# 45 years old about to start ivf but what London clinic?



## Pinkhat1 (Nov 16, 2014)

Hello

Looking for advice and your recommendations.

I am 45 years old (46 in March next year) and my husband and I want to start IVF but are not sure what clinic would be best for us.

A bit of background: was at a clinic in Surrey and was about to undergo IUI using donor sperm (and my own eggs) but then after a hycosy procedure discovered I had both tubes blocked.

Now my options left are IVF and want to change clinics as I don't feel confident the clinic in Surrey any more (for various reasons).

So therefore does anyone have experience with ARGC or Lister or any other clinics in London? Would greatly appreciate your help and advise please.

Thanks in advance.


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## nevertoolate (Jul 15, 2015)

Hi
I wish you best wishes with your journey. I have heard positive things about create who are also in london.
Xx


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## Pinkhat1 (Nov 16, 2014)

Thank you dreamingofBFP for your suggestion. And good luck too!


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## Wonderthecat (Apr 23, 2014)

It really depends on where you are in London because it an be really stressful trying to negotiate clinic scanning and blood testing times with commuting. 

If you are South of the river, I'd go:

1. Create
2. Lister

Good luck on your journey x


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## Pinkhat1 (Nov 16, 2014)

Wonderthecat- thank you very much. I'm south of the river so Lister and Create are in good locations for me.


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## Wonderthecat (Apr 23, 2014)

You are welcome.

Perhaps you should go to their open days and get a feel for the staff/clinic? 

In the end we were persuaded by the milder approach and that one cycle with the Lister was roughly the same as a 3 cycle package with Create. You pay a bit more for the swankiness of the Lister. One friend was successful there.p and another at Create. In the end, go with your gut.

Wishing you every success on your IVF journey,

X


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## miamiamo (Aug 9, 2015)

If you are open, consider ivf abroad. Look at international boards http://www.fertilityfriends.co.uk/forum/index.php?board=261.0 you will find reviews and comments also from current users. Good luck


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## Claudia H (Oct 2, 2015)

Hi - I did IVF at the Lister. They have good success rates. If I were you, (and of course its your choice) i would spend some time on the HFEA website and look at the various success rates for the different clinics. I wouldn't worry so much about the commute, it may be an inconvenience but its not for long and I'd go wherever gave me the best chance. If you get pregnant you won't be sorry that you had to suffer a few traffic jams. 

You might be best off at ARGC as they have about the highest success rates in the UK - mainly because they do a lot of double embryo transfers which other places don't (for good reason). But if you are 45 and trying with your own eggs that might be your best option. 

good luck!


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## Bluebell82 (Jan 24, 2015)

Hi Pinkhat,

Ladies aged 45 and over have a 1.2% success rate nationally.. You probably know that very well. 

It doesn't seem to make a massive difference which of the London clinics you use (ARGC had 0 life births from 21 cycles for your age bracket in the most recent period, which means they aren't massively better than anyone else for your case. Lister was a very pleasant experience in terms of staff and facilities.
Good luck

Also wanted to defend ARGC. Their live birth rates per embryo transferred are 34% better than those of the average UK clinic (and 50% more babies are born per ARGC embryo compared to a Lister embryo, my husband is a physicist and just crunched the HFEA stastics numbers). And this is on patients who have 75% of the time failed at those average clinics. 
So double embryo transfer is just one tool out of many for them to achieve their amazing success rates. They for example have almost no cycles that are cancelled due to poor stimulation or lack of embryo development and most ladies observe improved embryo quality compared to previous cycles, more mature eggs retrieved and more embryos to freeze for subsequent FETs.

Also some people won't mind twins after prolonged IF journeys. I know that ARGC embrace elective single embryo transfer if people ask for it.. It's just most ARGC patients have long given up on SET because of not being successful at the very clinics that criticise ARGC, clinics that produce lower quality embryos and fail to achieve implantation of chromosomally normal embryos. 

Also of note is that despite ARGC transferring 2 (and 3 embryos for ladies >40) most of the time, 63% of all ARGC births are singletons. Showing that for many ladies double embryo transfer helps them deliver one baby.


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## Claudia H (Oct 2, 2015)

Look at the full picture yes, which I why I said if you are over 45 ARGC is probably your best bet as they do a lot of DET. However people should also be aware of the risks of DET - if it leads to a healthy twin birth then obviously that is great, we would all love that, but the point is it also increases the risks of other traumatic events that we wouldn't wish on our worst enemy. It's a personal choice whether you want to take that risk or not. ARGC have great success rates - and if I was allowed to do DET (which I'm sadly not), I'd be very tempted myself as obviously the more you put in, the more likely it is that one will stick. But the centre is not without controversy, and people going there should also be aware what the HFEA said about them in the last inspection in 2014:

_'The Panel noted that at the time of inspection one critical and four major areas of non compliance were identified. The Panel noted with concern the recurrent nature of some of the non compliances and that four of the timescales for action have already passed without the centre taking action

'The Panel was particularly concerned about the critical non compliance relating to multiple births. A multiple pregnancy is the single biggest risk of fertility treatment. The Panel agreed that the non compliances relating to multiple births require action from the Person Responsible (P
R) to mitigate future potential risks. The Panel noted that the Inspectorate plans to engage with the PR to determine how the centre's multiple births minimization strategy should be reviewed to ensure that the centre does not exceed the current maximum multiple birth rate of 10%. The Panel agreed that if satisfactory progress is not made in reviewing the strategy and reducing the centre's multiple pregnancy rate by 11 September 2014 then the Inspectorate should consider whether it is appropriate to take further regulatory action in line with the Compliance and Enforcement Policy.

The Panel was deeply concerned about the lack of response from the PR on the draft inspection report, particularly given the number of times the Inspectorate attempted to make contact by sending three emails and making five telephone calls. The Panel also agreed that the absence of a response demonstrates a lack of engagement with the HFEA and the findings of this inspection.'_

anyone who is interested can read the full report on the HFEA website.


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## Bluebell82 (Jan 24, 2015)

Hi Claudia, 
In my opinion then single biggest risk of fertility treatment is spending money and effort and remaining childless. But that's obviously a personal view and not shared by HFEA officials. 

My remarks were for patients who in principle can carry a twin pregnancy, I'm sorry that I didn't consider you and other cases (e.g. With cervical incompetence) where the risk of something going wrong is very different. 

I have looked at the one at a time website, but to be honest I think they have tilted to the other extreme, scaring people over the top by selecting only horror stories. I could get you the same Type of stories for singleton pregnancies if I started looking. Fact is that The vast majority of twins (as the vast majority of singletons) are born healthy, statistically. I have also looked around me and I know personally so many adult people who are twins (I counted at least 7 sets) and even one set of triplets, and they (and all of their siblings) are healthy and have achieved amazing things in their lives like any singleton friend or colleague. I also heard horror stories about singleton pregnancies ending in medically indicated terminations or disabled children, and my sister in law delivered her singleton sons very early at 29 and 30 weeks due to an unknown issue. Does this mean I won't be having a baby at all because something like this could happen to me? I also looked at divorce rate after twin birth and it was a tiny bit higher (like 17% compared to 16%)).

Also as my calculation show you'd still have at least a 50% higher success rate with SET at ARGC compared to Lister - based on official HFEA statistics.


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## Rosalind73 (Apr 25, 2012)

More words of warning about ARGC - another reason they have the highest success rates in the country is because they are selective and turn away those women that are unlikely to succeed. So of course they are going to do better than other clinics. I have also heard other things (from those inside the industry) about their client base (which I'm not going to say in public here, but do PM me if you want more info) which also explains their stats.

In addition, it's well known that they have a separate sister clinic set up for their older (and I suspect more difficult) patients, thus artificially raising the success rates for ARGC. For a while this clinic - which was the subject of a BBC Panorama documentary - lost its HFEA licence as it wasn't reporting its statistics to them.

Plus, they might seem cheap, but because of all the monitoring and treatment they do, people ending up spending an absolute fortune there - around £15K per cycle or more in some cases. A lot has a very poor scientific evidence base and is argued to be completely unnecessary and highly questionable. Worse still, some of it is not only completely unethical but dangerous in my opinion e.g. using drugs that increase the risk of cancer.

And for a clinic that ends up costing you an arm and leg, I've heard they have pretty poor facilities as well. I know people who've cycled there and said they had a terrible time.


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## ♥JJ1♥ (Feb 11, 2006)

ARGC or the Lister specialise in older ladies whose cycles may have failed elsewhere so harder, I have cycled at ARGC several times and would recommend - they focus on FSH and not LH, whereas other clinics do.  I had a consultation at the Lister as well and they seemed very nice - Dr Jay, and understanding and good with older ladies. I had a consultation with Create and wasn't impressed.  CRGH is another good place.  I would go for a consultation at either and see what they recommend and if you like it. ARGC has a very individualised approach, and that if you have immunes then yes it does cost £12-16K (and I haven't cycled there for several years) and it isn't posh- it isn't the carpets and curtains that you are paying for it is the expertise of Mr T.


The panorama stuff was also a long time ago and about IVIG - and most clinics now offer intralipids etc  and Mr T won his case!!! I have spent £150K ob treatments and am childless but can say I gave myself the best chances I could. Good Luck


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## Bluebell82 (Jan 24, 2015)

Hi everyone, hi Rosalind,

All these things Rosalind mentions are untrue, I'm a patient at ARGC and know young and old patients, a lot of us have very complex issues. I'm have been monitoring a couple of ARGC boards for months and not heard of anyone being turned away.

These are (old) allegations told by other clinicians who want to damage the reputation of ARGC and MR T. Please look at the ARGC boards and the HFEA stastics.
As JJ1 Said The HFEA has apologised about the allegations and the immune treatment that was the issue is widely used now, including Lister and create.
http://www.hfea.gov.uk/440.html

I think there's a lot of ego stuff going on in the IVF industry, to the detriment of us patients. it's important to not just believe what someone says without checking the facts. There would be a lot Higher success rates if other clinics copied the ARGC approach (and cost would come down, as the immune tests would become cheaper if there was a lab in the UK, at the moment they have to courier to the US). 
And It's not more expensive if you have a more complicated history, as you get the same success rate from ARGC in one cycle as you get in 3-6 cycles are other clinics, plus the saved time and heartache.

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## Rosalind73 (Apr 25, 2012)

Hi Pinkhat - sorry to hijack your thread, but some things are too important to be left unsaid. Regarding clinic recommendations, I've personally had very good experiences at the Lister and reasonable experiences at CRGH.

Regarding ARGC, it's a fact that:
- They are selective - they don't let women with a high FSH cycle with them.
- Taranissi does have a second clinic (The Reproductive Genetics Institute) {NB this was in response to Bluebell stating there was no second clinic - now removed}. There are many women on this board who can testify to having their egg collection or embyro transfer at a second site/clinic. 
- The Reproductive Genetics Institute did not have its licence renewed in 2005 due to a lack of required data yet it continued to operate: http://news.bbc.co.uk/1/hi/health/6225951.stm And I remember personally looking for their success rates a few years back and not being able to find the data anywhere.
- Patients generally end up spending much more with them than any other clinic.

Plus as I said I know of other information (which comes from a very reputable fertility consultant who runs the fertility services at a London NHS hospital) about ARGC's client base which may well be distorting their stats.

I also hear from several reliable sources that the equipment at ARGC is outdated and I personally know people who've had a terrible time with them because of their whole ethos and attitude towards patients.

Humira may increase the risk of cancer and other nasty diseases, steroids during pregnancy increase the risk of cleft palates, gestational diabetes, pre-eclampsia and pre-term birth and there is a risk of catching disease if you have donated blood (i.e. IVIG) from other people. Here's what the HFEA say about them:
http://www.hfea.gov.uk/fertility-treatment-options-reproductive-immunology.html

NB It's also a fact that there is a very poor scientific evidence base for reproductive immunology. It's true that some things are treated empirically (i.e. without randomised controlled trials - the gold standard of medicine) however not only is the evidence not there yet (as might be the case with some areas of medicine that are yet to be proven or we only have observational data for at the moment), much of it is based on a basic misunderstanding of science and might actually be hindering our prospects of conceiving (as well as putting the health of ourselves and our babies at risk). For example we don't know what 'normal' levels of NK cells in the blood are, they bear no relation to uterine NK cells anyway, uterine NK cells probably play an important role in implantation and reducing their levels may hinder this.

This doctor explains it quite well:
http://www.drmalpani.com/knowledge-center/failed-ivf/failedivf
http://blog.drmalpani.com/2014/03/nk-cell-testing-ivf-failure.html

Papers by some of the top fertility and miscarriage experts in the country:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC534451/
http://humrep.oxfordjournals.org/content/20/5/1123.full

Here's a more recent update from the HFEA:
http://www.hfea.gov.uk/docs/2015-02-04_SCAAC_-_Reproductive_immunology.pdf

And a very comprehensive recent review of the literature with respect to recurrent miscarriage:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4229790/

If this were more mainstream Ben GoldAcre AKA Bad Science would be having a field day!

Trouble is, as I've experienced myself, when it comes to infertility we're all incredibly vulnerable and willing to try anything, which unfortunately many clinics are willing to exploit.

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## nevertoolate (Jul 15, 2015)

It is tragic just generally speaking how ivf patients get treated in this industry. It gas been a real eye opener for me reading peoples experiences. I am shocked that tge government are not taking more interest in industry practices. It needs random clinic checks to check on how people are treated and if the course of treatment is tailored to the individual or just going throygh the motions. It is tragic that people in such a fragile and emotional journey are not being protected.


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## star17 (Oct 31, 2012)

To balance things out a bit I thought I would post about my Argc experience.

Having had 3 fresh and 3 frozen cycles elsewhere, I decided for my next try to go to the clinic with the best success rates and therefore Argc was the obvious choice.

I found my experience there to be heads and shoulders above my last clinic - they are honestly amazing.  (Apart from the facilities I suppose - but I don't really care about that!).

They prepare properly - by doing monitoring cycle to understand you and your body and in my case advance humira/intrallipids.  

Their monitoring is second to none.  During stimms you have blood taken once or twice every day and many scans.  This resulted in trigger at exactly the right moment and the best set of embryos we have ever got (both quantity and quality).  

They work every day - none of this nonsense about EC not being on a Sunday - they did what is right for you.

The embryology lab is awesome (see comment re quality above).

Only a very few people do collection and transfer - I think this is a massive differentiator - very senior doctors only.  My experience at my other clinic was not the same.

The immune treatment was a lot more tailored and seemed to work for me.  Although you do have to make your own mind up on unproven treatments.  I decided trust them.  (It was much better than the approach of other clinic where a blanket intralipid/pred approach is used without understanding).

I was lucky to get pregnant with twins.  Now I got into exactly the multiple issue that the hfea have - however I do find it incredible that I can get pregnant with twins at the Argc where I had had bfn for most of my cycles at the last clinic whether one or two were put back.  Surely the focus should be on what other clinics are doing wrong rather than how Argc are being so succesful!!

They do have other clinics - the RGC and another one that they bought recently (lwc I think).  They report their stats too.  They are not as high as Argc - but they are not bad.  I had my transfer there.  

I do not know about how selective or not they are - but I do know that they treat a lot of people who have been unsuccessful elsewhere.  (Including me!).

Good luck with your decision.  It might be worth having a consult with more than one to get a feeling/advice from all three.


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## Rosalind73 (Apr 25, 2012)

Two quick things. Here's what the eminent Professor Winston has to say about embryo quality:
"Of course, a poorly formed embryo is unlikely to produce a pregnancy though it may occasionally. But I think it is regrettable that embryologists and other staff in IVF clinics continue to give meaningless information to patients about the quality of the embryos they can see down the microscope when they look 'good'. It is worth thinking about what they are actually looking at. They are looking at high magnification at a very imperfect image of a faintly outlined cell without being able to see any detail inside the cell at all. Most of the time it isn't even possible to clearly identify the nucleus which is the control centre of every cell. Even if you can see the nucleus, you cannot see the DNA or all the other structures and molecules inside it. So an embryo may look perfectly formed, but this is a very imperfect impression of something which is incredibly complex. Think about it: this tiny object is going to be a complex organism like your beloved daughter with all the characteristics which make her development possible. So the judgement of whether this is a 'good' or a 'bad' embryo is actually nonsense." Taken from here:
http://www.genesisresearchtrust.com/ivf-and-other-answers/embryo-quality

And regarding immune treatment seeming to work, again I quote Dr Malpani:
"What about those patients who have had multiple IVF failures, and then do finally have a healthy baby after immune therapy ? While these patients ( and their doctors) are happy to credit the immune therapy with their success, the fact remains that there is no evidence to suggest that it was in fact the immune therapy which resulted in the successful pregnancy. This common post hoc ergo propter hoc (after this , therefore because of this) logical fallacy is based upon the mistaken notion that simply because one thing happens after another, the first event was a cause of the second event. All IVF clinics have had many patients who have finally conceived after multiple IVF attempts, even though there was no change in the treatment protocol whatsoever. Sometimes, it just needs a bit of luck , patience and perseverance!"

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## Bluebell82 (Jan 24, 2015)

Rosalind,
Just because you don't need immune treatment and have formed an opinion, you shouldn't bad-mouth it with such passion for those who may do. 

yes the carpets and Scanners aren't as nice at ARGC, but I totally don't care, neither do most other patients who just want a baby; and a high FSH is just a temporal delay, ARGC will wait for a cycle when it is lower (these values fluctuate quite a bit from Cycle to cycle), and if your FSH is sky high it means that you are nearing menopause and won't get many eggs retrieved, so they are being honest with patients and not taking their money when there isn't much hope as maybe other clinics do. 

regarding side effects of immune treatment: yes, don't take them if you don't need them, that's the rule for any medication, it should also be noted that the added risk of temporarily taking these drugs is small. ARGC only give humira if your cytokines have tested high, and you can opt out if you don't like the risks.

The informants from the industry you quote may have their own agendas, they probably want to keep their business running as they do, with less effort, rushing through more patients, and not have to go in for egg collections on a Sunday. These informants may also just not have the same insight as Mr T, jealousy of the capable is very common across industries. When I want to buy a sofa in one shop I'm weary of what the competitions says, because they will want to sell me their own stock - I will hence see for myself or ask customers who have bought a sofa there.

Please moderate your opinion on topics that you Aren't an expert on, as you have never been a patient there.
Fact is that ARGC has the best success rates in the country for all age groups apart from 43 and over, officially verified by the HFEA, even if you include RGI, and they have not found anything substantial against them in all the years (20 years) ARGC have operated. Because ARGC are the best and some colleagues are critical, they are probably also under the greatest scrutiny from the HFEA.


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## Ava and Thomas (Aug 27, 2015)

ARGC - I commute from 4-5 hrs daily (there and back)


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## Ava and Thomas (Aug 27, 2015)

They are no frills and not terribly organised but once  your cycle starts they are amazing and so individual and if you need your transfer on Christmas Day that is exactly what you get! No exaggeration!


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## Kaballie (Mar 7, 2015)

Just to throw in my two pennies worth (am currently 13 weeks with twins after IVF at argc:

Argc customer care sucks. Argc medical care is incredible.

You don't have to have immunes if you don't want to. I didn't and they didn't force it.

Argc rotate the clinic that transfers are done at according to the day you had your collection. Given my history I was likely to get pregnant. I was sent to Portland Place for my transfer and was there with women in their mid 40s who only had one egg. There does not seem to me to be any manipulation of the figures in this sense.

Argc will not cycle you with high fsh as it is unlikely to work. If the rumour that they manipulate figures by sending women to other clinics to have transfer then they would surely just be accepting anyone?

I met 15 women whilst at argc. All ages, many different reasons for infertility. Most on between round 4 and 8. Of that, 7 are now pregnant with another 1 getting pregnant on a later frozen cycle. It's only a straw poll but from this does seem to me that their success rates are pretty accurate.

I honestly couldn't recommend them enough - the level of attention and detail you get compared to an NHS cycle is unbelievable.


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## Maggiephatcat (Feb 21, 2010)

Ladies,

There is clearly a lot of difference of opinion here. That's fine. Can I please however remind you to keep your replies supportive. 

Thank you 

Maggie
Forum Moderator


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## Ava and Thomas (Aug 27, 2015)

It also might depend on how high your fsh is for them to turn you away. They like it to be 10 or below. They tried on 4 separate times to get 10 or below to start me and I didn't achieve it... Still the highest was 13.8 and they were then happy to go ahead.


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## Chirp (Dec 11, 2012)

Just wanted to speak up as an over 40 'difficult case' 
I was of the general opinion of Rosalind73 - I felt I wasn't going to be a sucker throwing money at a controversial clinic. I did four full IVFs and a FET at a major London clinic which was known for being evidence based. I started off patting myself on the back feeling I'd done my research and was in good hands. After multiple failures, results that got worse and worse and a misdiagnosis of a major uterine abnormality I was utterly broken and I started my research anew. Panorama and the BBC paid a massive compensation to the ARGC for their inaccurate accusations.. I found out that the senior nurse at my first clinic used to work at the ARGC and as I'd got to know her and was crying in her office after my fifth and worst failure I asked her honest opinion about other clinics and what I'd heard about the manipulation of statistics at ARGC. She no longer worked there but was massively offended as she pointed out that any manipulation would involve all ARGC staff and there was no way it happened - she then said I should try them as they did get amazing results.
I'm fully aware that my one case only counts as anecdotal but here it is: everything was better at ARGC: number of eggs, fertilisation rate, number and quality of blastocysts. They also immediately realised my uterine abnormality had been misdiagnosed and helped me sort that.  I did one IVF, immediately pregnant. That pregnancy didn't work out due to a major abnormality at the 12 week scan (not ARGCs fault obviously) I then had a FET with them, got pregnant again and my beautiful boy was born this year. I was 41 when he was born. 
I am so grateful to ARGC and Mr T and only wish I'd gone to them in the first place. Yes they are expensive but if I'd gone to them first I would have saved myself thousands and thousands. Yes they are shabby and chaotic but what matters is their results - and my particular bit of that statistical picture is gently snoring in his dad's arms as I type.


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## daisyg (Jan 7, 2004)

Hi,
It is a very long time since I cycled, but I just wanted to say that if you have the money and strength for a go at IVF at 45, you need a clinic that specialises in women over 40 and that would be primarily the Lister or ARGC.
You will find that neither clinic will have had particular success with live birth at 45, but we don't know your individual chances so if you know the facts and would like a cycle for closure, I would think those clinics are the best.
What I would say as someone who did get pregnant 6 times with OE and DE between age 44 and 44.5 but miscarried all pregnancies, is to make sure you and DH have some basics miscarriage testing before cycling.  Both ARGC and the Lister can help with these, e.g. Uterine, Thyroid, Sperm, clotting, autoimmune and immune.
Best of luck,
Daisy xx


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## Tincancat (Mar 19, 2012)

I've been following this thread with interest.

I'm not a believer in blood immune issues rather I'm more inclined to go with uterine NK cells needing to be optimal to have the right uterine environment for an embryo.  I was tested and had a treatment protocol from Professor Brosens and Professor Quenby in Coventry.  I like them because their research makes sense.  They are NHS consultants with a research interest rather than an expensive London Clinic to fund.  Money paid to them gets put back into research which is what infertility community needs.  There is evidence from these two Professors that giving immune treatments to people who don't really need them because uterine NK are fine can be detrimental.  Proper research so that effective affordable treatments are available for everyone who needs it is the key to resolving the controversy.

Controversial approaches will always attract criticism but it's usually from some of these approaches treatments can be refined and become proven by research as the best way forward.  Someone has to be the brave one to step forward and say the old ways are not working let's try a different way.  I believe ARGC have good results because of the intensive monitoring and tailoring of treatment my reservations would be - does this really have to be done in the most expensive city in the UK which massively inflates the cost of the whole procedure?

I went abroad to another controversial clinic and got my babies without feeling totally ripped off by UK clinics.  I'd paid out massive amounts to clinics in the UK for one size fits all approach.  By using information gained from my consultation with Professor Q and B with my clinic abroad I was able to put together my own tailored treatment for a lot less cost.  In the process I've made a contribution to valued research into infertility by having uterine biopsy.  I want my infertility problems to help others in the future.  I do not like to waste a learning opportunity from any experience I have -  it might have been too late for me by the time I got to the bottom of my problems ( as I was too old to continue OE) but I'll do my best to ensure others can benefit without it costing so much emotionally and financially.
TCCx


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## nevertoolate (Jul 15, 2015)

Hi
So for ladies 45+ between argc or create. Which is the way to go?


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## daisyg (Jan 7, 2004)

Hi Dreaming of BFP,
If it is for own eggs it seems a moot point as neither clinic has had a success with a 45 year old.  Almost no clinics do have live births 45 plus in UK or anywhere in the world which is a really difficult statistic to absorb when we really want to have a baby with OE.  I know from my own experience.  Of course if we have the resources, there is nothing wrong with having a cycle to see how we respond, as long as we are realistic about it.

If it was me, I would go to either the ARGC or the Lister.  I would also find out if there were any other issues apart from age preventing pregnancy as the chances of natural conception are still very slim but greater at 45 than with IVF.

D xx


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## nevertoolate (Jul 15, 2015)

Create are suppossed to have a better results with lower amh which which would normally fit into that age group. I believe they allow ladies up to 50 to try with their own eggs.is that a waste of resources in your view. I guess it is straight to.DE to.minute you get to that age then.


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## Rosalind73 (Apr 25, 2012)

Hi Bluebell,

On the whole I am not expressing opinions about ARGC or immunes, I am simply reporting established facts and I'm only doing so to try and help others. I have a scientific background, so a bit of an understanding of what is essentially a complete minefield (plus I have a 3 year history of having fertility investigations and treatments at 5 different clinics plus recurrent miscarriage - often addressed with immunology so I have looked at it very thoroughly) hence I have seen many many specialists and also done a heck of a lot of reading). Understandably it's a very impassioned subject and people will believe what they want to so you and others can of course choose to ignore what I say if you wish.

To clarify a few points; I think you misunderstood - I'm not saying that ARGC are not a good clinic. They clearly do have a very good lab, some excellent doctors, monitor extremely carefully (some argue to an unnecessary extent), tailor their treatments accordingly and get good results. However they have been steeped in controversy (not without reason) and some of their success is undoubtedly due to the fact that they are selective (as are some other clinics by the way) and have been using a second clinic for some of their patients (Kaballie - the older and perhaps more difficult cases of those they have decided to treat). It's my understanding that these patients are still receiving the same care as standard ARGC patients (albeit it sometimes on a different site), but it's their DATA that is being submitted to the HFEA in a different way. (Chirp - it's unlikely nurses would have any involvement with this or that patients would be informed about it - we are not generally privy to how clinics deal with their paperwork!). As mentioned, for a time no data at all was being submitted for this second clinic, hence the suspension of its licence.

I believe Mr T is now submitting some data for the RGI (there wasn't any available about 3 years ago), however according to the most recent HFEA report, ARGC are still non-compliant on a number of areas:
http://guide.hfea.gov.uk/guide/ShowPDF.aspx?ID=5615&merge=1

Star17 & Chirp - personally it doesn't bother me that much if a place is run down or has old equipment (although I know ARGC patients who once pregnant, have gone to other clinics to get a better view of their developing pregnancy because apparently ARGC's ultrasound machines are so old!), however my point was why should that be the case when people are paying them around £15K or more per cycle? More than double and verging on triple what they would pay to other clinics. I think it's an indication of their priorities i.e. profit.

With respect to immunes, please read the scientific literature (or at least the abstracts of the papers I've attached) and then we can have an informed discussion about it.

You said that ARGC don't turn anyone way but you later say that "if your FSH is sky high it means that you are nearing menopause and won't get many eggs retrieved, so they are being honest with patients and not taking their money when there isn't much hope as maybe other clinics do." So which is it, do they or do they not turn people away? As it happens I know for a fact that they do.

It also doesn't make sense that they wait for a woman's FSH to come down before they will go ahead with a cycle. High FSH is one of several indicators of ovarian reserve and yes it is possible to lower it, but as this article explains, it's not the FSH that is the problem in the first place:
http://www.inviafertility.com/infertility/katie-koss/can-you-lower-my-fsh-level/

It does vary from month to month, but it's the fact that it's been high in the first place that could potentially be an issue. This is another good explainer:
http://www.draimee.org/what-does-your-fsh-level-say-about-you

Tintincat - Whilst Prof Quenby is definitely well meaning and an academic (as opposed to a clinic with financial interests), and also I think has been in some kind of advisory role to the HFEA, I'm afraid that despite working on it for many years she has never proved anything regarding uterine NK cells. Her and her team did a pilot study testing those with high uterine NK cells with prednisolone and the results were statistically insignificant:
http://humrep.oxfordjournals.org/content/early/2013/04/12/humrep.det117.full
"The live birth rate was 12/20 (60%) with prednisolone and 8/20 (40%) with placebo (Risk Ratio 1.5, 95% confidence interval (CI) 0.79-2.86, absolute difference 20% CI-10%, +50%), and hence, this was not significant."

It's been explained to me by several doctors that this is not surprising as cells taken from a uterine biopsy (which are flushed out when you have a period) are probably not related to cells present in the uterus in the next cycle or more importantly during implantation (when there are a whole load of other chemical and biological processes taking place). A doctor at the RMC, St. Mary's, told me they no longer think her work on uterine NK cells is valid.

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## Rosalind73 (Apr 25, 2012)

P.s. To get back to what was originally asked - Pinkhat1, have you had any fertility blood tests done? Do you know anything about the state of your ovarian reserve? As others have said, I'm afraid the chances with OE are incredibly slim at aged 45, but it's not impossible. It's just a question of whether you have the emotional and financial reserves to go through numerous cycles searching for that golden egg - with at the end of the day very low odds.

Create also have their faults - have a look at what other people have said about them. In my opinion you are definitely best off at the Lister (if you want to go to a London clinic). 

As tintincat says though, it's definitely worth looking into going abroad as well.

Although the frightening reality is that you will probably have success much sooner with donor eggs, I completely understand that need to keep going with your own eggs and wish you the best of luck with it.


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## Bluebell82 (Jan 24, 2015)

Hi Rosalind,
I have a PhD in physical sciences from one of the top 3 UK universities and I work in science as does my husband. We are both leading experimental scientists in our fields. I deal with designing studies and look at scientific data every day of the week and I still disagree with your argumentation. I know from my work that scientific committees aren't always right, it depends on the Make-up and they do change their opinion over time. Egg-freezing has only recently been released as a recommended procedure - after years of doing it by a wide range of clinics.

I Have been reading about infertility for 4 years and believe it is the right time For me to try immune treatment, as there isn't anything else wrong, and I was 29 when we stared trying. Immune treatment after appropriate pre-testing is likely to stay, if you like it or not. For those who need it, which isn't every IF patient. Think of me in 10 years time when the HFEA have changed their stance and most clinics will operate ARGC style (maybe with better carpets and customer care).

when you quote high cost you forget that you get a much higher baby take home rate (even taking reproductive genetics institute into account), this may in the end come out cheaper for the individual patient, compared to having to do 3 cycles elsewhere. And this is on people who have failed elsewhere, so have a below average chance of conceiving. See it as a one cycle covers two-three cycles package..

And if you have a science background you should know that individual clinical studies can be flawed and not probe the right patients or aspects... I deal with people publishing flawed studies every day. Maybe people haven't carried out the right studies yet, due to lack of funding for such studies. 

I also don't see evidence that ARGC do make more profit than other clinics, the increased costs are for more tests and extra treatments. If you look at the ICSI cost for example they are actually cheaper than for example at Lister, who I bet have a more comfortable profit margin. I feel you are looking for evidence to fit your theory about ARGC and ignoring the very important good bits.


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## Rosalind73 (Apr 25, 2012)

Hi Bluebell82,

I'm very sorry to hear of all your troubles - I know only too well myself how traumatic and difficult this whole journey can be.

When did I mention individual clinical case studies? {NB this was in response to Bluebell's statement that I was quoting individual clinical studies from 8 years ago - now removed from her post} I gave accounts of what people I know have described about the clinic. I was not citing the latter as scientific evidence, which I did actually provide with respect to the medical issues at stake i.e. the question of immunes.

I'm absolutely not looking for evidence to fit my theories about ARGC and immnue treatment {NB this was in response to Bluebell's more general statement that I was looking for evidence to fit my theories - Bluebell has now edited this to she feels I am looking for evidence to fit my theory about ARGC}. I don't care what the actual facts are either way, only that we should be aware of them, so why should I have constructed any theories? I'm simply stating what is known about ARGC (and other clinics - as you know none of them are perfect) and that there is a _lack of rigorous scientific evidence_ for immune treatment, yet it is widely practised and accepted as established science.

And I wasn't trying to patronise you at all {NB this was in response to Bluebell asking me not to patronise her - now removed from her post}- it's just that many people are not aware of what qualified and reputable scientists have to say about reproductive immunology, and you didn't seem to be aware of the literature on the subject either. And if I'm honest, I'm surprised to hear that as a scientist you conclude that because you say nothing else is wrong {NB this was in response to Bluebell stating she was convinced she needed immune treatment - now modified}, that you must need immune treatment. As I'm sure you well know, there are million different factors involved with reproduction, of which we currently only have a small amount of understanding about.

Unfortunately because no-one has come up with a satisfactory explanation as to why it's not working for you i.e. nothing else _has been found_ to be wrong - which I completely understand must be heartbreaking - that doesn't therefore mean that there's a problem with your immune system.

I see your point about the increased costs at ARGC going towards more tests and extra treatments, however these tests are not without profit for the clinic (as you probably know an excessive use of tests and treatment was one of the accusations levelled at him). And don't you think the fact that Taranissi is reported to be the country's wealthiest doctor - paying himself a £25 million dividend in 2010 - is a bit of an indicator about the amount of money the clinic makes? Plus even if you assumed (probably incorrectly) that they don't make any more profit than other clinics, why is it that other clinics are less shabby and have more modern equipment (and the NHS too for that matter)?

It's true the Lister isn't cheap either, but at least for the money you get your own private room and 3 course lunch (it's like being in a hotel) when you have egg collection. But yes, all the UK clinics make ludicrous amounts of profit out of people's misery - for example the liquid nitrogen involved with freezing gametes costs pence, yet most clinics charge hundreds and hundreds of pounds to freeze and store embryos/sperm. Personally I don't think it's right that such huge sums of money are involved (which prevents many people having private treatment - and we all know about the limitations of NHS funding) and I believe the whole industry needs to be better regulated and controlled.

I wish you all very best and very much hope that you have success with your next cycle.


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## Bluebell82 (Jan 24, 2015)

I don't think the dividend is an issue. He's not been on a holiday as he works every day and he lives in a flat. What would he use the money for? I believe the dividends for buying more clinics to preserve the ARGc way and bring it to more people outside London.

My case is complex and almost everything has been looked at so far. I make eggs that fertilise very well, my tubes are open, my stimulation response is 'textbook', my uterus is normal shape, my linning perfect each time, my ovaries are normal size and shape and not polycystic, I don't have endometriosis, my Antral follicle count was 22 earlier this year and my AMH 21; my husband has excellent sperm parameter down to Very low DNA fragmentation, my hormones are always right, my chromosomes normal, and still we fail after embryo transfer.

I think it makes sense to take humira in my instance. And I happily am a Guinea pig, as IVF without immunes does not work for me. I don't feel vulnerable and used (apart from NHS not funding my treatment or Lister getting a lot of immature eggs and giving most of the mature ones to the recipient without asking me) - it makes sense to try something new. As somebody said earlier in the thread, if everyone would just cling to proven treatment, progress would be a lot slower. Wide practise will lead to the evidence you are looking for. We need to take steps into the unknown and I don't have time to wait until the medical community has looked at all of the million things (minus 10 or potential issues that cover most of the key reproductive events that preceed implantation and gave already been looked at) that may be wrong in my reproductive system, when I can try this now.

Here are some studies for you to read, but you will probably dismiss them, based on the fact that you have already made up your mind about what kind of person the author is:
http://www.ncbi.nlm.nih.gov/m/pubmed/21223418/
http://www.ncbi.nlm.nih.gov/m/pubmed/19055656/
http://www.ncbi.nlm.nih.gov/m/pubmed/21623994/

I have to go now. Good luck with everything including advising people to not do immune tests and treatments whatever their situation.

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## deblovescats (Jun 23, 2012)

I don't have any experience of London clinics as I live in the north - but just wanted to say that whichever clinic you go to, the chances of success with OE are not very high - over 45, it is about 1%. Obviously, it's a difficult decision and some women want to at least try. As I was 45 and money was an issue, wanted the highest chance of a healthy baby, so went straight to DE as advised. I am with CARE - who I think have CREATE as one of their clinics, and I am very happy with the treatment. I spent less than AARGC are charging (and that is with DE cycle, which is more expensive than OE, did Double Donor as well) - cost was around £6,000. This was my third cycle (first with CARE) and I now have a gorgeous 18 month old son, who I adore. I am so grateful. I also got 3 blasts to freeze and am embarking on a further cycle in Jan to try for a sibling. I know all clinics make a profit, but the care from staff is excellent - and the facilities are up to date and not in need in refurbishing (I realise this is not the main concern for people) but when we're paying privately, I do think that facilities should be a good standard.
Good luck with whatever you decide.
Deb


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## deblovescats (Jun 23, 2012)

I think it might CRM for CARE in London. Sorry!


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## Saska (Nov 9, 2014)

Argc gets my vote hands down. As you can see from my signature, I've had a lot of fertility treatment and I can honestly say I was totally gobsmacked at the level of care at argc. I have just done my first cycle there and could not believe the personal tailoring of the treatment. Every day the dose , type and time of the meds would
change. I don't know the outcome yet ( Saturday yikes!) but even if it's negative then I do not begrudge spending my money there as I feel they really did the best for me. Yes it's intense but give me that anyday over previous treatments where they just give you same dose every day at the same time. And that was a top clinic. I chose argc because of the intensive monitoring and that's exactly what I got. Immunes is a personal choice and totally not pushed if you don't want it. All IVF treatment is a journey into the unknown whichever clinic you are at but personally I would rather be at a clinic that really does take personal service seriously.


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## Pinkhat1 (Nov 16, 2014)

Thank you for all your responses. I appreciate your advice and suggestions it's really helpful to read them all. 

In answer to Rosalind73's question I have had fertility blood tests done and can't for the life of me remember what my ovarian reserve results were. I realise if these were poor, and because of my age, it looks likely I'll have to use DE, that's something my husband and I both have no issue with doing.

Following the research (and your helpful comments) I've done already I'm planning on going to both ARGC, Lister and Create open evenings. Following that I will have consultations with the clinic I prefer the most and will make my final decision then.

Moving forward, i'll be using this thread to post updates on my progress only, now I've narrowed down my decision to three clinics. 

Thanks again for all your responses and most importantly happy new year!


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## concho007 (Oct 18, 2015)

We live in West Sussex and used the Agora in Hove 5 times (for our sins) very poor in fact on the 5th go they messed up wife's drugs dosage due to inexperienced staff. Waste of money. 

We now are with the Lister, its our second round of IVF and I cant fault them, total professional care, excellent  fertilities, and more or less the same cost as the tiny clinic in Hove. 

No bother either getting into London. 

Good luck to you

S & S


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## Rosalind73 (Apr 25, 2012)

One last point (which I made before but is worth clarifying) - I agree that we don't always have the evidence for everything, perhaps because the studies haven't yet been done, and we need to treat conditions empirically i.e. with just anecdotal reports or observational studies (which unfortunately can often lead to completely the wrong conclusions being made, and is why we ideally need gold standard intervention trials). This lack of evidence is particularly the case in reproductive medicine when it's very hard to do intervention studies (although not impossible as Prof Quenby has illustrated in her pilot study looking at uterine NK cells and the trials listed here http://www.miscarriageassociation.org.uk/information/research/), and also the point has already been made that as women with ticking clocks, we simply don't have time to wait.

HOWEVER, it needs to be a based on a proper understanding of the science in the first place, which is simply not the case with immunes. And it's particularly important - in my opinion - if people are going to spend thousands and thousands of their hard earned cash and put their health/their babies health at risk. That's why I think it's so problematic, why I think people should be aware of what the facts are before they choose to go down that path and why it makes me so angry at how - in my opinion - so many women are being taken advantage of by doctors who simply do not understand enough about immunology, or worse still are just trying to get a competitive edge over other clinics. This is a very painstaking look at the theories about NK cells and why they don't make sense (which I posted before):

http://blog.drmalpani.com/2014/03/nk-cell-testing-ivf-failure.html

Conversely, in my opinion, it's fine to do the cheap harmless stuff even though it's probably not going to do very much e.g. I have always taken progesterone for weeks after my IVF and even IUI cycles, and for every one of my pregnancies (until the end of the first trimester or until I've no longer been pregnant) in case it prevents miscarriage, even though there's never been any evidence and I've been told that it's probably a placebo. And actually it's just been proven (in a huge randomised control trial called PROMISE) not to have any effect on the live birth rate i.e. it doesn't do anything: http://www.miscarriageassociation.org.uk/information/research/the-promise-trial/. The good news (if you can call it that) is that it's not been found to be harmful, so for women who are taking it anyway (and it's necessary at certain points in IVF cycles) it's not a problem.

Also, I completely and utterly understand the need to leave absolutely no stone unturned and try everything under the sun in the hope that it might make a difference. I've done it myself and have taken prednisonlone (steroids - very cheap ones at least) on a couple of cycles (although those were negative cycles and I decided against it after that because of the health risks) and at one point was also going to do intralipids just in case there was anything in it - because it's relatively cheap and is essentially just a soya and fat drip! (but decided not to bother in the end after I came to the conclusion that it was completely futile)

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## Tincancat (Mar 19, 2012)

I really welcome this clarification for the thread.  This is sort of the message I was trying to convey.  The evidence is poor for immune issues and I hate to see people ripped off by expensive private clinics.  This is why I highlight the work of Professor Quenby and Brosens.  At least both are trying to conduct research in an organised and scientifically acceptable manner.  Professor Q pilot study was just that a pilot study with small numbers.  I'm no good at statistics but it could be the sample size was not big enough.  Anyhow now Professor Quenby is working with Professor Brosens I have high hopes this team can do some valid research for the infertility community.  I for one am more than happy to help having gone to their implantation clinic and been one of their subjects.  I got the right combination for me in the end with their help which didn't cost an awful lot of money.

People must have the choice to spend money on how they wish for IF.  One.does become desperate to try anything.  Empirical treatment with steroids and intralipids, which are indeed cheap,  is all well and good but there is evidence, from Professor Q, that taking them when you don't need them could be detrimental.  In my opinion it's always worth having a NK biopsy to check this out beforehand.  

Array embryo screening is probably going to be helpful for some people but again not the whole picture for IF.  Even microarray testing has it's flaws and could conclude embryos are duff when they in reality might be fine.  IF has so many factors having an influence on the result only valid research will get to the bottom of it.  Sadly research into IF is at the bottom of most government and drug companies agenda.  This leaves a small nucleus of people to do IF research.
TCCx


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## Rosalind73 (Apr 25, 2012)

Thanks Tincancat,

I totally agree re steroids - not only can they increase the risk of cleft palates, gestational diabetes, pre-eclampsia and pre-term birth if taken during pregnancy, but we probably need those NK cells in our uterus for implantation. Looking back I'm glad I wasn't on them whilst pregnant and wish I hadn't taken them at all (I'll never know if they were a contributing factor to one of my BFNs).

Re CGH, which is the form of PGS that is most commonly done here (newer techniques are now starting to come in) the chance of mosaicism (an embyro with normal and abnormal cells, which might go on to correct itself and become normal) or a false negative i.e. identifying an embryo as being abnormal when is actually normal, is 5% on day 3 biopsies and 1% on day 5 biopsies. Just one anecdotal report but it was a bloody miracle for me! (so far....)

Hope you and the boys are doing well.

xx


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## Caroline1759 (Sep 10, 2009)

Hi
Just thought I'd give my 2 cents worth as was in a similar situation last year. Was 1 month off 45 and wanting to do IVF using my own eggs. I had one cycle at Lister.

My experience was that they have very good facilities. My consultant was very nice and personally available even in evenings for phone calls. The post egg collection care is excellent. As someone said you get a private room in the hospital that's like being in a hotel. Also the anaesthetist used acupuncture on me whilst I was under to help reduce pain on waking. Not sure it was necessary but a nice touch I thought.

That's the good bits, now for the bad. Whilst my consultant was very nice I got the impression his specialist interest was not in treating older women. I was put on maximum stim doses and it felt like this was just a routine prescription they give older women rather than a specific and tailor made for me individually. The other big problem for me was that they kept me on down regulation for far longer than necessary. When I called them on the first day of my period to come in for a scan and start stim process the nurses couldn't fit me in for another 9 DAYS!! I felt VERY unhappy about this as I was getting horrendous side effects from down regulation drugs. Plus it caused me a lot of anxiety in worrying that it completely went against mimicking my natural cycle. Plus I started worrying it would send me into premature menopause. When I raised my concerns with my consultant he just said it was fine and not to worry. 
The other problem I experienced was they had no counselling available during my treatment. When I first signed up to them I had one counselling session which was mandatory because I was using donor sperm and I think it's regulation now that you have to have an implications counselling session before the clinic will start treatment. I told my consultant and the counsellor I would need regular counselling throughout the IVF treatment because I was single and going it alone felt I needed psychological support. I expressed that this was very important to me and would choose a clinic based on whether I would get access to me. I was reassured that I could have regular sessions during my treatment. But when I started the treatment I was then suddenly told they had no counselling sessions for 3 months and to find my own fertility counselling elsewhere! Incurring yet more costs on top of the clinic fees. I asked for a manager to contact me to discuss my complaint about this. No manager ever got in touch with me.
I had 3 top quality embryos transferred back into me. Sadly it was a BFN.

So my experience as an older woman of Lister was very mixed. But then I think choosing a clinic is such a difficult minefield. I do wish you luck with choosing and your treatment.

Rosalind - you make some excellent points. 

C x


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## Lily0750 (Aug 1, 2015)

Hello Ladies,

I am new to this forum and surprises to read that 45 years old consider ARGC. I emailed ARGC in summer 2015 and was told that they did not accept women over 44.


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## Claudia H (Oct 2, 2015)

Lily - I think that's for Donor Eggs. xx


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## daisyg (Jan 7, 2004)

Why would that be for donor eggs?!  Surely you can be older to use DE vs OE?  
D x


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## Claudia H (Oct 2, 2015)

yes that's what I mean.   45, and considering ARGC for DE. x


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## daisyg (Jan 7, 2004)

Claudia,
Doh! Sorry I misunderstood that one  
D xxx


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## Lily0750 (Aug 1, 2015)

Claudia H said:


> Lily - I think that's for Donor Eggs. xx


I was 45 year and 3 month old when I emailed ARGC. I was not insisting on OE just wanted to enquire if they accept me at all. ARGC reply said that unfortunately they have not had any successful outcomes for ladies over the age of 44 at their centre.


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## Lily0750 (Aug 1, 2015)

I am considering CREATE. The other option would be Lister. ARGC said "no" to me just based on my age, did not even offer DE option, even though I told them that I have regular cycles and according to ClearBlue tests ovulate every month (not sure how correct these tests are). 
I had MOT scan at CREATE which showed very good blood circulation but just five follicles (three in one ovary and two in the 2nd) which I understand is average result for my age).
I keep reading on this forum about ladies having 7-12-15 IVF cycles. I was surprised to read on other sources that the average number of IVF cycles should be 3 and the success rate drops with each additional IVF cycle.

Because I have quite severe psoriasis which started when I was 14 or 15, so clearly hereditary, I would prefer to go straight to DE.
In fact, all the years when I was younger and single my main fears of having a child on my own was that I my transfer psoriasis to the child or my psoriasis would get so severe that I would not be able to work and support my child.

The consultant at CREATE said that IVF does not increase success chances for ladies over 45, so basically success rate would the same as with natural pregnancies.
I am thinking of going for 3-cycle package at CREATE. I believe with DE it would be mild IVF. If I have no success even after 3 cycles, I will stop trying.


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## Claudia H (Oct 2, 2015)

Best of Luck Lily - with DE I think you should have a good chance if nothing else is wrong! we will be here for you all the way. x


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## Lily0750 (Aug 1, 2015)

Thanks for support Claudia.


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## CND (Oct 22, 2016)

Hi Lily
How is your treatment with Create going? i am also considering DE with them and interested in your experience?


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## deblovescats (Jun 23, 2012)

Lily - can't help with regard to London clinics, but can't believe you were turned down even with DE for AARGC. 
As I'm based in the north, I had 2 failed cycles at LWC Darlington - with double donation, as I'm single.
I changed clinic and went to Sheffield CARE and couldn't fault them  - I did double donation again and this time had success on fresh cycle, DS is now 2 years old, got 3 frosties from that cycle. I then had FET this year and had DD in October. I also have 2 frosties in storage. 
I was 45 when had failed cycles, 46 when started treatment at CARE, and gave birth to DS at 47, had tx this time at 48 and gave birth to DD aged 49. So I think most UK clinics will treat women up to 50, but usually with DE. With DE, as long as you don't have other problems, the success rate is higher and can be about 50%, whatever your age.
Good luck
Deb


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## Lily0750 (Aug 1, 2015)

CND and Deb, thanks for your messages.
I had tandem cycle at TM Cyprus in October which resulted in BFN. Have 5 frozen DD embryos at TM so hope to go back to TM in March, possibly. Just need to clear some of my credit card debts.


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