# Sticky  Follow up questions and Hints/Tips for next cycle



## Shellebell

Well this will be an ongoing and updated thread to help you find help, poss investigations to look into etc while you are waiting for next treatment.

If you have any suggestions to links or info to have on here, please send me a PM.

I will be copying info and links to other threads on the site as well

Thanks

This may be a link that might help you with friends and family  
Infertility Etiquette :http://www.resolve.org/support-and-services/for-family--friends/infertility-etiquette.html


----------



## Shellebell

*QUESTIONS FOR A FOLLOW UP*

This thread is intended to help those people going into a follow-up appointment after a negative cycle. Mookie originally started the thread, which you can read here: http://www.fertilityfriends.co.uk/forum/index.php/topic,23451.0.htmlSince it's conception (no pun intended) a number of other questions have been added and I felt the time was right to take all the questions and sort them in to some kind of order.It is a suggested and not a comprehensive list; if you can think of any more please PM to have them added to the list.
Equally you should not feel that you must ask all these questions of the consultant at the follow-up consultation, many of them may not apply in your case so use discretion. The important thing is that you should ask any question you need to, to feel comfortable (hopefully even optimistic) going into your next cycle - don't be put off by thinking 'this is a silly question' if the answer is important to you then it is an important question!

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) Is there anything else that can be done to improve the eggs?
e) 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.)

Regarding a cycle that failed because no eggs fertilised, I am going to ask:a) How unusual is this in ICSI?b) Was it due to poor sperm quality, or poor egg quality?c) What are the implications for further attempts? How high is the risk of it happening to us again?Regarding Surgical Sperm Retreival, we are going to ask:a) Does there come a point when doing more SSRs can cause more harm than good to sperm production due to scar tissue etc?b) Does there come a point when multiple SSR's poses a wider health risk, eg long term tissue damage, any connections to cysts and growths etc.

In summary18 eggs collected2 fertilizedInitially clinic suggested ICSI but then decided to proceed with conventional IVFSperm count & quality reduced at 7%The questions we think we should ask:Why didn't they do half IVF and half ICSI and wouldn't this procedure have given us a better chance?Which treatment type they would advise for the next cycle?

*Don't forget you can create a print friendly version of this page by clicking on the 'print' button, which is on the right at the top and bottom of this thread.Finally coping with the effects of a negative cycle is never easy and while time is a great healer so is counselling. Your clinic must provide counselling free of charge to any of their patients struggling to come to terms with the effects of any treatment that has taken place at that clinic. It is within your rights to ask for it and indeed to insist on it. *


----------



## Shellebell

*Some links round the site that may be of help for you to read if you haven't seen them already*

Board for complimentary therapies which may be of help that you hadn't thought of before http://www.fertilityfriends.co.uk/forum/index.php?board=530.0

In the diagnosis board there is the thread for immune issues, it might be something that your clinic wouldn't look at under basic investigations but may be your issue if you have had a few failed cycles
http://www.fertilityfriends.co.uk/forum/index.php?board=52.0

A guide to learning from your failed IVF cycle
http://www.fertilityfriends.co.uk/forum/index.php?topic=283000.0


----------



## Shellebell

Have you seen we have a new board on Fertility Friends 

*End of the Road .............. Or Not?*
When tx has failed or you are unable to have tx - deciding if there are any other avenues left before making the decision to join the Moving On board
http://www.fertilityfriends.co.uk/forum/index.php?board=539.0



Debs said:


> Dear members,
> 
> This is a new board specially created for those of you who are contemplating what you will do next with regard to your infertility journey. If you are reading this board then you are someone who may fall into one of the following categories:
> 
> This is your last go at tx - for whatever reason
> You are wondering if theres one more thing you could possibly try to get that BFP eg immune testing/pgd etc
> You cant do another tx - but are considering adoption/fostering/surrogacy
> 
> I really hope this board provides a place where you can ask questions and find an alternative "something" to help you make your decision whether to continue on your current path - or to take a slight detour
> 
> Good luck to you all - I am sending you all
> 
> Love
> 
> Debs xxx


----------

