Blockage on tubes?
Dear Professor Winston,

Hi, thank you for reading my question. I’m 37 my partner is 34 we have been trying for a baby for over 3 years now. Last year I had the HSG which showed I have proximal blockage on both tubes. I opted not to have a laposcopy done as felt it was invasive and miten fix the problem. Instead we attempted ivf, my partner test all came back good and all my bloods too. I responded well to all the medication and fertilised 4 embryos. First transfer failed, second was a positive, but ended at 6 weeks miscarriage, the next two transfers failed. The follow up appointment they suggested PG testing and ERA testing. We are are a loss what to do, do you recommend these two tests or to just try another cycle with-out the tests. I’ve researched both and getting mixed information on them.

Thank you, Amy


Dear Amy,

Please do forgive me for saying this but it seems to me that you made an error of judgment when you refused the laparoscopy after you had a hysterosalpingogram.  I keep emphasising endlessly that making a diagnosis is all important before any medical treatment.  Now you have had three attempts at IVF and are no further forward and are wondering about further treatments which do not have a solid basis for a supposed problem for which there doesn’t to be any clear evidence.  Moreover the treatments – PGS – you are now considering (in complete desperation), as I have repeatedly emphasised on this website and in various books have no clear proof they work. 

Just suppose the apparent blockage of your tubes (which you say is proximal; and therefore close to the uterus) is due to a problem inside the uterus.  I am not saying this is necessarily a problem, but I am advising proper inspection of every avenue before getting into IVF prematurely and which, now, I am sure you find is demanding, causing great anxiety and is presumably expensive.   

 I can’t really help you much more because you give me inadequate information – even simple stuff about your general health and weight – but I fully appreciate how sad and frustrated you feel.  I am genuinely sorry you are in this position but I do think before you have any more treatments which are so likely to cause heartache, you consider getting proper testing to find out what really underlies your problem. Maybe, of course, you have had more informative tests than you tell me in your email, but really unfortunately I am not sure that I can do much more at present except to apologise and to say I feel bad about writing this letter and truly sorry for your dilemma.

 Best wishes

Robert Winston

Further to your reply to my original answer, I do understand that laparoscopy is expensive – but so are repeated IVF cycles and PGS adds greatly to the cost.  ERA which you mention is an assessment of endometrial receptivity which assumes there may be specific molecular changes for largely unknown reasons which affect implantation of an embryo.   

I know of only one randomised trial, done recently in Valencia – though this test, in various guises has been around for over ten years.  

That most recent research is published by a large group in Spain and the study was done by Carlos Simon.  ERA is expensive and my impression is that further trials would be needed before one could clearly endorse its use for most IVF patients.  It seemed to show some advantage in their recent study but the authors themselves admit that having compared results in over 300 patients with fresh or frozen embryo transfers in three different groups, much bigger studies would be needed to confirm its value. 

 I hope this helpful.  If you want the link to their most recent paper it can be found on here