# 3rd IVF BFN Anyone got some advice for next time?



## Bunjy (Jan 25, 2007)

Hi there
You'll see my history below. Each IVF I've had has been the Long protocol but this time I was on Menopur instead of Gonal F. I've also been taking Clexane and Aspirin since the EC. The Menopur wasn't great for me - My build up was very slow and I had just one embryo (5 eggs collected). I have been with the same clinic, investigated Guys and ARGC but just wondered if anyone else has advise...I stayed with the same clinic as they know me so well - I just changed consultant for this try as he is much more compassionate and willing to try alternatives.
The embryos don't seem to implant and my number of follicles has always been low  'a Poor responder' - yet I'm 33 and fairly healthy etc.
Are there tests anyone can reccommend? Has anyone had similar experiences? I just need to know that I'm doing all I can as its wearing me out and I don't want to waste my time if there are things I could be finding out or trying for the next time...grateful to you in advance xx


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## ☼♥ Minxy ♥☼ © (Jan 13, 2005)

Hi bunjy

I _think_ we've "chatted" before because you're at the same clinic as me for a couple of your IVFs (Chelsfield).

I'm sorry to hear you got another BFN   I can completely understand how heartbreaking it is and how emotionally draining and physically tiring it can be too. 

Are you under Mr Steer now by any chance ? Only ask as he's our consultant (other than when we had our NHS funded cycles and then we had Dr Reid). He really is very forward thinking and likes to try and "tweak" each treatment cycle to try and tailor it for each of us. It's a shame that the menopur wasn't as good for you.....but again, I spose it was something different to try. If you're considering further treatment then perhaps you could discuss having short protocol which is sometimes used for poor/slow responders. Have you had any further investigations such as hysteroscopy, laparoscopy....blood tests for blood clotting and autoimmues such as raised NK cells ? Mr Steer is really open to all those so I would definitely pursue these with him.

Whilst I'm not quite same situation as you in that although I'm several years older, I do respond extremely well & get top grade embies (and managed to make blastocyst transfer on our cycle back in Mar/Apr) but despite all that, we've had 4 fresh IVFs which were all BFN and 2 natural FETs which were chem pgs (as well as 2 naturally conceived early mc's). Aside from all the laps/hysteros etc I've had for various reasons, I've also had lots of blood tests done back in 2005 (twice with 6mths in between to check changes) and been prescribed clexane/aspirin/prednisolone but Mr Steer feels that both me & DP should have full Chicago tests with a view to me having IVIG now. Although you were prescribed clexane & aspirin, have you had any of these blood tests done ?

We sort of considered maybe changing clinics because we'll be on our 7th IVF/FET next time round but to be honest, we really like Chelsfield and feel that there's more to clinic than high stats (although obviously we want success !).....and Mr Steer is always trying something new with us so wanna give them another chance. We've got 6 frosties left (frozen on day 3 on our 2nd fresh cycle) and have been advised to thaw all and take them to blasto....so that's the next plan for early next year (when I'll be 40 so may be able to have 3 put back if we get any make it through !!)

Anyway, if you have any questions then feel free to contact me directly by PM (personal message) and/or come and join all the other Chelsfield chicks on the thread (on ICSI but some of us are having IVF/FET etc)....there's really quite a few of us now !

http://www.fertilityfriends.co.uk/forum/index.php?topic=148706.450

Take care
Natasha


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## Bonse (Sep 27, 2007)

Hello there

My husband and I have also just had our 3rd BFN - our first (so our 4th) cycle was cancelled.

Here is our brief history. I hope it is useful to people in a similar situation to us. Similarly, if anyone has similar experience (and particularly of IVIG or HUMIRA) I would be most grateful. Most importantly we have not given up hope. In hindsight, protocol and test day 2 weeks before Christmas was not ideal but we did not want to wait any longer (having waited 6 months between cycles this time). 


Me and DH
Husband vasectomy 12 years ago in previous marrriage (he was 27 at the time)
We married in Sep 2006. Failed vasectomy reversal Jan 2007. No chance of reversal, except possibly in USA
I am now 36 and 3 months! DH is 38

We were literally ushered from the urologist at the private clinic straight over to the fertility department. In hindsight we would have spent time investigating clinics. My GP was and is useless and totally unsupportive so off we ventured regardless and naiively. 

A further biopsy found sperm so we were recommended for ICSI. We went through 1 cancelled and 2 full cycles of IVF at that clinic. On both occasions a long protocol (buserelin and menopur). On each occasion the cycle lasted up to 8 weeks, usually due to the consultant working around his holidays. I was on 450 menopur (high) and produced 9-12 eggs. On each occasion we were lucky to have 2 x 6-8 cell embryos implanted but BFN both times. We visited the consultant in May 08 to ask what we should do next cycle to try to improve things. He said we should consider donor eggs and donor sperm - we were no experts yet strongly felt this was very negative advice.

We spent the next 4 months investigating new clinics and researching generally. Our findings suggested that immunology could be an issue with me so we contacted one local clinic where we had heard good results, one an hour's drive away and one in London (Midland Fertility Services, Nottingham Care and ARGC respectively.)

We were encouraged by all 3 having had consultations at each - we decided to set aside money for these 3 consultations and any blood tests to give us chance to make the correct decision. We felt that ARGC could possibly be difficult given the blood tests required during the cycle unless I camped out in London, which could add to stress.

We had the 'Chicago Blood Tests' taken at Nottingham. The consultant suggested  long protocol with extended steroids and IVIG (a transfusion of white blood platelets). I was (and still am) extremely anxious of this. Partially as this treatment is used for illnesses such as cancer, I feel a bit of a fraud. Is our situation really that serious and is it worth risking my health? Humira is another option, but the consultant feels that IVIG is our best chance for implantation to occur.

Midland Fertility Services strongly suggested a short protocol with extended steroids, (start buserelin on day 2 of cycle, stimulate from day 3. Egg collection on approximately day 12-14). Short protocol was suggested since it is felt that women who are relatively poor responders do not benefit from the 'shut down' period. 

We saw a lot of sense in this. Nottingham would not recommend short protocol so this plus my concern of IVIG led us to decide on a short protocol at MFS. Interestingly, my best friend of many years who has gone through ICSI with cycles at exactly the same times (she did have one positive cycle previously but miscarried in week 5) went through the short protocol at a clinic in the south. She had a BFP one week before our test date.


Our protocol at MFS was as follows:



Short protocol (commenced day 2 of cycle)

Me
8 eggs collected (Wed 26th Nov)
4 fertilised
1 x 6-cell and 1 x 4-cell transferred day 2 (Fri 28th Nov) with assisted hatching
1 x 4-cell frozen
Negative pregnancy test (Fri 12th Dec)
It was noted that i have a very strange shaped/angled uterus! (photos were taken) - very full bladder required for transfer

DH
Testicular biopsy under general anaesthetic by urologist consultant  Tuesday 25th November. This has been a revelation and we are very grateful for being introduced to him. DH has always been very concerned about new clinics and their desire to carry our aspirations under local anaesthetic which is simply too painful and not successful to date. We can not keep 'digging away' at DH indefinitely so getting 11 straws was amazing this time. We only hope they unfreeze successfully (frozen sperm collected before did not survive the thaw).
Motile sperm collected


Protocol

Day 2 (Sun 17 Nov)
commence buserelin injections 0.5 mls  (continue days 3 and 4 only)

Day 3 (Mon 18 Nov)
commence merional 300 iu (2 powders x 1 water)
Folic acid 400 mcg daily - continued throughout cycle
Aspirin 75 mg daily
Cytacon B12- 3 tablets daily - continued throughout cycle
Dextamethasone 1 tablet am, 1 tablet PM


Day 8  (Sat 22 Nov)
Scan 1 am
(first follicle 16mm - commented egg collection likely Wednesday 26th Nov)
Commence orgalutron 0.25 mg
Continue merional
Continue dextamethasone


Day 10 (Mon 24 Nov)
Scan 2  am (leading follicle 21mm)
Hcg @ 9.30pm- choragon 5000 iu amps
Stop dextamethasone (taken am)
Stop aspirin (taken am)

Day 11 (Tues 25 Nov)
DH testicular biopsy under general anaesthetic
11 straws of sperm collected and frozen after fertilisation

Day 12 (Wed 26 Nov)
Egg collection, 8.30 am under local anaesthetic. This was painful. i don't mind but I would rather have known what was coming (at previous clinic ec under general). I did feel well much quicker after the procedure however.
I received antibiotic cover with 750mg Cefuroxime and sedation 3.5mg Midazolam intravenously
2 paracetamol pessaries am
Commence Metronidazole 400mg - 2 tablets am, 2 tablets pm
Commence Oxtetracycline 250 mg tablets x 4 daily from lunchtime
Commence Prednisilone 5 mg tablets. X 4 daily from lunchtime


Day 13 (Thurs 27 Nov)
Commence cyclogest pessaries x 2 daily (am and pm)
Recommence aspirin 75mg
Salbutamol 2mg tablets (first at 8pm)


Day 14 (Friday 28 Nov)
Embryo transfer 3.30 pm
(Very full bladder required)
Continue Salbutamol 8am , 8pm
Hcg gonasi 2000 iu 8pm (then every other day last one Thursday 4th Dec)
Continue Oxtetracycline x 4 daily
Continue Prednisilone x 4 daily


Day 15 (Saturday 29 Nov)
Commence clexane 20mg am
Final Salbutamol 8am


I had extreme cramping pain on the night of day 14 and day 15 (at 1am each time lasting half an hour, accompanied by pains in my legs and feet and extreme sickness). I thought this was a good sign at the time but in hindsight believe the opposite (I had similar pains in my first full cycle on the same day of the cycle). The MFS consultant said these pains are related to the follicles filling with fluid. I am trying to discover if there are any issues with rejection - does anyone have similar experiences?

Pregnancy test was Friday 12th Dec - BFN. I feel I have been going through a grieving process for the last week - I am so scared this simply won't happen for us. On Monday we went to see MFS, in particular to discuss the cramping which as I said was excruciating (I have had cramping all this week since the result, however it does seem to be easing now). The consultant was very helpful, suggesting we try our frozen embryo transfer next cycle and then possibly they would look into Humira (not something currently used at MFS). It could be simply the case of the penny landing on the wrong side (ie bad luck!). But I am not so sure. It was also suggested that sperm dna fragmentation may be an issue but we would be unable to test this given the limited amount of sperm available. This was not good news for my head. Have we been 'batting away' with no hope because of DHs sperm, no hope because of my immunity, or are we both useless!!! The consultation ended with the discussion "sometimes it is time to know when to call it a day". Not helpful for me I'm afraid at the moment. I think ideally I could do with some counselling to get things straight in my head. I can't however, deal with a consultant suggesting there is no hope when we have consistently had 2 good embryos transferred.

We have been (humbly) in contact with Nottingham who have been lovely. We are going to see them on Jan 5th to discuss our protocol, although by telephone they are still suggesting long protocol with extended steroids and IVIG. I will be reading up over Christmas but if anyone has experience I would be so grateful.

DH has spoken to his urologist who has tested the sperm collected and rated it 9/10. DH going to see him Jan 9th to find out what this means but hopefully good news. Or at least in as much as we know the issue is with me and I can focus positively on this.

Again, I do hope that this is useful and not too much of a ramble. I am reading an excellent book at the moment (Making Babies the Hard Way) about a couple with male infertility who went through pretty much every IVF process and eventually decided to call it a day. Rather than being a negative read I have found their experiences (and humour) very touching during my 'dark' week. I think DH is grateful it has calmed me down a bit too  Approx 5 of our close friends are currently pregnant, 4 of whom had fertility problems. This should of course be encouraging, but at the moment I feel that it will be *od's law and we will be the unlucky ones. I wish them all the very best but I am so very jealous it actually hurts. Plus I feel like a totally selfish moo - big viscious circle.

I've also ordered the book "is your body baby friendly' by Alan Beer (recommended by Nottingham). I hope it arrives before the Christmas break so I can read it before our consultation.

Into 2009 with a positive frame of mind! Hopeful and very much in love with my wonderful DH.


Good luck to you all. A happy new year and I hope your dreams come true soon.

Nicola
x


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## kizzymouse (Jan 13, 2006)

I personally think its down to nature, and thats it. Sometimes nature is a f**king b**tch though!!


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## Choice4 (Aug 14, 2008)

Nicola
Sorry to hear of your BFN
I think that Care is a very good centre, check out their website below and chat to some girls
http://www.carefertilityweb.co.uk/ivf/viewforum.php?f=11&sid=b92f7155a67da8cb41319337ebd65a51

Ivig and humaria are good for immune problems, intralipids is now being usedin USA and Dr Gorgy in London is also begining to use them
Intalipids if a fat solution which can reduce high NK cells, and it is cheap

I have had IVIG, and it was fine,

If you don't want to use the long protocol, you can transfer your frozen embs to Care and use them for your net cycle

also check out the website below where you can ask any dr questions and they would reply

http://forums.haveababy.com/index.php?showforum=10

/links


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## ayrshirelady (Aug 31, 2008)

So sorry to here your story.   

reading these always shows me how many brave couples are out there. I'm interested in some of the test and treatments you have mentioned.

I have been going through my 2nd IVF treatment ICSIS this time. 2 embiees a 7 and 9/10 implanted 12th December 08 but bleeding started 24th December. I very much this we have lost out this time. To add insult to injury my outcome date was due 29th Dec my 39th birthday.

Both Ist IVF and 2nd ICSIS cycle we have been on gonal F. Both cycles I have had a very disappointing low number of eggs. Only 4 first time and 3 second time for ICSIS even though I was on higher dosage. This time they have also had us on aspirin and low dose heparin.

Afraid we are very much in despair and wondering what to do next. Do we carry on or give up. Do we take a break and then try our last NHS try. 

No one has mentioned such things as short protocol to use. Until I read your post I had not heard of NK cells can anyone give some more light on these. I see this is to do with autoimmunes could my body possibly be rejecting the babies. Previous to IVF I had 3 natural pregnancies that ended in miscarried around the 12 week stage.

We've also never heard of chicago test what are these? pr IVIG transfusion. Would like to know more so that when we see the specialist w can enquire as to whether any of these would be applicable to us.

My hubby is so supportive and I love him very much. I just would like to make him the proud dad he deserves to be.

Ayrshire lady


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## Choice4 (Aug 14, 2008)

Ayshire
There are 2 issues here to consider
1.Poor response or low number of eggs, you may consider estrogen priming( used in some clinincs to improve egg number) or donor egg.
2.Immune issues
I think that your history of your 3M/C, may signify that your body seems to reject the embryo. The only way to determine this is to do some immune blood tests, I don't know which park of uk you are in, but only few Drs do immune treatment
Dr Taranassi(ARGC Lond.), Dr Gerorge Ndukwe (CARE nottingam), Dr Gory (Lon) Dr Sheeta(Epsom)

Here are some of the chicago level 1 and level 2 immune tests you may need
My level 1 tests were:

1. Full blood count, liver function tests, Urea and Electrolytes
2. Thyroid function tests (both free T4 and TSH)
3. Immunoglobulin panel (IgG, IgA and IgM)
4. Autoimmune antibodies (must include anti-nuclear antibodies,
thyroid peroxidase and anti-mitochondrial antibodies)
5. Anticardiolipin antibodies (both IgC and IgM)
6. Thrombophilia (must include lupus anticoagualant, Factor V Leiden
and Panthrombin gene mutation)

My level 2 immune tests aka the 'Chicago Tests' completed at RFU were:
Natural Killer Assay $385
Th1:Th2 intracellular cytokine ratios $333
HLA DQ alpha (male) $52
HLA DQ alpha (female) $52
MRTHR $82
Leukocyte antibody detection $104
total: $1008 = £514.39

Advisable to get the book " is your body baby friendly by Alan Beer"

Check out the thread below on guide to immune testing in uk
You can also search for immune treatment on this site or other sites

http://www.fertilityfriends.co.uk/forum/index.php?topic=82741.0


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## ayrshirelady (Aug 31, 2008)

Thanks for your advise. I will look into all of these tests.

looking at your list though  know I have in recent years had a full blood count, liver function test and thyroid test carried out. All of these were normal. I'm not sure if we have had some of the thrombophilia tests carried out I know I have been tested for sticky blood which I think is Lupus anticoagulant. Again sticky blood test was negative but they did put me on aspirin and heparin this cycle anyway as the spin cycle has shown some success with such treatment even with couples who's tests have all shown negative.

You just feel if someone could give you a reason for things not working it would be easier to take.

I'm currently with Glasgow Royal Infirmary. Staff have been very nice and supportive. Would consider talking to other clinics to see if they recommend anything different before going ahead with a 3rd cycle but I'm not sure if you can shift to another clinic with your NHS cycles.

Will get the book you have recommended and have a look at the other forum.

Thanks again.
Ayrshire lady


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## Choice4 (Aug 14, 2008)

Hi ayrshie
I am glad you are thinking of further investigations before your next cycle
The level 1 test can bedone by your gp, so go see them and get it all done, and request a copy of your results

Level 2, test is mostly done in usa, not available on nhs
You can arrange the blood test yourself, the usa lab would fax you a blood form and information on what bottles to use and how to pack before postage.
You go to a private lab, or hospital have the bloods drawn, then send it off by fedex to the lab, then put the name of the dr or fax number you want the results sent to.
When the results arrive it is easy to interprit, as they would highlight abnormal results or you can paste it on the yahoo immunology group and they would interprit it.
Then the next step is to find a Dr that would treat the immune problems such as high nk cells and you can still have your ivf on nhs

You can use any lab RFU 8475783233, millenova 3122741928, 
Beers lab 4089721687

Below is the webste for the yahoo immunology group, there are a few girls from glasgow on it
http://health.groups.yahoo.com/group/immunologysupport/messages?o=1

Below is the immune board at Care nottingham
http://www.carefertilityweb.co.uk/ivf/viewforum.php?f=11&sid=d3a6a308c164d74ed91f36bdb1ae3e81

Below is a site where you can ask any Dr any ivf related question and get a reply
http://forums.haveababy.com/index.php?s=fae064d9a118b9eb489d1bd5f8185d77&showforum=10

I hope these help, if you have anymore questions let me know

/links


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## ayrshirelady (Aug 31, 2008)

webste for the yahoo immunology group, there are a few girls from glasgow on it
http://health.groups.yahoo.com/group/immunologysupport/messages?o=1

How do I become a member of this group. Would be useful to try to make contact with some otrher Glasgow folks.

Ayrshire lady

/links


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## Choice4 (Aug 14, 2008)

To become a member
1.Get a yahoo email account.
2.click on home on the left side of the website
3. you would see join this group come up on the screen
4.When you join, you can ask for attention of mandy, i know she is from scotland and some other girls


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