Dear Prof Winston,

I would be eternally grateful if you could offer me some impartial fertility advice.

My husband and I have had trouble conceiving since 2003 and sought fertility treatment in early 2005 (two ICSI cycles). As my hormone profile was good it was assumed I was fine but we were recommended ICSI due to my husband’s results. My husband has a very low sperm count and high abnormal forms.

We were all set to try again in Jan 2006 but by some miracle I fell pregnant naturally and we now have a beautiful 7 year old son.

He has completed us but the guilt we feel at not being able to give him a sibling is crushing us. I do not want him to grow up lonely, especially when he gets older and my husband is not sure he could adopt, although maybe later down the line he may change his mind.

Anyway, in 2010 we started investigations again. We weren’t sure whether to pursue IVF again as the financial strain just added more stress. We went to a clinic in London and I had an AMH test done which came back at 9 PMOL. I also had the Chicago bloods which also show raised NK cells. They told me then I had the ovaries of a 40 year old. This was heartbreaking and I just hope we haven’t left it too late.

The things I have been trying to weigh up and getting confused about are:

Would Natural IVF/ Mini IVF be a sensible consideration for us or are our chances still better with conventional IVF? We just don’t want to pay a fortune on drugs that aren’t producing results anyway as I am clearly a poor responder.

Is it worth paying for the ENDO scratch / Endo NK biopsy to check my NK cells level or are the blood results reliable enough?

All the extra things clinics tell you can help your chances also baffle me!!

We really can’t afford to be wasting money but if would truly will help our chances then obviously we will do everything possible to get the money.

We looked at one particular clinic but I when I asked about about minimal stimulation and short/flare protocols they said they don’t do it as their research/data suggests it is ineffective. That contradicts things I have read elsewhere, so I am not sure if it is the right clinic for us or not?

Essentially we want to help other couples from being exploited by greedy fertility clinics. It’s such a pity that some feel it acceptable to treat us like a cash cow when we are dealing with something so personal, very difficult and upsetting.

Warmest wishes and the most heartfelt thanks,

J&R

REPLY….

Dear J&R
 
I am very sorry to hear the complex situation you find yourself in and the time it has taken for me to reply. Please understand that you must not expect very specific advice from me about your precise problems because I do not have full information and have never met or examined you.  A website cannot replace a full consultation. Clearly, without having taken a full history, examined you carefully, looked at ALL the tests results including X-rays and ultrasound etc. and above all, have met both you and your husband eye-to-eye, it would be presumptuous to make very specific suggestions.
 
Having said that, you have managed to conceive spontaneously, which presumably means that you can do this again. That is very good news because the figures clearly show that people who have conceived once are much more likely to do it again. But I think you have to recognise that a human embryo only has about 18 – 22% of implantation and successful pregnancy.  This means that, no matter what any clinic tells you, your chances of IVF being successful in any one cycle is around 35% or slightly more with two embryos transferred.  Do not believe what you see advertised by individual clinics as quite implausible claims are frequently made.  The national statistics show very clearly that the overall average successful pregnancy (live birth) rate for an individual IVF cycle is around 25%.  It is a bit better than this in women of your age (around 35) not being treated by ICSI* but not much. Although some clinics will claim better success rates than this (and some worse, of course) there are various ways that a clinic can present its results which make them look more successful – bear in mind, as you have found out, this is a highly commercial market and highly competitive. The results that clinics actually get very often mostly depend on the kind of clientele they are treating as for example clinics treating younger patients or patients who have not failed many previous cycles or who do not need treatments like ICSI will generally get better success rates.
 
A few specific points – 
1. Measurements of AMH are only an approximate indication of how ‘good’ your ovaries are.  To say that you have the ovaries of a 40 year old is just silly.   In any case, AMH fluctuates from test to test. 
2. Remember that a less expensive clinic may in no way be a worse clinic.  Be careful when going to clinics that claim extraordinarily high success, or those that have a ‘magic’ profile.
3. I am very dubious that NK cells would be relevant in your case. Their role is doubtful anyway and you have quite enough reason for your infertility with a husband with a fluctuating sperm count.
4. Failing two cycles of IVF (given a 35% chance each time) is a normal result, not an abnormal one.  That fits with the average biology of humans.
5. I don’t want to sound presumptuous but you really should not feel guilty about your son being an only child – he will not be lonely, believe me. Try to count your huge blessing.
6. Try to have pleasurable sex as often as possible, without too much timing of the cycle.  You won’t make the quality of the sperm worse and you may have as much chance of getting pregnant as with IVF or ICSI
 
My best wishes
Robert Winston
 
*Sadly, an apparent deficiency in the published figures of the HFEA is that the national success rate for ICSI cycles does not seem to be reported.
 

Leave your thought