# Help - advice needed



## Johan (Dec 6, 2007)

Hello:
I am new here and just wanted to introduce myself. (I'm really glad to have found this site and wish I had found it sooner!) Also, I wondered if anyone esle had been in a similar situation to my current one.
I am over 40 (just turned 44) and trying IVF for the first time. It was going okay until my most recent scan on Day Five of my Menopur phase. They told me my estrogen was low and that I had three follicles at 8mm and a number of smaller ones they couldn't measure yet. I've not to go back for another week, staying on the same drugs (Buserlin and Menopur - 3 vials). The nurse I saw today (about injections) said other clinics might have cancelled my treatment when I had my last scan but they were giving me 'every chance' by leaving it a week. Has anyone else had had this experience, or something similar? I was feeling quite positive until my scan and now feel quite depressed. I don't know if my follicle count for day 5 was really bad or not and am wondering if they will cancel on Monday. Also, I was wondering why they didn't arrange to see me again to check my estrogen and if necessary up my dose of Menopur. But that didn't seem to be an option at all. For all I know my estrogen could still be too low. 
Has anyone else had IVF at this age and had a similar kind of 'problem' with follicles? I'd really love to hear from you!
Thanks,
Johan


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## Ellie.st (Mar 11, 2005)

Dear Johan

I'm not an expert but my clinic don't normally scan until Day 8 of stimming.  On my third cycle (when I was 42), I only had a few follies on Day 8 (can't remember the exact details now but I think 2 or 3 reasonable sized ones - ie about 10mm, can't rememb er exactly - and a few more small ones). I had definitely had had more and larger follies on my previous two cycles by that stage. I was really worried that the cycle might be cancelled but I continued on the same level of stimming (Menopur 225 from memory, which I think is 3 vials and I was also on Buserelin). I eventually had about eight reasonably sized follies so EC went ahead.  The rollercoaster took another downturn then as I only got four eggs compared with eight and nine on previous (negative) cycles, and I still remember crying in the recovery room after EC thinking that it was all over.  However, three of the eggs fertilized into Grade One embies and one of them is now sitting beside me in her play pen just three weeks short of her first birthday.   

I think what I am trying to say is that it is early days yet - alot can happen, and, in fact, your follies will keep growing even after you have had your trigger shot.  From memory, I think that follies can grow 1-2mm per day of stimming. The other thing I can say from my experience is that quality rather than quantity is what you are after.  My advice would be to rest up as much as possible over the next week, keep your water intake level up (2 litres a day if you can manage it), eat lots of protein, and drink a litre of milk a day (again for protein)- this should help get those follies growing.  I'm not sure about oestrogen levels (my problem on my third cycle was that they were too high during d/r as I developed a cyst and had to d/r a week early - it really was a nightmare cycle) but if I were you, I would phone your clinic and ask for a doctor to talk you through your treatment plan with you - this will give you the chance to ask your questions and hopefully it will put your mind at rest (as much as is possible under the circumstances).  I did this on my third cycle as I, like you, wondered why they hadn't increased my stimming dose. In the meantime, hang on in there.    

Good luck

Ellie


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## Johan (Dec 6, 2007)

Dear Ellie,
Thank you for really helpful reply. That is wonderful news about your baby! Congratulations!  I drank some milk at lunchtime today. (I'm not a great fan of milk but I'll drink lots from now on) and will drink even more water. In general, I've been eating very healthily and trying to rest up as much as all these early morning hospital appointments and injections will allow. My next scan is in three days time (Monday morning) at which point I'll find out the latest on the follicles. 
One encouraging thing is that I feel a bit more 'pre-menstrual' than I have done - possibly a sign that the estrogen is a little higher (at least that's what I'm deducing with no medical training whatsoever)! 
I feel quite shy about phoning up and asking for a doctor to speak to. I know I won't get one over the weekend and generally it is the nursing team who deals with enquiries and worries. I see the doctor for about two seconds and then it is over to the nurses (who are very nice but don't make the decisions). In the middle of a scan or just after I just don't think to ask the necessary questions. However, I might try and speak to a doctor before the end of today (Friday).
I'm very nervous about Monday (day 12) and hadn't realised what an emotional rollercoaster this whole thing would be. 
Thank you for all your encouragement. I'm glad you've had such a happy outcome.
Johan.


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## Ellie.st (Mar 11, 2005)

Dear Johan

Will be keeping my fingers crossed for you on Monday.    

Ellie


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## LondonJax (Jan 30, 2006)

Hi,

I just wanted to tell you our story as I hope it will give you a bit of comfort.

I was 43 when we started our ICSI story.  In April 2006 I had just three follicles when it came to EC (I had to leave it another week then too) and the decision was left with us whether we wanted to take the chance.  We went ahead.  Unfortunately my body was playing tricks and the follies were immature but sending out signals to say eggs were on board when really there were none.  We were devastated as you can imagine.  We went back to our clinic - The Lister - thinking they would recommend egg donation.  Instead they put me on the highest stimming with Menopur (I was on Puregon on the first cycle) and the lowest down regging they could do by law as they thought I may be down regging naturally with my age.

In July 2007 we unwent our second cycle.  This time in secret as we couldn't bear having to tell people another failed cycle (that's how positive we were NOT).  Again I had to do an extra week of stimming as my follicles were slow growers.  Again we ended up with three follicles of any sort of size.  This time though we got three eggs.  Amazingly all three fertilised and I had them put back two days later - one was an 8 cell, one 7 cell and one just 2 cells but dividing as they put it back.

The result is currently laying on the floor beside me fast asleep surrounded by his toys.  His name is Ewan, he's 7.5 months old and is the love of our lives.  The miracle of his life doesn't stop with the IVF.  He was born with aortic stenosis (heart condition) and was critically ill before it was spotted at 2 weeks old.  He underwent a procedure to push open the aortic valve at 15 days old and was likely to need a new valve before he started school.  At his last check up they now think, as his valve is mending itself, that he may last well into adulthood with the valve he has - by then who knows what will replace the open heart surgery he will probably need to have.  That little boy was just meant to be and is fighting all the way and we're so glad he's ours.

Don't give up hope.  Just try to celebrate every time something goes your way with the IVF - you've got this far.

Good luck

Jackie x


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## Johan (Dec 6, 2007)

"I just wanted to tell you our story as I hope it will give you a bit of comfort."

... Thank you Jackie. It has! Congratulations on Ewan and I hope he continues to heal as well as he has done up until now! He sounds like a real fighter. Thank you also to Ellie. 
The latest news is that I went yesterday for my second scan and there are more follicles, though none yet 16mm which is apparently which the lead one has to be. I go back tomorrow morning for another scan and am very much hoping things have moved on again (even just a fraction of a millimetre)! I think you are correct that you just have to celebrate everything that goes right - it's such a rollercoaster. I hadn't anticipated all the various stages we'd be worrying and anxious about. First it was the down regulation stage, now it's the stimulation stage. 
You mentioned you were put on the lowest down regulation possible. I was wondering how my ovaries are just supposed to kick into action again after I'm off the Buserlin. Is it something that just 'happens' when you come off the down-regulation drugs, do you know?
Sorry for asking so many questions but so many seem to come up and there are so many things to think about.
Thank you again for sharing your story.
Johan.


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## Ellie.st (Mar 11, 2005)

Dear Johan

Just wanted to wish you good luck for tomorrow.  You're right - it's a case of taking things step by step (although I know that's easier said than done!).  Don't worry about what happens when you stop the buserelin - from memory, you take buserelin up to when you take your HCG trigger shot, and then (don't ask me how, although when I was doing it I did understand ) your body will take over.  Good luck again.   

Ellie


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## Johan (Dec 6, 2007)

Thank you. Things have moved on! Have to do my injection tonight and go in for the EC on Friday. Feeling quite nervous but also excited.   I can't stop myself from worrying about everything - what if this happens, what if that doesn't happen ... and so on. But I'm going to concentrate on Ellie's good advice and just celebrate each good thing that happens. There is one follicle about 18 and others coming up behind at various stages but they need to move now they say as they might lose the larger one otherwise. They seem to have grown a lot in the last few days. Thank you again for all the advice and help. Trying to stay calm and not worry ...! Johan.


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## Jo (Mar 22, 2002)

Wishing you all the best for Friday  

Love Jo
x x x


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## Ellie.st (Mar 11, 2005)

Glad to hear that your follies have been doing the business.  Good luck for Friday, Johan.      

Ellie


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## Johan (Dec 6, 2007)

Thank you. I think it must be all that milk you advised me to drink!  Thanks to everyone for their good wishes!

Johan


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## 1watson (Dec 4, 2007)

Best wishes for tomorrow Johan    

Jo


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## Johan (Dec 6, 2007)

Hello Jo, Ellie and other well wishers,
Thanks for all your good wishes. Friday was fine in the end. I was completely zonked afterwards, not to mention a little terrified when we got in there. Go back again on Monday now for the ET. We've had a lot of ups and downs this far but I know the big test lies ahead. How on earth do you keep sane with all the waiting? I've never been the calmest of people - I'm also a worrier - but this is a big test for any woman! We didn't get a lot of information, although may do so on Monday. Do they tell you about grades of eggs and embryos? Meanwhile, going to try and do a bit of Festive Shopping. Battling the crowds should keep my mind off things for today at least. Hope you're all well and wishing you lots of happiness over the Festive Season. Thank you so much for your support. You've no idea how much it has helped. Johan.


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## Ellie.st (Mar 11, 2005)

Dear Johan

Sorry I wasn't able to log on for the past few days as our wee poppet has had a nasty cold and been very clingly (on the mend now, however  .  I'm so glad to hear that EC went well - I still remember how nerve-racking it is (and ET was even worse!).  I do hope ET went well today.

I haven't heard of any clinic grading eggs other than to say if they looked mature or not.  Some clinics seem to be more forthcoming than others about grading.  However, try not to get to hung up about grades even if the clinic tell you as there are lots of examples on this site of lower grade embies turning into lovely babies.  

I've no advice really about coping with the 2ww - I might as well be honest and say that it is a real rollercoaster, especially the second week, as, if you're anything like me, you will overanalyse absolutely every twinge and go from being certain it has worked to certain it hasn't, then back again (and this repeates itself at least hourly during your waking hours    ).  During my 2wws, I tried to relax as much as possible, especially for the three days after ET when I did alot of lying in bed and on the sofa.  I also tried to keep up the healthy eating, especially protein, water, selenium (2-3 brazil nuts every day) and essential fatty acids (I ate walnuts with my breakfast cereal as well as sunflower seeds and pumpkin seeds).  Make sure you keep your tummy warm as well, but don't use a hot water bottle.

Good luck.     

Ellie


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## Johan (Dec 6, 2007)

Ellie, sorry to hear the little one has had a cold but glad to hear she is on the mend. The ET took place yesterday and I am already analysing everything! I'm also having difficulty with the progesterene pesseries I was given (they seem difficult to keep in place) but I suppose I could maybe go and see my GP for some advice about these. Did you get these? This of course gets me worried because I'm terrified I'll be missing some of what my body needs ... so it goes on. I keep remembering how friends have told me they knew 'instantly' that they were pregnant and not feeling really any different. Is this crazy? The doctor told me just to go about things as normal and be positive but I am going to take some time off and rest - apart from anything I'm quite tired after everything! Anyway, thank you for sharing all your own experience as it's really helpful and reassuring. Hope you're all cold free!


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## Ellie.st (Mar 11, 2005)

Hi Johan

Glad ET went OK.  The pessaries (I assume you've got progesterone ones) are definitely a bit of a fiddle.  Putting them in when you are lying down might be easier (sorry if TMI), and I used to try to lie down afterwards for around 20 minutes to try to let them dissolve.  Don't worry if you end up with a residue on your underwear as if they dissolve inside you you will get enough progesterone.  Re knowing you are pregnant - well, I had no idea and, in fact, was convinced on my third (successful) cycle that it hadn't worked. I couldn't get a blood test done till two days after my test date because my test date was on a Saturday.  I remember waking up early on the Saturday morning, convinced that it hadn't worked and deciding to adopt plan B (ie if I can't have a baby I'm going to start landscaping our garden!). So I got up and then it occurred to me that as the gardening was going to involve some heavy lifting I had better do a home test just in case ....  The rest is history (and the garden still hasn't been landscaped!   ).

Seriously, you will find threads on this site about symptoms during the 2ww and everyone's experience seems to be different.  One of the reasons I thought it hadn't worked on the third cycle was because I had what I thought was PMT with a vengeance from about Day 8 or 9 post ET, and from reading other posts, people with both BFNs and BFPs have had this.  On my first cycle, I had a small implantation bleed about Day 10 (which is thought to be a good sign) but went on to get a BFN.  I honestly think you just can't tell until test date comes along.  One tip I would offer is to invest in a ClearBlue Digital HPT kit as the results are much clearer than on some other types of kit when it comes to test day.

I personally think that trying to rest a bit won't do any harm.  Quite apart from anything else, you have been through quite a bit physically and mentally over the past few weeks, and you also have more ups and downs (hopefully ending in a great big up!) to come over the next couple of weeks.

Wishing lots and lots of good luck.  Hoping that your embies are getting ready to snuggle in as I type.

Ellie


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## Johan (Dec 6, 2007)

Thanks Ellie - that all makes me feel better. I still have a kind of mild 'period-like' pain (not exactly cramping but that 'low abdominal ache' you sometimes get before your period). Needless to say I've been trying to find out what that means but can't really find anything definitive to say it's good, bad or indifferent. As you say, it could mean anything - or nothing.
Yes, I'm on the progesterone pessaries. Visited my GP (who is lovely) this morning and asked her if there was any sort of applicator available but she said not that she knew of. (Hospital didn't offer any so didn't see much point in contacting them about it.) She suggested using one of the ones that comes with Canestan, which I bought, but it's not the right size. So back to lying down and hoping for the best! Finding it quite strange resting up like this as I'm usually on the go all day long but just trying to what I can. 
Does everyone test at home first? I'm too scared ... but maybe that will change. I'll be scared whatever way I do it. 
A garden sounds like a good alternative project. I like the outdoors so just getting out and about into the countryside again and exercising more again would help. But must think positive!  It's all full of ups and downs this IVF business. Hoping the wee chaps are getting comfortable in there!  And hoping your wee one is well again.


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## Ellie.st (Mar 11, 2005)

Dear Johan
I'm not an expert but I would think that any discomfort just now is probably just due to all the activity (stimming, EC, ET etc) that's being going on down there during your IVF cycle. 

Enjoy resting and pampering yourself - you've got the perfect excuse, especially when the alternative is going out in this cold weather or braving the rush in the shops etc.  

I tested at home because I had to get blood taken on test day by my GP then post it off to my clinic (as it was such a distance from where we live) which meant not finding out the results until two or even four days after the official test date.  I also felt that I would prefer to find out the result myself rather than hearing it for the first time on the phone but I'm sure everyone is different so do what you feel is right for you.  However, if you do decide to do a HPT, don't do it before the test date your clinic have given you as getting a doubtful result too early is even worse than not knowing at all (at least in my opinion!).

Sending lots of     to you and your wee chaps.  

My wee one is still a bit out of sorts but definitely much better than she was, so hopefully she'll be back on form again soon as she has not only Christmas but her first birthday coming up very soon.  

Ellie


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## Johan (Dec 6, 2007)

Hi Ellie, doing quite well at the resting  . I'll need to remember that I have to back to work sometime. My head isn't always so good, however, as I am now convinced I'm having period pains. (They usually start quite early.) But then every so often I think, 'maybe it's not all over'. It really is difficult - as I am sure you know. Reading other people's experiences helps and am trying to do a bit of positive visualisation. It's just feeling those 'familiar' 
aches that is worrying me ...  
Glad the little one is doing better. Must be really special having your first Christmas with her and I hope you all have a lovely time. I go for my test on the 28th but hopefully Christmas will be a good distraction. Meanwhile, I keep telling the wee chaps to make themselves at home    Take care and thanks again for another lovely message. It really helps!


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## Jo (Mar 22, 2002)

Good Luck for your test day  

Love Jo
x x x


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## lucymorgan (Nov 2, 2007)

Johan,

when I went for my consultation after my fertility tests back in November I was gutted as my oavrian reserve was low.  I look really young for my age and had it in my head that genetically I was quite young so this came as a big surprise.  UCH offered me GIFT as they belive leaving the eggs to fertilise in the natural env't is the best think if they are older and more sensitve.  I was even more gutted as i'd got my head around IVF but was now being told that I could do IVF but wasn't a prime candidate.

So I did it not thinking it would work but not wanting to give up without trying while there were still some odds.  I got 9 eggs which I was really pleased with as I was expecting one or two.  And now have a BFP, so anything is possible.

Good luck with you test.

LucyMorgan xx


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## Ellie.st (Mar 11, 2005)

Dear Johan

Just wanted to tell you to hang on in there - and to wish you a very Happy Christmas.  

Good luck for your test date.  Not long to go now ..... As Lucy says, anything is possible, and my experience is that you can't read anything into the aches and pains.  Keep up the positive thoughts - and here are some from me too      

Love

Ellie


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## Johan (Dec 6, 2007)

Hello Ellie and Lucy. Woke up this morning and seems period has arrived. Very low. I don't know quite where to turn. I too produced 9 eggs Lucy and six fertilised, two grade twos were put back. No-one has mentioned GIFT or anything like that. I think they treated us on the basis that we wanted it not because they thought it could work at our grand old age and though they were nice there wasn't much information or concern about hormone levels and so forth. 
Truth is it took months to see a specialist and then months before the tests were done and then months before we finally got treatment so time has been marching on and we don't have a lot of it. We are paying clients at our local NHS hospital and I am wondering if we should go completely private (ie to a much more expensive private clinic) where we might get a bit more follow up. I always had this feeling the problem was after conception. I've charted for some years and I ovulate normally, have one LH surge mid cycle and so forth. However, after ovulation I always have my period within 12 days and it's always preceeded by terrible pains (had these since teenage years). Whether embryos don't implant or I don't have the hormone levels to sustain implantation I don't know but I think this might be where the problem is. (Just an amateur's guess.)
We don't have much money. But I'm willing to try elsewhere if it might help.
This has all been much harder as I'm currently at my parents who know nothing of the treatment and having to be Festive and cheerful. Also, I currently have about four friends, all in their forties, who are pregnant. I am happy for them but it's hard - as you probably understand.
Is GIFT a better idea do you think?
Thank you again. My notes say I have to go for my test even if my period has started but I don't see why. It seems like another blow to have to do that.
Anyway, thank you for being such a lifeline.
Johan.


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## lucymorgan (Nov 2, 2007)

Johan,

really sorry to hear your news, its hard wanting something and not getting what you want. Especially if like me you think if I'd of realised I would have done this in my mid 30s, I had met my DP then but it was early days. I also have heard of other women in there late 30s / 40s who have had at a late stage children. Some people can but for a lot of us it becomes very difficult and we start needing help. Its a really myth that you can put off having kids until late with no worries.

I have spent approx £6000 on my GIFT cycle, not sure how much your paying but if you can afford it I suggest going to one of the top rate places. Lister is supposed to be good, as is ARGC (but some people don't like the intensive monitoring) and I do recommend the UCH. Although I have to say they probably don't have proportionally as many women in their 40s as the lister. They have very good success rates and I think part of that is that they are less likely to treat more difficult cases. So the Lister may be better with your age as some places have a cut off age of 42. Time is really important and I had my 1st consultation in October and was cycling in November, I just decided I had to get on with it quickly. If this cycle hadn't worked I was going to repeat in March then in August. Then probably decide it wasn't to be. I do recommend GIFT, at UCH they have had some amazing success rates.

I have also read a lot about DHEA, which is a steroid that it supposedly able to help boost egg production and quality in older women. http://ezinearticles.com/?DHEA-Helps-Thwart-Infertility-In-Older-Women&id=702017 If I didn't have a positive result I was going to use this as I've read some +ve things and cant see there are any bad side effects.

Good Luck.

LucyMorgan xx


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## Johan (Dec 6, 2007)

Hi Lucy: Thank you. Problem with all these clinics is that I live at the other end of the country (in Scotland). I suppose I'd have to attend all the appointments I have done here (and more) and can't see how I could get to a London hospital on a regular basis. I could stay down there for a spell with a friend but that would be it. I don't know what to do now really. I suppose I could phone these hospitals and explain where I am based etc and see what the possibilities are. I just feel heartbroken right now. It brings up so much - life (mainly love) not having gone as I'd have wished, not being able to speak with my mother about such things ... the list goes on. Johan.


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## Cotswold Girl (Nov 16, 2006)

Dear Johan,

I'm so sorry to see that this cycle hasn't worked for you. Christmas is a particularly tough time to get news like this. Just wanted to send you big hugs    and wish you well for 2008. I really hope your dreams come true and you're joining your friends.

Love, CG xxxx


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## lucymorgan (Nov 2, 2007)

Johan,

there are also fertility clinics in Scotland. If you look at the HFEA website you can search for clinics in different areas and you can look at their inspection reports and success rates.

http://www.hfea.gov.uk/

I would also suggest some form of counselling as that can be really helpful. I've had it in the past for a different issue and it was a real life line.

Other options are adopting, I have looked into it here in London and as we are not mixed race and would need a child under 2 due to our DSs age I haven't got anywhere. But it is probably very different in Scotland. Also you can adopt from abroad in particular Russia and China. There are other possibilities to getting what you want.

Good luck

LucyMorgan xx


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## Johan (Dec 6, 2007)

Thanks for all the good wishes and info, and Lucy congratulations on your BFP . Feel a bit better (and more together) today. Yesterday was all a bit much, it being the Festive Season and all! Have had counselling in the past (about infertility and other issues) but right now I think I just want to concentrate on exploring all our options. I still feel there are things to try before we accept and move on, if that is what we have to do. We were looking into adoption before the IVF option came up and will definitely return to it 'as and when'. Just don't feel I can keep any more plates spinning at the moment (and keep sane).  
Had my pg test this morning which wasn't exactly a joyful occasion but have found out we can probably have another go in three months time at current clinic if that's what we want. Still have to have follow up with doctor though so a lot of questions unanswered. Seems GIFT isn't really an option in Scotland except at one clinic. But it might be possible to have another go at IVF quicker somewhere else. We were turned down for IUI at our current clinic and I'm wondering if we should maybe have a go at that in the meantime - less invasive and if we have to take break from IVF anyway we might as well. Has anyone else done that?
Meantime will look into DHEA and acupuncture, possibly diet as well - although I have - I think anyway - a pretty healthy veggie diet.
Wishing you all the best on your scan date Lucy.
Johan.


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## Ellie.st (Mar 11, 2005)

Dear Johan

Sorry not to have been able to log on earlier to find out how you got on (we've had visitors). I am so sorry to see today about your BFN.       I have been in a similar situation to you in many ways as we are also in Scotland and there was no apparent reason for our problems ttc (and we didn't tell our family about ttc or our IVF either which I still think on balance was the right approach for us but it does bring problems with it, especially at family gatherings etc). 

A BFN from IVF is a very hard thing to cope with so I hope you are being kind to yourself.      

I see that you are keen to consider options - well done you for being so determined!  After my first and second BFNs I did lots of research on this site and elsewhere then went to my follow-up appointments armed with a long list of questions about each stage of the process, how the clinic thought things had gone, and what they might do differently the next time. After my first BFN, I also suggested changing to a different stimming drug (Menopur, which some research says is better for older women) and the clinic were happy to do this.  

Also - have you had the tests which daisyg lists on the "Starting out" board of this site (immunology and investigations)?  Your GP and/or clinic should be able to arrange quite a few of these - I had them done after my second BFN and they might just show up something which could be treated.  (Mine all came back negative but I felt it was still a worthwhile thing to have done, and I wish that I had had them done much earlier).  Be prepared to be assertive to get the tests done as some doctors won't do them until you've had three BFNs. (My approach was to say that we had been ttc for 9.5 years and therefore had been having BFNs just about every month during that time.  Also, time was not on my side so I wasn't prepared to have further treatment without the tests). Some of them (especially karyotyping) take a while for the results to come through so, if you want to get tests done, the earlier you get the ball rolling the better.

The other thing I did after my second BFN was to get immune testing done - I had to travel down to London for this which took a bit of time and money but again I thought it was worthwhile doing.  Immune testing and treatment is a bit controversial but having the tests done may throw up results and treatment options which you could consider. (My tests came back negative for immune issues but the doctor who did the tests did give me the option of taking a course of steroids, aspirin and heparin on the basis that I might have immune issues which his tests hadn't shown up. I personally decided not to have this treatment as I was worried about potential side effects for me and a baby (if we got a BFP) but I know other people have had this treatment with successful results.  

We had also considered having a final IVF cycle in London (ARGC probably) if our third cycle in Scotland hadn't worked - the logistics were a bit offputting but were "do-able" even for us living in the north of Scotland - so it might be worth considering.  We got as far as getting an info pack from ARGC which provided quite a bit of useful info and there are also ARGC threads on this site with alot of helpful advice about accommodation in London etc. If you have a friend in London you could stay with, that might make things much easier.

I think the other thing to bear in mind is that you responded pretty well to the IVF drugs which suggests that it is worth trying again. I think that alot of IVF success is down to luck (not a scientific view, I know!). Most people, even women much younger than us, will not be successful on their first attempt and although time and money are limiting factors for us older women, having more than one attempt is probably worth considering (especially if you get tests done now to rule out/treat any obvious problems and feel that you can face the emotional strain again).  At our age, the chances of success are obviously much lower and you don't need me to tell you that there are no guarantees of success even if you have multiple cycles.  However, from your posts, I think you sound a bit like me  (ie thrawn   ) - I was determined to keep going until I felt that we had given things our "best shot".  I also didn't want to think in the future "if only we had tried such and such...." so we explored all the avenues I could for things we could do which might make a difference.

I'm not an expert but I personally think that you should wait three months before starting any further tx - it takes that long in my experience for your system to sort itself out after the IVF drugs plus you want to get back into good physical shape.  Three months is also a good lead-in time for getting yourself prepared diet and supplement wise.  I see you are veggie - we are too and thought we ate a pretty good diet but when we started looking into our diet one of the things we found that was that we were light on protein, zinc and essential fatty acids etc. If you haven't looked at them already, I would really recommend Zita West's book "Fertility and Conception" and also Marilyn Glenville's book "Natural Solutions to Infertility". (You can also google their names to find their websites as these have useful info on them).  We both rattled with supplements (I also took bee pollen to improve egg quality after my first cycle), cut out caffeine and alcohol, ate organically etc - I don't know if any of it made a difference but it didn't do any harm and did make us both healthier which must have been a positive factor.

I also think that acupuncture is well worth considering - I had it for the first time during my third cycle, including the "German protocol" on ET day.

I'm afraid that I don't know anything about GIFT but I am sure other people on this site will. We've not tried IUI . As you say, it's less invasive (and less expensive) but the chances of success are lower than with IVF.  (Although, at our age, there's not alot of difference in it statistically). I would say that it would still be worth having the tests mentioned above , however, even if you decide to go down the IUI route.

Sorry for the ramble - I'm not an expert in any way but hopefully seeing the types of things we tried will give you some ideas for things you could follow up.  The main thing is that you still have options - you are definitely not at the end of the road.

In the meantime, take care of yourself.  Hoping that 2008 is your year.  

Love

Ellie


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## LondonJax (Jan 30, 2006)

Oh Johan I'm so sorry to hear your news. I haven't been on here for a while what with Christmas and all but I hoped you were doing well.

The Lister do have satellite clinics all over the UK (not sure where they are but here's a link with a phone number - you never know there may be one nearer your hometown.)

http://www.ivf.org.uk/TechList.asp

Good luck

Jackie x


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## Johan (Dec 6, 2007)

Hi Ellie and Jackie, and sorry for not being on the message board for a while. I found it all a bit distressing for a few days and couldn't face reading about the bewildering number of options and possibilities. There is so much to think about. Anyway, I very much appreciate all your advice Ellie, and also yours Jackie and will look at these tests you advise straight after writing this.
Since I last posted I've had my follow-up and also a preliminary meeting at a fully private clinic (in Scotland) where they tested my egg reserve. I will get the results of that later in the week. This 'new' clinic doesn't believe in FSH and LH tests for some reason and goes only on egg reserve. They have offered to do IVF for us again in March (when I have some holiday time) if we'd like, our NHS hospital has offered July with the possibility of an earlier cancellation quite high.
Everyone keeps going on about age, and it does get depressing. However, apparently my LH and FSH are good, 4.7 and 5.8, and the number of eggs I produced (9) also good, so all these sorts of things seem to be in our favour. We managed two grade two embryos but neither implanted. As you'll both know, the crucial thing seems to remain egg age and the private clinic suggested egg donation might be the way to go. I'm not keen on that yet and feel at the moment that I might prefer adoption to that.
Having done a bit more reading I'm wondering if 5-day transfers might be more suitable for a woman of my age but that wasn't mentioned at either appointment and I hadn't thought to ask at that point. (Egg hatching also seems a good possibility at this age but again very few places up here, if any, seem to do it.)
The private clinic does not have such a good success rate as the NHS one (in our age group) but is more able to fit around our diaries and would see us earlier. I'm worried with time being such a factor that if I have to wait until July I'll be wasting precious time. It's really difficult to know what to do. Another problem is that the private clinic would want us to get our test results from the NHS one which might mean effectively having to come off the list of the NHS (as we'd have to say we were going elsewhere).
One thing I am definitely going to do is try acupuncture and hypnosis. Everyone (including the doctors) tell me being positive is crucial but that is difficult when they constantly go on about time and you've just had a BFN. Ironically being positive is another pressure! But one I hope to deal with.
I'll also take a look at those diets you mention Ellie. I do think I am probably a bit short on protein (a danger for veggies) and had to consciously up it during stimming - can't do any harm.
Oh, by the way, the private consultant said Gift wasn't worth trying ... he seemed to think it was a bit pointless ... and both thought IUI was a waste of time and money. Hey ho.
Anyway, any advice on this bewildering number of new options and considerations would be very welcome. DP thinks I shouldn't alienate the NHS  hospital by letting on we might be considering going elsewhere. I confess I am a bit at sea other than knowing I'm going to try hypnotherapy and acupuncture.
Hope you had a good Christmas and Happy New Year. Ellie - nice to know you are also north of the Border, although it sounds as if you are further north than us (possibly in my favourite part of the country - the North West). 
Thanks again.
Johan.


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## Violet66 (Dec 28, 2007)

Hi Johan 

I am 41 (approaching 42) and just starting the TTC journey. 

I was interested to read your account because in the past month I have had two different fertility experts at two different clinics tell me that they put no weight on 'egg reserve' testing - ie the AMH. 

I had my FSH, LH, oestrogoen and progesterone measured - and (thankfully) got excellent results in all. I enquired as to whether I should have the AMH done and both doctors (un-connected) said no as the tests I had already undergone were a far better indicator. 

As your FSH and LH levels were good I think you shouldn't lose hope and you should definitely keep plugging away with your own eggs.


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## Ellie.st (Mar 11, 2005)

Dear Johan
Good luck for the results of your AMH test.  I must say that your FSH level looks really good - mine was 7.something before my last IVF cycle.  As you say, you responded well to your last cycle - the clinics will always go on about your age because that's their job ( ) but if you are realistic about the chances of success and can handle them, don't feel pressurised into going down the donor egg route if you are not ready for that.  Biologically speaking at least, there isn't the same time pressure with donor eggs in any case because your chances of success in a donor egg cycle are those of the donor's age, not yours.  

I don't know much about five-day transfers (blasts) other than that you would probably have to a have a fair number of embryos (five, I think, at most clinics although I'm not sure, and not all clinics offer blast transfers in any case) before it would be a realistic option as the proportion surviving till Day Five would be lower.  I believe that there is a higher chance of success if you do get to blast stage and it certainly sorts out the stronger embryos from the weaker ones.  My own experience was that of three- and two-day transfers, and it was actually a two-day transfer that worked for us.  Our clinic were licensed to carry out assisted hatching but when I asked about it they said they didn't actually do it anymore as they felt that there was a slightly higher risk of minor birth defects (such as cleft palates).  So it might be worth getting more advice on this if you want to pursue it.

I know everyone says that having a positive attitude is important but my own experience was that the cycle that worked for me was the nightmare one when everything went wrong and I was convinced that there wasn't a chance of it working.  Don't beat yourself up with the pressure to feel positive on top of everything else - if you can manage it, fine (and maybe the hypnosis will help), but I personally think that it's also important just to be determined to give it your best shot. 

About changing to another clinic and losing your place at the NHS one, why don't you just ask the NHS one straight what the position would be?  You never know, they might be prepared to hold your place on the July list, and if you know what the situation would be, it will maybe help you decide what to do. I doubt it would alienate them as I am sure they are not short of customers!

It IS all really bewildering but it sounds like you are already making good progress with sorting out the next steps - well done.  

PS: we had a lovely festive season, thanks - the first one with our wee poppet at home and an experience I had just about convinced myself when ttc would never happen.  

Best wishes

Ellie


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## Johan (Dec 6, 2007)

Hi Violet and Ellie,
Violet - I decided to get the ovarian reserve test just to have a bit more information. I'd read about other women having it and decided it might be a good idea given my age. I don't think it is crucial and if your other tests were fine I wouldn't bother at this stage. It was really just that this other clinic uses this test as measure of, I think, your possible ability to respond during IVF stimulation and if we were to do a cycle with them we'd have to do the test anyway. However, for the record, the consultant did say that LH and FSH can fluctuate whereas the ovarian reserve test gives a definitive picture about your response potential. Good luck! 
Ellie - Thank you for your encouragement. I'd actually been thinking along the lines you outlined. I just feel I want to go for it and give it my best shot and will probably phone our original clinic tomorrow to ask about staying on their July list even if we go elsewhere in the meantime. At the moment I'm sticking with IVF without egg donation. Have made an appointment for hypnotherapy, just to see what it's like really. It feels important to try everything at this point ... and anything that will help  . 
Glad you had such a nice Christmas with the wee one!
Johan


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