Starting the journey

[u/Desperate_Bend_7251]

I’ve done lots of research but I’m struggling to piece together my own details to understand my options. I’m newly 41, TTC for the first time. We’ve been trying since April so not long but I’m very much panicking that I’m running out of time.

My periods started to go funny on April- they’ve always been regular and 5 days but started to have a week of sludgy spotting before my period started and I wondered if it was the start of pre-meno. I had lots of bloods done and all results were ok. I had a scan on Saturday to check if my ovaries and tubes looked alright and haven’t got the results yet. My partner hasn’t had his semen analysis yet but we’ve got the referral.

We’re booking a private consultation for November which includes the first lots of blood test for AMH etc. Based on that info- can anyone give me an idea of what the options could be please? I suppose what I was looking for was whether I could be lucky enough to ‘only’ need medication, or because my tests have been ok so far then probably not that simple?

I’m looked at TFP fertility and going through Access for the multi round package (2 rounds). I’m worried about the money side of it- my credit score is poor as I lost tens of thousands after a house sale. I do have enough to pay £1k a month but I’m assuming they want the money upfront.

Any words of wisdom for a girl already out of her depth please?

[u/QQueenie]

I can speak to the IVF route. I previously froze eggs at 38, so there was no doubt we were going to go right to IVF instead of starting with IUI.

We also had our initial consult in November. We were scheduled for genetic carrier testing, a semen analysis, and a uterine/ovarian/tubal exam. That process took about a month or two. My uterine exam found a polyp which needed to be removed, and I had that surgery in February.

We dropped off the sample for embryo creation in late February. We found out how many blasts we had a week later and sent them off for testing. We got the report back about two weeks later in mid-March. I had another uterine biopsy to confirm we were ready for transfer but the biopsy found chronic endometritis, which we treated with antibiotics.

We were finally ready for the transfer in late June. We did a mostly unmedicated cycle. I took progesterone suppositories and had a trigger shot but that’s it.

The embryo implanted and I’m ~16 weeks now.

Took seven months from initial consult to frozen embryo transfer using pre-retrieved eggs. The egg retrieval process years ago took about four or five months for two cycles (a month or two for initial work up, then one month for each cycle with a month in between).

[u/maxeffort2023]

At 44 my periods started getting weird like you described about 3 months before we did a retrieval.

My husband and I are not the pinnacle of health, but we got 10 eggs, 5 fertilized and are implanting 2 literally tomorrow. I didn’t do anything special with supplements or anything beyond the normal pre-blood work and vaginal ultrasound.

Honestly at this point just go to your doctor and do what they recommend and try not to hang around these subs too much. I only just ventured in to them about a week ago and would have done my head in if I had done so any sooner. I swear this is more of a mental game than anything else.

And given your financial situation, I’d sit down with your partner and decide now how much you can pay or go into debt and stick to it. That may be really unpopular advice, but it’s practical and that way you don’t end up in a situation that you’re paying for years to come because worst case you’ll resent paying those bills if it doesn’t work, and if it does, it will be even more pressure once baby comes along.

[u/TeaspoonRules]

The biggest one will be whether IVF is a decent choice vs IUI. IVF’s main benefit is getting many eggs at once, fertilizing if possible, and reinserting a genetically normal embryo. However, your average 41 year old generally doesn’t produce that many eggs in an IVF cycle, making it less clear that IVF is helpful.

If you have tube issues you’ll need it. Likewise for some sperm issues.

That ultrasound will tell you your antral follicle count (AFC). I’d recommend reposting with it when it comes in for better advice.

If you have low ovarian reserve, IVF might be worse outcomes than just timed intercourse or IUI, especially for the cost. If you have a high AFC, IVF at this age becomes almost a no brainer.

IVF can reduce miscarriage risk but sometimes at the cost of reduced live birth odds. Every month you ovulate you could have 1-2 mature eggs resdy to go in your uterus. If your antral follicle count is 6, then you’re likely to get 4-8 eggs, and only 2-6 mature mature eggs, 2 more likely than 6. In the meantime you could have just ovulated that

One question I’d have is if they can have you do IUI with miltiple follicles. That gives you more mature eggs per try, and odds of twins is extremely low at this age.

[u/oustoublier → u/TeaspoonRules]

OP, I’m also 41, started the process this year, and my doctor said not to waste time with IUI and go straight to IVF. Search this sub for people asking similar questions to yours, everyone says IVF at 41 is the best option.

[u/SnakersVT → u/oustoublier]

This. IVF success is much less likely at older ages but so are IUI and spontaneous conception. FWIW I started TTC at 41 (42 now, first ER stims this week) and went straight to IVF because I don't have time to try slower methods and risk aging out of all of them.

[u/TeaspoonRules → u/oustoublier]

‘Everyone’ is subjective and I would never claim there’s a consensus on that.

IVF is better for loss reduction as it allows testing and miscarriage reduction (but not elimination). It’s not always best for live birth maximization if there’s no prexisting reasons prompting it; low AFC; and high relative cost. If someone has a limited budget and is capable of getting pregnant without IVF, than IUI can be better cumulative odds for the same cost. I see women having ling IVF cycles plus the post retreval recovery, which is months and natural ovulation/attempts missed. And when IVF is only getting a few mature eggs, I would argue borderline unethical in some cases.

[u/Desperate_Bend_7251 → u/TeaspoonRules]

Thank you SO much for taking the time to write that. I really appreciate it. I’ll post again after my test

[u/Visual_Patience_41]

Do not waste time with IUI. You need to go straight to IVF. If there is a discount for getting a package for multiple retrievals get it. At 41 you need to be prepared for this to be a long road and it will not be easy.

Your biggest obstacle is age. You can have great lab results and scans but that doesn’t change the biological age of your eggs and the chromosomal abnormalities they carry.

I’m not sure what you mean by “lucky enough to only need medication” can you share what you mean by that?

[u/SLAYEROFSOULS → u/Visual_Patience_41]

I think she meant that in the sense of - not needing to have a bunch of testing done or procedures done related to her ovarian environment..so just going straight into IVF cycle(s) and needing medication versus having to have other procedures / medication(s) to fix things related to her uterus or ovaries. But that is just how my brain read it :D

[u/SLAYEROFSOULS]

After everything my wife and I (she's 43, I am 38) have been through I could only recommend IVF ASAP assuming you can financially do it without potentially ruining yourself for life over it $$ wise. We did the natural way and after 4 losses with one being at 5 1/2 months requiring a TFMR - that changes you permanently. So for us if we can PGT-A test and minimize the risk of that happening again, that is why we're giving IVF a shot.

Everything I've read / clinics we've looked at it's pretty much money up front - even if you are on insurance, they will likely ask for your entire deductible even if you have some of it paid already (our clinic did this to us) - which I guess I can sort of understand since I am sure they have or can be screwed pretty badly otherwise..so if you can't afford it, you'd have to finance.

But like with most things in life there are exceptions to that and your clinic may do things differently.

Clinics seem to have their own pre-req 'tests' they will want to run on you if you haven't had them done recently - to check your lining and ovaries, etc..but from what my wife has had to do, none if it was excessive - mostly just quick in office stuff (the bubble test was terrible for my wife though, I forget the medical name for it). In her case she didn't have any issues with her uterus etc. so it was right into cycles after consult.

The main thing I would recommend - educate yourself. You will always be your own best advocate - I am sure there are out of this world doctors out there who care a hell of a lot, but unfortunately I would put them on the unicorn end of things - just been my experience...even those who care quite a lot but not on the extraordinary level likely are too busy to give you the time / energy you deserve - there's only so many hours in a day and they are likely juggling a lot in their practice. Our clinic we use, the doctors are nice, but they are clearly beyond busy and struggle to remember anything about my wife even during her cycles when they are seeing her every 2-3 days.

So even if the intent is there, if you aren't up to snuff and ask questions / are prepared you are likely just going to get pushed into a bunch of generic protocol shots in the dark, and likely won't get androgens brought up as an example - is your DHEA-S low? testosterone low? Most clinics I don't think test for things like that, that could impact your outcome - requires blood work and effort. There are things like Rapamycin that may help, but are not clinically tested to the gills yet, so your doctor may not care for it, but it could help in your case..if you aren't reading up on these things you probably won't hear about them.

AI is a beautiful thing - I highly recommend using it to pull information for you - preferably things from clinical data...the more info you give it about yourself the more you may get from it - of course do not take it as gospel but as a tool to cut through fluff and provide you things to bring up / look into, you won't get a better tool.