# What to ask after failed ivf cycle?



## nudge (Oct 16, 2008)

I know I have seen this somewhere, but  darned if i can find it!  Can anyone help or suggest some questions?  Desperate to know everything i possibly can - feeling very odd after failed tx - whihc i suppose is to be expected.  Thanks fro help!


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## MrsYG (Oct 30, 2007)

*Is this what you are looking for?.....*

1. What were the main factors that contributed to this negative cycle?

2. What are this clinics success rates for couples in our position (taking age and diagnosis into consideration)? And what is that statistic nationally?

3. Eggs:
a) How was the quality of the eggs? (Were they mature enough?)
b) Were there as many as you were expecting?
c) Would having egg collection a few days earlier or later help?
d) Would more monitoring during the stimulation phase help you to control my drugs better (and thus get a better result)?
e) Is there anything else that can be done to improve the eggs?
f) Can we still do egg share? /Should we consider using an egg donor?
(If you were the donor in an egg share scheme you might want to ask how the recipient did, some clinics wont tell you directly but they can give an 'indication'.)

4. Sperm:
a) How was the quality of the sperm?
b) Had the count, motility or morphology improved at all?
b.ii) Is there anything that can be done to improve this? 
c) Would we get better results with SSR?
d) Should we consider donor sperm (or 'donor back-up')?
e) Should we consider an appointment with an urologist? (Whom would you recommend?)

5. Embryological questions:
a) How did the embryologist feel the ICSI procedure went? (E.g. was it easy to find sperm of good morphology in the sample?)
b) How well did fertilization go? (E.g. more quickly or slowly than expected)
c) Did any fertilized eggs produce unusual results? (E.g. 3 nuclei)
d) What was the overall quality of the embryos like? 
e) How do you grade them/what is your opinion of grading vs. live baby rate?
f) Does any of this suggest any issues?
g) Could assisted hatching help us?
h) Would delaying transfer (or carrying it out earlier) have helped?
i) What is your opinion on going for blastocysts next time?
j) Can the embryologist remove the fragmentation in the embryos?
k) What do you feel the link is between fertilisation rate, embryo quality and live baby rate?
l) What is the policy with regard to freezing/frozen embryos?

6. The drugs:
a) How do you feel I responded to the drugs for down regulation? (Did it take longer or less time than expected?)
b) How do you feel I responded to the drugs for stimulation? (Did I respond too quickly or too slowly? Did I produce enough eggs? Did coasting for a few days effect egg quality?)
c) Did the trigger injection work as expected? (Should I have taken it earlier or later for better results?)
d) Do you feel I am on right drugs at the right dose or should this be changed next time?

7. Further tests:
a) Are their any further blood/hormone tests you would now recommend? (E.g. FSH, E2, etc.)
b) Should we test for immune issues?
c) Should we test for sticky blood?
d) Should we have any further genetic tests?
e) Would you recommend having a hysteroscopy? (Why?)
f) i) Would there be any point to do PGD?
ii) How many embryos to you need for this?
iii) What are the risks involved?
iv) Is each embryo tested for one genetic disease or 9 of the listed diseases?

8. Next cycle:
a) When can we try again? (Why then?)
b) i) Which drugs for down-regulation? 
ii) Why do you feel this one would be better? 
iii) What dose?
e) i) Which drugs for stimulation? 
ii) Why do you feel this one would be better? 
iii) What dose?
f) Would you recommend any additional treatment this time? (E.g. low doses of aspirin, IVIG, heparin, etc.)
h) How would you rate our chances of success for this next cycle?


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## nudge (Oct 16, 2008)

Thank you - yes!


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