# Follow Up Appointment after a BFN



## Buddug (Oct 2, 2004)

Ruth - I had a BFN on Thursday on my first ICSI cycle.

I have my follow up appointment on March 16th & want to prepare a list of questions for the next cycle.

I guess main thing is - is there anything that should be done differently next time, but should I be asking anything specific ref the drugs or the protocol or anything ?

Thanks Ruth - just want to make sure I have everything covered.

Buddug x


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## Marielou (Oct 18, 2003)

Hiya Buddug
So sorry that you too got a BFN     

I have my follow-up appt on 1st March, and have basically planned a list of questions as and when they have popped into my head.    I guess it helps that we're going in a different direction now  - we've given up in the ICSI, and are going onto DIUI, so our questions are centred around that.

However, I am planning on asking a few questions - I wanted to know about the quality of my eggs, and of our embryos.  For me, my AF began to arrive 8dpt, and I wanted to talk about gestone injections for future 2ww.    

I'm also planning on asking them what will be done differently this next time.

I'd also like to see other ideas on questions to ask.

Very best of luck,
Marie xx


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## Deb10 (Sep 5, 2004)

Hi Vik and Marie

During my 2ww, I out together a list of questions to ask the consultant if we got a bfn...

All relating to male diagnosis, icsi, cumulative success rate and from articles I had come across...

Its all in point form and a bit of a mess... Ill take a look at it over the next few days and post on our male icsi thread .. and here if you like, Debs x


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## Mrs CW (Jul 12, 2004)

Hi Buddug
really sorry about your BFN.  

Not sure if you're MF which we're not, so can't help with those kind of questions, but things I have asked at follow up include:

1. Was there anything we could do to improve quality of eggs?

2. Was the stimming dose appropriate? And was egg collection at the right time? ( I had 4 amps menopur 1st time, stimmed fast & got 10 eggs and mild OHSS, and 3amps menopur 2nd time, still stimmed very fast but got 4 eggs).  To me there was a financial as well as an emotional issue about being able to get as many eggs as possible.  So I persuaded them to give me an alternating dose of 4 & 3 amps this time (and got 12 eggs, stimmed slower, no OHSS) and to let me stim for as long as possible before EC and let me manage the OHSS now I knew how. As it turned out no FET possible as egg quality still not good enough.Basically though we had a good debate about the optimum length of time taken to grow follicles, the amount of follicles and the quality of the eggs. 

3. How long should I wait to let my body recover balanced with waiting too long and getting older all the time?!  I wondered whether the fact I had more side effects 2nd time around was due to not recovering for long enough from 1st cycle 
(I was told your body rids itself of the drugs relatively quickly, people just react differently each time to drugs) 

4. I asked about blastocyst transfer if I got enough embryos, to log that I was interested - not an issue in the end

5. I told them about my painful EC so that could be managed next time - more drugs!!!

6. I asked about implantation and whether anything could be done to improve that.... the view was nothing yet, as there's not enough evidence of miscarriage other than through natural odds, but some clinics might talk about extra progesterone or aspirin or heparin in 2ww, depending on your history.

Hope that helps,

Claire x


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## natalie34 (Jun 7, 2004)

Hi All,

Deb - great idea if we could start a new thread about common questions to ask. I currently have 5 about this cycle and 7 about my next attempt (FET). It would be good if we could all share, as sometimes you do forget the obvious. I had trouble too at ET, where thye had to change the catheter. Wonder whether they then put the embryos in high enough into my uterus. Also I had a nurse do the ET, not the dr. I'm guessing this is okay?

I've also listed everything I experienced during 2ww, to see whether anything of any significance might highlight an issue.

Nat x x x


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## Deb10 (Sep 5, 2004)

Hi Nat

I Will get a move on with questions... after treatment and shock of  bfp Im sleeping so so much - during the day too...
but it will definatly be a good idea... I will start something in the next week...

Im suprised your nurse did the ET....I thought that was the most important bit and that is what the dr was there to do? Egg collection and Embie Transfer... Id check with Ruth and others though - Im a bit suprised that a nurse did this procedure though...Did Vik have the same experience I think you both at the same clinics?
Debs x


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## CK78 (Mar 27, 2004)

Nat

I will also be interested to see what others experienced with ET - nurse v dr as i had a dr 1st go and nurse 2nd and i must say the 2nd was pain free compared to the first but it did make me wonder why the nurse was doing it - as deb says its the most important bit to get them in the right place to start with.  

Great topic anyway i hope we can all gain some knowledge for our follow ups!  Mine is next month - a whole 10 weeks after BFN  .  I suppose it gives us lots of time to think of questions!

Congrats on pg deb    

Marielou - i also started af on day 8 - what are gestone injections - are they in place of cyclogest?

Ceedubya - great list, v.helpful - do you mind me asking about why the blastocyst was not an option ?  I am hoping to have my frosties get to blast before fet in april.


Clare
x


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## Buddug (Oct 2, 2004)

Deb - I had my ET done by dr as although Nat & I are at the same clinic I had ec & et at London due to egg share.

I am so glad I asked this question now as I have learnt so much already about what questions I should be asking...hope that having this in this thread will be ok.

Ceedubya - can you explain what a blastocyst is exactly & differences with other embies ?

Thanks all

Vic ( aka Buddug)


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## clairelilley15 (May 15, 2002)

Hi all
I too had a nurse and was initially worried about getting them ' in the right place' particularly as my transfer took a long time as she struggles to get the catheter into position. The way I look at it though is the embryologist was watching her like a hawk and she wouldn't have spent so much time looking after my embies to get them to blastocyst to put them in the hands of someone who didn't know what they were doing. It is obviously ok otherwise people may sue if they get BFN... it is actually normal practice at my clinic. 
Best wishes Claire L x


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## Deb10 (Sep 5, 2004)

Here is the list of questions I though of - hope this helps, Debs x

*Here is a list of questions I had prepared for a follow up appointment - *

- how were the quality of my eggs? Did I d/reg or stimm for to long. How do you feel I responded to drugs? Could changing dosages /type of drugs improve egg quality.
Did coasting for a few days effect egg quality? What is your opinion of having clinic open every day or waiting a few days to have eggs collected? Would more monitoring on a daily basis - scans and taking E2 levels improve the quality of eggs?

- What do you feel the link is between fertilisation rate, embie quality and live baby rate. What part do quality of eggs, sperm, culture medium and embrology lab play? What is your percentage on average for fertilisation rate (ie 70% of embies fertilise- % rate of good clinics). Does male factor infertility play a role in the fertilisation rate?

- What would be the point of having a hysterscopy after a failed cycle? If your clinic doesnt do this, why?

- Would you test my FSH levels to see if they are to high to do another cycle? when can I cycle again? Why?

- What is your suceess rate for ICSI treatment within my age category? Please provide me with a list of diagnosis within that group? Does your clinic do reseach into the outcome of diff diagnosis and keep stats?
ie out of the average 30% ICSI success rate.... what is that group made up of
ie - unexplained feritlity, Failed IUI's that move on to ICSI, Failed IVF's that move on to ICSI, Severe male infertily (very low counts, no sperm - SSR) and donor and combined male/female infertility

- Sperm- what is your opinion on using fresh, frozen or SSR? What are your techniques used to freeze the sperm? What do you feel can be done to improve sperm quality? Also ask for uroligist they recommend?

- Re embies - from clinical reseach it has been shown that Day 2 or Day 3 transfer has no significant effect - what is your opinion on this? What is your opinon on blasts - by what % do they increase the live baby rate? Does your clinic only do blasts after 3bfn? Would assisted hatching have helped?

- Did the embie not take - 1 in 4 rejected by our body? Would there be any point to do PGD? HOw many embies to you need for this? Risks involved? Is one embie tested for one genetic disease or 9 of the listed dieases...

- what is the policy with regard to freezing embies? how do they grade them/ what is their opinion of grading vs live baby rate? Can the embrylogist remove the fragmentation in the embies?

- If relevant discuss bloodclotting issues/ immunology issues etc....

I would highly recommend this book - its been like my 'bible' during treatment - its written by a woman who had treatment at Cornells in NY - remember that US fertiliy laws different to UK - The infertility survival book - Elizabeth Falker - ISBN 1-57322-381-6.


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## Pickle_99_uk (Dec 12, 2005)

Hiya, 


Not sure I'm posting this in the right place but here goes..

We had our first failed ICSI last month and have a follow up appointment on friday.  I'm just wondering what we should be asking.  We obviously want to ask when we can have another try but I dont want to come out of the appointment then think of lots of questions!

Can you let me know if you have had follow up appointments following a BFN and what you asked?


Thanks alot, 

Tracy xx


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## Martha Moo (Jan 30, 2004)

Hiya Tracy

I just wanted to post to say  for ur follow up appt honey

I think in the icsi board close to the top there is a thread with some suggested questions maybe take a look it may help you and DH

Thinking of u sweetie

Emilyxx


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## Pickle_99_uk (Dec 12, 2005)

Thanks Emily.  I'll let you knwo how it goes and will start posting on the egg share board properly soon.  I am still reading about how everyone is getting on, just havent done a proper post in a while. 

Tracy xx


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## Pickle_99_uk (Dec 12, 2005)

Hiya, 

Well we had our follow up appointment yesterday and it didnt go so well.  We can try again but they have used all the sperm they collected from DH.  They didnt get much to begin with so SSR will have to be repeated and we'll have to hope for the best.  Also, the eggs they got from me weren't very good and out of the 7 we kept (as we dontated 7)  only 1 ever had a realistic chance of working (so why they bothered to put 2 back is beyond me!).  And to try again it will cost us £1300.  A huge amount of money to us.  It took us 18 months to save enough for the last go and even then we borrowed some.  So, we came out and had our usual post appointment row!  Had a night with the girls last night and feel calmer this morning.  DH and I are spending the day together and will talk it all through.

hmph.

Tracy xx


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## rebeccas (Oct 26, 2005)

Hi Tracy

Sorry about your appointment and disappointment, it is really hard and takes its toll on your relationship doesn't it?  Take your time and hoping you find the answer.

Rebecca xxx


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## Pickle_99_uk (Dec 12, 2005)

Thanks for your message.  We are going on Holiday next week so have a week of time out thank god.  

Tracy xx


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## Dooleys (Feb 1, 2006)

Pickle

We have just had our first Icsi cycle end with a   , which is bad enough but have been told we cannot have a follow up appointment for just over 3 months!!! What use that'll be then i have no idea.
Hope you had a good holiday & feel rested after all the treatment  

Dooleys


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## Jess75 (Nov 4, 2005)

Hi

I found my last follow up we hardly even discussed the failed cycle it was all about what they would do differently the next time.  I have my follow up for this cycle on the 15th May
xx


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## Pickle_99_uk (Dec 12, 2005)

Hi Dooleys, 

Firstly, sorry for your BFN.  Its horrible isnt it.

3 months seems like such a long time.  Can't they fit it in earlier or do they make you wait 3 months for a reason?

Jess - It was the same at our follow up.  It was a little about this cycle but mainly about the next one.  I hope you are ok.  

T xx


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## Dooleys (Feb 1, 2006)

*Hi Pickle* 3 months feels like forever just for the follow up right now! They say they have no available appointments before this, so i'm going to keep ringing the cancellations line to check if we can get one before then.

*Jess* I thought the point of a follow up appointment was to discuss what went wrong last time  Or am i being daft? They have told us that we have to pay from now on as our NHS partial funding was only for the ISCI, nice eh!

How long have most people had to wait from results to follow up appointments

Hope your all enjoying the bank holiday
Dooleys XX


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## A1979 (Nov 22, 2005)

Hi everyone

I had a BFN on 21 June and my follow up appointment to discuss that cycle is not til 25 September.   It was originally 18th September but I rang and said we had booked a holiday so could we change it.  I also asked if we could change it to an earlier one as we are struggling and wanted some answers and feedback from that cycle.  I was told that due to holidays etc that was not possible.  

I find it extremely worrying that some 3 months will have elapsed before our follow up and I am sure I am not the only one who has had a delay like this.  Our anxieties seem to get worse as the time goes by and other than a standard sorry letter, we have had ZERO support from our clinic which makes me resent the £11k we have spent with them.

I have emailed the HFEA and asked if they have any plans to introduce guidelines for waiting times for a follow up for IVF patients.  I mean the NHS has to adhere to all sorts of waiting times for a variety of patient treatments so why should IVF be any different?

I just wondered if any of you had experienced delays like this and if you could email the HFEA so that hopefully something can be done about it to support the many women who get BFN's and need help understanding the reasons why.

Anna x


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## saphy75 (Mar 15, 2004)

Anna, sorry i can't answer your question just wanted to send you a big ^cuddle^ 3 months does seem a long time to wait for a follow up.

pam xx


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## fraochdiana (Oct 18, 2005)

Anna
I had my second negative cycle in July and like you I have to wait until the end of September, but that was because our consultant is very busy. We could have had an appt within 4 weeks but with someone else.

It is so hard as you want all the questions answered, and want to be seen as early as possible.
As far as the NHS is concerned they do have waiting times.... and I had to wait 14 months for a simple laparoscopy. So dont think that much of them either.
Is this your first failed cycle?
Kind Regards
Heather


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## A1979 (Nov 22, 2005)

Hi Pam

Thanks for your message.  I see you have a lovely little boy - congratulations!

Love

Anna

Hi Heather

This was my 4th cycle.  Hope you get lucky next time.

Love

Anna


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## pi30 (Jun 8, 2005)

i think to wait that long is totally ridiculous
I've i m'd you anna
Love Pi


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## collymags (Jan 3, 2006)

Hi Anna

my heart goes out to you, both because of the fail and because of the delay.  i had my last bfn 9th may and couldn't get follow up until 26th june. the delay was partly because everyone taking hols, and partly because we wanted a particular consultant.  even though its a horrendous length (and yours certainly seems excessive) there is a positive side. i wasn't coping well with the negative, and wouldn't have been very good at the follow up, probably just would have blubbed the whole time.  so it essentially gave me healing time, and time to be gentle to me and dp, and time for us.  i wouldn't have been ready emotionally or psychologically to have started anything sooner.  i also used the time to research stuff that was on my mind about forms of treatment and alternatives.  having said all this on the day of the appt. i did a hpt and it was a bfp, yet only the day before had been upset thinking about how limited our options were.  so though its long hun, ye might just find that the gap is useful in the healing process.  good luck lass.


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## sammij (Nov 9, 2005)

Hey everyone

Have my follow up appt tommorow and for some reason i feel really scared.

We had our BFN in Aug & since then have kept quite busy - work sometimes is a godsend (sometimes!!)
I deliberatley delayed the follow up 'cos i felt i needed dome time but now & especially today have been so tearful   & snappy     - why am i dreading this

I have in my mind what i need to ask, my consultant is very caring but i just feel - oh i don't know - scared in case they say 'sorry can't do anything else'
I think i've kinda had my head in the sand the last month, maybe i should have been a bit more realistic about my feelings this time - i was too quick to say ' yes it didn't work but i'm ok ....' and threw my self back into work.

Sorry - haven't posted for ages -needed to read some posts from my FF to get my head in order!

wish me luck

sam xxxx


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## Jo (Mar 22, 2002)

Sam
I am sure your appointment will go fine tomorrow, but I can understand what you are saying.

I felt like this many times, but every time they said it was unlucky, and if we wanted to try again, they saw no reason not to.

I think we all can do that ' hiding head in sand' I know I did, seemed the only way to cope sometimes , and it is OK to do that, if it is the way you cope with things.

Good Luck tomorrow, and please let us all know how you get on 

Love Jo
x x x


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## Ireland1 (Sep 13, 2006)

Hi Sam...I can completely understand how u feel...we hav our follow up this sat and i'm scared that when we get in there i wont remeber what to ask or we will b told there is nothing else that can b done for us...may b if you make a list of things to ask and hav a plan of what you want to do u might feel more in control of the situation...your consultant sound approachable which helps alot i think...
Good luck for today, look forward to hearing how it went.
Em xx


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## kara76 (Dec 14, 2004)

Ok girls I need some help.....

what should i be asking?

I have 1 clipped tube that was full on fluid, other than that the fet went well apart from the end result

my follow up is on thursday, i should get dates then for next cycle this time nhs


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## saphy75 (Mar 15, 2004)

hi hun sorry i'm not sure what you should be asking   but i just want to  this post up 

pam xx


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## BrightonBelle (Aug 16, 2006)

Hi Kara

Sorry to hear about your BFN, I know how you feel because I just got my third today! Just passing and was a bit shocked to read your post and that your blocked tube was full of fluid during tx. In my experience a fluid-filled tube is a hydrosalpinx and you should certainly ask your consultant about having it removed. There is a whole board about hydrosalpinges on here:http://www.fertilityfriends.co.uk/forum/index.php?board=114.0

I post mostly on the hydro chicks board, come and say hi. There are loads of amazingly friendly women on there who've had hydros and had surgery to have them removed - including me! Having a hydro can reduce your chances of success by 50% so it's best to get it sorted.

Hope that's helpful

Come and say hi.

All the very best
Clo XX


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## debster (Apr 23, 2007)

How long does it usually take to get a follow up appointment? Gettin a bit fed up of waiting. Had a message off em on my answerfone sayin they'll be in touch soon. Feel like I've been abandoned to get on with it and try and figure out why it didn't work myself. Suppose thats what ya get for bein in the backward westcountry. They've been next to useless all the way through my treatment. How long did u have to wait? thanks


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## sonia7 (Feb 9, 2007)

Hi Debster

I had to wait a couple of months to speak to the consultant, depending on what his/her workload is like. Why don't you try a different clinic next time especially if you are paying for your treatment. We are going to do that now.

Good luck.

Sonia xx


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## dollydaydream (Apr 18, 2008)

Hi everyone

I have just finished my first cycle of ivf and unfortunately six days before official tet day i started bleeding which led to a bfn.  I am really concerned about the fact that i bleed before test day, have never been early with a period before in my life.  We have one more go on the NHS and am just wanting to ask whether they will proceed with exactly the same procedure or whether they will change my treatment to work for me

I look forward to your help.

Clare XX


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## ☼♥ Minxy ♥☼ © (Jan 13, 2005)

Hi

Sorry about your BFN 

The first IVF is often seen as a "trial" as there is no way of knowing how you'll respond to the drugs, so hopefully your clinic will take this into consideration when deciding on your next treatment cycle.

An IVF cycle is completely different to a natural cycle as it's controlled, so it's irrelevant that you never normally bleed early but you did with the IVF....on a natural cycle you ovulate and produce progesterone from corpus luteum...with IVF you don't ovulate naturally as you have EC which is why you're prescribed progesterone support during 2ww. It could be that the progesterone support wasn't sufficient so it may be worth discussing trying another form of progesterone or increasing your dose.

I have naturally high progesterone levels and have a long luteal phase (from ovulation to AF) so it's never been an issue during natural cycles....but on every fresh IVF I've had (4 in total now), I've bled early and all were BFNs.....earliest bleeding/spotting started 8dp3dt....another couple of times was 10/11dpt and last cycle was 9dp5dt. I've had varying combinations of progesterone....crinone, cyclogest and/or gestone....as well as HCG injections as support during 2ww.

The only time I've not bled was with both our FETs which were on natural cycles so had my own naturally high progesterone level after ovulation plus additional progesterone and the HCG injections at 3dpt and 8dpt.......and both FETs resulted in chemical pregnancies.

Every IVF cycle I've had has been "tweaked" in some way to exactly tailor it for me.

Here's the link to a list of useful questions to ask at your follow up appointment. Some are specifically geared for after ICSI treatment but you can tailor these to IVF......

http://www.fertilityfriends.co.uk/forum/index.php?topic=66634.0

Take care
Natasha


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## dollydaydream (Apr 18, 2008)

How will they find out about my levels of progesterone to tweek them??  Am so worked up about getting it right.  XX


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## dollydaydream (Apr 18, 2008)

Also how soon can i go again. XX


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## ☼♥ Minxy ♥☼ © (Jan 13, 2005)

It's not a case of them finding out your progesterone levels to tweak them.....if you bled early then this could be one of the reasons.  Some clinics may get your progesterone tested during 2ww of next treatment but many others, like mine, will just increase or change your progesterone support anyway.  When I said about tweaking I meant in general about the whole cycle....trying different things until they get it right ie until get a BFP !

As for when you can have another IVF....this is a very very frequently asked question....most clinics will advise you leave at least 3 months (3 natural cycles) between treatments to allow you to recover emotionally and physically.

These are all things you need to discuss with your consultant.  Also, try using the search tool as you'll usually find previous threads discussing your queries so will have answers to all your questions.

Take care
Natasha


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## katiechick (Jan 12, 2008)

Hi Ladies,

We had our first negative fet last week   and was wondering if we are suppose to have an follow up appointment ? I had to phone my clinic to let them know about our negative cycle and the nurse didn't say anything an appointment she just said about having another fet after i have had 3 AF's so our next fet will be about Sept/Oct time. Just a bit worried about not having an appointment but then again i suppose different clinics have there own system about this.

Just wondered if i should request an appointment ?

Thanks
Katie 
xx


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## melo (Jun 27, 2008)

Hi Katie,

First of all just wanted to say how sorry I am to hear about your negative result.    

My clinic did automatically offer me a follow up appointment after my 1st negative result & I've been offered a follow up appointment after my recent m/c. If I was you I would phone your clinic & request an appointment so you can at least ask any questions prior to your next treatment.

We're also hoping to start our next tx in sept/oct so I wish you all the best of luck  

Mel x


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## Kushtaka (Jul 23, 2008)

katiechick ~

  I am so sorry about your BNF ~  .

  Absolutely, call the clinic to schedule an appointment!  I had a similar experience, and when I called they told me I had 6 weeks after the testing date to follow up, included in the price.  Apparently, after 6 weeks you have to pay another consultation fee.  The timing wasn't a problem, but it surprised me that there was an expiration date I wasn't aware of.

Good luck!  Kush


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