# Tips on persuading clinics to agree treatment for poor responders &/or 40+



## Peppermint Patty (Dec 22, 2008)

*Hi*

*Does anyone have any tips on persuading clinics to go ahead with treatment when test results are declining or do not look great already, especially when your age is already against you, but you want to carry on and not give up just yet.*

*How can you win the consultant over, how would you convince them, what would your argument be? What have you said in the past to influence a consultation where the conversation was not being very optimistic?*

*Any thoughts from fellow FF's would be helpful.*

*Thanks!*

*Peppermint Patty.*


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## daisyg (Jan 7, 2004)

Hi Peppermint Patty,

It depends on many factors.  I would ask these questions:-

Are you paying privately for treatment?  If so, you could always pay for a second opinion with a clinic who has good results for women your age or poor responders (e.g. The Lister?).

Your age is a big factor - how old are you?  It may be that if you are 43 plus, you consultant is trying to be realistic about your chances.  Very few women have live births via own egg ivf over age 43/44.

What is your full hormone profile i.e. how many months have you been tested on day 2/3 of your cycle.  What is your FSH AND E2 result plus prolactin, LH etc.  The full picture is important, as a high E2 figure can suppress FSH making it lower than it is.

Remember that age is the biggest factor in success stats.  FSH/E2 can give you a guide to how you may respond to a stims./ivf cycle but cannot tell you the quality of your eggs.

What is your antral follicle count at start of cycle?  Your consultant should do this.

Is your thyroid under control as this is a huge red flag for fertility issues.  TSH needs to be between 1 and 2 for good chances.  Have you been checked for clotting issues, infection, karyotyping etc.

Have you had any testing to see why you cannot conceive naturally or via IUI and stims plus timed intercourse for example?  Have you been tested to see whether you ovulate?
Have you checked your uterus for issues like fibroids etc??  Your consultant should talk these issues over with you.  Natural pregnancy over 42 is more likely than ivf, but you and DH obviously need to have eliminated all issues stopping conception.

What about your DH?  How old is he?  Has he had any sperm testing?

I think you need to present all these issues to your consultant.  I would also get a second opinion at a top clinic (i.e. ARGC or Lister).

You could just use the very simple argument with your consultant that every woman is entitled to one try with her own eggs for closure.  It is important to you psychological well being that you know you did all you could before either stopping or moving on to other ways of creating a family.

It is hard not knowing your age and fertility history to give you any more information.  Can you provide more??

Best of luck
Daisy
xxx


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## Peppermint Patty (Dec 22, 2008)

Thanks Daisyg for the response.

I am 41 and I have had some tests done including FSH AHM (both low) and I am on Thyroxine for underactive thyroid. I asked GP for extra Thyroxine so that it can be under 2 which I'm grateful he agreed to prescribed  Last time I had it tested it was just over 2 so I am taking an extra 25g per wk to lower it a little more. 

I do ovulate, as whenever I have tested at home I have got a positive.  There is no problems with DH.

Totally agree with what you said about psychological well being and know that you have done all you can before moving on.

Take Care.

PP


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## ♥JJ1♥ (Feb 11, 2006)

I think daisy has hit the nail on the head choosing a clinic that is expert in treating/ older/ complex women.
L x


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## Peppermint Patty (Dec 22, 2008)

They tend to be based in London though and I'm in the North, are there any up here?


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## Helen3 (Dec 2, 2010)

Care Notts under Dr George Ndukwe? Maybe not north enough? Sorry don't know of any others as I've been concentrating on London.
Good luck.


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## daisyg (Jan 7, 2004)

Peppermint Patty,

I would second that absolutely. I was also under the care of George Ndukwe at Care Notts. and he was fantastic. I would book a consultation with him asap.

Patty, it doesn't sound like you have been properly tested. You only mention FSH and AMH, but really you need to look at things like E2, prolactin, LH etc. to get a full picture.

Measuring ovualtion yourself is not very reliable. You need a day 21 progesterone/ovulation test from a clinic or your GP.

It sounds like you also need careful medication and monitoring of your thyroid which is critical.

You should also check things like your DH sperm and karyotype, your karyotype, your uterus, infection, clotting etc. either via somewhere like CARE Notts. or your GP may do some of these tests.

I would really recommend that you book a consultation with George Ndukwe at Care Notts. asap.

Here is a link to CARE Notts.

http://www.carefertility.com/loc-nottingham/care-fertility-sc0/page-care-fertility/

Here is a link to the Fertility Friends Notts. thread which may be of help.

http://www.fertilityfriends.co.uk/forum/index.php?board=243.0

Best of luck,
Daisy
xxx

/links


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## urbangirl (Jul 28, 2010)

Dear Peppermint Patty, why should you have to win any one over?  If you have a consultant who doesn't want to treat you because of your age he obviously doesn't have sufficient experience of women over 40 so you are better off going elsewhere.  I wouldn't spend my money at a clinic where they weren't supportive, along with being honest regarding chances etc (at the end of the day it's up to you to decide whether you think you have a good chance or not).  I'm going to the US and I haven't had to plead or convince my consultant over there to treat me. You need to feel confident wherever you go, otherwise it makes the process a chore and a battle.


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## JDP (Sep 26, 2010)

Hi PP i am also from the North and am at Gateshead QE - my first cycle failed and my FSH was 19 and i have a blocked right fallopian tube with a cyst in it which has to be drained frequently..........i only managed 2 eggs and only one of them fertilised - all doom and gloom i know but they didnt bat an eye lid about it all - obviously they gave me the facts (more doom and gloom) but never did they say they wouldnt treat me..........go there they are excellent and really friendly - about to embark on my 2nd go next week just waiting for AF to start the ball rolling AND i did loads of research re costs of the drugs and Menopur was cheapest at pharmacy at QE and the rest i need ASDA and Superdrug were the cheapest - good luck


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## Peppermint Patty (Dec 22, 2008)

Wow guys, thanks all for taking the time to reply, much appreciated!

urbangirl, yes I should not have to win over consultants! Thats the way I was feeling about it all though. 

jude2801, I will look into Gateshead, thanks for that.

All this has given me food for thought on what to do next. In the meantime, I am waiting to see a GP to see if he will do some immunes or better still refer me to a speciallist relating to immunes / fertility.

Heres hoping!!!

PP


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## urbangirl (Jul 28, 2010)

Peppermint Patty let us know how you get on with immunes from your GP, my Gp agreed to write me the script for the tests but they're specialist tests and have to be done at the hospital (I think).  There they told me I couldn't have them without being under the care of one of the consultants there because they're expensive.  I haven't been back to my GP about it yet so I don't know if he would be prepared to refer me to the consultants so they can decide whether I'm eligible for the tests or not, and now i'm kind of in a hurry anyway because of my age so will probably end up paying for them myself.


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## daisyg (Jan 7, 2004)

GPs cannot do so-called 'immunes' which are specialised tests.

What they CAN do is the following which is also part of a standard recurrent miscarriage workup:-

Full blood count
ESR rate
Thyroid - TSH, T3, T4 and antithyroid antibodies (VERY important test)
BASIC clotting panel - would include Lupus anticoagulant, protein c resistance and Factor V Leiden, prothrombin gene mutation and anticardiolipins and antiphohpholipid antibodies.
Autoimmune - Rheumatism factor, coeliacs etc etc.
Antinuclear antibodies

They could also arrange for you and DH to have your karyotypes done via blood test and possilby some infection testing.

For more in depth testing you need to be under a miscarriage consultant (private or NHS).  This would mean a clinic like St. Mary's, or if you wanted to include NK cells/Tnfa/cytokines and chicago tests, then a doctor like Dr. Gorgy, George Ndukwe at Care Notts, or via Dr. Beer's clinic in the US.

You also should have uterine testing for abnormalities, polyps and fibroids.  Also you and DH should be tested for infection like mycoplasma, ureaplasma, chlamydia, group b strep etd.  Gorgy and Ndukwe will do these.

There are other clotting issues like MTHFR which a specialist can test for.

Finally, don't forget sperm testing which is critical as so often women are blamed for issues which turn out to be sperm related (dna fragmentation, karyotyping etc etc).

These cover the basic recurrent miscarriage tests.

Best
Daisy
xx


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## urbangirl (Jul 28, 2010)

That is very interesting, because my Gp gave me the script for all those things you include in the *'basic clotting panel' * (I thought that wasthe immune stuff) and the hospital refused to do them. They said I had to be under one of their specialist consultants to have those done. I talked to the consultant briefly while I was there and he said he wouldn't authorise those tests. I'm going to talk to my GP about it but they can't do those tests at the GP surgery because they require special bottles, that why he sent me to the hospital. You end up wasting so much time with the NHS, backwards and forwards...


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## daisyg (Jan 7, 2004)

Urbangirl,

I am sorry you are having such difficulty.  I think it depends on your GP and hospital unfortunately.  I was so lucky to have an understanding and helpful GP who gave me a form for the local hospital phlembotemy dept.  Results came through from hospital to GP without any other specialist being involved.

The difficulty though is interpreting the results as GPs are ignorant of most fertility and miscarriage issues.  This is why it is good to be referred to a miscarriage specialist via the NHS (St. Mary's preferably).  If you can afford it, then using a specialist like Gorgy or Ndukwe is also a very good approach.

As you can see, it took 6 miscarriages for me to achieve live birth and that was even after being diagnosed with clotting and autoimmune issues - I just needed the right mix of meds. and embryos.

It is a very hard road and you need to be your own advocate which is very, very draining and frustrating.

Best,
Daisy
xx


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## urbangirl (Jul 28, 2010)

DaisyG, thanks for your post (sorry Peppermint Patty, seem to be hijacking your post but this is useful info, no?).  I'm going back to the doc today to reaffirm that these tests are available on the NHS and to ask if he can just get the bottles in from somewhere so that I can have the clotting panel done at the surgery.  Or I'll ask him if, like you had, he has some special form he can write them on that the hospital will accept so that I don't have to argue my case with a vile, superiority-complex consultant.  I have had an initial appointment with Dr Gorgy, but was trying to get some tests at least done on the NHS to keep down costs.  I haven't received much NHS sympathy for my miscarriages so I am looking into a private consultant for that also, before I spend all my money on my ivf.  For you to suffer 6 miscarriages is just horrendous and soul destroying, and to keep battling on through that must have been a nightmare.  Thank you for helping us all with your knowledge and experience.


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## Peppermint Patty (Dec 22, 2008)

Hi all

So my plan of action should be to first ask GP for basic testing including clotting issues hopefully without having to make any appts to see any consultants at local hospital as this will delay things. Then make an appt with someone like Dr. Gorgy or George Ndukwe if I then want more in-depth and thorough testing. Would I need to be referred by my GP to see these or could I go and make an appt myself?

DaisyG, did you see doc re your tests? Don't worry about hijacking my post, we are all here to help everyone and gain more knowledge and understanding, hopefully with the outcome that we all want.

PP


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