# Advice needed



## dillydolly (Mar 11, 2005)

Hi
I would appreciated your views on what I should do as i don't know what to do

I am 40 nearly 41, AMH 4.31, FSH 6, LH 3.9

I have 1 child conceived naturally

1 failed ivf and 1 failed FET

My choices are

Ivf icsi with embryoscope and PGS

Ivf icsi with just embryoscope no PGS as don't know how I would feel waiting for results or if they are rubbish results

Treatment abroad maybe Serum or Dogus possibly using donor eggs

What would you do?


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## JAD (Jun 14, 2012)

Hi

I am new to this forum, what does PGS mean ? (sorry being a bit thick, brain not working this week due to BFN)

I also have just had one failed IVF and one failed FET just this week   so dissapointed.

aged 40 with low egg reserve.

Not sure where to go from here either or what my options would be ? getting very expensive too as having to do privately.

thanks


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## BECKY7 (Feb 2, 2011)

PreImplanation  genetic screening.


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## BECKY7 (Feb 2, 2011)

Hi dilly dolly  If you really feel ready to have donor have it but I would rather use my own egg 1st as I am only just turn 41 and I still feel I can use my egg  but i will have donor when i get to 42 and nothing happen  as my friend got pregnant at 41.5 with her own egg and her husband own sperm with the help of immune testing and she is 30 week and 4 day  and now she is 42  Have you thought about doing immune testing  and I would have ICSI with embryos cope and PGS but beware of the news but I think your AMH is good for your age as well your FSH and LH  it just luck.
I will be having DIUI in reprofit as my DP think his sperm is so rubbish so we gonna give it ago.
Becky7 xx


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## dillydolly (Mar 11, 2005)

Thanks for you replies

What do you think about trying serum or dogus with OE?

In the uk I am looking at £8,000 for 1 cycle with ICSI, embryoscope and PGS. ICSI IVF is cheaper abroad so I could have a couple of goes


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## BECKY7 (Feb 2, 2011)

Hiya
If I was to have my own egg then I would go to reprofit mainly it only €1950 and the PGS etc is so much cheaper then uk and the flight and hotel is so much cheaper but if I want to have donor egg then I will go to serum as penny in serum is lovely and very helpful and she really into immune testing  but at the mo  in the summer the flight and hotel is way too expensive.
I am going to reprofit in 2 week time (1st time) I can alway let you know what I think of reprofit as it is suppose to be good clinic and lot of success too.
I say go with your heart  as I do know serum and dogus will do OE and DE together which I think it great but I don't have the money at the moment to have DE.
Becky7 xx


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## dillydolly (Mar 11, 2005)

Thanks Becky

I have no gut instinct that is probably my problem! 

I feel like I need a grown up to tell me what to do!


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## BECKY7 (Feb 2, 2011)

I know what you mean  horrible not knowing what to do for the best.

What does your partner/husband think or say about it ,  it his sperm any good.

If I was you I would go with OE 1 more chance with reprofit  mainly because it cheaper  then if it still doesn't work then go to serum with OE and DE together  that what I would have done with immune testing.

Have you thought about immune testing.

Becky7 xx


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## dillydolly (Mar 11, 2005)

Hi Becky

DP doesn't really know what to say. He will just go with what I want as he says it's me that has to have the actual treatment. His sperm isn't the best so will probably need ICSI

Havent had immunes. I have asked at my UK clinic and they said it isn't really worth it as I have managed a full term natural pregnancy and had no problems and haven't had miscarriage probs

I have emailed reprofit and they give me a 10% success rate! And also said embryoscope and PGS would really be a waste of my money. They then said DE cycle has 50/60% success rate!


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## greatgazza (May 27, 2010)

dillydolly, it's a nightmare decision and not easy!

However, just wanted to say that the fact that you have managed a full term natural pregnancy doesn't mean that your immune system might not be playing a part now.  There are so many factors involved but the best person to ask is Agate on the immunes board as i believe immune reactions can happen *after* a successful pg/child but you would need to tell her a bit more about your history, is your child with you and your current dp/dh etc.

i went to reprofit and thought it was a great clinic but if the last go (with DE) hadn't worked i was looking to have a hysteroscopy with peny at serum.

good luck

GGX


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## greatgazza (May 27, 2010)

also, did reprofit give a reason why they felt PGS would be a waste of money? i don't know what embryoscope is.  good, in a way that a clinic isn't trying to take money off you if it's not necessary but i'd be interested to know why they thought it wouldn't be useful


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## BECKY7 (Feb 2, 2011)

Hey dilly dolly  greatgazza is right about immune as just because you had natural child doesn't mean your body will stay the same  So if I was you and you wanted to use your OE then I Would ask for level 1 from your GP to make sure there isn't anything  and is your DP taking wellman and zinc and 1000 vit c.
Yes that is great reprofit was honest to let you know about everything you need to know but even so I still would go ahead as that what they said to my freind who was 41.5 at the time and she 30 week 4 day pregnant  on her 7th goes with her OE and her DH sperm with load of immune drug from Dr G.

Not being funny but time isn't on our side so we really can't pee about  shall I  shall I etc. but Aslo I still think 10% chance is still pretty good for you.
Have you thought about DS.

Where you from .

Becky7 xx


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## dillydolly (Mar 11, 2005)

Thanks

Reprofit have emailed again to say that what they meant was there was no pint doing embryoscope and PGS but just PGS maybe a good idea! Embryoscope is where they screen the embryos daily in a special incubator

I will speak to docs, there have been no changes re partner etc all still the same


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## dillydolly (Mar 11, 2005)

What level 1 tests do I ask for?


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## BECKY7 (Feb 2, 2011)

These are basically tests that provide some fertility immune information but are available through any doctor (e.g., your GP if they will agree to do them) .  They include:
•   Thyroid panel (TSH, free-T3, free T4 and antithyroid antibodies) – to test for under/over active thyroid and to test for the presence of antithyroid antibodies (untreated antithyroid antibodies or untreated under/over active thyroid have been shown to significantly reduce the chance of pregnancy/IVF success).
•   Insulin resistance (ideally the glucose tolerance test (GTT) - untreated insulin resistance raises the risk of untreated diabetes in pregnancy which can be harmful for baby and increases the risk of PCOS which hinders fertility)
•   Thrombophilia panel (ideally including Factor V Leiden, MTHFR, PAI-1 and Prothrobin factor II  - although these are rarely available on the NHS) and Antiphospholipid panel (including anticardioplipin IgG and IgA) – to test for ‘sticky blood’ signs  (untreated 'sticky blood' reduces the chance of pregnancy success)
•   FBC and liver function tests (basic check on your overall health)
•   Lupus and Rheumatoid arthritis panel (including anti nuclear antibodies and anti-mitochondrial antibodies – may signal undiagnosed auto immune conditions)

You may also want to ask for
•   Vitamin D level (deficiency is likely to lead to immune regulation problems)
•   Immunoglobulin panel (IgG, IgM and IgA) (- may signal some rare immune issues - and is also a necessary screening test before you can have ivig treatment if applicable)
•      Karyotyping for both partners (in rare cases, genetic problems are apparent from the karyotyping test which might mean that the chances for one of the partners having a healthy baby are very much reduced - see above) - but this is an expensive test, so your GP may not agree to do it.

Note that the level 1 tests may indicate that you have problems e.g., with your thyroid, with insulin resistance, with ‘sticky blood’ or that you are at higher risk of having autoimmune issues, but they don’t really give you much indication of what you might find on your level 2 (Chicago tests).

You should ask for a copy of all the results in case you need them.

My understanding is that Care Fertility's level one package is:

1. Full blood count, Fasting glucose, Urea and Electrolytes, liver function tests 
2. Thyroid function tests (must include both free T4 and TSH) 
3. Anticardiolipin antibodies (both IgG and IgM) 
4. Thrombophilia screen (must include lupus anticoagulant, Activated Protein C resistance, Factor V Leiden, Protein C, Protein S, PAl-1 Gene Polymorphism, Antithrombin III and Factor II Prothrombin gene mutation, Methylene Tetrahydrofolate Reductase (MTHFR) Gene Mutation (most NHS hospitals will be unable to do these). 
5. Autoimmune antibodies (must include anti-nuclear antibodies, thyroid peroxidase and anti-mitochondrial antibodies) 
6. Karyotype (both partners)

This package costs about £1,200 at Care.

13.3   Level 2 tests
Different clinics will include different tests in their immune testing.  The common tests are:
•   NK Assay (see below) & immunophenotype
•   Cytokine ratio (see above)
•   DQa (see above)
•   LAD (see above)
•   Tests for inherited thrombophilia (see below)
•   Uterine NK biopsy (see below).


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