# FET or fresh cycle at 40



## Lozster (Apr 15, 2012)

Hello there - after lurking a while I've bitten the bullet and registered to post!

I had my first IVF cycle (NHS) at 39 which was a BFN.  This produced 5 eggs, 3 of which fertilised, 1 of which was transferred and the other two frozen at the suggestion of the clinic (LWH).  Not a great response but ok for me as I have low AMH.

After the cycle failed I had a long hard think and decided that I would have a second fresh cycle (now private as I am 40) instead of a FET.  My NHS consultant, at my follow up appointment, strongly advised against this and said I should go for FET next. However, my logic was that the frozen embryos weren't getting any older where they were and that if a fresh cycle produced no eggs I could have the frozen embryos replaced if they defrosted ok.  My private consultant supported this idea so I went ahead.

Unfortunately I just found out that this second cycle failed too.  I had a different (short) protocol this time and produced 2 eggs, one of which fertilised and was replaced at 3 days when it was 5 cells.  

I'm now not sure what to do next - FET or another fresh cycle.  Obviously I will discuss with my consultant but I find he is very non-committal/non-directive.  One thing that is worrying me is the quality of the frozen embryos.  Neither the consultants nor either of the two embryologists would give us a grade?  I know they are 3 and 4 cells and were frozen at 3 days which I thought was ok as we were told that only good embryos are frozen.  However, on my second cycle the embryologist commented that the 5 cell embryo I had replaced was small for 3 days and should have been 6 cells by then.  So now I'm thinking that the 3 and 4 cell embryo's that are frozen must be really poor?

Does anyone have any advice for me on the quality of my frozen embryos? Also any thoughts on whether to go ahead with another fresh cycle given that the last one produced only two eggs/1 embryo, or whether to go for FET?

Oh, should also have added that I've ordered micronised dhea (previously mentioned by by my consultant but too late for my last cycle) and royal jelly.  Heaven knows if it will do any good but it all seemed bargainful after paying for IVF meds!  Will also be trying, in the interim, the novel route of trying to conceive with just the one other person in the room  

thank you!


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## Ellie.st (Mar 11, 2005)

Hello Lozster
Sorry to hear about your BFNs.     I was in a similar situation to you after my second cycle with two BFNs and two frozen embryos from my second cycle which had been worth freezing but which I knew weren't as good as the ones which had been transferred.  I decided to go for another fresh cycle on the basis that I had the frozen embies as back-up if I ended up having no eggs/embies from that new cycle.  I still think that that was logical but there is a "but" - we actually got a BFP and my beautiful DD (plus another frostie) from the "fresh" embies from that third cycle - great news except that I developed severe pre-eclampsia and she had to be delivered two months early (though thankfully she is fine).  If I hadn't had the frozen embies, I think I would have stopped there as we had hardly dared think prior to that we would ever even have one baby let alone try again after that.  

However, I couldn't get the thought of my frozen embies out of my mind, and after three years of agonising about what to do due to the worry of getting severe pre-eclampsia again (and DH being really, really unhappy about me taking that risk), I did have a FET.  Lightning actually struck twice for us in that I got a BFP and my lovely wee DS from that FET (and thankfully no pre-eclampsia) but it was a real worry until he was born.

What am I trying to say in my rambling way is that you need to think about what you would do about your frozen embies if you went ahead and had a fresh cycle which produced a BFP and/or more frozen embies.  Everyone is different, but would you feel an obligation to them?  I know our circumstances with my developing pre-eclampsia were quite unusual, but unexpected things can happen... 

The other thing I can say is that, at least in my experience, "poor-quality" frosties can surprise you - of my three frosties, two technically didn't survive the thaw and the third was "doing nothing" at ET time - yet I got a BFP which gave me DS and which was actually twins until about week 10.

While you are right in saying that your frosties aren't ageing, there will be a time limit on how long you can keep them, and you may also run up against the upper age limit for tx from your clinic, which made me feel under additional pressure when I was trying to decide what to do.  In fact, I put my FET off for so long because of my worry over pre-eclampsia (and then had problems with d/r which delayed things) that I ended up having ET the day before my 46th birthday (the cut-off point for tx with my clinic  ). You are a spring chicken compared with me, however, so that won't be quite such an issue for you!

You are right that the frozen embies aren't getting any older while your eggs are - that was my logic and the reason that we went for a third fresh cycle.  My FSH was OK (about 7.5) - didn't have a AMH score - but I was over 42 by my third cycle so the clock was really ticking.

However, there is also the thought that FET is alot less invasive than a full cycle (even a medicated FET which was what I had) and that doing FET would give you longer to build yourself up with DHEA and royal jelly etc for a full cycle if the FET didn't work (which, of course, I hope wouldn't be the case), though you might want to check about taking DHEA in the run-up to a FET.

Not trying to sway you either way, but thought you might like to hear about my experience.

Wishing you lots and lots of      whatever you decide to do.  (PS: good luck with what you are trying in the interim too  ).

Ellie


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## nevergiveup1 (Mar 23, 2008)

I would definately go fresh!

After 40 if you get 3 embies, put them all back, dont freeze at all. If you go to a foreign clinic and you make mor ethan 3 and are allowed to put back more than 3 then put back more.

If it was me I would just ignore the frozen and do another fresh.    

Good luck!!


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## Lozster (Apr 15, 2012)

thanks both of you for the replies.  Never give up - I think I am swayed towards the fresh cycle if the consultant says it's worthwhile.  Complication is that I may lose my NHS funded FET (just waiting for PCT to feedback), plus as Ellie says I could do FET whilst waiting for the dhea to 'kick in' - gah - I'm talking myself round in circles here   

Ellie, I hear what you say about the frozen ones, what to do with them and feeling 'attached', especially as I know someone for whom this caused real angst.  Mine are frozen for another 9 years and 7 months (courtesy of NHS).  The fertility nurse, prior to my second fresh cycle did ask 'what about your potential babies that are frozen?'.  I was   at the turn of phrase.  I do see what she meant however, I'm a very pragmatic person with no religious views and believe that they are simply cells.  If I had achieved one live birth I am 99% (note the missing 1% ) that I'd be totally fine with them going.

Ellie, your account of 'poor' frozen embies doing well is inspiring!  Maybe the fertility nurse may be right after all!

Thanks again - it's lovely to have your input.


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## TheYankee (Dec 15, 2011)

Just want to put more info out there - in my clinic, FET cycles get more positives than normal cycles for the over 40s.


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## Maisyz (Dec 15, 2010)

I'd say with low amh (which I have also) I'd be tempted to keep going with fresh cycles as let's face it we have fewer eggs sadly. Good luck.


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## goldbunny (Mar 26, 2012)

yankee - you said "in my clinic, FET cycles get more positives than normal cycles for the over 40s.  " is that statistic skewed though? FETs are by definition never the first go.. they're always a second or third try... since first go at IVF/ICSI contains a certain amount of guesswork as to how people will respond... and there is more information on a second go.. plus perhaps people are more relaxed on a FET cycle because they're already 'half way there'... 

i think you'd have to compare 'FET cycles' to 'second or third attempts at IVF/ICSI' and not 'FET cycles' to 'all fresh cycles', to be fairer... i wonder how that comparison would look...


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## cowhatgirl (Aug 12, 2008)

Hi there

In your position, I too would go with another fresh cycle.  I think it's logical to continue on this route, whilst you still can.  In fact I recall my consultant agreeing that whilst I was producing eggs, it made sense to capitalize on this and only resort to using frosties when it was a necessity (or financially a need). 

I can understand your comment that if you had a live birth you'd be happy to dispose of any frozen embryos.  Frankly, 2 years ago I would have agreed with you 100%, but feelings can change... Having been lucky enough to have a baby, those frozen cells somehow become something more tangible and it does become more difficult to consider the prospect of destroying them.  Despite this, if I were in your position I think my priority would still be how to maximise my chances of getting a bfp and the question of what to do with any frosties would be something I'd be happy to debate later.

Good luck!
CHG


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## Lozster (Apr 15, 2012)

thanks guys - I'm back to give an update!

Two things have happened - first my PCT have said they will pay for my FET and the NHS hospital have said I can go as soon as I want. Second, I saw my private consultant and he said that I can DHEA whilst going for a FET, there will be no harm and if anything, it reduces the chance of miscarriage.  Double hoorah - my supply arrived today.  So, I'm going to FET ASAP (!) then, after the DHEA has had a chance to build up, if I'm not already pregnant (see how I'm tempting fate there  ) I will consider a fresh cycle.  It will only be, say another 4 months down the line.  I'm giving up looking at data but  Yankee - I'm choosing to believe you on the FET data!

Oh, and, I'm pleased to report that I got my frozen emby size wrong and they are bigger and better than I thought (7 and 8 cells, not 3 and 4)   but triple hoorah! 

I hear what you ladies say on perception/attachment to the frozen embies changing.  I think I'm ready to go for it now, knowing that the dhea should be getting going.


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## TheYankee (Dec 15, 2011)

Good luck Lozster!


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## Ellie.st (Mar 11, 2005)

Good luck from me too!      

Ellie


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