Second opinion

Asking for a second opinion is normal in every other area of medicine, and somehow slightly awkward in fertility. People worry about seeming disloyal to a doctor who has been kind to them, or about being seen as difficult.

It is neither. You are making a large decision, repeatedly, at considerable expense, and wanting a second reading of the evidence is a sensible response to that — not a criticism of anyone.

When a second opinion is worth having

• Two or more IVF cycles have not worked, and you have not been given a clear explanation why
• You have been told your only option is IVF, and you want that tested
• You have been recommended an expensive add-on and are not sure it is necessary
• You are being asked to go straight to donor eggs or donor sperm and want to be sure
• Your cycle was cancelled and you do not understand what happened
• Good-quality embryos have repeatedly failed to implant
• You have had recurrent miscarriage without a cause being identified
• You simply feel processed rather than treated, and want someone to go through it properly

What we will actually do

The value of a second opinion lies almost entirely in reading the detail of what has already happened. A previous cycle, even an unsuccessful one, generates a large amount of information, and it is common for that information never to have been explained to the patient.

Your specialist will go through:

• The protocol used — which drugs, at what doses, and why that choice
• How you responded — follicle numbers, hormone levels through the cycle
• The egg collection — how many eggs, how many were mature
• Fertilisation — how many fertilised, and whether IVF or ICSI was used
• Embryo development — grades, what reached day five, what was frozen
• The transfer — how many embryos, fresh or frozen, lining thickness
• Investigations — what was done, what was not, and whether anything worth checking was missed

From that, the honest possibilities are: something identifiable should be changed; something should be investigated that has not been; or the plan was reasonable and the outcome was bad luck, which happens and is worth being told plainly.

What to bring

The more complete the records, the more useful the review. Ask your current clinic for your records — you are entitled to them, and requesting them is routine.

• Stimulation protocol sheets — drug names, doses and dates
• Monitoring records — scan reports and hormone levels through the cycle
• Egg collection report — number collected, number mature
• Embryology report — fertilisation, embryo grades, day of transfer, what was frozen
• Transfer details and lining measurements
• All blood tests — AMH, thyroid, prolactin, and any immune or clotting tests
• Semen analysis reports, and any DNA fragmentation result
• HSG, hysteroscopy or laparoscopy reports
• Any genetic testing results
• A written list of your questions

If you cannot obtain everything, come anyway with what you have. Partial records are still far better than starting from nothing.

What this appointment is not

It is not an attempt to recruit you away from your current clinic. If your treatment is being handled well, we will tell you so. If a change would help, we will explain exactly what and why, and you are free to take that advice back to your existing team and ask them to implement it. Many people do precisely that.