# Advice Needed



## JLB (Oct 31, 2011)

Hello all,

My name is Justin and I'm here to get some advice please. I am 36 and my fiancee is 44. 5 months after meeting each other (she was 39) she fell pregnant by me and I wasn't ready to have a baby - not at that stage of my life and not with someone I'd only known for a few months. She miscarried and we waited til we were ready and now here we are 5 years on.

I am perfectly healthy regarding my sperm - I am here mainly because of her dropping fertility - and I admit I am not that clued up on fertility. I'm interested in the various methods open to us (paid for privately) especially ICSI. Her fertility is weakening and she doesn't get the same cramps as she did a few months ago and feels her eggs are on the way out and so getting pregnant naturally is extremely remote.

I am under the impression, maybe wrongly, that injecting sperm via the ICSI method would give us the best chance of conceiving. I understand the odds are about 0.1% for a woman of 44 but that's with a man with weak sperm - so surely healthy sperm would stand a better chance?

As I said, I am not clued up on fertility issues, so this may sound naive but is there a method available where her best quality eggs are able to be identified and selected for such or any other viable treatment? Maybe FET? Time is running out and we weren't in a position to try sooner so need all the help we can get here. It's all so daunting and being a bloke with not much idea on female biology it's all a bit daunting.

Thanks in advance.


----------



## Swiss_Cookie (Sep 26, 2011)

Hello Justin,

I'm not a specialist so just take what I say with a pinch of salt. 

The issue as I understood is not really on your side - but on your fiancee's. With age, egg quality and quantity decreases. It means that even if she can get pregnant - she did, apparently - the embryos might not stick properly because they have chromosomal issues, hence miscarriages. There is no (known) medical treatment for that.  You can go through IVF treatments that could increase egg quantity and increase a bit the chances of pregnancy, but you can not guarantee the embryo will be fine in the end. 

Biologists can find what they consider being a "perfect" or nice embryo, but it's never a guarantee that it will lead to a successful pregnancy. This is why many doctors will refuse to do any IVF treatment past a certain age and/or FSH levels and propose go to through egg donation instead - because it's the donor age that counts here, not the receiver's (young donor = better eggs = better chances of pregnancy.)

You mention ISCI, which is used when the man has sperm problem, which is not the case here. I don't think it would particularly help.

Did you and your fiancee have some testing done ? It's the first step to do so you know exactly where you stand.


----------



## suitcase of dreams (Oct 7, 2007)

Justin, I'm no expert either but as I understand it, S_C is right - the issue at 44 is both quantity and quality of eggs. I don't have the exact stats to hand but I think I'm right in saying that over 40, 8 in 10 eggs are chromosomally abnormal. And if not many eggs are produced it can be a long journey to finding the one good egg. 
I think I am also right in saying that in your fiancee's age group, there is very very limited success with IVF and that successful pregnancies over 43yrs tend to be naturally conceived (there is I think a theory which suggests that the body naturally selects the best eggs whereas the IVF process can actually result in lower quality eggs as the medications taken to stimulate egg production can have a negative effect - not sure I've got that quite right but I'm sure I've read that over 43-44 your chances are better conceiving naturally than via fertility tx)

If you went to see a couple of different consultants at fertility clinics you would get a good idea of your options - the Lister and ARGC have good reputations for older women and more 'difficult' cases. However, be prepared for the donor egg speech. At 44 many consultants are likely to say that your fiancee's best chance of carrying to term and delivering a healthy baby is via a donor egg which raises a whole other set of questions for you both to think about

Apologies if this all sounds rather negative. Women can and do conceive at 44, but as I say, I think most of them are natural conception and miscarriages are very common at that age 

Wishing you both the very best of luck
Suitcase
x


----------



## Lil Elvis (Dec 31, 2009)

JLB,

Embryos can be tested to check that they are normal, though there is a risk that a normal one could be damaged during the testing. I know the Care group of clinics offer this at a cost of £2,000 in addition to the IVF costs - its called Array CGH. However they will only proceed with testing if you have 8 embryos. It can and does work, but I have also seen it give a lot of ladies closure on the idea of using their own eggs when the results are not good. 

Good luck to you both.

Caroline


----------



## JLB (Oct 31, 2011)

Thx all - especially Elvis for that nugget!

My logic is that ICSI injects straight into the egg so with my healthy sperm then as long as we can find a good egg then the success rate should be pretty decent. Perhaps I'm looking at it too simplistically but it seems to be much better iodds than doing it naturally and hoping for the best.

Do you know whether FET would work - catch a decent enough sample before she loses the ability?


----------



## Lil Elvis (Dec 31, 2009)

JLB,

FET is frozen embryo transfer, do you mean egg freezing? This is definitely not suitable post 40 as it is really designed for younger ladies who don't yet want to conceive but have good quality eggs and want to 'bank' them for possible future use. As we get older our response to the stimulating drugs typically declines, along with egg quality, so we get fewer eggs and a lower percentage of which are OK. If you go for IVF then you are looking at a one-shot deal (with a small chance of a couple to freeze), but due to the high rate of abnormality the chances are sadly slim.

We had two attempts with my own eggs (with disastrous response to the drugs), but I don't regret the money or heartache as I needed to at least try. I was happy to accept that I had done everything I could, but I would have opted for Array CGH if I could. I was then able to move on to donor eggs, and though I have lost three babies along the way, Hannah was the baby we were meant to have and is more wonderful than I could ever have imagined.

It isn't easy, but you will both find a way through. I hope you find the same happiness with which we have been blessed.

Caroline


----------



## MJ1 (Aug 8, 2011)

Hi Justin,
Can I just add my little bit of knowledge to you re ICSI. My partner and I have had 3 cycles in all and failed, he is an ex sperm donor and has given the gift of 8 children to other couples.... we suggested ICSI even though he has a very high sperm count but we were told even if you inject an egg with good sperm it still may not fertilise, so there is no guarantee there either. Good luck on your journey
MJ1 xx


----------



## jei70 (Oct 7, 2011)

Just a bit more clarification regarding ICSI.  If, as you say, your sperm is perfectly healthy (have you tested recently?), there is no need for the more expensive and additionally stressful (to the egg) process of ICSI.  After all, not all eggs injected with sperm actually do fertilise...

In regular IVF, your healthy sperm will be chomping at the bit to do what comes naturally to your partner's eggs.  Now, all this about donors - age is but a number, and she needs to have tests to determine her ovarian reserve and FSH levels.  It might still be possible for her to produce good quality eggs.  On the other hand, it may not, and that's why you should think about whether you'd want to go the egg donor route.

Best of luck to you both!


----------



## suitcase of dreams (Oct 7, 2007)

jei is right to some extent that yes, some initial tests would be a good idea, but there is no test which can tell you in advance (until you actually have fertility tx) what the egg quality is
AMH gives an indication of ovarian reserve - ie how many eggs there are left (we women have a finite number unlike men who generate new sperm throughout their lives) and FSH gives an indication of how you respond to fertility drugs
But if both these are OK, you still have a big question mark over egg quality....and there is no denying that this is a major challenge once you are past 40....
I don't think any of us here are saying there's no choice but to go the donor route. However I do think you have to be realistic and look at the odds - 50-60% success with donor eggs vs 1% or poss lower with own eggs. Doesn't mean you shouldn't try (especially naturally) with own eggs, but food for thought if nothing else - IVF is a stressful (emotionally and physically) and expensive process so I do think it's important to consider whether you put yourselves through it when the odds are so low....

best of luck, hope all this information has helped at least somewhat
Suitcase
x


----------

