# IVF Wales/caru follow up questions



## kara76 (Dec 14, 2004)

i thought i would post these as they may help someone....


if i add any i will update

last time i asked around 20 questions too lol.....they love me 

MY FOLLOW UP QUESTIONS, just a few added

1. Is there anything we can do to help us succeed on our next attempt?

2. Is there anything you can do to help us succeed on our next attempt ? Any drugs that may help?

3. Will I still be taking clexane on our next attempt?

4. I am having acupuncture is this a good thing?

5. Could natural killer cells be an issue for us?

6. Can I have my prescription so I can ask gp to fund or get elsewhere?

7. Can I start in Dec/Jan for ec/et around the second week in feb?

8. What are our chances of success?

9 . If my clipped tube fills with fluid will it be drained?

10. What is best to do after embryo transfer? rest or work?

Embryologist

1. How were our embryos last fresh cycle?
2. How did they thaw?
3. How do you grade the embryos? Do you use ges?
4. Is blastocyst transfer an good option for us?
5. What day would ec/et fall on if we went for blastocyst transfer?
6. Would someone check on them over the weekend when clinic is closed?
7. How many good quality embryos would we need to go for blastocyst?
8. Would the final choice be made on day 3?
9. Would you freeze any suplus blastocyst?
10. Would assisted hatching be an option?

Cost

1. How much is a full cycle?
2. How much is blastocyst transfer?
3. How much is assissited hatching


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## crazybabe (Apr 24, 2007)

Hi Kara

Do you know what sort of time they ask people to go into the clininc at CARU on the day of EC and ET.  HOw you getting on with your treatment, i am on day 9 with my DR already only another 10 to go.

 

crazybabe


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## CookieSal (Jun 24, 2007)

Great collection of questions Kara - I was a bit like you when I went to see Mr G after my initial diagnosis (I had 2 pages of questions but he wasn't phased bless him) - I don't think it would be helpful for me to add my questions here though as I'm not aware of anyone else in my position at present.  Will keep them for the future in case there is a chance I can help anyone out.

What are natural killer cells?  

Will you be posting the answers to the questions you ask at your follow up?  Might be something that people find really helpful as they enter this minefield of a process.

Hope you're doing OK x


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## kara76 (Dec 14, 2004)

long post coming

THURSDAY 25TH OCTOBER the follow up

HAPPY BIRTHDAY DH

on to the follow up, well we are both over the moon with the follow up, we met with the main con and the head embryolist first i will go through the questions


1.Is there anything we can do to help us succeed on our next attempt?

this will be answered as we go through them but yes

2. Any drugs that may help us succeed? Steriods?

yes you can try steriod this cycle 

3. Will I taking clexane on our next attempt?

yes

4. I am having acupuncture is this a good thing?

yes it is proven to help with blood flow to the uterus and also with staying postive

5. Could natural killer cells be an issue for us?

possible, she went into good and bad killer cells but the steriods will help this , if there is an issue

6. Can I have my prescription as my GP is funding this cycle of drugs?

yes.....the gp's now have it and i collect the drugs on monday

7. Can I start in Jan for ec/et around the second week in Feb?

yes.....dr on around the 3rd jan baseline the 8th and ec 25th feb omg

8. What are our chances of success?

50%, the clinics current rates are 54%, she said its like flipping a coin with us and that we have the same chance as on the first cycle

9. If my clipped tube fills with fluid will it be drained?

only if it is causing pain

10. Would my clipped tube cause any problem, can it contract the uterus to expel the embryos?

no this does not happen

11. What is best after transfer? Rest or work?

its up to me what ever makes me feel most confident

12. Are they any tests we can can to find out why it isn’t working?

no or they would be doing them, but they are gona do day 3 fsh and thriod


Lyndon Embryologist

1. What was the quality of the eggs and the sperm?

excellent

2. How were our embryos last fresh cycle?

fantasic ( his words ) 2 were put back 1 was a 8.1 and was a 7.9, they were the best he has ever seen, text book embryos and he would have said that a pregnancy should have happened

3. How did they thaw?

2 thawed well but with freezing an embryo can look fine but be damged that why they have changed to Vitrification,

vitrification is as good as fresh

4. How do you grade the embryos? Do you use ges?

they use ges but in a different way, they grade number on cells, shape and fragmention, our were scored very high 

5. Is blastocyst transfer a good option for us?

yes, i told him i felt nervous about having none to transfer and he said with embryos like ours that is ver very unlikely

6. What day would ec/et fall on if we went for blastocyst transfer?

same, they would open at the weekend as someone is always there

7. Would someone check on them over the weekend when clinic is closed?

yes

8. How many good quality embryos would we need to go for blastocyst?

if we have the same quality as last time he would want 3 prefect on day 3, this way 1 is pretty much a cert...more would be better, he like to get 10 eggs at ec

9. Would the final choice be made on day 3?

yes


10. Would you freeze any suplus blastocyst?

yes they can Vitrification the no transferred one

11. Would assisted hatching be an option?

yes


12. Is assisted hatching done with a laser or acid?

he preffers acid as he doesn't like the idea of a laser heating the cells, but if we want it done by laser he can

13. Are they any tests we can can to find out why it isn’t working?

the con said i could again have my ovary freed but sod that lol as they only got 3 eggs from that side anyway its just very hard to reach

so we have a plan.

the plan can change and we can change to blastos if we want but here is the plan

THE PLAN


DR in jan around the 3rd with baseline on the 8th feb...due to work, so need to call the clinic with decmeber af.

ec is pencilled in for the 25th feb and we have decided on assisted hatching and any sulplus to be Vitrificated ( type of freezing ) and if needed we could take these to blasto for a bro or sister ( good pma lol )

the embryolist asked me to email him when we are coming for our baseline so he knows im having a cycle before ec, that way he will see he before ec etc to have a chat and if i ave any question i may email him direct, he said i am the most knowledgable patient and do i what a job lol bless him , he said knowledge is power and that is something i say ALOT

it was all very very postive so here i am 10 weeks til dr 

omg


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## CookieSal (Jun 24, 2007)

WOW, that is so positive, you must be really chuffed   ...and now you have a date to aim for.  With Christmas coming up the next 2 months should fly by!  Really pleased for you chick!


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## kara76 (Dec 14, 2004)

more follow up question...after 3rd fresh cycle

FOLLOW UP QUESTIONS


This cycle


1.How do you think this cycle went? 



2.On this cycle my first follicle scan showed a thick endometrial lining of 13mm and lots of follicles yet on the second scan there were less follicles and lining was 10mm, At the time I questioned it and was told it was because a different nurse did the scan and each has different eyesight and scan different, is this the case? Can I request the same nurse to do each scan next cycle?



3. I passed a strange clot with this period, large and one 3rd of it was white, what was this? 



4. At the end of this period i passed what can only be describe as dirty water, what could this of been?



5. How many eggs were collected from each ovary? 



6. How difficult was it to reach my left ovary?





TESTS



1.  I have noticed that most people have a hysteroscopy after this many failed cycles do you think this would be beneficial and if so what would you be looking for, would an endometrial biopsy be worth while? How long would the wait be for this? Can I request one?



2. At the very least can I have a detailed 3D scan again?



3. Do you have an opinion on immune testing and if so 

what is your view?



4. Are there any other tests you would recommend?







FSH LEVEL



1. My fsh went up to 10.3 what would cause this? 



2. At the start of this cycle ( day 3 before down regulation) my fsh was 6.7 does this seem high for my age?



3. Could this be the reason 2 less eggs were collected?



4. Would it be checked again at the before down regulation begins?





WHY DOES IT KEEP FAILING



1. What could be the causes of implantation failure? 



2. Does the reason for failure now go back to unexplained cause?





WHAT NEXT



1. What would you suggest the next step to be? Would you change anything for the next cycle?



2. Should I use the clexane and steriods again? Would any of these affect implantation?



3. Is it our choice whether to go fresh or frozen? What would you suggest and why?



4. How soon could be start treatment?



5. Which do you suggest for the best chance of pregnancy? 



6. What are our chances of success? 



7. What would be the benefit of a short protocol? 



8. Is 2 the maximum number of embryo that you will transfer?



9. Is there any way to reduce the cost of treatment?



10. Would you advise carrying on with acupuncture?



Lyndon



1. I have spoken with Lyndon about the possibility of trying to go to blastocyst with the 3 frozen embryos? If we try and culture them and they do not reach blastocyst so no embryo transfer what would the cost be?



All other questions regarding embryology have been answered by Lyndon.

We have also discussed doing another fresh cycle with then hope of blastocyst and adding to the frozen embryos if this next fresh cycle were to fail we would then try for blastocysts with the frozen embryos from 2 cycles.


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## miriam7 (Aug 8, 2007)

bloody hell kara you dont half know your stuff  i think blastocyst sounds good but i wouldnt want to risk having none to put back if i only had 3 frozen embies so i would prefer having another fresh cycle and trying blasto and freezing the rest to go with the 3 already froze..i hope you come away with some positive answers tomorrow   if i get called in tomorrow i will be listening for the name kara to be called!


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## kara76 (Dec 14, 2004)

glad you like them

andi will be there at 11am too.....i will be watching for you now lol


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## miriam7 (Aug 8, 2007)

i will keep an eye.. well ear out for u both then! when you have been called for a fet what time did they ring you to go in?


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## kara76 (Dec 14, 2004)

they called at 9am and i left home and was there for 11ish


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## miriam7 (Aug 8, 2007)

sorry been hoovering as plan on doing   all tomorrow! im hoping thats what will happen to me it only takes 20 odd minutes for me to get there as im in newport(and jeffs driving)  have u heard of andi68 2day is she alright?


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## kara76 (Dec 14, 2004)

i live 2 hours away so they needed to give us time to get there lol


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## kara76 (Dec 14, 2004)

FOLLOW UP QUESTIONS
Kara & Luke Ellard
This cycle
1.How do you think this cycle went? 

Text book cycle

2.On this cycle my first follicle scan showed a thick endometrial lining of 13mm and lots of follicles yet on the second scan there were less follicles and lining was 10mm, At the time I questioned it and was told it was because a different nurse did the scan and each has different eyesight and scan different, is this the case? Can I request the same nurse to do each scan next cycle?

Different nurse do measure different and yes i can request the same nurse next time

3. I passed a strange clot with this period, large and one 3rd of it was white, what was this?

This could of been where the lining was so pumped up, also this could have been a small polp

4. At the end of this period i passed what can only be describe as dirty water, what could this of been?

She said, i dont know and then went on to say, sometimes glands on the cervix can fill with fluid and pop, this could of been that

5. How many eggs were collected from each ovary?

This was not in my notes but not all eggs from the left were collected, as it so high

6. How difficult was it to reach my left ovary

very difficult, not all eggs collected

TESTS
1. I have noticed that most people have a hysteroscopy after this many failed cycles do you think this would be beneficial and if so what would you be looking for, would an endometrial biopsy be worth while? How long would the wait be for this?

She said that lots of private clinics do this pretty much to make money and most of the time all in fine, the wait in 6 months of more, a fus(fluid ulta sound is just as good and if something was notice, she would then do one)

yes i can ask for one

2. At the very least can I have a detailed 3D scan again?

Yes i can have a 4D scan if i want, opted for a FUS......maybe a 4d after that and she will also be doing a blood flow scan

3. Do you have an opinion on immune testing and if so what is your view?

She has been to many confrences and the immune testing that most clinic do concerning immune issue is done with serum(blood from your vein ), she said this is pointless, levels of nk cells do not go up and done throughout each cycle, lastest studies are starting to think that nk cells in the womb are useful and pave the way you implantion.!!

as im on clexane and steriod this would most likely be the treatment for immune issues anyway

4. Are there any other tests you would recommend?

AMH test which the blood was drawn for today

FSH LEVEL
1. My fsh went up to 10.3 what would cause this?

Either a blip or a lab error

2. At the start of this cycle ( day 3 before down regulation) my fsh was 6.7 does this seem high for my age?

6,7 is normal range and as i produce good eggs and a good number this is fine

3. Could this be the reason 2 less eggs were collected

Probably because my left ovary was so high, she then said that freeing it up in pointless as she looked at the pics and thinks its just the way i am, the stem in short and the ovary is streched, but still producing so freeing it would stop any pain i get but would also cut the blood supply and the ovary would die, and as it produces eggs this it not worth it....phew thank god lol, i said that too

4. Would it be checked again at the before down regulation begins?

I can either have it done each month with gp , or can have day 3 fsh before down reg...the amh test is much more effective , as fsh goes up and down and doesn't give a clear picture, the amh test will tell me how many eggs i have left ( scary )

WHY DOES IT KEEP FAILING
1. What could be the causes of implantation failure?

No one really knows, they wish they did, could be chromosome problems which they just can not see

2. Does the reason for failure now go back to unexplained cause?

yes

WHAT NEXT
1. What would you suggest the next step to be? Would you change anything for the next cycle

The next step is the scans, the changes would be next 2ww will be gestone and extra hcg jabs and results of the amh test

2. Should I use the clexane and steriods again? Would any of these affect implantation?

They should help but there is limited evidence

3. Is it our choice whether to go fresh or frozen? What would you suggest and why?

Yes it our choice, the nice guidelines say to try frozen

4. How soon could be start treatment?

Have a holiday....i laughed and said we cant afford it and would like to wait maybe 2 natural cycles, she agreed

5. Which do you suggest for the best chance of pregnancy?

Fresh but they are getting good results from frozen cycles

6. What are our chances of success?

Up to 3 cycles the chances are the same, after 3 cycles most people have either had success of give up that is why the success rate seems less when in reality its just less people are going through more than 3 cycles

7. What would be the benefit of a short protocol?

Short protocol in best for poor responding ladies and as i get good results from the long we will stick with that

8. Is 2 the maximum number of embryo that you will transfer?

Yes 2 is the max, she laughed and told me they would sue her if they transferred 3

9. Is there any way to reduce the cost of treatment?

Egg sharing i said we have thought of this and its not for us just yet, and she said you know about getting drugs from gp and other companies 

10. Would you advise carrying on with acupuncture?

yes, it improves blood flow and if it makes me feel postive carry on

Lyndon
1. I have spoken with Lyndon about the possibility of trying to go to blastocyst with the 3 frozen embryos? If we try and culture them and they do not reach blastocyst so no embryo transfer what would the cost be?

damn forgot to get the answer for this lol

All other questions regarding embryology have been answered by Lyndon.
We have also discussed doing another fresh cycle with then hope of blastocyst and adding to the frozen embryos if this next fresh cycle were to fail we would then try for blastocysts with the frozen embryos from 2 cycles.


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## CookieSal (Jun 24, 2007)

How do you feel about things now babe?


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## kara76 (Dec 14, 2004)

i feel good we at least have a plan now

fresh with blasto


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## CookieSal (Jun 24, 2007)

That's good news, glad you have something to aim at..... are you looking at starting in May then?


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## kara76 (Dec 14, 2004)

will down reg in may or june if all ok with the scans


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## popsi (Oct 11, 2007)

Great news Kara, you will still be cycling before me, i dont think i will be DR until July, we could have been cycle buddies ! x


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## CookieSal (Jun 24, 2007)

Well let's keep our fingers crossed that the scans are all good.


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## ANDI68 (Aug 17, 2007)

Glad it went well Kara


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## kara76 (Dec 14, 2004)

in the past i have taken notes or even wrote in down as soon as im out

i now remember it all, its kinda of hobby for us now lol, sad yet true

i might even flip a coin to decide when next as sil is getting wed on the 31st may, do i down reg and have a drink or wait another month!!!!??


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## CookieSal (Jun 24, 2007)

I guess once you have had the tests and got the results it will help you determine when to start - that together with your patience level!


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## ANDI68 (Aug 17, 2007)

These were our first follow up questions in November:


What were the main factors that contributed to our negative cycle?


Were you satisfied with my D/R and stimming results?


I am having acupuncture, is this okay to continue with?


Would you change any drugs next time?


Can we do anything (e.g. increase vitamins) to help our chances of success?


What is best after transfer, rest or work?


Are there any tests to find out why it didn't work?


What are our chances of success second time, are they greater or less than our first time?


I bled early in my 2 week wait, would gestone injections be better for me?


I believe I ovulated early, how did this affect my egg quality/fertilization?


How can early ovulation be prevented next time?


How was my egg quality, can I do anything to improve it?


The quantity of eggs, were there as many as you would expect?


Would egg collection earlier have helped?


Should I have taken the trigger later?


I took penicillin during my stimming, would this have affected my eggs?


Should we be tested for immune issues?


Is my age affecting the egg quality?


When is the earliest we can start again?


Do I need a scan before starting again?


Can I have my prescription and rough treatment schedule today?


What chance do we have of a natural conception now?


EMBRYOLOGIST
How do you feel the IVF procedure went?


Was the sperm of good enough quality?


Was fertilization more slower than expected?


Two of our fertilized eggs produced unusual results (3 nuclei) does this suggest any issues?


What was the quality of the surviving embryo?


How unusual is poor fertilization using IVF, 3 out of 8 eggs fertilized, 2 abnormally .... what percentage is expected?


How do you grade the embryos?


Would you now perform ICSI due to the poor fertilization, no matter what the count is?

These are questions I've prepared for our second follow up in 2 weeks:

•	Apart from the fertilisation issue again, how do you feel our cycle went?

•	Were you satisfied with my D/R and stimming results?

•	Why do you think we are having fertilisation problems?

•	Lyndon suggested some genetic tests that could be done on our eggs/sperm next cycle, are there any tests that could be done in the meantime?

•	Would I lose any eggs due to this testing, or would only unfertilised eggs be tested?

•	I had better fertilisation with our IVF cycle, even though 2 eggs were abnormally fertilised. Next cycle, Lyndon suggested fertilising half ICSI and half IVF but he said I would need at least 12 eggs &#8230; do you think this is possible if my early ovulation can be combated? Would this also depend on DH's SA results?

•	How was DH's last SA results, would they have been good enough for IVF?

•	I believe I ovulated early again this cycle despite having my trigger an hour later, do you think I could be losing my best/ripest eggs due to this?

•	Have you seen early ovulation combined with poor fertilisation in patients often before? Could there be a connection?

•	Would the antagonist protocol with Cetrotide or Orgalutran be of any benefit next cycle?

•	Could my body be overriding Suprecur?

•	I had minimal/almost no side effects from D/R last cycle which surprised me and made me wonder if I was responding, would it have been detected if I wasn't?

•	What are the negatives of the antagonist protocol, would egg quality, quantity and pregnancy rates be affected, or does it depend what drug is used to prevent the premature LH surge?

•	Is the risk of OHSS greater or less with the antagonist protocol?

•	I had mild/moderate OHSS last cycle, would gestone injections instead of extra HCG be better?

•	What stimming drug would you recommend for next cycle?

•	I didn't hyper stimulate on Puregon is this because I had less follicles?

•	Can early OHSS affect implantation?

•	I changed from Puregon to Menopur last cycle and believe this drug contains LH. Would this have contributed to my early ovulation and LH surge?

•	Could more scans and blood tests during stimms help detect/prevent early ovulation?

•	Could steroids during stimms improve egg quality?

•	Was my left ovary reached at EC?

•	Would aspirin have any benefit for me?

•	I took Co-enzyme Q10 during both cycles up to egg collection, should I continue with this next cycle?

•	I believe from previous hormone tests that I have a high testosterone level, could this be affecting my eggs?

•	Was the fertilisation and development of our embryo on track and as expected?

•	Our embryo was a grade 1, after having such a poor fertilisation rate would you expect this?

If anyone can think of anything I could be asking, please let me know


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## kara76 (Dec 14, 2004)

good girl and im well impressed with your question, they will love you as much as they do me lol


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## popsi (Oct 11, 2007)

Andrea .. brilliant love x


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## CookieSal (Jun 24, 2007)

Wow, I'll be cribbing off you if I am in a similar position in a few months time.  Very impressive!


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## miriam7 (Aug 8, 2007)

just wondering what to ask at my follow up next tue?   i dont know where to start!


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## popsi (Oct 11, 2007)

miriam ! i did not know your follow up was next week, you will be on this crazy tx road again b4 u know it chick ! 

have a look at Kara and Andi's questions, they are fab !


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## miriam7 (Aug 8, 2007)

i only want to do a natural go like kara though seen as i only have the 1 embryo left...dnt want to wast loads of money ..


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## kara76 (Dec 14, 2004)

hunni

i would ask about your tubes and whether they think removing/clipping would be a good thing to do
, go through the questions hun and add these on, its always good to ask egg/embryo and sperm quaility

1. do you think my tubes might hinder implantion ( hydrosalpinx)

2. would removing or clipping increase my chance of sucess with IVF?

remember if they say to remove or clip that is it then, no chance ever of a miracle and it does feel different once the op is done, emotionally its like the end of all hope naturally however slim


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## ANDI68 (Aug 17, 2007)

Did you get your questions sorted Miriam, your appt is next Tuesday isn't it?


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## miriam7 (Aug 8, 2007)

yep appoinments tue 3.40 ... gunna try do questions tonight as going for a meal tomorrow night...


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## kara76 (Dec 14, 2004)

good luck with your apointment hun


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## miriam7 (Aug 8, 2007)

thanks kara .. i only have 10 questions i got emma to help me last night.. love her! i will post them later so you can see...


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## kara76 (Dec 14, 2004)

good girl and good luck


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## miriam7 (Aug 8, 2007)

well ladies ...this is all i have ! as i have only had 1 fresh and 1 frozen not too sure what to ask .. but 
here it goes..  Is there anything u can give me to help the embryos stick ...any drugs?
What was the quality of the eggs ? sperm ? embryos ? uterus ( endometrium)? 
Would aspirin have any benefit for me?    
why do you think the cycle failed ?  
what could be the cause of implatation failure - is theres any way they could check my womb/uterus?
Are their any further blood/hormone tests you would now recommend?  
Would you recommend having a hysteroscopy?
do you think my tubes might hinder implantion ( hydrosalpinx)
could i have endo as i have some symptoms and that you have heard that this can affect implantation faliure??
can i do a natural cycle with my 1 remaining embryo?


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## ANDI68 (Aug 17, 2007)

Miriam, 

Good questions.

Didn't you bleed early while taking the gestone?

Good luck with your appointment xxx


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## popsi (Oct 11, 2007)

Miriam 

Great questions  , when I had my follow up i had a long list of them, but to be honest after speaking with Janet and her explaining everything, there were only 2 left on the list she had not covered !, so good luck with it hun, hope you get what you want xxxx


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## kara76 (Dec 14, 2004)

good luck with your follow up hun

looking forward to hearing your news when you get back


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## miriam7 (Aug 8, 2007)

afternoon ladies .. andi68 ..no i was ok on the gestone they just didnt give me enough to get to test day remember! they gave me enough up until the thur night and test day was fri so i tested a day early and came on the monday..right i better get ready to go now!


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## kara76 (Dec 14, 2004)

bumping this up for scouse

you might find some of the questions helpful for your appointment


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## Tiny21 (Jul 24, 2007)

Hi girls
Spooks kindly put me on to this thread for your comprehensive list of questions which I am now editing to take to our follow up tomorrow!!

Thanks, they are very helpful and included things I might not have thought of - poor consultant, that's all I can say!

Tiny x


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## kara76 (Dec 14, 2004)

tiny

im so pleased they have helped you

good luck


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## Jule (Oct 12, 2008)

Just read those questions i will also be using some of those for my follow up, hope you dont mind?
What do you mean when you say about doing a natural cycle with your embryo.  I assumed natural was with no fertility help.


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## miriam7 (Aug 8, 2007)

natural was just putting the embryo back after i ovulated ..so we tricked my body and it worked   the only drugs i had were steroids for the assisted hatching and pessaries which i phoned up for 3 days after transfer even tho my own progesterone levels would of been high enough to carry it off


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## Jule (Oct 12, 2008)

That sounds brilliant, i dont suppose that would work for me then because i dont ovulate?  I need to take the mini pill every month to bleed.  What a difference in the price as well-huge difference.
Question for you nothing to do with fertility.  Im just getting used to the site and i notice you have put your web as your ******** how do you do that, id like to do that?
Jule


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## miriam7 (Aug 8, 2007)

yeah you have to be ovulating normaly for natural transfer ... to put ******** as your link just copy and paste the link in bar when your viewing your profile page...add me!


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## kara76 (Dec 14, 2004)

they would do a monitoring cycle the month before a natural fet

i have always had medicated and its ok, the hrt is yuck though


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## kara76 (Dec 14, 2004)

bumping this


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## Cath34 (Oct 14, 2008)

Kara, I have already asked these questions. I was thinking more along the llines of any specific tests that I could have done that are not done as routine.
I know about dex pred asprin gestone. Tried them all. Just wondering what else can they test for. I've had karotype and thromophilia testing with Arianna at her clinic. I also know day 3 v blast and have done them  both also. What about any tests to do with the uterus, did you day a blood flow test before and something else? Sorry hun I can't remember?


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## kara76 (Dec 14, 2004)

i had a 4d, saline and blood flow scan but this is cause ive not had a hysterscopy which i will be having with my next op

fet isn't counted as a cycle in clinics eyes and 3 fresh cycle is how many lots of people take to become pregnant

you could do down the immune route yet i doubt you would get any info or testing at clinic as this is very specialised and pretty much unproven so it depends very much of what you believe


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## Laura36 (Jun 27, 2007)

Hi ladies,
These are my questions so far for our appt later today? Can anyone think of anything I've missed?
What does aspirin do? Should I ask about that?
Just want to make this last go work, more embryo's and some over to freeze would be good this time!!
Thank you  

1.	I responded poorly to the drugs on both previous cycles, is there anything you can do/change to improve my response? i.e. different drug protocol
2.	How soon can we start treatment?
3.	What are the benefits of short protocol & would it be suitable for me?
4.	How does having had a pregnancy affect the chances of success on an IVF cycle and does it improve the chance of getting pregnant naturally?
5.	Out of 5 eggs we only had 2 embryos.  Is there anything that can be done to help the quality of eggs/sperm to ensure more of the eggs fertilise?
6.	What was the quality of our eggs, sperm, endometrium, embryos on the last cycle?
7.	I have heard about DHEA, would that be useful for me either during this cycle or in general?
8.	What was my AMH result? It was tested on the last cycle but the results didn’t arrive in time before I started stimms.
9.	Is having a positive result last time a good indicator of success on this next cycle? What are our chances of success?
10.	We are still waiting for a follow up appt with Dr Long in Fetal medicine to find out the results of the tissue sample taken from our baby.  Ideally we want those results before starting the next cycle.  Is there anything you can do to help speed things up?
11.	Would the termination I had in mid November affect the next cycle? I’ve had 1 period since and expect the 2nd next week.


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## kara76 (Dec 14, 2004)

they look great

gona pm you


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## kara76 (Dec 14, 2004)

just bumping this up again


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## kara76 (Dec 14, 2004)

bump for liz


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## PixTrix (Aug 20, 2008)

Here are my questions at last!! Well a redraft, there was so much more, I thought I'd better cut back a bit! Suggestion to take anything out or add most welcome  

•	Looking at the cycle as a whole, what were the main reasons for failing?

•	What were the problems at EC? Not 100% sure why out of so many follicles only 5 eggs were collected. Was it to do with the right ovary being so high? Or could a higher dose of pregnyl release more mature eggs?

•	What causes an ovary to be so high and is there something that can be done to lower it? 

•	I have never had a lap, could this reveal any problem with the situation of the right ovary?

•	Is there anything different that you could do to hope for a more successful cycle for example extra or different drugs?

•	Are my eggs of very poor quality? I know that the shell was double the normal thickness, is this an indication of poor quality and does assisted hatching overcome this? If so, am I right in thinking steroids could help if had assisted hatching?

•	Do polycystic ovaries cause poor quality eggs and can they lower chances of IVF working? 

•	I have been told that by some that have polycystic ovaries and by others that I haven’t, what are your thoughts and do I actually have the syndrome? Very irregular cycles.

•	Should I restart metformin? Can it improve egg quality? Does it interfere with stimulation?

•	What can be done to improve egg quality?

•	Going to start taking bee propolis, bee pollen, honey and royal jelly, is this ok? If so should I stop at EC?

•	What causes fragmentation? Is it unlikely to have a positive cycle with so much fragmentation?

•	Could DHEA be of benefit to me? Are the testosterone properties a problem in cases of PCO?

•	Could my fibroid cause any problems?

•	What are the benefits of steroids?

•	What are the benefits of aspirin?

•	What could help implantation? 

•	Could I try gestone instead of cyclogest? 

•	Should I have a repeat AMH done due to the poor results of two treatments?

•	From ET got terrible cramping and very painful lower back could something prevent this? 

•	Lower back has continued to be sore and since IVF have been getting terrible pains under right rib cage. Been told poss gall stones. Could this be due to the drugs or process?

•	Have not had a period since the bleed after IVF. Now on cycle day 64.  Been having painful niggles around ovary area, sometimes like a knotting feeling and pains as if period coming over the past few weeks but nothing. I had old blood when wiping inside that lasted just over two weeks but nothing more.

•	I have heard that having an empty bladder is better at transfer if got a retroverted uterus. Is it worth trying this to help with getting a better scan of uterus as this was a problem? 

•	Why was it difficult inserting the catheter at ET?

•	Would an increase in stims be a good idea?

•	Should I have any tests before attempting another cycle?

•	Is there any more sperm left in storage?

•	Could I arrange to have E/C in March?


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## kara76 (Dec 14, 2004)

great questions hun

i have dropped you a pm


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## PixTrix (Aug 20, 2008)

thanks Kara


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## miriam7 (Aug 8, 2007)

great questions hope you remember all the answers


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## PixTrix (Aug 20, 2008)

thanks Miriam. I have printed off a sheet with space for my answers will have a pen at the ready!!


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## miriam7 (Aug 8, 2007)

its the only way to do it ...im useless at remembering things


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## PixTrix (Aug 20, 2008)

me too


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## ANDI68 (Aug 17, 2007)

Hope your appointment goes well Pix ... great questions.


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## mimi41 (Feb 28, 2008)

Pix good luck with your questions hun.  I will be thinking of you!


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## PixTrix (Aug 20, 2008)

thanks Andi and Michelle x


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## Shellebell (Dec 31, 2004)

I would print off a copy to give to them to fill in


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## PixTrix (Aug 20, 2008)

now there's an idea Shell. I have printed 2 copies maybe I should give my copy with the big gaps to have filled in   Gosh is that the time really need to be going but wanted to see if any news from Queenie!


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## Laura36 (Jun 27, 2007)

Right, I think it's about time I started sorting out my questions for follow up on 11th Feb!

My main objective is to find out what NHS tx we can have between now and May.  But I'd also like to specifically ask:

- why did I get AF after only 7 or 8 days following ET? Should I use different progesterone to help prevent this?
- I had bad cramping on the day of ET and the following day, could this have caused tx to fail and what can I do about it next time?
- if I can do IVF on NHS what protocol and dose of stimms would you recommend?
- my left ovary was impossible to reach last time, is there anyway around that? ie. do they ever access hard to reach ovaries through vaginal wall?

I can't think of anymore right now. What do you think girls?


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## Laura36 (Jun 27, 2007)

also, I need to ask about getting scans done at the clinic for our DE treatment in July.  Or perhaps I shouldn't mention that in case it impacts on us getting another NHS cycle.


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## kara76 (Dec 14, 2004)

hiya laura hun, not long til your appointment

you have had 2 cycles of ivf as converted cycles shouldnt count so there is no reason why you can not have another cycle of IVF....this is my opinion of course lol

ovaries are reached through the vaginal wall now, a high ovary could be high for lots of reasons including just not enough follicles to weigh it down!

i would ask about using a womb relaxant from et, i did this last cycle as i tended to cramp after et!

might be worth asking about gestone for progestrone support! its ok to do honestly hun

i would have a word with the nurses about the scanning for DE cause you might well not need it


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## Queenie1 (Aug 21, 2008)

good luck laura i hope that they can answer your questions and have a plan for you.


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## Mrs Thomas (Jan 19, 2009)

Hi Laura.

I went to see JE this week for a first (private) consult to try and get on the NHS waiting list. I was at LWC previously and had 1 IVF cycle converted to IUI. 

She told us that the converted IUI doesn't count so we are still eligible. She also said you are allowed one private cycle before you can have 2 NHS cycles because the NHS believe in success from a total of 3 cycles.

One tip she gave us in so many words is that if you want to have any more private treatment in the meantime, it will affect nhs attempts if we tell them. ie go somewhere else but don't tell them! 

Hope this helps, good luck with your appt x


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## ANDI68 (Aug 17, 2007)

Hope f/u goes well Laura x


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## Laura36 (Jun 27, 2007)

thanks all, I'm really hoping they can fit me in for another cycle soon.  

Kara, I will def ask for womb relaxant. Do you remember what the drug was called?  Also, gestone def worth a go!  I'll have to find the courage to cope with the big needle though - will flippin terrify me!


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## miriam7 (Aug 8, 2007)

really hope you can get another nhs go and soon!


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## kara76 (Dec 14, 2004)

laura the first gestone jab is scary but once you realise it doesnt hurt its all ok. the womb relaxant is called nifedipine, i took it 3 times a day from et on day 3 to day 5 so 3 days in total


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## Laura36 (Jun 27, 2007)

Thanks hun i am def going to ask for womb relaxant. I will have to trust you re gestone not hurting though,lol. Worth a go for sure.


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## kara76 (Dec 14, 2004)

i bet you cant wait til thursday now, what time is your appointment?


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## PixTrix (Aug 20, 2008)

good luck Laura


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## Laura36 (Jun 27, 2007)

Its 11am. You are right i cant wait. My ideal outcome would be to do nhs iui march then nhs ivf april or may! Just want to get on with more tx now as its been a long wait.        Hi pix  sorry on mobile so cant do grammar very well,lol x


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## kara76 (Dec 14, 2004)

i will be thinking of you at 11am and waiting for your news hun


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## PixTrix (Aug 20, 2008)

Be so great if you can do that Laura, except IUI followed by a BFP!


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## kara76 (Dec 14, 2004)

laura good luck with your appointment tomorrow hope you get the answers you want


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## PixTrix (Aug 20, 2008)

good luck x


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## mimi41 (Feb 28, 2008)

good luck laura


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## Queenie1 (Aug 21, 2008)

good luck today laura.


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## Laura36 (Jun 27, 2007)

thanks all.  I'll update you later.  Just online to write my questions down before I leave.

Just hoping they agree to let me have more NHS tx


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## kara76 (Dec 14, 2004)

cant wait to hear your news

good luck


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## Queenie1 (Aug 21, 2008)

laura hope app went well today.


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## PixTrix (Aug 20, 2008)

how did it go today Laura? Hope all is well x


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## Laura36 (Jun 27, 2007)

Hi, thanks for the good wishes and sorry it's taken me a while to get online to update.

Appt went well.

JE said cramps and early AF last time were probably down to low hormone levels in second half of cycle so can take more pregnyl.  She suggested taking it on day of ET plus 3 days later.  Anyone heard of this approach before? She also suggested more progesterone.

She has confirmed I am entitled to 2 more NHS IUI and 1 more NHS IVF which is fab news.

So, I'm going to try and fit in the IUI at next AF which could be next week.  They are restricting to 5 IUI starters per week so I could get pushed back til next month which would be a shame but just one of those things.

I have an IVF planning appt 20th April, which is ages away but that's when they are booking for now.  

So very positive overall.  Does anyone know how long typically it is from planning appt to booking EC dates in?  I'd probably do short protocol again.  My concern is how close the cycle could be to my donor egg tx which is booked in.  I don't yet know when I'd start drugs for that but I wouldn't think before June.

So I'm feeling better as we now have effectively 3 more tx's in the UK if we need them plus 1 DE. Surely with that lot I would hope to get lucky  

For the first time ever DH was actually interested in how it went and felt it sounded sensible (he's thinking of how much money we'd save, lol. But did also say it's better as my egg too).  In fact he said we ought to push back the DE cycle if we need to so we fit in the NHS IVF first.  We'd lose our flights that I've booked but hopefully the clinic would be able to find us new dates.  

We have to do new bloods as all out of date so I did mine whilst there.  Debs said I don't need IUI planning appt as I know what I'm doing


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## Laura36 (Jun 27, 2007)

forgot to add, JE suggested taking DHEA again so watch out of the zits, lol


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## kara76 (Dec 14, 2004)

very postive appointment hun. is putting back your DE cycle an option for you?

extra hcg is used to aid implantation and extra progestrone sounds good, does that mean gestone and cyclogest?

3 more goes sounds really good hun, do you know what dose they are putting you on for IUI? im just thinking that maybe if you respond well on your IUI will they convert to IVF! just a thought


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## Laura36 (Jun 27, 2007)

Hi,
450 for IUI but she didn't specifically mention gestone/cyclogest just said more progesterone. So I guess I can figure that out when I start tx with the nurses. I'd be happy to go with gestone if they felt it would make a difference on top of the pregnyl.  
I'd be happy to push back the donor egg cycle if it was because we wanted to fit in the NHS IVF first. But I'm going to wait until after planning appt on 20th April as it could be possible to leave dates as they are.  I don't want to push back the donor cycle unnecessarily although I get the impression from reading about reprofit on here that they would be quite flexible to that which is good.
Yes, was good appt and I'm pleased to have up to 4 cycles in the pipeline.
How are you today?


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## kara76 (Dec 14, 2004)

sounds like a good plan to me hun

so back to popping DHEA for you then


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## ANDI68 (Aug 17, 2007)

Hi Laura,

Glad things are moving along for you.

I took extra Pregnyl after 1 cycle after early bleeding.  I think I had a shot on ET day and then another 5 days later.


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## Queenie1 (Aug 21, 2008)

laura so pleased it went well for you.

could you not ask them to pencil in a ec date for you. they did that for me as i wanted it before half term. i had worked my dates out and they penciled them in for me.


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## PixTrix (Aug 20, 2008)

thrilled that your appoint went well Laura. here's to a BFP


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## Laura36 (Jun 27, 2007)

thanks all.  Andi, that's good to hear you'd had extra pregnyl. JE said take dose on ET day then 3 days later so quite similar.
Queenie, that's a good plan. I think when i go in for IUI appts I'll ask about that.  Problem for me is that my cycle so irregular I can't be sure of dates. Although in previous cycles I've taken the tablets to start AF (can't remember what they are called).


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## ANDI68 (Aug 17, 2007)

I will say Laura to monitor the HCG as I was sensitive to it and ended up with OHSS.  If you feel at all bloated, seek advice

During my last cycle I took gestone and cyclogest ... maybe this is an option and I didnt bleed until 3 days after stopping meds


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## Laura36 (Jun 27, 2007)

JE mentioned that it was a risk but to be honest I'm rubbish at responding that I doubt it'll make too much difference. But I will def watch out for it just in case.  She wasn't at all concerned given my usually poor response.

luckily I had DHEA still in the cupboard so have started them already.  I'm just hoping AF arrives soon so I can start - that is if they can fit me in


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## ANDI68 (Aug 17, 2007)

I dont think it matters so much to how you respond as I didn't have a great amount of eggs it's what the HCG does to you after the egg collection, but I did have 10,000 iu at EC and cycles thereafter only 5,000 iu


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## Laura36 (Jun 27, 2007)

oh right, well I'll def look out for it.  And drink lots of water.  

How are you andi?

With potentially 3 treatments in the next 6 months I'm not going to be able to take time off work for them all.  I think I'll need to prioritise the IVF cycles which should have better chance.


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## ANDI68 (Aug 17, 2007)

Why are you cramming them in, if you need them all?
Why not have the IVF first?


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## Laura36 (Jun 27, 2007)

The donor IVF is July because it was an 11 month waiting list.  The NHS IVF has to be after April for funding 2nd cycle and earliest planning appt they had was 20th April.  So I wanted to do IUI in the meantime as plenty of time for that.  I figure it's a numbers game too.


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## miriam7 (Aug 8, 2007)

thats brill news laura so pleased you get your free cycle and the iui's   with 4 chances 1 has got to bloody work


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## SarahJaneH (Nov 21, 2009)

Great to hear you have a plan Laura, hoping that you won't need all 4 but good that you have things in place to give yourself the best chance. All the best


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## Mrs Thomas (Jan 19, 2009)

Excellent news on your follow up Laura, praying 2010 will be your year Hun, so good to have your plans in place x


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## Laura36 (Jun 27, 2007)

aww, thanks all.  I really hope 4 more is enough! That'll be 8 altogether.


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