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Discussion Starter #1
Hello All, and Happy New Year!

I am looking to change clinic (in London) after two failed cycles. I have had two rounds of IVF (one FET which ended as a chemical, and just recently a fresh transfer with BFN). For each cycle I ended up with only one embryo to transfer (top quality  - I was told), therefore, nothing to freeze and egg retrieval for each round. 2 made it to day 5, but lost 1 in each cycle (for frozen, one didn't thaw, and for fresh was told it was not good enough to freeze on transfer day (5).

I know nothing can guarantee better results, but looking for a change due to a few reasons from current clinic. We have unexplained, sperm is good quality, and I have history of endo (I have had laproscopy and cysts removed earlier this year, well last year now :) 2019).

We are looking at Guys ACU (private) and CRGH. I would appreciate any thoughts or feedback on either given my history, and other clinics others recommend.

Thanks so much !
 

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CRGH has excellent results - better than ARGC per embryo transferred.

We went there and were successful on first attempt (although my fertility history is very different from yours).
 

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Discussion Starter #3
Thanks Londonwriter! And congrats!

Is there a particular consultant you recommend please, or should I not be too concerned about getting anyone in particular? I did think about ARGC too, but its very difficult for work (from what I have read) and too many mixed reviews
 

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I was at ARGC for pregnancy monitoring (I was going to do IVF there, but fell pregnant naturally beforehand) and wasn't impressed at all. And, yes, it would have been impossible to even do pregnancy monitoring there (!) if I'd had an 9-5 job and there was really no necessity for it - CRGH get similar results and are a lot more accommodating.

I went to see Dr Saab, but specifically because I have immune issues and was told he was the 'immune guy'. Dr Ozturk and Dr. Serhal also get mentioned positively on Fertility Friends.
 

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Here's my 2 pence worth - Guys knew I had a "polyp" - but for reasons known only to them, they left it in situ. Free cycle failed, so went off to CRGH.  They wanted to check out this "polyp" before doing anything.  Turns out it was stage 1, grade 1 endometrial cancer.  Clear case of negligence.  CRGH then refused to do any further cycles even after the cancer was removed.  The only person who was willing to treat me was Mr Taranissi at ARGC.  So whilst people are quick to slate them and comment on their stats, at the end of the day, they are prepared to take on high risk cases.  I had four pregnancies through ARGC, which resulted in two live births.  One aged 41 and second when I was 45. 
Yes ARGC is hardcore, but they're there to get you pregnant and have a successful pregnancy, not molly cuddle and offer cups of tea.
 

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Hi, I had 3 private cycles at Guys under the care of Tarek El Touky who is excellent and the most lovely man. If you do go to Guys I would definitely see him and pay the small amount extra for consultant led care as it makes all the difference. Basically you get to see Tarek for every appointment and he even gives you his mobile number so you can contact him whenever you need to during your cycle. He is 100% committed and really cares about his patients. Transfers and egg collection will happen on the most relevant day too, including Sunday, if you have Tarek as your consultant. And they do 3 day embryo transfers as well as 5 day blatocyst transfers, depending on how many embryos you have.

Out of my 3 cycles I had one pregnancy through IVF at Guys but unfortunately ended up having a missed miscarriage discovered at nearly 12 weeks... I was very happy with my care there but then went on to donor egg treatment in Spain as my age meant that it wasn't viable to keep on trying with my own eggs - the likelihood of success was too low.

The only thing I would say about Guys is that they are very science based and won't recommend or incorporate anything into the treatment which does not have the backing of successful clinical trials. So they wont be on board with immunes testing or treatment or anything like that which is still somewhat unproven or experimental. It doesn't sound like you necessarily require that, but just a warning in case.
 

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@Londonwriter - I think your comments on ARGC are rather defamatory to say the least, particularly that they "spout complete rubbish" - they are a reputable clinic and if they "spouted rubbish", I'm sure the HFEA would have something to say about this. Each to their own, but making baseless comments is wholly unjustified.  It is interesting that CRGH chose to refuse to treat me, despite the cancer being removed, because clearly attempting to get a high risk patient pregnant would affect their "statistics".  In contrast, many (and I spoke to many patients) at ARGC, who had an assortment of very complex medical histories, were all embraced by and taken on by ARGC.

As to your comment on Dexamethosone, this is borderline scaremongering.  Unless you are a qualified medical professional and able to quote appropriate medical evidence, such profound statements should not be made.  I was on Prednisolone and my HCG started slowing down and I almost lost my now 6 year old.  The switch to Dex, saved my baby.

You are entitled to your view, but please stick to evidence and medical facts.
 

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@Bagpuss. I appreciate ARGC have helped you, as they have many women. I would not know I categorically have an autoimmune disease, never mind have my DS (and, hopefully DS2), except for ARGC pushing the boundaries :)

However, it is also a controversial clinic that has a chequered relationship with the HFEA (see links):

http://news.bbc.co.uk/1/hi/health/7686653.stm
https://metro.co.uk/2007/07/23/ivf-doctor-loses-treatment-licence-560662/
https://www.independent.co.uk/life-style/health-and-families/health-news/my-ivf-and-the-clinic-from-hell-432334.html
https://www.bionews.org.uk/page_95974

There is also a lot of controversy about add-ons, such as reproductive immunology:

https://www.hfea.gov.uk/treatments/explore-all-treatments/treatment-add-ons/

Specifically, the HFEA website says:

Not only will reproductive immunology treatments not improve your chances of getting pregnant, there are risks attached to these treatments, some of which are very serious.

Can't get clearer than that, really...

There have been several documentaries about the use of add-ons - such as reproductive immunology - with calls, at various times, for stricter measures from the HFEA (more links):

https://www.theguardian.com/society/2019/sep/10/ivf-clinics-face-new-crackdown-on-add-on-treatments
https://www.bbc.co.uk/programmes/b084ngkd

In particular, there are masses of papers in the academic literature and within the informed medical establishment about the flaws in blood testing for NK cell activity as a way of detecting risks of implantation failure and recurrent miscarriage (couple of links - I've read hundreds):

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC534451/
https://www.rcog.org.uk/globalassets/documents/guidelines/scientific-impact-papers/sip_53.pdf

For obvious reasons, I am in favour of immune treatments being offered to ladies with fertility issues. However, it is important to emphasise that they are a) experimental, and b) there is no consistent evidence about mechanisms. Talking about NK cells 'killing' embryos is, thus, unequivocally 'spouting rubbish'. As evidenced by a similar claim (not from ARGC) made during undercover filming in the Panorama documentary, it is not uncommon for fertility clinics to make this sort of claim.

I am not scaremongering about Dexamethasone. My husband and I read the Swedish study cited in the Atlantic (https://www.theatlantic.com/health/archive/2013/01/ivf-on-steroids-the-dangerous-off-label-use-of-dex-during-pregnancy/267187/) article (i.e. a peer-reviewed, evidence-based paper) when we were offered Dexa during treatment monitoring at ARGC. Despite nightmarish Chicago test results, we opted to refuse this treatment largely - to be fair - because my pregnancy had got to 6 weeks undetected, and with no signs of being in trouble, so there was no reason to suppose I'd miscarry if I didn't take it. This was, as you might imagine, a very difficult and stressful decision for us to make and one that, according to our CRGH consultant, we never needed to make.

I tend not to talk about this as, the one time I've seen someone mention Dexa, the general response on FF was very similar to yours. Lots of very upset ladies who were worried about their infants, because they'd taken it during pregnancies, who responded in an understandably emotional way. This makes me very cross (not at the ladies, obviously :) ) because, ultimately, the contents of that Atlantic article (and the associated scientific literature) should be no surprise to anyone who has taken Dexa in pregnancy - this is the essence of informed consent.
 

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These are such old articles, that you have selectively provided, all in an attempt to undermine the ARGC and all disproved by Mr Taranissi and he successfully sued the BBC. As for the medical links - there are always several sides to every medical opinion.  Clearly you have sought to selectively provide only those that support your position, which provides for a very unbalanced and biased opinion.
 

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Bagpuss1972 said:
These are such old articles, that you have selectively provided, all in an attempt to undermine the ARGC and all disproved by Mr Taranissi and he successfully sued the BBC. As for the medical links - there are always several sides to every medical opinion. Clearly you have sought to selectively provide only those that support your position, which provides for a very unbalanced and biased opinion.
I challenge you to find irrefutable evidence for reproductive immunology :) As I've interviewed multiple reproductive immunologists, with the aim of writing a book one day about my experiences, I'm aware there are very few clinical trials. I'm also aware of the limits of the Chicago tests - through talking to their developer.

There is categorically no evidence that blood NK cells invade the uterus and 'kill' embryos. Uterine NK cells and blood NK cells are not the same cells - this is shown by multiple studies. Most research work on reproductive immunology today is focused on uterine NK cells. The Chicago tests are a measure of systemic inflammation, but the mechanisms by which this links to reproductive health is not known. A certain amount of inflammation is required, within the uterus, to promote implantation. In the small number of studies done on ladies with unexplained infertility, most medications provide - at best - inconsistent success in improving IVF success rates. At the moment, the only one with any consensus over its use is Pred, and even that is patchy, highly conditional and still experimental.

These are the 'facts' as currently understood by medical science. It is these facts that has led to the HFEA taking the blunt position it has on its website. Having spoken to a HFEA trustee, the HFEA position is designed to protect ladies from the over- and inappropriate prescription of immune medications for fertility purposes. The trustee agreed that, as someone who was genuinely sick with a hard-to-diagnose autoimmune disease, I didn't fit into this category - however, my situation is very rare.

I'm sorry that seems biased. I'm in the striking position of actually having conceived twice on immune treatments - once naturally after three years of total infertility, once while deliberately running an experiment/diagnostic IVF cycle with my consultant at CRGH to see if I could work out how to repeat my 'miracle' pregnancy. I should be the biggest advocate imaginable of what ARGC are doing. Sadly, my somewhat unusual experience, my attempts to understand it, and my debates with my skeptical consultant at CRGH, means I have seen one of the wizards behind the curtain in the emerald city that is ARGC. And I'm not impressed.

[NB: One of those articles is from 2017 (so not old) and refers to when ARGC challenged the HFEA over the way they present success rates on their website. The HFEA had changed to success rates 'per embryo transferred', which penalised ARGC for transferring multiple embryos. The change in the way the success rates were presented did, indeed, show other clinics had similar success rates - when taking into account those clinics' attempts to comply with HFEA regulations on reducing multiple births. From reading the case at the time, ARGC's argument was that they had no choice about transferring multiple embryos because they dealt with higher risk cases (you've made a similar argument). Before I went to CRGH, I tended to agree with ARGC on this. After going to CRGH and undergoing a cycle of IVF with PGS, I believe ARGC *do* have a choice since freeze-all cycles with PGS reduce the health complications of pregnancy following a fresh IVF cycle *and* the risks of multiple births - without compromising chances of success or the likelihood of having two children from one cycle. So I'd question why, given how expensive ARGC are, they don't do PGS routinely, especially given monthly IVIG gets very expensive if you've no guarantee the embryo you've put back is chromosomally normal to start with. I'd also question, given the health complications I'm experiencing with a singleton autoimmune-complicated pregnancy at 40, why so many women with complex gynaecological histories are being put unnecessarily through inherently high-risk twin pregnancies when they could have two kids from consecutive FETs].
 

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I decline your challenge, as I have no inclination whatsoever to waste my time on your wholly disproportionate theories, when there is clearly documented data on various sites to the contrary - you are simply selective and biased.  I would rather put my energies into supporting other women who have been diagnosed with endometrial cancer and want a chance at having a family.
 

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I'm not sure if this is going to be helpful at all but as a medical doctor that is going through infertility myself and having worked in research and obstetrics and neonatology for several months and being a great supporter of evidence-based medicine, I would like to weigh in as well. I think you both have many good points, but I am going to have to side with Londonwriter's conclusions.
This is a massive industry, the clinics and doctors make huge amounts of money on desperate patients. There is so so so much advice that gets thrown around that is not evidence-based. One can make a study and it's statistics show almost anything - only randomised control trials and cochrane reviews hold any real value. Google is the enemy.
There are two sources of information I have come to trust from hours of my own research and analysis- (1) the HFEA website and (2) the Lister clinic. That is not to say, that there are not many other great clinics out there, like the CRGH, Guys etc. - I simply found the Lister and have not found the need to research further.
There are 3 clinics I would avoid all for different reasons, the ARGC (because I don't want a child at all costs and I don't mean financial), Zita West (infertility is so much more than a nutritional problem) and Create (not because they do harm but because there are just more successful and proven protocols).
I have had and am currently getting treatment at the Lister and I can not recommend them enough. Their doctors are smart, honest and completely informed within their specialisation. The information on their website is all evidence-based, well-laid out and not in support of unnecessary add-ons.
In particular, the ARGC - Dr. T is clearly a very intelligent and informed RE. They go all the way to help the difficult cases and more often than not, they succeed. They also very intelligently know just how to make the statistics at their clinic shine (refuse/move patients with high fsh and do multiple transfers), that is no coincidence. And...having worked in neonatology I can not forgive a clinic for opting for high rates of multiples as opposed to an extra frozen transfer. There is NO excuse for this in the current age where frozen transfers are as successful as fresh transfers. The complications of multiples are exponentially higher and last a lifetime - neonatal ICU's are full of them. I understand a woman's desire to take the risk after the horror journey some of us have been through but it is the doctor's job to make sure she sees that there is no need to take the extra risk for no added benefit. Every time ARGC produces twins, a failed cycle is covered up in the statistics and as can be clearly seen, their success rates are pretty standard for per embryo transferred - especially if you take into account that they don't treat patients with FSH>10.
This is all my opinion, I am not a RE and it is not intended to offend previous happy clients. I am so glad for the ladies it worked out for at the above clinics - I am sure they also do some great work inbetween the not-so-above-board stuff.
 

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Saltysea thank you for your more reasoned arguments, although I must say I disagree.  There is no way that a frozen cycle is as "equally" successful to a fresh cycle. There are tonnes of stats on a fresh cycle being more successful than a frozen.  You are 36 years old.  I was 41 on my first successful cycle and 45 on the second.  6 years is a huge difference in terms of the biological clock.  Your perspective may change when you're a desperate 40 year old.  And yes you have your opinion that it should not be at any cost, but at the end of the day, it's an individual's choice if they want to subject themselves to intensive treatment (or the ARGC - who seem to be in the firing line here), but for those 40 somethings, the ARGC have produced excellent results.  How do you know that the neo-natal cases that you are subjected to, are as a result of ARGC?
No they don't treat patients with an FSH of over 10, but wait until say the next month, or month after, when the FSH is reduced.  Your statement makes out the ARGC don't treat per se!  The clinical reason to start a cycle at less than 10 is to ensure a better outcome, rather than wasting the patient's time.  In contrast you fail to mention that CRGH won't treat anyone that has a low AMH!  That is shocking.  ARGC don't take AMH into account, as their ethos is that you just need ONE good egg to have a baby.  CRGH wouldn't touch me with a barge pole - just because my AMH was less than 1 - if that's not statistical manipulation, then what is?  Lets just put aside the fact I had cancer! 
 

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Hi Simz

I just wanted to add my experience as I’ve been treated at 3 clinics in London.  I’m not sure what your history is but I have low AMH and my husband had two varicoceles which needed to be surgically repaired and were impacting the quality of his sperm. I started IVF treatment in 2016 and our last frozen transfer was in October 2019 when I was 38. I had three fresh cycles - 1x Guys, 2x The Lister and then moved onto 6x natural modified freeze all cycles at Create where I had two frozen transfers one of which ended in miscarriage at 8 weeks and a second from which I am currently 15 weeks pregnant.

I cycled at guys - an nhs funded cycle not private, so different to what you were looking for - and wasn’t a fan, they were so so busy definitely the busiest of all the  clinics we’ve cycled with and the appointments often overran/were late.  I also don’t think the consultant we saw was particularly good, he seemed thoroughly uninterested.

We moved to the lister who were great (although our cycle near Christmas was chaos, again phenomenally busy) but the quality of care was high and their lab is very well regarded. Our consultant recommended that my husband see a urologist, who long story short was able to get his sperm the best it’s ever been and all within the normal range - something we never had. We moved from there for several reasons 1. our consultant went on maternity leave 2. Our last cycle was a bit of a disaster, tons  of meds and a poor response 3.  It’s very expensive 4. After the highly medicated disaster cycle I was convinced a gentler form of IVF was worth a shot.

Then at Create, we did 6 natural modified cycles, we started with 3 to see how I would respond and upped to 6 as it went well. Natural modified involves some medication but much less than conventional IVF so it’s gentler on the body and you can do consecutive cycles, so I did 4 months, then a break and then 2 months and got 6 embryos from those cycles for the freezer, no fresh transfers.  You still have to go through the egg collections which are invasive, but, for me, manageable. If you have decent AMH and are able to produce a good number of eggs each cycle, this approach by be less effective than other protocols, but for for me (so far) it’s been the best. I’m convinced that working with your body to get your naturally ovulated egg each month has better results and also using low dose meds for both stimulation and transfer was the final piece of the puzzle in my treatment.

Good luck with whatever you choose x
 

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I just want to add that the top reproductive immunologist in Australia uses dex on his ladies if prednislone hasn’t worked, but only up until 6 wks, by then they’re swapped  over to prednislone, many success stories and no problems with the babies born.
 

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Bagpuss1972 said:
And yes you have your opinion that it should not be at any cost, but at the end of the day, it's an individual's choice if they want to subject themselves to intensive treatment (or the ARGC - who seem to be in the firing line here), but for those 40 somethings, the ARGC have produced excellent results.
@Bagpuss - I know it's hard to read tone in text ^hugme^ So I just wanted to say that I agree with you and am incredibly sympathetic to your situation, and really sorry you found yourself in that position ^hugme^ Having been to CRGH, I know they're a very conservative clinic and the possibility of cancer recurrence due to stimming would have sent them scurrying for cover :'( - even excluding the low AMH :'( I don't agree with their approach on this sort of thing - while I was at CRGH, I spent a lot of time telling my consultant that, yes, I was doing a bunch of dubious immune stuff he didn't approve of, but - as he wasn't the person with the rashes, exhaustion, and recurrent fevers - I was going to ignore him ;D It is your body, and your family, and it's my view that, provided you're well informed about the risks, it's up to you - not a doctor - whether you want to take them :)

The reason I jumped in isn't because of your situation. It's because, as Saltysea has pointed out, ARGC is a clinic of last resort. They will do *anything* that is legal in the UK to help get ladies pregnant. For people who may be unable to have children of their own otherwise (and everyone here understands how painful that is), that is a big deal. However, it's important to understand the human cost of that ethos and it's not suitable for everyone asking for advice on clinics on FF.

My experiences of ARGC match that Independent article I linked to further up. I was extremely distraught, confused and distressed throughout my interactions with them, and I was just doing pre-treatment immunes and then monitoring a surprise natural pregnancy - I wasn't even doing an IVF cycle (!!!). Given that I have what turns out to be a reasonably easily controllable autoimmune disease (albeit we don't know what it is), and - once that's treated - it seems I just need a good embryo, I really REALLY didn't need to go to a clinic of last resort. I would also question whether the patient experience really needs to be *that* bad, given other clinics manage just fine and often get similar results (I've had positive experiences at both the Fertility & Gynaecology Academy and CRGH).

Bagpuss1972 said:
How do you know that the neo-natal cases that you are subjected to, are as a result of ARGC?
Sadly, all multiple pregnancies are high risk - not just ones conceived at ARGC :( They raise the possibility of health complications for the mother and children due to the higher risks of premature birth, etc. As many ladies with fertility problems have other co-morbid conditions (or they wouldn't have fertility problems), and are often older, it's asking for trouble creating unnecessary twins when you could put back one chromosomally-normal embryo, and freeze another for later use.

Due to the autoimmune disease, I have multiple health problems in pregnancy - because my body is put under a lot of pressure. This time around, for example, I have severe gestational diabetes despite a normal BMI, a low GI diet and a high activity level. My only risk factors are age (I'm 40) and that I have pathologically high levels of TNFa, which increases insulin resistance. In my last pregnancy, my waters broke shortly before I was about to be induced due to high blood pressure (I have cardiovascular issues linked to my disease). Ultimately, if I had had twins, these problems would be several times worse and likely to lead to delivery long before term. As both my husband, sister-in-law, and my mum were premie, I'm aware of the life-long impacts of prematurity. My husband, for example, is unable to run due to lung damage from being born at 35 weeks.

Obviously, I'd rather my husband be alive than not so, if the alternative is having no children, it's definitely worth it :) But it's not the best option for everyone and, again, it's important to fully understand these risks before taking them :) In the case of ARGC, I question whether they're taking these risks responsibly for the reasons Saltysea mentions - the general consensus is that fresh and frozen transfers now generate similar success rates (e.g. https://www.medicaldevice-network.com/news/frozen-vs-fresh-ivf/) with some clinics claiming that frozen transfers actually have the edge (https://www.ccrmivf.com/services/ivf-fertilization/frozen-ivf-advantage/).

***

Simz01 - sorry for hijacking your thread :-[ I just think it's important to avoid blanket statements of "ARGC, yay!" because, although it's a successful clinic that does good work with ladies who have few other options for having a family, it's really not for everyone.

And this isn't just a function of age. I was 36 when I had my DS, but am now 40. As there's good anecdotal evidence that my problem is autoimmune in origin, I have good FSH, AMH and AFC (for a 39 year old). Secondary infertility, although not as painful as being childless, remains a distressing experience - but I personally wouldn't go back to ARGC.
 

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Discussion Starter #18
Thanks Ladies,

Apologies it has been so long. I went with Guys under the personalised care (Dr Khalaf), and started yesterday on the Bueserlin.

x
 

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Crgh definetly.
I have been a patient at crgh and guys and crgh wipes the floor with guys.
 

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I have had one fresh and one frozen cycle with Guys both unsuccessful. Guys ACU provide the bare minimum, so stay far away if you can. The service is below standard, you can't get through to nurses/docs, etc. Monitoring of the cycle is very basic.
 
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