No question is a silly question!

Last night we were joined by the lovely Carole Gilling-Smith and her team from the Agora Fertility Clinic for one of our #ttcafterworkdrinks evenings.

It was so lovely to sit and chat to the team in such a relaxed environment whilst getting all of our questions answered.

It can be difficult sometimes, when you are in your consultation at the clinic, to take all the information in whilst remembering the questions you really wanted to run past the doctor. It’s so easy to panic and suddenly flat-line! Don’t ever feel silly about writing your questions in advance and pulling out your long list during your appointment. Asking ‘silly questions’ is a must!! (Remember- no question is a silly question!!!) Never be unsure about anything.

Don’t forget, we always have our live Instagram Q&As too!

Last week Carole joined us for a session and so we thought we would publish some of the questions asked, in case they relate to you too.

Understanding your treatment is so important, so always ask for help if you are stuck or confused.

Q: I have very extensive Crohns disease and a permanent illiostomy, my periods stopped about 6 years ago i thought this was due to so much weight loss and body changes however i am now at a healthy weight and coping much better with the disease but my period has never returned! I’m getting really scared as my period has still not returned! Maybe I won’t conceive naturally? Will I need IVF? Is my body able or ready to cope? Will it work? So many things to think of!

A: It sounds like you have had a tough time. You need an ovarian reserve check to find out what’s going on with your periods and that includes a pelvic ultrasound scan to look at your ovaries and antral follicle count and an AMH level and FSH, LH and oestradiol level and see a fertility doctor with the result. They can advise if you need IVF or a simpler fertility treatment

Q: I have PCOS fibro numerous allergies and psoriasis. 4th round about to start on a short protocol because of hyper stimulation last cycle. Should I be looking at immunity tests outside of what the nhs are offering us. We are on our last free go. Pregnant with twins 1st early mis. 2nd low hcg. 3rd nothing. 4th frozen low hcg. 2nd frozen didn’t thaw

A: We do not advise immune testing as there is not enough evidence to say that an increased activity of your immune system is linked to a poor IVF outcome. That is why the NHS and most private clinics don’t advise it.

Q: Carole what’s the best way to improve egg quality?Last retrieval for ivf I had a good quantity but none reached blastocyst stage.

A: There is nothing proven scientifically to improve a woman’s egg quality – many women seem to be taking co enzyme Q, DHEA, Zita West vitamins etc but none have been shown scientifically to improve egg quality so save your money and buy fresh fruit, veg and take regular exercise, avoid caffeine and alcohol4dReply

Q: Low egg count at 31, 2 failed cycles should we go Donor or can I improve my egg quality?

A: At 31 having a low AMH does not mean the quality of eggs is low so although it may take longer to great pregnant you still have young eggs so don’t need egg donation. The only exception would be with a high FSH which might suggest early menopause.

Q: What are the chances of sperm taken through aspiration (think that’s the correct term for surgical removal of sperm from the testicles) in someone who has Klienfelters, being good enough to fertilise an egg please?

A: The chances are low but if sufficient quantities of motile sperm are retrieved then the odds are better. The real test is at the retrieval stage as many men have insufficient sperm in the testicle to retrieve

Q: I’d like to know how long on average the testing phase should last before being referred for IVF. We’re two years in and still waiting desperately for a referral.

A: it very much depends on where you live but it shouldn’t be much more than 2 years. It would definitely be worth calling your GP to chase things up.

Q: Do vitamin infusions improve success rates?

A: There is no evidence to suggest that vitamin infusions improve success rates.

Q: Do you see any merit in having a ‘scratch’ to help with implantation after embryo transfer?

A: Yes, if you have had no implantation with IVF but not useful if you have conceived and miscarried

Q: We have recently had our only NHS funded round fail (FET) I have one ovary that is polycystic, husband has low sperm count/motility etc. We had 36 eggs at collection, 28 were mature, 23 fertilised but over the days they rapidly dropped and we were only left with 1 blast that was suitable to be frozen. Would this suggest there is potentially something wrong with egg quality? Our follow up, the doctor recommended a Karotype test, and I asked about a comet test, but not sure if these will be beneficial? Are there other tests you could recommend having? My husband was taking Condensyl supplements, but have just changed back to Wellman (because of the cost) and I am taking Zita West Vitafem, Vit D, Zita West DHA. I did take Ubiquinol before as I read it can help with quality, but not sure if I should add in again? Thanks

A: I feel that your IVF stimulation was too high and you had too many eggs collected so the quality may have been poor. Definitely worth checking his DNA fragmentation levels using a comet test or similar. I would advise lower dose stimulation on the short antagonist protocol and maybe that they culture your embryos in the embroscope. Maybe ask your clinic to use Menopur 75 with Gonal F 25. Gonal F is a very aggressive way of stimulating the ovaries if you have PCOS and often leads to over response

Q: Is it possible to increase your AMH? and what are the best supporting supplements to prepare your body for IVF

A: There are really no magic ways of restoring your egg count and therefore your AMH Women lose 100s of eggs every day but some women lose their eggs faster than others so have a lower AMH.

Q: Can Ii still have a chance with retrieving only 1 egg each time of conceiving

A: Unfortunately the chances with one egg are pretty low

Q: Hi Carole, I’ve got a follow up appointment next week after a disastrous first round of IVF (9 mature eggs collected, only 2 fertilised and they didn’t progress past 4/5 cells) What questions should I be asking my consultant? I’ve been pregnant naturally 5 times but always ends in miscarriage or ectopic. Just feeling so confused as we don’t have a problem with conception/fertilisation when we TTC naturally.

A: So sorry to hear this. Sounds like a sperm issue rather than your eggs and you should ask if there was evidence of the sperm binding to the egg. What was the sperm quality and motility. Sounds like you should have ICSI next time.

Q:thank you, the embryologist said that the sperm weren’t binding to the egg. My husbands sperm analysis came back as “very good” and on the day of egg collection his sample was also “good”. Will ask about ICSI next time. Could it be an egg issue too as they were only 4/5 cells and also previous history of miscarriages?4dReply

A: Yes possibly worth asking about your egg quality on the day

Q: Is PGS testing worth the extra money? One round of ICSI worked but ended in 2 miscarriages so told this is the best way forward?

A: You can go the the regulatory body the HFEA website where they have a traffic light system for all the add ons some clinics suggest and PGS is one of them which is hugely expensive but there is insufficient evidence that it would improve your chances so no don’t do.

Q: They say i keep miscarrying due to genetics I’ve only done one round? What would you suggest?

A: If you have repeated miscarriages more than three then they should check your blood clotting and maybe your chromosomes and your partners. He should have a DNA fragmentation test

Q: I try and find information about PCOS on the internet and all of them refer to people that have missed periods or irregular periods. I am thirty and was diagnosed with PCOS last year through my fertility doctor. I have never missed a period and always have 5 days period and 23 days off not been referred to my GP for medication to help manage my PCOS like metaformin is this because I don’t need my periods regulating? Also if i do get my period does this mean I am ovulating or can you still get a period and not ovulate? Thank you hope this makes sense.

A: if you have regular periods then 95% chance you are ovulating, but only way to check is with a progesterone blood test 7 days before your period is due. You may have polycystic ovaries but not the syndrome and so no symptoms.

To get in touch with the wonderful team at the Agora Clinic visit here

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