# Questions to ask after failed treatment



## Sweets_D (Jan 23, 2012)

Hi there,

I am looking for advice from other's who have had a failed cycle. 

I'm now 11 days past ET, but have been bleeding heavily since the evening of day 9 (which would have been the date I would have been due for my AF anyway had I not had treatment). I have spoken with the clinic & they have said to continue with the pessaries & test on day 13. They advise that all may not yet be lost, but I _know_ myself that's it "game over" with the colour, the amount & the clots i'm losing.

So at this silly time of the morning,  I have now decided it's time to get practical & try to rationalise what may have gone wrong & to request a follow up appointment with my consultant. I know IVF is a game of chance, but if I can be prepared with questions to ask, maybe a solution can be offered for if we try again. 

Something I have been concerned about throughout my treatment is that I have never had bloods taken although all the patient information included within each of my various meds have said this is importment. Guess I shouldn't be leaving it until now to ask why I haven't had blood tests. Just wondering if other ladies have been monitored throughout their cycles? Or is it because of the regular scanning, blood tests were not required as I showed I was responding favourably?

My next concern was the ET. As far as I'm aware, ultra scan was not used to assist this procedure. I think it was done more by guess work. Again is this normal or recommended? There was a moment during ET that a slight panic started when the catheter was bending as my "muscles were tight" - they seemd to get quickly past this though by using a stiffer wire to help. We know the embryo's went in, but did they end up in the right position if scan support was not there to help check?

Whether or not intercourse is recommended following ET seems to be another area of confusion. A lot of my cycling buddies were told it's a definite "no" during this time - my clinic said that after ET, "it is OK now to have intercourse". Have I messed it all up this way 

The next thing I'm considering after that is the progesterone support. I was given cyclogest pessaries & told that either route was just as good, but possibly the rectal route might be better for absorption & ease. Would i have been better off using the vaginal route? Would this have gotten the hormone right into the area needed? I've since heard that some other clinics offer a blood test during the 2ww to gauge how much progesterone is in the system & subsequently increase the dose if it's low (quite often doubling the pessaries each day and even adding a gel). Again this is something I have not had tested. Following the start of my bleed, I rang the clinic as soon as I could for advice... I asked them if checking my progesterone would be benefical as some women who start to bleed very early following ET are often given an increase to their dose. I was told this would not make a difference.

As i mentioned earlier, my bleeding started bang on the day my period would have been due had I not had treatment. Maybe I'm mistaken here, but I was under the impression my own natural cycle should have been surpressed & unable to take over the treatment due to all the hormones I had injected? Was this down to ET being too late in the cycle (day 20) or again possibly something to do with progesterone (or both)?

To summarise: Short protocol, 12 days of fostimon, 6 days of cetrotide, ovitrelle & cyclogest.

Should I have had regular blood test monitoring?

Is it better to have scan assisted ET?

Has intercourse effected implantation/outcome?

Progesterone; which route is better? Should my levels have been monitored? Should I have been offered to increase dose when bleeding started?

How did my natural cycle over take IVF cycle?

Was ET done at the right time or was it done too late?

Anyway, I'm now getting too tired to think straight anymore - not that I was before I started this. I will probably come back here later on & cringe at what I've written 

If anyone has got this far with reading & can offer their take on my cycle/treatment, I would really appreciate your responses. Perhaps someone can think of something I haven't. I've gone from 2ww  to just plain 

Wishing good luck to everyone in whatever stage of their journeys they're in  

Sweets x


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## Oceana (Aug 31, 2010)

Hi Sweets,
Sorry this time wasn't successful for you but you have a lot of good questions. I'm a practical person myself so I understand the importance of asking the questions. I'll try my best to stear you from what I have learn't.

*Why haven't I had blood tests?*
As I was over 40 when I started IVF my IVF specialist when I started made the comment "We can take some time running tests to investigate if there is a specific issue or we can get started right away and see how we go." 
In hindsight I see this statement he made was actually inaccurate. We could have easily done both at the same time. 
You should have all the basic level one immune tests done as a minimum. There is treatment for a lot of typical issues such as blot clotting issues and it seems silly to waste money on somthing that won't work if you were identified as having an issue when you could have been given medication to rectify the problem. Responding favourably to egg stimulation is totally a different thing to implantation.
*ET*
I thought it was general practice to use an ultrasound to assist guiding the embryo's to the correct area. (Or a similar camera devise that shows the path ) although on the ultrasound you dont see the embryo's as they are too small you do see the fluid that surrounds them on the ultrasound when the fluid is released. The embryoliogist then needs to check under microscope to make sure that none of the embryo's were caught in the devise and didnt make it out. (I've had that happen once)
I would have concerns with a rough transfer as there is research that suggests that when a catheter ends up with blood on it during the process of a rough thransfer that the results tend to be not good for it working.
*intercourse*
There is still mixed debate on this one but my clinic says no for 2 week wait and up to 6 weeks after a positive result. This is due to risk of infection causing problems and some saying an orgasm can cause issues. As I said still no definate on it but a lot of people fall on the side of caution just in case

Progesterone
If at the end of a 2 week wait you get a hcg level done I would ask for a progestrerone done at the same time. I have never had a bad reading though so dont know a lot abut this area.

Should I have had regular blood test monitoring? Not usually done usually only at the end of 2 week wait but I would definately look at having some test done like the immunes I suggested.
Is it better to have scan assisted ET? I would say definately yes
Has intercourse effected implantation/outcome? The debate continues on that one
Progesterone; which route is better? Should my levels have been monitored? Should I have been offered to increase dose when bleeding started? If the bleeding is from periods from the cycling not working then increasing the dose will not fix your problem. I wouldnt suggest its your biggest issue at this stage. It is best tested at the end of a two week wait.
How did my natural cycle over take IVF cycle? Often people will get their periods during the 2 week wait if it doesnt work. That said you are often advised to continue medication incase you have a late implantor (it does happen) in those cases often the period disappears sooner than normal or goes lighter quicker.
Was ET done at the right time or was it done too late?
ET's can be done too late as your body will have a "window of opportunity" I cant say if that is your case however.
Best of luck


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## Sweets_D (Jan 23, 2012)

Thank you so much Oceana for taking the time to not only read that marathon of questions, but to give me such full answers too.

You've been brilliant  

Lots of      coming to you

Sweets x


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## jayloutee (Feb 24, 2010)

Hi Sweets

Sorry to hear about your recent negative cycle. You may not be at this stage in terms of attempts and immune investigating but the wonderful agate has put together a list of questions that you should consider at yout follow-up appointment. 
You can find it here: http://www.fertilityfriends.co.uk/forum/index.php?topic=283000.0
As I say, its very comprehensive and may not all be relevant to your circumstances but very interesting read indeed.

Good luck for the future xx


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## Sweets_D (Jan 23, 2012)

Thank you lovelychops, that is brilliant! (thank you agate  )  

Sweets xx


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