What do you do next?

I am coming to the end of our 7th ART cycle (4th blast transfer) and Im really confused about what I should do next. I guess you always think that IVF is going to be the silver bullet - the cure all. Even my clinic said that I would get pregnant easily (well if it was that easy I wouldnt be having IVF!) and are suprised that I haven't fallen yet.

How do you know when to look at other options because honestly right now I don't feel like I have any options. I've thought about-
-adoption, but there is around a five year wait and it is still expensive with a lot of hoops to jump through
-fostering, but financially it would be really difficult for me to leave work (i get significant maternity leave if I fall pregnant), and also having to give the child back - its such a difficult job
-surrogacy - WA has just passed a law allowing altruistic surrogacy which could be an option, but we don't know anyone that would do it and for me being pregnant is a really special thing that I want to experience.
-More IVF - Possibly ending up in hospital from OHSS again, plus the money side - financially we are in a hole from spending so much on fertility treatment over the last 18 months.
-Donor eggs or sperm - I had never given this much thought before, as I am so young and we never thought there was an issue with my eggs. We still dont but how do you really know? Murrays sperm is a big issue - what if we used donor sperm instead, so many issues this brings up...

PGD - I dont know if this would even help us as what would we be looking for?

Are there any other tests that I should get done? I've never had a laparoscopy or hsg, but considering I have had three egg collections - surely they would have picked up any issues during these procedures, or at least I would have thought so.

I've done the weight loss thing, I lost 18kg last year to try and help get my body to ovulate but it really hasnt helped.

I really would like some "look outside the box" advice on what we could do, and also how other people handle this. I no longer have that feeling that IVF will work for us.

(Sorry for the verbal diarrhoea, I just wanted to get it all out there)
ETA - I should mention that we have one more frozen embryo left, so we have to make a decision about that also, as money is tight and we are over the safety net, it makes sense to do it now, but who knows...

Bec, it's a tough place to be in, and I don't think anyone has a magic answer for you. Just a few thoughts and comments from me...

As egg collections are done via ultrasound, they aren't going to pick up any problems that a regular internal scan won't find. There are some things (like endo) where they would need to actually see into the abdomen, so it may be worth requesting that they do one. I've heard of several women having no symptoms of endo at all, but when they have finally done a lap, they've been found to be riddled with quite severe endo.

Have you had further blood testing? There are a few different conditions (usually autoimmune or blood clotting) that can impact on whether IVF will actually work or not. There's a range of tests that they do in cases of recurrent implantation failures that can pick up stuff - but my clinic tells me it is standard procedure to not run these until you've had 6. I'm not sure if that's standard across all clinics, a sign of just how many transfers it can need sometimes, or just a hidden sadistic streak in my FS.

It is, ultimately, a numbers game. For some it works quickly, others... it takes much longer. In those moments where I felt like giving up, I'd think of Sushee - it was only on her 8th (I think!) transfer that she managed to get Charlie, which was a little beacon of hope to me that it may be taking a while, but it CAN work anyway, it just takes perseverance and the ability to save the money for the next cycle ASAP.

Finally - when it comes to avoiding OHSS, you may remember my history with it. First cycle I toughed it out at home, second cycle when I was in less pain I ended up spending a week in hospital and a month off work. Third cycle we finally managed to avoid it. My FS had me taking half a nizoral tablet on each day of puregon injections (apparently it helps reduce the amount of VEGF in the body, which is what makes the ovaries leaky and causes all the problems, I was put on it after each egg collection with OHSS), and before and during the cycle I was following a VERY strict low-carb, low-GI, high-protein diet. We started that about a week before I began lucrin, although my FS would have preferred to have me do it for about 4-6 weeks before beginning lucrin, but it seemed to be enough - just! I only had one slip up on the diet, it was towards the end of my puregon injections and the resulting jump in E2 was pretty obvious as I was on daily blood tests at that stage.

Has your FS suggested anything to improve DH's sperm? Our last cycle was done in the days before menevit was readily available, but he did have him on folate and massive amounts of vitamin C. I think they suggest 3 months at least to see if this has any improvement. He was also on a regime of daily ejaculations while I was on puregon to continually flush the sperm through and make sure we had the freshest available. As we had to do ICSI anyway, any possible drop in numbers wouldn't have been a significant issue.

Finally - it was our 5th transfer that gave us Munchkin (with another 3 cancelled transfers on top of that), and I was so convinced that it wasn't going to work, that neither of the two frozen embryos we had would work that I spent my TWW planning out how long a break we would take from IVF and how much money we needed to save before we could go again and how quickly we could do it... The rest, as they say, is history. Hopefully that's a little encouragement for you.

I'm sorry if it's not outside the box enough, but adoption, fostering, donor eggs/sperm/embryos weren't an option for us so our thoughts never went that way.

BW

Bec

I too wish that I had answers for you but I just don't.

So I am sending you a huge hug and just reminding you that we are all out here ready to provide cyber hugs at a moments notice :hug:

i think BW has some great advise for you and hope that you get some answers soon.

It really doesn't help when they say to you 'oh you will have no worries with falling' ahhhh

maybe get a second opinion

GL

BW - Thats actually a huge help. Lots of things for me to think about and take back to my FS.

Honestly I feel really helpless right now, I never planned this far into it. I always thought that IVF would work, if not the first couple of attempts, then at least by number 7!

Hi Bec

I just read your post and wanted to say that although i don't have any answers for you, i do know exactly what you are going through. My DH and i have now done 3 fresh IVF transfers and 5 FET and never had any of them 'stick'

I am about to go see my FS and demand more testing. As a healthy 30 year old with "beautiful embies" and no reason not to fall pregnant - they keep telling me the same thing "you will eventually fall pregnant" But WHEN !!!!!!!!!!!!!!!!!!!!!!!!
Surely after 8 attempts I have been extremely patient.

I have considered some alternatives but hubby is not interested in adoption or fostering and although i have a beautiful sister who would be a surrogate for me, unfortunately it's not legal here so that option is out.

I honestly don't feel like i have the energy to go on, especially when all of my friends either have children or are pregnant. Sometimes i just want to pack up everything and run away.I know it sounds selfish but i just don't feel like i have the strength to be happy for one more pregnant friend.

So if you ever need to have a chat or a cry just know that i feel everything that you feel

Hun, I just want to say I'm sorry :comfort:

I'm another one that was told that I would be an 'easy' case... well,7 yrs of trying I'm still here waiting :rolleyes:

Finally, now though, after getting an excellent 2nd opinion and changing FS we have found an answer that has been there since my DS was born in 1998 and no one else, despite numerous laparoscopy's could find :o

DON'T GIVE UP HOPE xxxx

There is always another thing to try with IVF - I've definately learnt that over the past few years.

My advice would be to get another opinion... see an FS that specialises is miscarriages/failed transfers/ etc.

Can tell you of a wonderful one, but you would have to take a trip to Sydney ;)

Am hoping Sushee sees this thread as she is a wonder of info - and being in Perth can probably help with specialists & clinics, etc better than I can ;)

My thoughts are with you - and I second everything BW has said.. you haven't had (from what I've read) any auto immune tests and extra BT done yet, so there are STACKS of other options.

Keep positive sweetheart.. there will be an answer, sometimes its just a harder search ;)

Wow - I could have written many of these posts myself.

I have recently been asking myself the same questions after our 5th transfer. We had one pregnancy which resulted in a m/c and unfortunately I've not come close since.

I've recently sought answers from my FS looking for answers. He couldn't really give me anything except to suggest blood tests for clotting. I recently underwent blood tests for anti-thyroid (I thought the clotting was part of this but apparently not :rolleyes:) which came back fine.

The other things the FS mentioned were studies that looked into low dose asprin and high doses of folate which may help implantation, so that's something else you may wish to discuss.

BW has provided some good advice as you've already acknowledged. The only other thing, although it will have a cost, is trying accupuncture and traditional chinese medicine if you haven't already.

Wishing you all the best.

Hi Bec,

I wish I had some easy answers for you, but this road we all are travelling on in our quest to conceive is certainly not easy. All the girls have given some terrific advice, especially BW , lots of stuff there to talk to your FS about. I agree also with getting a second opinion and perhaps changing FS or clinics. I myself have been doing some research into the different clinics in Perth and success rates/procedures that they do.

I have also started seeing a naturopath, she is in Mt Lawley, I can give you the details if you like. She just looked at my diet, did a saliva test to check all my estrogen levels plus progesterone (which was quite low in fact). So I am now taking a herbal supplement plus eating a lot more variety of vegies with each meal, cut right back on my coffee intake, to just one cup every week or so (mainly if we go out). Also eating a lot more organic foods, plus I always make sure that I now buy free range chicken. I am also thinking about giving accupuncture a try - there are a couple of threads here in BB about accupuncturists in Perth.

Good luck, keep us updated on how you are going. Take care sweetie, wishing you all the very best.

Thanks for all the advice ladies.

Murray and I had a big talk last night and I think we are going to try and fit another FET before the end of this year and take advantage of the safety net.

After that I think I am going to set up an appt with both my FS and also someone from Concept to get a second opinion. Hopefully they can run some additional tests on reccurent implantation failure and I can aim to lose some more weight.

We can't afford to do another stim cycle until our tax returns come back, so probably August, at which point it's probably better for us to wait until January again for the safety net... so confusing as to what to do.

I think I'd like to look into Assisted Hatching, apparently that can assist in people who have had failed transfers before.

Another thing that we are considering is starting the process for local adoption. I dont think we are quite ready to go as far as international adoption but Id like to at least find out what we need to do if we go down that path. Id also like to look into weekend/respite car, especially of newborns/young children. I dont know how much demand there is for it, but i could be facing an uphill battle with Murray to convince him this is a good option.

I just dont want to feel so desperate anymore, like there are no other options. Murray panics easily and so its easy for me to feel that way.

Bec,
You are still pretty young, and research into infertility and treatment motors along rapidly. I would seriously talk to your FS about what options might be available to you in 5 or 10 years time before you make any decision.
all the best,
Kate

hi ladies !

I have just read through this thread ... while I don't have any answers for either of us ... I may hold just a little bit of hope :D ..

DH and I have been on this rollercoaster since we found out in Nov 05 that I have PCOS .. and we also found out that DH's swimmers weren't the best so I took him off coffee straight away and moved him onto tea and a good multivitamin also (In April 2008 - DH's swimmers were classed NORMAL !!!!) .. in 2006 we did 8 months of OI and IUI - all BFN month after month ... we had a 5% chance each cycle because of DH's swimmers ..

We left that FS and moved onto another clinic just up the road and started IVF - I can't remember the quality of our embies (hopefully I will know more tomorrow - long story) .. I got OHSS and ended up in hospital .. not long after we left that FS for yet another FS - within the same clinic .. Alot of moving around I know - but totally unavoidable ..

Anyway since March 07 we've done 3 IVF's with 1 of those cycles in april 08 being cancelled due to E2 levels of 22,000 !!! .. we've also done numerous FET cycles during that time ..

At our last FET in September 07 - we thawed out 9 D1 embies to take to D5 - sadly we only ended up with 2 out of 9 :( ... so that to me suggests that egg quality wasn't good ..

It wasn't until our cancelled cycle that we started to think maybe this is the end ? .. well here we are in Dec 08 8 months later and I"m ready to FIGHT for our miracle .. so what has made me want to fight again ? .. it's amazing what RESEARCH on the net can do ;) ..

We are in the process of changing clinic's yet again - yes I know .. lol .. change clinic's like we change our undies .. rofl .. rofl .. so why are we moving to this new clinic ? what makes it so special ? .. well the fee's aren't cheap that's for sure .. BUT ! there are 2 Dr's - well 1 is a Professor who hold a CREI ..

What is CREI?

Certified Reproductive Endocrinology and Infertility (CREI) subspecialists are specialists in Obstetrics and Gynaecology, electing to undertake an additional three years of subspecialty study to ensure comprehensive management of patients with reproductive endocrine disorders and infertility.

After going to Monash IVF at Sunnybank, Brisbane last Saturday - just flipping for ideas etc ... and seeing the brochure I proceded to ask the recpeionist about the Dr's .. who told me about the 2 Dr's who hold the CREI .. our new FS who see on the 14th January is Professor Bruce Dunphy - who has studied in America/Canada/England and holds a CREI ..

When I got home ... I sat down and started thinking - hmmmmmmmm ... maybe this is a worth a try .. so I started researching .. and found more out about CREI ....

out of all the FS's DH and I have seen and been to in the past 4 years - all have just been a gyno/fertility specialist ... none have had the qualifications that our new Dr has .. none has trained overseas .. none had the CREI ..

I am also a member of another forum - and there are 2 girls who are seeing Dr Dunphy and they have said how his treatment plans are so different from their other specialist's .. 1 girl is so happy with him that she's thinking of leaving her current Dr to move over to him .. (her current FS is away on holidays and Dr Dunphy is looking after her) .. they also said even the FN's can't talk about Dr Dunphy enough - and how is treatment so is different - and the new idea's that he's bringing to the clinic they said is amazing !

They also told me about "Luveris" which can help improve egg quality .. so yet MORE research .. lol .. and low and behold what i found shocked me ! .. most of the cases I read were all women with poor egg quality - so their FS's put them onto LUVERIS .. some embies weren't even making D2 ... yet when put on LUVERIS they were getting HIGH QUALITY embies at D5 and most had got their BFP !

So then I sat down and asked myself more questions ...... why didn't my FS mention LUVERIS to me ? .. surely she know's about it ......

So the point of the above essay ? .. lol .. I think when looking for a FS it's important to check their qualifications - I had no idea about the CREI until Saturday when I went to Monash .. our new FS is actually a PROFESSOR not just a Dr/Gyno/FS ..

Apparently Sydney IVF have some Dr's who hold a CREI - not sure about other states - but it sure is worth checking into that's for sure in my opinion ..

We are starting IVF #4 in March 2009 - and I know that in April we'll be annoucning our BFP !!!!

GOOD LUCK to everyone .. and I hope this information has helped !

OMG I just wrote this HUGE, LONG post clicked SUBMIT and lost the flamin' lot ..

I would suggest finding a DR who holds a CREI - they are a subspecialist of IVF and are more qualified than a normal FS ..

You can find a CREI Dr by going to:

http://www.ranzcog.edu.au/publicatio...I-Handbook.pdf

go to pages 9 and 10 .. there are 3 Dr's in Qld - Dr Forbes, Dr Dunphy - both at Monash IVF, Sunnybank Brisbane and Clare Boothroyd - Assisted Conception Australia - Brisbane ..

We have done 3 IVF's of which 1 cycle was cancelled in April this year due to E2 levels of 22,000 .. we've also done hatching and glue - neither worked for us .. but a g/f used glue and now has a beautiful 4 month old daughter ..

we are in the process of moving clinic's to a new dr who has a CREI and all the reports I've heard about this new dr are fantastic! ..

We see him on the 14/01/2009 and start IVF #4 in March 2009 .. I can't wait I'm so excited !!!!!

Hi Bec,
DH were also told when we started IVF we would get pg...but after two stim cycles and 4 transfers, I knew something was not right. We started IVF because of poor sperm, and I was like you, I'd had very few tests as it was male factor infertility.

Anyway, I was sure something was not right - reading the stats I was convinced that after what we had done we should have got at least a BFP - even if we then went on to lose it - but nothing. So based on some info from BB, I asked for more tests...the ones that BW mentioned. And despite the odds, I came back positive for ANA - antinuclear antibodies (test is positive in only 2% of the population which is why they dont automatically test for it). I was refered to another specialist who put me on 100mg of asprin and 2 x .2ml 5000u heparin injections from transfer, as treatment for antiphospholipid syndrome (APLS) (this causes my body to attack the embies - we never had a hope of falling pg without this medication). We have just got a BFP on this FET now that we are on this protocol! We still have a long way to go, but this is the furtherest we have got so far.

I guess I'm just trying to illistrate that even a FS does not have perfect knowlege and if you are in doubt ask for more tests - it would have been another 4 failed transfers before they would have done the extra BTs for me had I not asked for them to be done sooner. Just because you have MFI, does not mean there are not other underlying issues affecting the ability of your embies to implant. Keep asking questions and push to have tests done.

Good luck
FG

tctbub1 - I just read your post and i just felt like i had to reply. Now before I go on i just need to say that I am not trying to burst your bubble but my story is slightly different.

My DH and I have been through numerous (as you can see from signature) transfers all resulting in a BFN. And many BB users have said to me that they can't believe that i haven't demanded more tests and more ideas from my FS. So this year i switched clinics and ended up at Monash Sunnybak also. And i too started seeing Prof Dunphy this September when he first arrived. I have just completed my first cycle with him which ended in a BFN. So to date thats 8 failed transfers for me, so I made a follow up appointment with him this week to insist on more tests to find out why i fail to implant everytime. I went in there armed with info from fellow BB members about tests their FS had done as well as some of my own research and ideas. WELL to my absolute shock and horror he shot down each and every idea - right down to farmgirls aspirin protocol (even though it clearly worked) and told me that there is ABSOLUTELY NOTHING he can test me for or nothing we can do differently. I am still in shock!!!!

Please feel free to PM me if you want any more info but that is the absolute truth about what he said.

Can't wait to see what some of you guys think about this. Professor or no professor title i think i would prefer someone who is at least willing to try something. I don't really have much to lose at this stage!!!!

mollygirl -

I can't do PM's cause I don't have enough posts or something ? .. I"m sure that's what I read somewhere - and not only that I can't find where I send a PM ... lol ..

I would really like to talk you ..... so if you can PM me ? .. then we can exchange email addy's or even phone numbers ..

I wouldn't say you've burst my bubble - but it is a little deflated :(

ttcbub1 - yeah i tried to PM but it wouldn't work. Not sure how else to get in contact but i would really love to talk to you and find out where you live - we might be close

mollygirl -

we're at Loganlea - I have msn - it's only for MSN not email .. I have another email addy .. but if you use MSN your more than welcome to add me :)

Hi Bec,

I'm really sorry to hear about everything you are going through. You are a tough cookie!

You mentioned some 'look outside the box' suggestions, so I thought I would mention 2 natural fertility experts that I know of working in Perth. They are loaded with info and advice that you are most likely not ever going to hear from your GP or IVF specialist (no offence to them- the things I'm referring to are just not their forte).
One specialist is Natalie Pickering, of Perth Natural Medical Clinic in Mt Lawley, the other is Jane Lamprell-Jarrett, who works at both Pivet Medical Centre and Synergy Clinic in Leederville.
They conduct intensive 3 month pre-conceptual care programs (sperm takes 3 months to fully mature) which incorporate intensive diet control and supplementation tailored to each partners individual constitution, as well as rigorous detoxification. They are also able to conduct blood, saliva, and hair analysis tests to ascertain any hormonal imbalances, heavy-metal and pesticide toxicity, as well as many other common barriers to conception.

Friends of mine fell pregnant after following Natalie's pre-conceptual care program- although they had been trying for 2.5 years to fall pregnant naturally prior to this and were ready to board the IVF train.

I wish you both all the very best in your journey to becoming parents. I will say a little prayer for you, your DH's sperm and your eggs!! Remember, miracles DO happen every day........ I believe your time will come.

X

Bec on the surrogacy front - most of the laws in Australia are focusing on gestational surrogacy rather than traditional surrogacy. To do gestational surrogacy you would still have to under go IVF and risk OHSS. Also normally there are ethical boards you would need to sit before and normally they have conditions attached to them like GS to be used at risk of maternal life/health, or uterine issues. Occasionally they will consider repeat failed IVF however this is often when someone has done 12 transfers or more.

Currently in WA it takes over a year (maybe 2 from what friends tell me) just to get to the basic level of information classes for adoption, my advice is to put your name down now and continue with IVF until then at the very least.

I advise you to have a lap done as it can show up issues not seen at egg collection - this can assist with things like placement of embryos when transferred, etc. EPU is not the same as a lap.

Has your DH had SCSA or a tunnel assay for DNA breakage in his sperm?

M7Missy - Thanks for the info on surrogacy. I think Ive pretty much decided that it is out for us, I dont believe that I could cope with another woman growing my baby inside of her, its too big an emotional trigger for me. That being said who knows about the future.

DH hasnt had SCSA or a tunnel assay, his issue has been very low sperm motility for which they have told us there isnt much they can do. He is on Menevit tablets to see if they make a difference but so far they haven't done anything.

Jellybean - That sounds really interesting, Synergy Clinic is near my work, so I might pop past and find out some more information.

Well we ended up with a BFP from this FET cycle but unfortunately the beta levels were low from the beginning and we lost it at 5.5wks. But it really has given us renewed hope that we know we can at least get pregnant. Up until that point I honestly didn't think we could and was feeling terribly hopeless. Unfortunately for us finances will probably pose our biggest problem in going forward with treatment, but I think we will continue on with a FET and then probably another stim cycle later in the year.

BW - I am definitely going to be requesting some additional testing to be done, and if our finances allow it, I might even get a lap done - will speak to the FS about it at least.

Thank you all so much for your advice and encouragement, it has really helped me out.