you just getting some thorough testing and a new perspective would be really helpful.

Mrs.McIrish

beth0874:

MAbride0808:

What clinic are you using now?

We are at Boston IVF and we like them.   You do need to be a little proactive, but I think that comes from any clinic.

I'm using Woman and Infants in Providence, RI right now.  (They are also affiliated with Tufts).

Hi,

I'm so sorry about the IVF failures. I am also going to W&I in Providence so I am disappointed to hear that they aren't helping you. Who are you seeing there?  I just had my first IUI and have elevated FSH as well so I expect to move on to IVF shortly. 

STL34

Hey Beth.  I would definitely look into getting a second opinion.  I think the PPs gave you a lot of good things to start with.  But, it sounds like to do anything you are going to have to get a second opinion.  You know I am trying to do that now.  It is tough and it is a big step.  But, I even told me RE that I was getting a second opinion and he understood.  He said it doesn't hurt to get a new prospective.  (You also know that I am likely going to end up doing another cycle with my previous RE because of the free cycle I won).

I would definitely find someone to look at a few things.  Definitely get a second opinion on your fibroid.  A new RE may have a different perspective (especially since you have had multiple failed IVF cycles). 

I know many of these have already been suggesting, but:

1.  Hysteroscopy - may want to have an SHG first and get a new RE's opinion on your fibroid so it could be an operative hysteroscopy if indicated.

2.  Immunologicial Testing - I know this is controversial, but it might put your mind at ease if there isn't an issue (NKa, APA, DQ Alpha, ATA, etc.).

3.  AMH b/w and AFC - this is an important consideration for us DOR ladies.

4.  Ask about doing a laparoscopy?  I know my RE does them sometimes after multiple failed transfers if there isn't something else specific to consider.

5.  Trying to do a blastocyst transfer.  I know there are people that go both ways about this.  But, if they don't try to let the embies grow to blast stage, you do not know as much about embryo quality.  Again this is somewhere else that REs disagree. 

6.  Protocol - is there a different protocol you should use.  I know SIRM often uses the agonist/antagonist conversion protocol with or with out EPP for DOR patients. (you can read Dr. Sher's blog post about the importance of protocol there are a few of them, here is one https://www.ivfauthority.com/2009/06/eggembryo-quality-critical_12.html).  There are others that use the microdose lupron flare protocol. 

7.  RPL testing.  There are a few REs that believe some of the same problems that cause RPL can cause implantation issues.  While this may or may not be the case, my thought was that if I had a problem that could cause RPL, I would rather be treated for it before I had a loss.

8.  Since you were doing 3DTs, did they do assisted hatching?  If not and you will be doing a 3DT again, you might ask about it.

Whatever you decide, just know I am here to talk.  (If you are on FB, you can PM me and maybe we can get together on there since it is a little easier to chat. Or, I can send you my email address since it is easier than PMing on here.)

beth0874

STL34:

Hey Beth.  I would definitely look into getting a second opinion.  I think the PPs gave you a lot of good things to start with.  But, it sounds like to do anything you are going to have to get a second opinion.  You know I am trying to do that now.  It is tough and it is a big step.  But, I even told me RE that I was getting a second opinion and he understood.  He said it doesn't hurt to get a new prospective.  (You also know that I am likely going to end up doing another cycle with my previous RE because of the free cycle I won).

I would definitely find someone to look at a few things.  Definitely get a second opinion on your fibroid.  A new RE may have a different perspective (especially since you have had multiple failed IVF cycles). 

I know many of these have already been suggesting, but:

1.  Hysteroscopy - may want to have an SHG first and get a new RE's opinion on your fibroid so it could be an operative hysteroscopy if indicated.

2.  Immunologicial Testing - I know this is controversial, but it might put your mind at ease if there isn't an issue (NKa, APA, DQ Alpha, ATA, etc.).

3.  AMH b/w and AFC - this is an important consideration for us DOR ladies.

4.  Ask about doing a laparoscopy?  I know my RE does them sometimes after multiple failed transfers if there isn't something else specific to consider.

5.  Trying to do a blastocyst transfer.  I know there are people that go both ways about this.  But, if they don't try to let the embies grow to blast stage, you do not know as much about embryo quality.  Again this is somewhere else that REs disagree. 

6.  Protocol - is there a different protocol you should use.  I know SIRM often uses the agonist/antagonist conversion protocol with or with out EPP for DOR patients. (you can read Dr. Sher's blog post about the importance of protocol there are a few of them, here is one https://www.ivfauthority.com/2009/06/eggembryo-quality-critical_12.html).  There are others that use the microdose lupron flare protocol. 

7.  RPL testing.  There are a few REs that believe some of the same problems that cause RPL can cause implantation issues.  While this may or may not be the case, my thought was that if I had a problem that could cause RPL, I would rather be treated for it before I had a loss.

8.  Since you were doing 3DTs, did they do assisted hatching?  If not and you will be doing a 3DT again, you might ask about it.

Whatever you decide, just know I am here to talk.  (If you are on FB, you can PM me and maybe we can get together on there since it is a little easier to chat. Or, I can send you my email address since it is easier than PMing on here.)

Thank hon!  Those are all helpful.  I asked for assisted hatching too.  He said no.  I thought about 3dt and he said no.  I don't know why you won't be more aggressice.  He was aggressive enough in putting 4 back!  I am putting my list together from all the help you have provided and the other girls.  Once I can breathe a little better I will probably start calling around.  The thing that is also weighing in the back of my mind is DH.  I'm not sure he will be willing to give it another try.  He is OOT so I can't even talk to him.  (He will be home late tonight).

I am not on facebook   I will PM you my email address as well.  Thank you!

STL34

YGPM