Hello there ,
My next FS appointment is not until October , but in the meantime I'm putting together a list of questions for her to try and find out why my cycles keep failing. Yes, I know I am paying her the big bucks to do this herself, but I just don't have the confidence that some FS's are in it to help others or to help their bank account. This is the reason I have already changed 1 FS. After my first 2 cycles failed his only suggestion was to try again . IMO, that wasn't good enough, shouldn't he at least try and do some investigations as to why they were failing? Anyway, here is a brief outline of my cycles:
1st ICSI long cycle = 7 eggs, 4 fertilised, 1 ET, 0 frosties = BFN
2nd ICSI long cycle = 4 eggs, 1 fertilised, 1 ET, 0 frosties = BFN (changed to new FS)
3rd ICSI short antagonist cycle = 2 eggs, 0 ET
Both of my emby's were not at blasty stage.
We have only ever had the following tests:
· Endo removed (had a lap, D&C in Feb 10)
· Pelvic ultrasound and hyCoSy (both results normal)
· Blood tests (Hep B, rubella)
· DH SA (low sperm count)
DH is currently taking Menevit and I'm taking Elevit with Iodine. I would love to start trying DHEA to improve my egg quality (something I have learnt already from some of you) but cannot get a prescription until I see her in October (I tried calling to get a script sent to me but her receptionist refused and said I had to wait until my appointment ). I am also currently taking DHEA from the vitamin shop but it's not the same strength as the one from the chemist.
After reading many of your stories here on BH, I have heard some of you say that you've been tested for things I've never heard of or at least never been tested for, eg NK? cells, AMH? levels, etc.
I would love to find out what kind of tests me and DH should undergo to see if there is any underlying reason for our infertility. Sometimes it just feels like it's too easy to label us as "unexplained infertility", but I just cannot accept this when obviously there has to be an explanation if we already conceived a child naturally.
Any information, advice, stories would be greatly appreciated. Thanks .
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29-08-2011 16:41 #1
What tests should I ask our FS to do?
30-08-2011 08:48 #2
I have gradually accumulated a huge list of questions that ask my FS after each failed cycle, i think he dreads speaking to me on my follow up appointments with this list. Some of these may not be relevant but it will give you and your FS lots to hink about.
1. What were the main factors that contributed to this negative cycle?
(well you might as well start with the obvious one!!)
2. What are this clinics success rates for couples in our position (taking age and diagnosis into consideration)? And what is that statistic nationally?
a) How was the quality of the eggs? (Were they mature enough?)
b) Were there as many as you were expecting?
c) Would having egg collection a few days earlier or later help?
d) Would more monitoring during the stimulation phase help you to control my drugs better (and thus get a better result)?
e) Is there anything else that can be done to improve the eggs?
f) Should we consider using an egg donor?
a) How was the quality of the sperm?
b) Had the count, motility or morphology improved at all?
b.ii) Is there anything that can be done to improve this?
c) Would we get better results with a Biopsy?
d) Should we consider donor sperm?
e) Should we consider an appointment with an urologist? (Whom would you recommend?)
5. Embryological questions:
a) How did the embryologist feel the ICSI procedure went? (E.g. was it easy to find sperm of good morphology in the sample?)
b) How well did fertilization go? (E.g. more quickly or slowly than expected)
c) Did any fertilized eggs produce unusual results? (E.g. 3 nuclei)
d) What was the overall quality of the embryos like?
e) How do you grade them/what is your opinion of grading vs. live baby rate?
f) Does any of this suggest any issues?
g) Could assisted hatching help us?
h) Would delaying transfer (or carrying it out earlier) have helped?
i) What is your opinion on going for blastocysts next time?
j) Can the embryologist remove the fragmentation in the embryos?
k) What do you feel the link is between fertilisation rate, embryo quality and live baby rate?
l) What is the policy with regard to freezing/frozen embryos?
6. The drugs:
a) How do you feel I responded to the drugs for down regulation? (Did it take longer or less time than expected?)
b) How do you feel I responded to the drugs for stimulation? (Did I respond too quickly or too slowly? Did I produce enough eggs? Did coasting for a few days effect egg quality?)
c) Did the trigger injection work as expected? (Should I have taken it earlier or later for better results?)
d) Do you feel I am on right drugs at the right dose or should this be changed next time?
7. Further tests:
a) Are their any further blood/hormone tests you would now recommend? (E.g. FSH, E2, AHM etc.)
b) Should we test for immune issues?
c) Should we have any further genetic tests/Karotyping?
d) Would you recommend having a hysteroscopy? (Why?)
e) i) Would there be any point to do PGD?
ii) How many embryos to you need for this?
iii) What are the risks involved?
iv) Is each embryo tested for one genetic disease or 9 of the listed diseases?
8. Next cycle:
a) When can we try again? (Why then?)
b) i) Which drugs for down-regulation?
ii) Why do you feel this one would be better?
iii) What dose?
c) Any extra drugs ie DHEA, Melatonin?
d) i) Which drugs for stimulation?
ii) Why do you feel this one would be better?
iii) What dose?
e) What trigger - HCD or Ovidril?
f) Would you recommend any additional treatment this time? (E.g. low doses of aspirin, IVIG, heparin, etc.)
30-08-2011 11:31 #3
Wow EO, you are so nice to send me this info. You've obviously been through a lot to have such a detailed list, I wish you the best and really hope you get your BFP soon
This is exactly what I was looking for, I just need to go in with some direction and have a list of questions ready and hopefuly get some useful answers.
Thanks for sharing.
30-08-2011 12:10 #4
This list is amazing! I will also be using some if these questions if you don't mind.
Good Luck OP with your Oct appointment. The constant waiting is the hardest part of the IVF IMO.
Short and sweet because I sent this from my iPhone.
30-08-2011 12:10 #5
No worries at all hun . I find the more info i know the calmer it makes me feel about the whole process. Ever since we were told we needed IVF (18 months ago) i have googled like a maniac, stalked hundreds of IVF forums, and pretty sure i have read every Medical journal written about IVF at every spare opportunity i got and made lots of notes about everything i read.
I hope you are able to get some answers when you meet with your FS.
All the best for your next cycle .
30-08-2011 13:18 #6
Wow!! I was just about to come on here and ask the exact same question mumtochris! That list was very helpful Eternal, thankyou
I think after doing some research I'm also going to ask if we can have the DNA fragmentation test done on Df's sperm. I think he may be a candidate for that with his varicocele and poor morphology at 2-3%
Eternal, I was just wondering if you have had any further immune testing done and what that entails? Is is bloodtests or biopsy?
30-08-2011 14:11 #7
Daydreamer, it’s been really hard for me to accept as i have nothing wrong with me and we are doing IVF due to DH. I had all of the immune tests done; they took around 14 vials of blood and test for a variety of immune isues, all of which was covered by medicare except one test which cost $40. They all come back normal. I then had a biopsy for NK cells and this also came back clear.
With regards to the DNA Frag tests, while its really good to get the info, there is only really two forms of treatment. 1) DH to have a biopsy to retrieve sperm directly from the testes as DNA damage occurs when sperm travel through the Vas deferens as this process takes 2 weeks or 2) – which every FS will have a different opinion– is to get DH onto a really high dose of antioxidants. As a brief summary we have now done 3 Stim cycles, DH only took meneveit for the first two and Stim 1 we had 13 collected, 12 mature, 10 fert and 3 made is to day 5 (1 X Grade 1 and 2 X grade 2), BFP but MC and then 2 FET which were BFN. Stim 2, 9 collected, 8 mature, 5 fert and 1 5hit day 5 grade 3. Then on our third cycle after DH took 5 months of a super high level of antioxidants we had 25 collected, 20 mature, 15 fert and 5 perfect day 5 embies. Had to freeze all due to OHSS. Best cycle outcome we have ever had. So i am a HUGE believer of this antioxidant treatment. Even our FS was amazed at how good this cycle was compared to our others. (PM me of you want the list of supps i put DH on hun)
30-08-2011 15:41 #8
Awesome list of questions EO, no wonder your FS dreads seeing you!
Mumtochris, after 3 failed cycles I had the following tests:
- Antithrombin III
- Prothrombin II
- Protein C
- Protein S
- Factor V Leiden
Activated Protein C Resistance
Anti Cardiolipin Antibodies (ACA)
Anti beta 2 glycoprotein 1 (IgG & IgM)
Anti Mullerian Hormone (AMH)
Antinuclear antibodies (ANA)
Antiphospholipid Antibodies (APA)
Antithyroid Antibodies (ATA)
Full blood count
Karyotyping (chromosomes)- Both DH & I.
Thyroid levels (TSH, FT3 and FT4)
Laparoscopy and hysteroscopy
Natural killer cell uterine biopsy (at 10dpo)
Like EO, I spent alot of time googling, reading journal articles and lurking in forums. This list covers clotting factors and autoimmune issues. All are done via BT, except the lap/hyst/NK biopsy. Be prepared to lose 14 vials worth of blood for all of those. If your FS is already resistant, find another one that will happily turn over every stone for you.
I'd recommend checking in advance what it will cost you. For DH & I combined we spent $1500, but I hear from others that they pay much less.
30-08-2011 16:43 #9
Lindy, that is a great list for bloodtests too. This is all the info I'm after and this saves me some time researching so thankyou i notice you have Hasimotos and so do I, so I've been wanting to have my thyroid antibodies checked for a while. Can I ask how your thyroid results were?
I was also wondering whether I could ask my GP to run some of these bloodtests? It's not until September 28th that we have our FS review and if I could get some results to take into him I would at least feel like I'm doing something. What do you girls think?
sorry for hi-jacking your thread mumtochris!! Hopefully we will both be able to bombard our FS with questions now
Eternal, I think i want to know about the DNA frag to confirm my suspicsions. Like you I am finding it hard when the problem doesn't seem to lie with me. I think if the results were bad df would be more willing to have the sperm retrieval done. He goes for an ultrasound to see how bad his varicocele is in a few days and from what I've read if it's the varicocele causing the MFI vitamins and antioxidants probably won't help. I have had him on the following for the last few months:
Fish oil high dose 1500mg x 2
Vitamin E 500IU x 1
Vitamin C 1500mg x 1
Vitamin D 1000IU x 1
Sperm Max, which has zinc, selenium, Co-enzyme Q10, ginseng, and some other things I can't remember.
he also takes a Berocca most days.
How does this compare to your DH's regime If nothing else df says he feels better lol!
30-08-2011 17:55 #10
Oh just to add, the $1500 was for the BTs and $900 of it was karyotyping. It was extra for lap/hyst/biopsy.
Daydreamer- my TSH hovers around 1.6-2.0. T3 & T4 are normal as well. For the thyroid antibodies, my thyroglobulin was <40 (normal) and thyroid peroxidase was >1000 (super high). If you have hashi's, one or both of your antibodies will be high.
You could try getting the BTs via GP, no harm in asking. You'll probably get a 'blank' look though! I also suggest printing the list with the full names of the tests for the pathology. The lady who took my blood couldn't understand my FS abbrevations on the form. The list came in handy.
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