# Completely mind-blown by Penny at Serum - would love your opinions ladies!



## coldhandswarmheart (Nov 22, 2014)

Hi there
Just looking for some advice or thoughts from any of the lovely over 40's brigade....

I'm 41 and in a total 2 years of trying and after 2 miscarriages (from natural conception pregnancies - one very recently) and 2 failed IVF attempts (on high doses of drugs), I'm in a total quandary about what to do and where to turn next.

In the middle of the usual trawl of the IVF clinics, weighing up money, distances, protocols etc to decide on our 3rd attempt, I had a great phone conversation (first consultation) with the lovely Penny at Serum. She blew my mind completely by what she said:

The gist of her theory is this:
- in my particular circumstances, that is, my age bracket, my AMH/FSH levels, which aren't bad for my age,  no obvious issues in either partner, 2 natural pregnancies on our own and none on IVF - what is it that IVF is actually doing for me that we can't achieve on our own? She suggested doing a number of very detailed blood tests (the period blood ones for those that know them!), and then possibly a hysterospcopy or similar, just to cross off all other possibilities and then to just "go away and try naturally on our own" for 4 - 6 months. 
Her theory is that although IVF is obviously the answer in some circumstances, particularly in younger women where they are producing larger quantities of eggs and therefore can achieve a choice, or blastocyst or PGS screening or whatever, in cases like mine where much lower numbers are involved, IVF as a procedure is just not really achieving anything that we cannot do for ourselves.
She also (interestingly and possibly controversially!) says categorically that high doses of stimulation drugs has an impact on egg quality in older women.
I asked her about lower dose stims but again she said she couldn't see the logic of putting myself and my body (as well as the expense) for odds that ultimately were almost the same as if we tried for longer on our own. She kept using the words "proven fertility" about us.
She also said that after that time frame, 4-6 months trying on our own, then the best thing would be to think about donor. Which again blew my mind, not in the sense that I was surprised she mentioned it, more at the fact she is simply ruling out IVF altogether.

She also kept saying, 'I'm being honest because I don't take money from people for the sake of it" which frankly, given the money- haemorrhaging situation we've been for the last 2 years, was like a breath of fresh air!

So, yes, mind well and truly blown.

We then had a consultation with another lovely Dr, Dr Hall at City Fertility, who although initially had a suggestion for trying lower stims, possibly back to back cycles to try and freeze (she then admitted this would be tough and probably unlikely to achieve results as we'd never got to blastocyst before and so this could be a sort of all for nothing route),  also suggested getting a few things checked (karyotyping etc) and then trying on own again, perhaps with clomid (which I've never taken) and a monitored cycle. So basically the SAME!

My mind is scrambled. Initially it was a great feeling, sort of having the situation almost handed back to you as couple to have a bit more control over, and also feeling the pressure and weight of time and money etc being lifted for a while, amazing.  But then this morning masses of the horrible ticking clock nightmares started to kick in about thinking we have to do SOMETHING, not just be trying naturally.

What they have both said makes total sense to me - I do agree that possibly IVF isn't really technically achieving anything for us and the numbers bonus you would normally get just doesn't factor into it for us. They also both mentioned it would probably be a good idea for me mentally and physically to have a bit of a break, having had 2 failed IVFs and a miscarriage in the space of 4 months, which feels great to sort of have the permission to take the foot of the gas for a bit and get my life back.

But I just don't know now, I really don't know......

I'd love your thoughts ladies if you had a sec
Thanks so much xxxx


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## Greyhoundgal (Oct 7, 2013)

Coldhands

As a serum lady I can't recommend them enough   I wish we hadn't wasted time elsewhere   All the staff at serum are fabulous - penny has recruited a great staff to work with her and her husband Thimmios who is the embryologist.  We got pregnant our first cycle with them (I've never been pregnant before) but sadly miscarried but it was a massive step forward for us. We are back for an FET in about ten days time.

I honestly believe that if serum can't get us our family then I'm not sure who can. We like their tailored and personal protocols and we seriously doubt that anyone else would answer the number of questions we have had since last June when we first set out with them  

Ultimately it's down to personal preference. I don't think cost comes into it massively as you would probably try more with serum so it might cost the same in the end plus the hotels and flights but for me it's preferable to the treatment we had in the UK.

Good luck making your decision - whichever way you choose will be right for you  

Grey xx


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## berberprincess (Oct 8, 2013)

Hi, it's hard doing nothing so to speak. When you want something to happen so badly you just need to be doing SOMETHING. Have you thought about close cycle monitoring, duofertility or similar Never used it as they don't work with iPads which is all we have otherwise I would have done. I was in similar situation and did a few mid cycle scans to check I had eggs there. It was £60/scan and gave us reassurance we weren't wasting our time. Best of luck BP XX


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## urbangirl (Jul 28, 2010)

I would try the tests she suggests, a lot of women here find out they have latent Chlamydia and it seems it can be an issue for some.  I am wondering- what is your amh & fsh, how many follicles did you get from stimms and what dose were you on, as two -3 embryos seems very low. That is my perspective as a woman with an almost zero amh. Maybe the protocol they used wasn't right for you. I think that Peny's train of thought is that for the over-40's, if they're got pregnant a few times but miscarried/ had chemicals it must be an egg quality issue. I don't agree but that's just my view. 
I would look into - optimising health to help egg quality with vits and acupuncture (quality issues other than dna), do the hysto & maybe check out the basics of immunes such as clexane, pred, and the egg infusion (can't remember- everyone here will know though). If you do do another IVF you could try pgs. 
Some women have had success with fets after failures with fresh, the explanation suggested being that the stimulation drugs affect the endo in a negative way and a month gives it time to recover. IVF and all its peripherals are so expensive, if you make the decision to go back to just trying naturally it will certainly save you a lot of stress!


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## CrazyHorse (May 8, 2014)

If you are wanting to take some time to try naturally, that's also a good opportunity to take supplements for a few months to optimise egg quality if you do go for an IVF cycle in 4 - 6 months' time.

In addition to the standard prenatal multivitamin, I would suggest 400 or 600 mg. / day CoEnzyme Q10, 4,000 iu / day Vitamin D, and 2 - 3 molecularly distilled fish oil capsules / day (I like the BioGlan ones), and a handful of Brazil nuts every day (for selenium, plus more healthy fats). The Lister is big on CoEnzyme Q10 (I think they usually recommend 600 mg / day), and I think they're right that it improves egg quality. None of the above are unsafe if you conceive, either -- i.e., you can keep taking them after ovulation.

If you don't have a history of PCO(S) or symptoms of high testosterone (e.g., adult acne, more body hair than average, oily skin persisting past your 20s), you might also consider micronised DHEA. I was reluctant to start DHEA because I do have a history of mildly elevated testosterone in my younger days, but decided to give a small dose a go before my most recent IVF cycle, on the understanding that I would stop if I started having a bunch of acne or other signs that my testosterone was getting too high. Anyway, I had really excellent results (for me) on my recent mild IVF cycle; this was after about a month of taking 25 mg DHEA / day. IVF clinics that recommend DHEA usually recommend 75 mg / day, and say you need up to 3 months to see the full effect. Opinions are mixed on whether to take after ovulation on a cycle where you are trying to conceive -- I believe some IVF clinics actually keep you on it past BFP and wean you off, so most probably it's one of these cases where there's no clear evidence of harm, but no large body of evidence to conclusively demonstrate safety in pregnancy. You may find the info here interesting: https://www.centerforhumanreprod.com/services/infertility-treatments/dhea/benefits/

The other thing you might consider trying before your next IVF cycle, if you have another one, is wheatgrass juice to help lower your endogenous FSH. From the reading I've done, it seems like ladies have more success using the frozen juice rather than powder, so I drank a shot a day of the frozen stuff (purchased here: http://www.bigjuiceltd.com/). Fair warning: it tastes like what I imagine chewing lawn clippings would. Not horrendous, but not nice. I preferred to just defrost it and gulp it down all at once. If you use wheatgrass, you MUST stop it when you begin stims, because you want your FSH to go up at that point.

Gail's quite right about high-dose stims cooking your eggs. On my recent mild cycle, I had 75 iu /day Menopur plus letrozole 2.5 mg twice/day, and got better quality embryos than I ever had with higher stims. (PUPO currently.)

Wishing you lots of luck! Believe me, I know how exhausting all this is. 

This post contains an unconfirmed link/information and readers are reminded that FertilityFriends.co.uk or its owners are not responsible for the content of external internet sites


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## coldhandswarmheart (Nov 22, 2014)

Thank you so much all for your wonderful thoughts and suggestions - so helpful.

My AMH is 5.2 and my FSH 6.7, so all in all I thought for my age and from what most Dr's have said, not too horrendous. First cycle on high stims I had 7 eggs retrieved but a big drop off rate and so ended up with 2 to put back, nothing else to freeze or whatever, and the second time on even higher stims (on advice of clinic I'm now beginning to really think in hind sight were useless) had 5 retrieved and 3 put back and all put back on Day 3, no chance of blasts, no chance of freezing.

I would definitely be interested to see if much lower dose stimms made any difference - my hunch is that it would, but would it be enough of a difference to justify going through it all again? ie if I ended up with 1 or  2 to put back that would be great, but would the quality actually be any better?

I'm currently on 600mg CoQ10, 1000iu Vit D, and the NHP Fertility Support (inc folic acid, vits, etc). 

Can I ask you CrazyHorse about DHEA? I'm really keen to give it a go - although slightly alarmingly the Dr I saw at City Fertility thought I meant DHA which is a fatty acid nutritional supplement and said I must have the name wrong! - can you let me know the best suppliers/type to take? There seems to be a whole load of different info about where and how to buy online - I'd be really grateful for any tips! I'll also look into the wheatgrass - I'm pretty good with those type of things generally, especially after months of vegetable juices, so thanks for the tip! Fingers crossed for you on your result soon too! Keep us posted!

And yes, deffo the more I read the more I am so horrified at the levels of stims I was on. But what do you do? A very well respected IVF Dr is sitting there telling you it's your only chance of producing more eggs, getting better results and getting a baby - at that point I don't know about you, I'd have sold my soul for that to happen, let alone pump my body with a load of hideous drugs.

So I think on balance we're probably going to wait it out a bit, probably until I go nuts, and in the meantime, run all the Penny tests, get on the vits, supplements etc and give it a go. I think if nothing else it might give us a few months to try to think about something else - is that really possible?

Thanks so much again for all thoughts....
x

Thank


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## CrazyHorse (May 8, 2014)

I bought my DHEA tablets from DHEA.com, which ships from the U.S. I will say that I have had no side effects whatsoever from the 25 mg / day that I was on. 

Your AMH and FSH stats are encouraging, as is the fact that you've managed to get pregnant before! Based on your sig, it sounds like your embies also had pretty low fragmentation as well. 

Have you looked into NK cell testing? I don't know if you have any history of immune system issues, but given your two early miscarriages it might be worth looking into. The price can be steep if you go through someone like Dr. Gorgy, but you can order blood tests direct using a service like Blue Horizon Medical, or you can get it done much cheaper abroad (I'm awaiting the results of the test from my Czech clinic, but taking prednisone and intralipids in the mean time as I have a long history of an overzealous immune system).


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## berberprincess (Oct 8, 2013)

Hi cold hands just to add, I had fairly low dose stims (300 gonal f)as my amh is rubbish, it was my one and only ivf cycle as it felt Id taken the most expensive contraceptive drugs ever as my ovaries shutdown totally. I had zero follicles on day 12!!! Gutted. Yet I then went on to get pregnant with clomid and no other assistance.i had early miscarriage but still did much better on this than ivf.  For me anyway, and my scarce eggs, ivf wasn't the answer. Hope things go well whatever your decisions. ️Xx


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## Keeping busy (Apr 13, 2011)

I haven't read the whole thread but has anyone suggested iui? Might be a good option for you xx


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## coldhandswarmheart (Nov 22, 2014)

Hi, thanks Keeping Busy. No-one has suggested IUI at all, never even been discussed, but I wonder if it might fall under the same theory in some ways as IVF in that, what would it be doing for us that we can't do for ourselves (and have done to get 2 pregnancies?) I guess the monitoring etc would be closer but again, wouldn't we get that from a monitored Clomid cycle? I'm sure you know alot more than me about it though, so would be glad of your thoughts on it...

Thanks princess - that's so interesting about your low dose IVF cycle vs Clomid. Kind of my thoughts exactly and I think what we are leaning towards. So sorry to hear about your miscarriage, do hope you have much better luck coming your way soon xxxx

Crazyhorse - Thanks so much for suggestion - I have actually done NK assay tests (the hideously expensive ones - eek!) which came back all clear apart from slightly raised NK cells  - 18% where 15% is the cut off for "normal" level.

In the meantime I've just sent my delightful period blood test off to Penny at Serum - even if we don't decide to take it any further with her, I'd like to cross those infection possibilities off the list. One more (tiny) thing we can control in this hideous uncontrollable situation.....
x


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## urbangirl (Jul 28, 2010)

CHWH 5.2 is a really good amh, what was your AFC? Maybe you could get more eggs becoming good embryos with diet changes etc. I thought DHEA was mainly for women with low reserve, which you don't have, but not sure on that point. You should check your testosterone & SHBG levels before taking it. Low stims can be worth it, I got 4 eggs on one cycle but just two on others, you never know how it's going to work out, and maybe you would get some embryos going to blast. If you had a good afc count at the beginning of your cycle it would be worth trying.


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## berberprincess (Oct 8, 2013)

Hi, I removed my previous post as it sounded horribly smug. Basically I've had another clomid BFP this morning !!! We did nothing but clomid, supplements including DHEA, traditional Chinese medicine and good old fashioned bedroom action!!! My consultant discouraged us from IUI saying it only overcomes poor motility ( DH has excellent motility) and said not to waste our money (£1000/go). So the low tech approaches for us are definitely better, so  keep the faith CHWH!!! Xx BP


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## churchmouse41 (Jan 10, 2014)

Hello. My stats and age were similar to yours. I went straight to 'mild' Ivf on 175 Gonal F. Obviously I don't know what would have happened on high stims, but I do know from the two rounds I undertook I had 12 usable/freezeable embryos - from 11 eggs collected on round one and 13 on round 2 (4 were immature on the latter). All 8/9 cell on day 3 (I didn't take them to blast). They all looked good. I found the magic egg on my third transfer - I'm 38 weeks on Wednesday. 

As you say it's hard to know what's best. On my successful cycle I was really doubting my decision to stick with a mild protocol but it worked and was undoubtedly easier on my body even if I will never know whether it protected egg quality or not. 

Given that you've responded before, it might be worth considering. I'd also mention that I'd tried naturally for 18 months on the diet of a Tibetan monk with millions of supplements, reflexology, acupuncture - the works. It wasn't happening on its own although I know plenty who have got lucky!

Good luck with whatever you decide. 

CM


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## Tigger99 (Dec 15, 2012)

I just want to chip in and say I had  a similar  conversation with penny after she put DH on her sperm improving protocol. I couldn't believe it when after over 2 years of ttc naturally (with zip apart from one short lived chemical) she said to carry on ttc naturally. She was right. I was pregnant naturally within the same month!! It wasn't meant to be as I had a mc but penny was right. Have faith. She's usually right. 

With regards to the line that ttc naturally is  'doing nothing' then I'm afraid I disagree! Ttc successfully was and is hard work. Lol!! We took ttc to the whole next level with a cbfm to indicate when to start in earnest and we didn't stop dtd every day until the day after my temperature went up. It was knackering but it worked.


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## Asja (Oct 8, 2013)

Tigger99, what was the sperm improving protocol?


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## Caroline1759 (Sep 10, 2009)

Hi all

Just been reading back through this thread and now I'm worried! Had never heard the theory about high stim drugs affecting egg quality in older women. I'm currently on DR with the plan to start stimming on April 8th for a cycle of IVF . When I had my  initial consultation at the Lister I specifically asked about whether there were any differences in treating older women and was told there was no difference and the treatment was exactly the same as for younger women. 

Really worried about this now and wish I'd seen this sooner. Think I'll try to call my consultant tomorrow.

Happy Easter by the way! 

C xxx


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## Altai (Aug 18, 2013)

Caroline - I don't think Lister will put you on a high dose protocol.
When I was with Lister  - the max was 300u. With Peny (Serum) I was once on 450u plus 2 letrozoles, the other 3 cycles with her I was on 300 u plus 2letrosoles. So, overall the dose with Serum was much higher than with Lister. 
I am now doing mini  ivfs much lowers doses. Unfortunately I can't say that resulting embryos were better quality   quite the opposite. 


I only found  one research which claimed that low doses gave higher prg rate but that was for good prognosis patients under 38.


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## coldhandswarmheart (Nov 22, 2014)

Hi Caroline

Happy Easter to you too!

Honestly, you shouldn't be too worried about the "high dose/low egg quality" theory. Every Dr we've spoken to (and we've spoken to a-lot!) has a different opinion on it, with every possibly explanation from every side of the argument - e.g  low dose means you get the eggs that would have been selected by your body anyway, therefore they're "better" - vs -  higher doses are simply better as you get more numbers to play with - vs - older women's eggs get "cooked" by too many drugs- vs - older women need more drugs to get their ovaries going... and so on and so on and theory in-between!

In the end , I think the one that I sort of felt like made the most sense, was the idea that there's almost a "bite point" for most women with FSH drugs but that this varies from woman to woman, ie that beyond a certain level, higher doses don't really do anything more, so what's the point in taking  more? It's just that sometimes they have to adjust the dose each cycle to know where that is. 

Essentially, my DH have decided after all these meetings, that for all the amazing amount of knowledge Dr's and specialists in this field have - no-one really knows anything! They honestly don't know why miracles happen for one person and not for another.

I'm sure your Dr has sorted you with the right doses for your stats.

Really good luck on your journey
xxxx


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## CrazyHorse (May 8, 2014)

coldhandswarmheart said:


> In the end , I think the one that I sort of felt like made the most sense, was the idea that there's almost a "bite point" for most women with FSH drugs but that this varies from woman to woman, ie that beyond a certain level, higher doses don't really do anything more, so what's the point in taking more? It's just that sometimes they have to adjust the dose each cycle to know where that is.


Yes, this is largely what I think too. I do think that some older women's eggs (incl. mine) are much more adversely affected by higher dose / longer stimming periods, but it's really variable, and unfortunately experimentation is required to find exactly what works for you.

Not what anyone wants to hear, is it! But the most honest doctors will simply admit that there's an enormous amount of trial-and-error in IVF treatment.


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## coldhandswarmheart (Nov 22, 2014)

Wow CrazyHorse - I've just seen your signature and realised you're pregnant! Congratulations! That's amazing, well done and massive good luck for the rest of your journey...

Do you mind my asking where you went for your 4th cycle (which looks like your best one?) and if they changed anything at all?

Thanks so much
xxxx


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## CrazyHorse (May 8, 2014)

Thanks, CHWH.  I went to Reprofit for my most recent cycle and had mild IVF -- 75 iu / day Menopur plus 2 letrozole tablets per day, no GnRH agonist or antagonist, except for some Cetrotide at the very end to prevent ovulating before EC. I stimmed for about half as long on this cycle, and had excellent embryo quality with little to no fragmentation. If I have to do this again, I will definitely do the mild IVF again!


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