# Follow-up consultation questions



## LiziBee

This thread is intended to help those people going into a follow-up appointment after a negative cycle. Mookie originally started the thread, which you can read here: http://www.fertilityfriends.co.uk/forum/index.php/topic,23451.0.html
Since it's conception (no pun intended) a number of other questions have been added and I felt the time was right to take all the questions and sort them in to some kind of order.

It is a suggested and not a comprehensive list; if you can think of any more please add them by posting below. 
Equally you should not feel that you must ask all these questions of the consultant at the follow-up consultation, many of them may not apply in your case so use discretion. The important thing is that you should ask any question you need to, to feel comfortable (hopefully even optimistic) going into your next cycle - don't be put off by thinking 'this is a silly question' if the answer is important to you then it is an important question!

We hope you find this list of questions useful:


> 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?


Don't forget you can create a print friendly version of this page by clicking on the 'print' button, which is on the right at the top and bottom of this thread.

Finally coping with the effects of a negative cycle is never easy and while time is a great healer so is counselling. Your clinic must provide counselling free of charge to any of their patients struggling to come to terms with the effects of any treatment that has taken place at that clinic. It is within your rights to ask for it and indeed to insist on it.

Good luck and best wishes,
Lizi.x


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## Ermey

Regarding a cycle that failed because no eggs fertilised, I am going to ask:

a) How unusual is this in ICSI?

b) Was it due to poor sperm quality, or poor egg quality?

c) What are the implications for further attempts? How high is the risk of it happening to us again?


Regarding Surgical Sperm Retreival, we are going to ask:

a) Does there come a point when doing more SSRs can cause more harm than good to sperm production due to scar tissue etc?

b) Does there come a point when multiple SSR's poses a wider health risk, eg long term tissue damage, any connections to cysts and growths etc.


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## LiziBee

Thanks for adding those Ermey - I hope the consultant can give you some answers.
Lizi.xxxx


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## Kats

Thank you both for all those questions. Thus far, we have always felt pretty helpless in the consultation after BFN and I am worried that we are not being given the full picture because of this. E.g. we've never been given any advice on further tests.

Kats


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## zozo

HI

This is very useful info ty, Ive just had my first ICSI which failed and I have the follow up consultation as soon as I can bring myself to face it 

Many Thanks Zoe xx


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## Taxmin31

Wow - lots of questions to ask there - think I'll print them and go throug them when I have my consultation on Christmas Eve. 
I didn't realise I could ask all those, I just thought that my first IVF/ICSI cycle didn't work and that was that. I am planning on starting a FET in Feb next year (try and have a few months of normality first!) so will definitely be asking about the drugs and whether I responded as I should, etc. 
I am alos interested in leaving the embryos longer to mature. Does anyone know whether I can do that using frozen ones? 

Thanks for all the very useful info.

Em x


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## desiderata

Very useful list of questions.  We've got a BFN as of yesterday.  
In summary
18 eggs collected
2 fertilized
Initially clinic suggested ICSI but then decided to proceed with conventional IVF
Sperm count & quality reduced at 7%

The questions we think we should ask:
Why didn't they do half IVF and half ICSI and wouldn't this procedure have given us a better chance?
Which treatment type they would advise for the next cycle?



d


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## GERTRUDE

Thanks for these questions, we havnt had our BFN yet but its due on friday! 

very helpful thanks


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## lconn

Not sure whether this is the right area but i've had a consultation after 2 failed icsi.Thinking +ve because even though my DH has sperm antibodies apparently there is still a chance we can get preganant naturally due to sperm antibodies going up and down. Im continuing with drinking plenty of water as well as all my vitamins but if not I'm having another go in about 6 mths so hopefully it happens naturally.


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## nilu

me too got bfp last week only to lose it few days later.Still wondering should I wait a month or two before starting again ?






me 36 DH 39
ttc for 3 years.
first icsi 17th sept 09 and one bfp
m/c at 3 weeks.


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## HopeD

Dear all

Thanks for all the questions and advice. I had my BFN on Monday and have been to see the consultant today, quite soon I know but I needed to know what to do next. Iit was my first ICSI and I had two blastocysts transferred. The consultant said to try again asap due to me having a high FSH so we have booked back in for NOvember, self funding this time, which is hard as I'm sure you all know.

I was wondering if anyone had any advice on how to prepare for round 2?

Hope x


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## lisa_A

hi ladies,

got my first BFN today, this was my second cycle, first time it worked but the baby died.

what questions should i be asking.

8 eggs collected, 2 grade 1 put back an 8 and 7 cell so normal for a 3 days tf. there was also no fragmentation.

i dont know hwy it failed so what should i be asking?

lisa
xxx


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## beachgirl

Lisa   so sorry to hear this cycle hasn't worked  

After my second failed cycle I did a lot of searching and there is a list of things on the investigations area of the forum...will have a look and see if I can locate it.


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## beachgirl

http://www.fertilityfriends.co.uk/forum/index.php?board=52.0

Try this link....might give you some more ideas x


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## Sarahob

great thread ladies..

have got our fu on 14th april following our first bfn...

we thought everything was going well we had 10 eggs, 8 fertilised... 2 transferred at 7 cell and 8 cell ... the other 6 didn't make it to blast so bit concerned if there was a problem in the growth of the two they put back in! 

Thinking of asking to go to blast for next tx, at least we wouldn't have agony of 2ww if the embies don't make it that far!

Got some good questions to ask at fu now!!!

xx


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## julymermaid

Thanks for this ... I have a follow up scheduled this Thursday after a cancelled IVF cycle due to poor response to Fostimon.  Did anyone have a poor response with this drug?
What are the alternatives?


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## beachgirl

July mermaid, just off to work now so can't do a search for any help till tonight, I've not used the drug but hopefully someone can who might know more..


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## julymermaid

Thanks beachgirl .... I'm still not used to FF and finding my way around slowly ...
Appreciate the fab support system that this obviously is and your help ....

Thanks again .....


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## beachgirl

No worries, jsut hollar if you need anything


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## NicolaandDarren

hey ladies!
just found this thread and i hope you don't mind me joining! well we had a BFN in Aug and our follow up appointment in on the 5th Oct! i have a couple of questions but not many!


it was our first icsi cycle (mf) so was happy going along with them but now i want to let them know its my body and i want to know exactly whats going on as well as what could have gone wrong!!!!


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## SR3

Hi NicolaandDarren,

Like you I have just found this thread.  We had a BFN on the 17th Sept and have a follow-up appts on the 4th Oct.

It was our first ICSI cycle and we also now feel that we have lots of questions which they can hopefully answer.  We too want answers and not just be fobbed off with things like 'at your age we will put you on Gonal F and Short Protocol.  What if that wasn't what a needed ??


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## NicolaandDarren

its frustrating!!! we have just had to cancel our follow up and DH has been called to Japan for 2 weeks with work leaving on the 2nd!!! not the best time as been waiting 5 weeks for this appointment now!


getting cold feet about next cycle and this first go was not pleasant at all!!!!!


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## franmc

Hi All

I had 2 ICSI cycle but jsut on teh 2nd one I had the ET of 2 blast. the 1st cycle had 44 eggd collected, 26 fertilized and frozen (because i suffered of OHSS after EC). when ready for ET all my embrys died. Just finished the 2nd cycle and had 2 blasts transferred. got a BFN. SOOOOO disappointed but i m fine...i m taking it as another expereicne becuase ther is not too much we can do about.
i need to get a review appointment but i dont know when i ll eb able to face the clinic again. I did not have a great experience...they even didnt tell me the quality of my blasts when they implanted them so i feel a bit wierd about it. I had 16 eggs collected and 13 fertilized, at day 3 most of them were at 8 cells stage so doc decided to go to day 5 and to transfer just 1 blast. But on day 5 there were just 2 blasts and they decided to implant the 2. I think probably ebcuase the quality was not great (but why not telling me the truth?) or becuase of my past bad experience with freezing them.

what dou think?

i want to try again, but this time i ll go with teh NHS...i m looking forward to it.

fran


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## beachgirl

Fran, sorry to hear about your negative cycle , most clinics follow up a cycle with a letter which should have all the relevant information such as number of eggs collected, sperm count, number fertilised and so forth..


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## mandy71

Hello everyone
I'm new to this site, posted for much needed advice at the weekend after first cycle and negative pregnancy test, and had such a helpful response. I just saw this thread and would appreciate anyone's advise about what to ask in our follow up. In summary we had our first cycle on long day 21 protocol, very good response apparently with 12 eggs over 17mm, 9 of these fertilised, 3 got to blastocyst stage (and one other possible - they said they were't sure about this one) I don't think it was where they inject the sperm in, just where they put it all together.
The best two blastocysts were stage 3 and 2 and were transferred, the other 2 frozen. All seemed to be going so well and then negative test result and monster period. Can't figure out what happened. 
So we are now waiting for our letter to arrange follow up. I don't know really what to ask (what I want to ask is what the hell went wrong! But I don't know what is realistic here to ask) 
Are they always able to say what went wrong, or what could be better? I don't drink or smoke (although I did used to, gave up for this), had hardly any caffeine over the last 6 weeks, no lifting etc etc. I'm 39, partner 36. All pre treatment tests were done and were normal for us both, is classed as 'unexplained infertility' because we have been trying on and off for 12 years and consistently for 3 prior to referral and consultation at hospital.
Any advice? 
Many thanks
Mandy xx


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## Han72

Hi Mandy

so sorry to hear of your BFN     there is a list of questions to ask at a follow-up on the first page of this thread. You may need to change or omit some of them, depending on your circumstances but it's a good place to start.

Good luck for the future hon 

xxx


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