# Please help - what qu's should we be asking / what should we do now?



## nutmeg (Aug 21, 2009)

Really a wwyd situation here ladies and looking for some opinions on the best way forward. Apologies if this gets long   

So we've been using the same clinic for 6 years and have run the usual gamut of tests and treatments - unexplained infertility.
We are so very lucky in that we have our beautiful dd who came from a frostie following our 1st IVF   
In total we have had 7 embryo transfers with 13 embryos transferred - some from fresh and some from frozen. Our embryos are usually very good quality with the latest being top quality blasts (2). From our 13 embryos we have our DD and have had 2 (that we know about) chemical pg's. The latest BFN was a chemical - BFP's for a week and then a BFN but I've had no bleed yet    As much as I like my clinic and really like the nursing team, I feel their "after care" at the end of treatment can be lacking - they won't even do BETA tests.

So, where do we go from here? We have 6 blasts in the freezer. We seem to respond well to treatment but my babies don't want to stick. 

My protocol has never been changed, nothing different has ever been suggested. As far as my consultant is concerned it's been bad luck but I'm now struggling to believe that and think surely something else can be done. What questions should I be asking at my next consultation in a fortnight. I'm conscious that my uterine lining may not be thick enough, but this is my own supposition and not something the clinic check on a fresh cycle - should I mention this?
I'm also reading up about immunology but am waivering over whether I should mention it as it's not widely accepted practice.

We're also considering getting a consultation at another clinic to get another viewpoint and see if they would do anything differently. What should I ask them?

Sorry for the ramblings just really need some help. Would you ask for immunology tests?

Thankyou x


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## karenanna (Dec 27, 2008)

Hi Nutmeg

Sorry to hear about your BFNs     

I have pasted some questions below from the ARGC board that includes questions about immunes etc... As you will see from my profile I went down the immune route and although it is not a widely accepted it did make a difference to me. I have also come across quite a few ladies who didn't have immune issues with their first pregnancy but they kicked in when they tried to get pregnant later.

I would mention anything you think of at your next consultation - lining thickness (and whether something like viagra may help with this), progesterone levels (if you think implantation is an issue), immunes etc... - if they ignore your questions I think this tells you something about their approach.

Lastly, I would definitely get a second opinion from another clinic - after all in the grand scheme of things the cost of this is relatively low and if your clinic aren't prepared to change how they approach things a fresh pair of eyes may be just what is needed.

All the best     

Karenanna xxx


QUESTIONS FOR A FOLLOW UP

1. What were the main factors that contributed to this negative cycle?
(well you might as well start with the obvious one!!)

2. What are this clinics success rates for couples in our position (taking age and diagnosis into consideration)? And what is that statistic nationally?

3. Eggs:
a) How was the quality of the eggs? (Were they mature enough?)
b) Were there as many as you were expecting?
c) Would having egg collection a few days earlier or later help?
d) Would more monitoring during the stimulation phase help you to control my drugs better (and thus get a better result)?
e) Is there anything else that can be done to improve the eggs?
f) Can we still do egg share? /Should we consider using an egg donor?

4. Sperm:
a) How was the quality of the sperm?
b) Had the count, motility or morphology improved at all?
b.ii) Is there anything that can be done to improve this?
c) Would we get better results with SSR?
d) Should we consider donor sperm (or ‘donor back-up’)?
e) Should we consider an appointment with an urologist? (Whom would you recommend?)

5. Embryological questions:
a) How did the embryologist feel the ICSI procedure went? (E.g. was it easy to find sperm of good morphology in the sample?)
b) How well did fertilization go? (E.g. more quickly or slowly than expected)
c) Did any fertilized eggs produce unusual results? (E.g. 3 nuclei)
d) What was the overall quality of the embryos like?
e) How do you grade them/what is your opinion of grading vs. live baby rate?
f) Does any of this suggest any issues?
g) Could assisted hatching help us?
h) Would delaying transfer (or carrying it out earlier) have helped?
i) What is your opinion on going for blastocysts next time?
j) Can the embryologist remove the fragmentation in the embryos?
k) What do you feel the link is between fertilisation rate, embryo quality and live baby rate?
l) What is the policy with regard to freezing/frozen embryos?


6. The drugs:
a) How do you feel I responded to the drugs for down regulation? (Did it take longer or less time than expected?)
b) How do you feel I responded to the drugs for stimulation? (Did I respond too quickly or too slowly? Did I produce enough eggs? Did coasting for a few days effect egg quality?)
c) Did the trigger injection work as expected? (Should I have taken it earlier or later for better results?)
d) Do you feel I am on right drugs at the right dose or should this be changed next time?

7. Further tests:
a) Are their any further blood/hormone tests you would now recommend? (E.g. FSH, E2, etc.)
b) Should we test for immune issues?
c) Should we test for sticky blood?
d) Should we have any further genetic tests?
e) Would you recommend having a hysteroscopy? (Why?)
f)    i) Would there be any point to do PGD?
ii) How many embryos to you need for this?
iii) What are the risks involved?
iv) Is each embryo tested for one genetic disease or 9 of the listed diseases?

8. Next cycle:
a) When can we try again? (Why then?)
b) i) Which drugs for down-regulation?
ii) Why do you feel this one would be better?
iii) What dose?
e) i) Which drugs for stimulation?
ii) Why do you feel this one would be better?
iii) What dose?
f) Would you recommend any additional treatment this time? (E.g. low doses of aspirin, IVIG, heparin, etc.)


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## nutmeg (Aug 21, 2009)

Thank you so much for your reply and all the advice, it's very helpful. I will type those qu's out this week!

Huge congratulations to you and good luck


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