# can I ask some advice too please :-)



## lulumead (May 29, 2008)

Hello ladies:

I figure you are probably the best consultants!! and I need to think about what to do next and wondered if you had any advice.

Here's the story so far:
3 x natural IUI's BFN's
hycosy, tubes spasm'd - so inconclusive, decided to cut my loses and move to IVF
LH & FSH good around 4/5 can't remember exactly, and E2 good.

1x mild IVF: 150 gonal f and cetrotide - 7 eggs, 3 fertilised, 2 x grade 1/2 day 3 embies put back. biochemical
2 x mild IVF: 225 gonal f and cetrotide - 3 eggs, 3 fertilised, 2 x grade 1/2 day 2 embies BFN, severe UTI and on 2 courses of antibiotics (1st time ever for me!) consultant believes this is why it didn't work...they were also surprised that only 3 eggs as around 10 follies and they were expecting more. 3rd one was taken to blast but not good enough to freeze.
3 x mild IVF: 300 puregon and buserelin - 12 eggs but 10 mature, 7 fertilised, 2 x early blasts put back, BFN, the other 5 got to day 6 but hadn't progressed far enough to freeze.

Before the third go I had my AMH tested which was 17.4....apparently good.

Lining always been triple layer and thick enough.

Basically I'm stumped...I assume there has to be an egg quality issue or implantation issue. Although clinic dispute this as implantation occurred on 1st attempt.
I think there has to be something with the embryos has although they can get to blast they aren't good enough quality to freeze.

My clinic doesn't believe in immune testing!

Any suggestions at all?

At the moment, I am thinking of getting tubes checked again and switching back to IUI....or going natural IVF avoiding all drugs which might be impacting on egg quality.

arghhhhhhh - this is all so frustrating. I think I just need to feel like I am doing something.

My GP is great, so am going to ask her to refer me to an NHS consultant as she said she would if I wanted, they could do my tube test on NHS but it might take awhile.  And get LH & FSH retested as that was over a year ago....but isn't AMH a better indication and that is really good suggesting lots of eggs still knocking about.

Sorry to complain, I know I am in good position really in that all suggests that its ok but I am just so frustrated and I know my clinic are just going to say that there is no reason why it won't work for me.

Thanks all.

xxx


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## cocochanel1 (Oct 15, 2009)

Lulu,    definitely get your bloods (LH/FSH etc) done again as you have had a lot of treatment since last test. I am curious that your treatment is described as 'mild' IVF when 150, 225, and 300iu of stimulation is actually quite alot (or so I thought)? I had 125iu, 150iu and the 137iu puregon so I'm wondering what defines the treatment you have had as 'mild' IVF? I offer this just as a point to investigate further before you decide on next steps re more intensive IVF.

I've read a lot of information that suggests embyro's that don't make it to blast are 'incompetent' so going to blast (or not) is the best test of embryo quality. ie. if they don't make it to blast they wouldn't have made it.

At our age I think roughly 1 in 8 eggs should be 'good'. 

It would also be worth having first level immune testing done - eg. CD69 because this can be a pointer for more detailed investigation or not. 

Coco xxx


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## lulumead (May 29, 2008)

thanks coco...yes I think really I have just been doing short protocols!  Its mild in that there is no down regging but that seems to be the only difference!!!  And she first suggested mild stims as she thought I was good candidate and my stats were good...once I have got to ET they have always said 50/50 chance. 

I really don't want to be on 375 and then the max 450 before I know it which is what will happen I think if I carry on with this protocol.

Basic question but what will LH/FSH really tell me?

I know AMH suggests how many eggs you have left.

LH is about ovulation?
FSH is about follicles?

if these are high what does it indicate?
x


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## suitcase of dreams (Oct 7, 2007)

Lulu,

Wish I could offer some practical suggestions but in all honesty the more I read/hear about this whole process, the more I become convinced that often there actually aren't any answers. Some people diagnosed with immune issues follow the immune protocol and conceive, others don't. Some people with terrible test results and told they've no chance, fall pregnant naturally, others with perfect test results go through multiple IVFs and don't get there, some women get lucky first time round, others 9th or 10th time round...there's no apparent rhyme or reason  

I've kind of come to the conclusion that there's only so much you can do and quite a lot of it is down to luck and whether it's 'your turn' or not....I'm not usually a great believer in fate, normally I like to take control and make things happen myself. But ttc doesn't seem to let you do that unfortunately...

I would echo the other girls in that I don't think you've actually been doing mild IVF. As I understood it, that was very low drug doses and only producing one or two eggs - ie more like IUI but instead of trigger and insemination, they extract the eggs and fertilise them. Whereas I think you've just been doing pretty standard short protocol IVF. Looks like you get quite good numbers of embryos so clearly no problem in your response to the drugs etc. You could have the immune tests done, but that's such a minefield - some consultants believe very strongly in it, others don't. You have to make up your own mind and also decide how far you will go in terms of potential treatment (eg are you prepared to do ivig/intrallipids etc and if not, then you could just take clexane, steroids anyway...without the tests)

Wish I could be of more help, hope you manage to find the right next steps for you soon,
Good luck!
Suitcase
x


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## winky77 (Nov 27, 2007)

Hi Lulu....
The others have given some good advice.  You and I are quite similar...My AMH was also 17 and FSH was 6.7 a year ago. Respond well to drugs etc.  What grade embies have you been getting to transfer?  

Suity is right about the immune bloods...I had them done but haven't gone down the ivig/intrallipids route as results were not great but not bad so it was borderline.  (Coco what's the CD69.....not a number i had tested?) I am re-looking into this at the moment tho. 

One thing you might want to get checked out is your thyroid function....you can get this done through your GP....get your antibodies checked as well as TSH levels....high thryoid antiobodies is an immune issue and an indication that there may be other immune factors happening.....I already knew I had a slightly underactive thyroid but then found out that was caused by hashimotos disease - high thyroid antibodies.  That's what led me to do the general immune protocol (Heparin/ Aspirin/ Steroids) on the last few cycles (but still no luck as you know). I am also looking into this some more at the mo as I keep reading about the link with infertility. 

The luck factor is definately part of all of this too...

..winky


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## cocochanel1 (Oct 15, 2009)

Lulu, I've been on short protocol too so comparatively I've been on mild IVF when I look at the iu number compared to yours. I'd go back to your clinic and ask some more questions about their definition of 'mild' as it seems to me you have been doing pretty standard IVF which seems really strange given that the clinics strap line is 'mild ivf'??

FSH is an indicator of how hard your body has to work to ovulate (so should be less than 10), LH is a hormone that is produced in the run up to ovulation and must not be too high (like mine) otherwise it makes too much testosterone which damages the egg (which is what I think is happening in my case, because I have polycystic ovaries and naturally over produce LH) ie. the drugs and protocol are causing me an unnecessary problem). You would know if you had polycystic ovaries because your ovaries have black dots all over them on the scans (the 'cysts') and look like they are wearing a string of pearls  . This is why I over produce on very low stimulation which is why my clinic are terrified of me getting OHSS each time.

Get LH/FSH tested via GP.
Winky, CD69 is a marker test for NK cells. I'm also about to have Target Cell Test k562 which is done in the USA. I'm going to London to have blood taken tomorrow which will be FedEx'd to the USA. If this is also negative I can fairly confidently rule out immune issues I think. If it is positive I will have the full set of immunes done with Dr Gorgy.

Coco xx


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## Betty-Boo (Oct 14, 2007)

Honey reprofit do mild IVF - which is clomid and 75iu of gonal f. Very similar to medicated IUI - 800 euros last time I tried. They aim for a couple of eggies to ICSI.

FSH is the hormone which stimulates our follicles to make them ovulate. The higher the level of FSH means the more stimulation your ovies need to produce follies therefore the higher the drugs will be. If that makes sense.... AMH measures the anti mulleran hormone which gives an indication of egg reserve... this probably explains it better. your AMH level is fab honey.

http://www.tdlpathology.com/index.php?option=com_content&task=view&id=201&Itemid=73

I really do hope you find some answers to help you decided on your next steps.
Big hugs x x x

/links


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## ♥JJ1♥ (Feb 11, 2006)

Lulu would u consider changing clinics? Also the mildness of your ivf cycles is not really relevant as you hAve produced eggs on your doses -600 is the max gonal f or puregon that is prescribed-but you can also have a paradoxically effect on max doses so doesn't mean more eggs necessarily if you increase the dose.

You can get your immunes treated independently of your clinics but you would need a clinic to work with you or it is irrelevant if you have results you can't or don't want to act on. I have raised cd 56's.
I do think at yhe end if the day it is a game of numbers and chance if you have no obvious 'structural' issues. Good luck
l x


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## lulumead (May 29, 2008)

Thanks all...sadly luck seems to be the biggest factor and we can't control that one!

Follow up booked for the 20th. Sort of can't be bothered with it.  I really don't want to change clinics as I like them but I'm not really sure what's best.

Seeing my GP on friday so will ask about NHS doing some blood tests, and maybe my tube check.

winky: i had thryoid done in my initial blood tests...all was ok. Maybe this could have changed?  I'll ask my GP about this, thanks for the tip.
coco: might see if GP can do CD69 too.

thanks for the advice as always.
xx


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## cocochanel1 (Oct 15, 2009)

Lulu I don't think GPs do CD69. I did mine privately at the clinic xx


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