# OE or DE IVF - what would you do?



## nellvans (Apr 13, 2009)

After a few years TTC naturally I'm now seriously considering moving on the IVF of some form or other, as it's now been almost a year since my last BFP. As you can see from my signature I have a history of pg loss and am now 41. I've been diagnosed with a couple of minor clotting factors which might *possibly* explain the stillbirth. I have also been diagnosed recently with immune issues (slightly raised killer cells and a cytokine imbalance) and have had intralipid treatment via Care, Nottingham, plus during cycle taking low dose aspirin for the clotting factors.


DH and I agreed in the Summer to continue to TTC naturally for a few months on the suggested protocol from Care, however I've now had my second negative cycle with the IL/aspirin support, and don't feel hopeful that the situation is going to change any. 


Care were keen for us to move onto OE-IVF without delay, but I've always been put off IVF on account of cost and low success rates in my age bracket. I am still ovulating, and my last scan at Care showed a reasonable number of developing follicles for someone of my age. I do have regular AF, however since our consultation in the Summer I have started to get spotting during my cycle around cd 10/11 plus my luteal phase over at least the last 2 cycles has been particularly short at only 8/9 days.


I feel like my days of getting pg on my own are over but am unsure what to do next - i.e. whether to go down donor egg route now, or whether to have 'one last go' with OE via IVF. DH has said he would be supportive of the latter, but I hate the thought of spending all that money for such a low chance of success - esp. as it's quite possible that all my previous m/c have been down to egg quality alone. If so, I haven't produced a good egg since 2006 - so really what chance have I got!


DE-IVF seems like the logical next step, but of course I'm then closing the door on any possibility of my own biological child, which after the death of my daughter is a pretty big step for me, so friends have suggested that I may find it easier to move onto DE after trying OE first. 


Interested in people's views on this.


----------



## reb363 (Mar 1, 2009)

Nellans - I'm so sorry you've had such a hard time    .

For me, I felt like I had to properly close one door before I could open another and struggled to ever think about DE until I felt certain that there was no possibility of me getting pregnant with my OE.  

I was all ready for DE this cycle but, in similar dilemma, had one last go with my OE - I only got one follicle but so far the news has been good (always cautious once you've experienced MC I think) and I am 10.3 weeks pg.  So it is possible to have success at 41.

I was glad I tried one last time as, whatever the outcome, I would have felt like I'd tried everything possible and was ready for the next step.  

Clexane is meant to be good for clotting/sticky issues once you have had ET, along with aspirin, and I took steroids for NK issues.  My consultant hasn't seen much success with Intralipid though I did try it one cycle.  

As for cost - yes it's so expensive with nothing being available on NHS at 41.  I guess I'm lucky to have a mortgage so I put it on there.

Sorry bit of a ramble as it's such a hard personal decision but I do wish you loads of luck in whatever way you decide to go.    

Reb


----------



## nellvans (Apr 13, 2009)

Reb - thanks for your input and congrats on your BFP. Fingers crossed for you.


nellie x


----------



## Kuki2010 (Oct 22, 2009)

Dear Nellie,

When I read your story my heart sunk. I am so sorry you had to go through that.. 

You have not got any issues with getting pregnant so no problem there. Yes age is a factor but if you eat well and take all the extra vits..You should be okay to create some good eggs. And get pregnant to healthy baby.

I think and believe you need to look into why the m/c accurring and rectify that before deciding to go for IVF. 

If your body is going to have m/c it is going to have it either eggs; OE or DE. Why your body is rejecting the babies? That's need to be found out first. Is there any DNA issues? I would do all the investigation before start IVF. IVF is great for people who can not get pregnant but not m/cs..

Wishing you lots of luck to get your baby into your arms as soon as possible.

Love. Kukixx


----------



## lily17 (Sep 25, 2008)

Dear Nellvans


Its such a difficult dilemma, I know how you feel....in theory you should be able to do IVf with OE and it  work...... but IVF is not an exact science...and all the docs can do, is do their bit to get your eggs out, fertilise and put back.....the rest is down to nature...and it either works or it doesnt....there are so many variables, lining, immune issues, egg quality...you can spend a fortune trying to get everything checked out.....and every month you wait...time is running out and your egg quality is deteriorating as you get older...its very very tough.
Then there's the money issue...OMg its all soooooo expensive.... I think if all IVf were free...all of us ladies would just go on and on trying with our own eggs until eventually we either fell apart or it worked!!  .....but we have to be realistic...most of us just havent got ££££££££ to keep throwing away...its a costly 'hobby' in more ways than one!


I think if you discuss your history with a second consultant you may be able to make a decision...go and see some one completely unrelated who does not know you or has not treated you to get their opinion, it maybe a chat that will cost you £150-£200....but you will have a balanced view from a doc who knows, go and look up a top doc in harley st or somewhere and see what they say.?


I chose to do DE because I am a bit older than you and I already have a children from my younger years....but even so, it was a difficult decision as you are giving up you own fertility...and its a sort of grieving process. 
DE isnt always the answer to everyones problems, but if egg quality is your problem, it may be the way forward for you. It doesnt mean you would not be the mother.....I look at it this way....an egg is NOT a baby...it is a set of instructions on how to make the baby....there needs to be two sets of instructions for baby to be made...and then the flesh and blood of a female body to build the baby.....your body provides every bit of protein and flesh and blood for the baby to grow....the only difference is the instructions didnt come completely from you....but your body does have an effect on the outcome of the instructions...(epigenetics) you can actually alter how the baby develops even though the genetic material is donated----amazing but true!


Only you can decide...its very difficult, lots to think about, I personally dont mind DE as  I think you would love a little baby just as much if you gave birth to it- it would still be very much part of you  


Lily X


----------



## lily17 (Sep 25, 2008)

Dear Nellvans


I just remembered there is a fab consultant called Dr Raj Rai working in London, he is THE authority on M/C, he works out of a clinic in Harley street you can go an see him ( will cost £200 for 30 mins) take all your med IVf history and see what he says...I think its called The Harley Street clinic I'll check


Lily x


----------



## nellvans (Apr 13, 2009)

Thanks for your replies ladies.

Kuki - yes, completely agree with the argument of checking for reasons for m/c before embarking on IVF. Unfortunately, DH and I already checked out for practically everything you could think of, inc, genetic stuff (all clear) and even the controversial immune tests (most recently with Care). 

I do have some immune issues it seems, which may (or may not) be related to m/c but they're a bit borderline and whilst I've been happy to try the intralipid tx I'm currently on - 2 cycles in it hasn't resulted in a BFP and it's now been almost a year since I last conceived, plus my cycles have been wonky since the Summer. 


Lily - thanks for the recommendation, but Raj Rai was one of the first consultants we saw back in Summer 09. He suggested an abnormality of my womb, which was later ruled out after an HSG.

I think what I'm trying to say, is that I've done all I can to try and find a cause for all those m/c and still don't really have an answer. So whatever I do next (unless I give up completely) is going to be a gamble. What a bummer.

nellie


----------



## Millie88 (Jul 25, 2010)

Hi Nellie, so sorry for your difficult journey  

We have been ttc #2 for 5 yrs and had 6 m/cs. The last one was on immune meds from CARE but from pathology we found out our baby girl had an extra chromosome. So we have been trying again for last 6 mths. The longest it has taken until now has been 9 mths to conceive..however I'm about to turn 43. Recently I had FSH, AMH and follicle scan done. Before I got the results back I started to investigate DEs as I thought that would be our only route but quickly became quite comfortable with it. Results came back more favourable than I thought with FSH and AMH both just below 10. After much discussion we have decided to do IVF for the first time but I said I would only do it if using CGH. Have you thought of this? CGH is by no means perfect and there can be challenging scenarios to cope with using this method too. But I didn't see the point, for us, in doing IVF the once without it. We have an appt end Nov to see what CARE think.

Good luck with your decision. Let me know if I can help in any way.

x


----------



## nellvans (Apr 13, 2009)

Sorry to hear about your m/c Millie. 

I arranged an FSH test via my GP (had it done yesterday, so should get the results back next week). I've also arranged to see my GP next week to discuss the spotting I've started getting and short luteal phase. I'm also going to try and blag another FSH test for next cycle (to see if there's a pattern). Are there any other tests you think I could ask about - you mentioned AMH? I've heard about it, but not sure what the significance is. 

Basically I'm trying to get a hormonal profile worked up before I go back to Care for my review in December. To see whether IVF worth my while or not. Do you know what the thresholds are with these tests - I heard that your FSH needs to be less than 10 to indicate viability. What about the AMH? My antral follicle count back in May wasn't too bad (8 follies in all) but of course that doesn't say anything about egg quality and was several months ago.

We were told about aCGH at our initial consultation in May. Sounds Ok in principle but it's so expensive I'd have a hard time persuading DH it was worth it. 

Just out of interest what did your immune comes up with? Your last m/c must have been much later than any of mine - all have occurred before the 7 week mark with the exception of one which was a blighted ovum only discovered in week 10 - development was only around 5 wks though.

Nellie


----------



## reb363 (Mar 1, 2009)

Hi Nellie

The tests can definitely help guide you on probabilities but just to say my FSH is always over 10 and my AMH was always negligble...

I was thinking you can get pregnant so the issue is more about staying pregnant.  It might be immune? (then steroids can help?)  it might be sticky blood? (the Clexane can help?), it might have been bad luck and won't happen again....or could be other things - I had chromosome testing for example to check compatability.... Or do you have anything like fibroids/polyps/scar tissue (there's evidence that they might decrease blood circulation and hysteroscopy can help) or anything unsual about womb, or do you not produce progesterone (I don't) and need extra support etc. etc....  

Not sure if that helps....

Reb


----------



## Millie88 (Jul 25, 2010)

Nellie, that's a great idea about getting the hormone tests done. That's exactly what I did a couple of mths ago. I also decided to get the AMH done with a scan as that is what the IVF clinics tend to go on as they feel that gives them the best info in order to guess which type of protocol is best that you will respond to. I used a local clinic to do these as CARE is some distance from us but I know CARE will accept the results so won't have to be repeated. At that time we were considering the local clinic as they have good IVF results and as another option they have link with a DE clinic abroad. Could you do the local tests locally or are you close to CARE anyway? As it turns out the local clinic to us is about 6mths- 1 yr away from CGH and so we decided to pursue the CARE option.

Both my FSH and AMH are just below 10. With FSH the lower the better, AMH the reverse altho very high can be problematic too with over stimulation a possibility and can indicate PCOS. I got 6 follies on CD7 in case it's of interest.

YOu might be surprised at DH's reaction once you start to talk about it? I was all prepared to move to DEs but my DH felt since we hadn't done IVF before we should try it and he felt CGH was a great option to have at this stage of the game. He felt we had taken very logical steps until now and moving to DEs now would be, in his mind, skipping a stage. I had raced ahead in my mind to DEs but am glad he feels this way and is willing to give me ole eggs a chance   The financial cost is huge I know. We have spent £13k+ so far and not even done assisted. But we have forgone niceties over the last 5 yrs to pursue this so dont' have holidays and such. Nevertheless, our 'flexible friend' has had to cope with most of the cost!

I first had immunes tested 2 years ago. I had v high TNF-a and I took 4 Humira to bring that down. NKs were ok but covered off with steroids. LAD wasn't so good but CARE don't treat that with the traditional approach anymore but we decided to have LIT nonetheless. So when pg the last time had the usual immune basics plus had intralipids. Scans started to show things not rosy and ended up with a surgical m/c at 10 wks. Previously had another surgical m/c at 12 wks and the other m/cs have been around 5 wks.

I did have some immunes re-run after last m/c which showed TNF-a up a little so took more Humira. The NKs linked to prog were up high so gestone was advised as well as utrogestan. LAD was good. Had them all re-run again recently and they showed a similar scenario, just wanted to know if I needed to do any treatment before pursuing IVF.

I am having days when I'm grieving for our natural fertility. Think we are almost at the same stage of the process Nellie but you've got a couple of years on me   But just to say I understand   Please let us know how your tests come out and keep in touch.

Reb, you've given me some more hope   So glad all is going well.

x


----------



## Helenb33 (Mar 29, 2004)

Hi Nellie

I'm very sorry to hear about your loss and the difficult time that you have had

Obviously the next steps are a personal decision for you, but I've recently been through a similar thought process. I decided to go for 1 x ICSI cycle using my own eggs and will then move on to donor eggs. I've got a good FSH of c.6 and a lousy AMH of 1.7. Although DE has a much higher success rate than the c.10% at best using my own eggs, I wanted to feel that I had given it a good shot. I've had various miscarriage tests, and also have a clotting problem so am going to be taking Clexane. I haven't pursued the immune tests yet (although to be honest, even though it makes  me sound like a total bimbo, I've almost lost track of the tests that I have had and what they were for). I've also opted for pre-implantation genetic diagnosis. My husband would have opted to go straight for DE, but we talked it through and he's supported me in going for 1 x ICSI with my failing old eggs first. I'm reasonably sanguine about then moving on to DE, but I think it'll be a tough one to accept that I'm not going to have a child who will be genetically mine if/when I'm faced by the reality of this.  

So no brilliant advice I'm afraid, only my own decision making journey. The only thing that I would recommend is Lesley Regan's book about miscarriage if you haven't already come across it? She runs a very well regarded at St Mary's in London, treating women who have suffered from recurrent miscarriage.

Whatever you decide, I wish you all the very best
Helen x


----------



## jo_11 (Apr 1, 2009)

Nellvans,

I couldn't stop by and read our thread without putting in my two pen'eth   

I'm so sorry to hear about your daughter   

I'll be brief as it seems that all the other lovely ladies (hello Millie, Helen, Kuki, Reb and Lily) have covered most of the areas I'd mention.

For me, I've 'bought in' to DE but it's DH who hasn't quite given up on OE yet, so we're giving OE another whirl at the mo, and if this one doesn't work, it's another go with my eggs before moving to DE.  This is our 'plan' that we're sticking to.  Someone mentioned epigenetics, and this is something that helped both me and DH get used to the idea.  We've already had consultations in a couple of Spanish DE clinics.

I'm like you, in as much as I've only just discovered NK cells issues, so am on prednisolone this cycle.  It does make me wonder if this issue has affected previous cycles, and as such am I back to square one in terms of trying?  I haven't got clotting issues, but as the other ladies have said, clexane deals with these.  

Have you looked into using IVIG?  It seems to have v high success rates; I know a couple of ladies who've had failed cycles on intralipids but have gone on to have BFPs on IVIG.  It's something used at ARGC a lot.  If you're going all guns blazing for your next (and possible final) IVF with OE, maybe have a consultation there?  I'm at the Lister myself, and I can't fault them.  The reason I say ARGC is that they do a full monitor of your cycle prior to the tx one, and will look at issues such as your lining, if you feel that may be a problem... at the Lister they will look at this too, and I know ladies who've had vagifem (for example) to help with this.  

It does sound like, from your post, that you haven't quite closed the door on OE yet, so if you can afford it, I'd be considering this first before moving to DE.  

Good luck in making your decision.

Jo
x


----------

