IVF – Have I been unlucky?
Dear Professor Winston,
I am so pleased to have found a way to write to you thanks to my mother who pointed me in the direction of this site after listening to you on the radio yesterday!
I am 37 this month and my husband is 35. We are both healthy, non-smokers of a normal weight and I experience normal periods with a cycle of roughly 28 days. After trying to conceive naturally for two and a half years we decided to seek advice. After a referral from our GP to an NHS fertility consultant, we were told we were eligible for funding and went ahead with the required blood tests, semen analysis and an HSG for me (which showed both tubes patent). We were/are classified as having ‘unexplained infertility’. I was extremely interested to read what you had to say on this matter!
After my husband was told he had poor morphology we were told ICSI would be used during our treatment. However, upon both samples being collected during our fresh cycles, the clinics used IVF as the samples were classified as ‘good’.
During our first fresh cycle I responded well to the drugs and produced fourteen eggs. We ended up with three at blastocyst stage and had a single five day transfer leaving two blastocysts frozen. I started to bleed on day six and the cycle failed. Our second cycle was a double frozen embryo transfer and this resulted in a pregnancy. However, after experiencing a bleed I was referred to an Early Pregnancy Unit and diagnosed as having a Missed Miscarriage. I was about six weeks pregnant. While I’m not sure it’s relevant, I had a very complicated miscarriage which lasted about two months. My miscarriage was finally diagnosed as complete after being taken by ambulance to hospital in Austria for an emergency D & C.
We have just had our third embryo transfer after another fresh cycle. I, once again, responded well to the drugs and fifteen eggs were collected and we had a five day blastocyst transfer. We have four, day five frozen blastocysts. This morning marks the end of my two week wait and unsurprisingly my test was negative after beginning to bleed last week.
While I know our chances are relatively low because of my age, I am loathed to sit and listen to our consultant say we have once again “just been unlucky”. I feel there must be more going on and that I’m perhaps rejecting the pregnancies.
I am interested to know your opinion of ‘killer cells’ and what, if any, further tests you feel could help us.
With huge thanks for your time and attention to my letter.
Kind regards,
Dear A,

Thank you for the enquiry. It is true you may have been ‘unlucky’ and so  I am not sure that your reaction is entirely realistic. As I have said on an earlier answer, a failure of a transfer from a previous stimulated cycle is, in reality, a failure of a single stimulated cycle – please read carefully my letter to C (Shall I continue with IVF?) earlier today on this website.

I would say though I cannot regard you as being completely investigated – I would have thought making sure that there is no genetically abnormal background is important as is having a laparoscopy to ensure there isn’t a subtle problem, even though your tubes are reported as ‘open’. At Genesis we are always happy to glance at your X-rays if sent digitally, because sometimes subtle changes in the hysterosalpingogram are missed.

But ultimately to have failed two stimulated cycles and a frozen embryo transfer is well within normal mathematical probability and is not necessarily at all meaningful providing there is genuinely nothing else wrong. Also the statistics show that you are not unlikely to conceive naturally even when you least expect it.

Best wishes
Robert Winston

Shall I continue with IVF?

Dear Professor Winston
I have been trying to conceive for over 7 years. After one round of IVF I got 2 blastocysts. Both were put back- one fresh, one frozen. However I lost both at week 6/7. I am reluctant to go for more treatment in case there is something else I need tested for in relation to early miscarriage. I should be grateful for your advice. C

Dear C,

Without knowing how well you have been investigated for the basic cause of infertility, it is tricky giving a sensible answer. But I would offer this obvious advice that the outcome of your one IVF treatment, even though you had two transfers, is mathematically problematic; that is to say, with any single stimulation cycle you would have been more likely to not conceive than to conceive. You have to face the fact that unless you have had three cycles, you have been treated completely inadequately. Yes, I know you have had two blastocysts – but they are both derived from the same cycle, under the same hormonal influence, with the same environment during development. Consequently, if one embryo was inadequate for some reason, it is not unlikely that the other has developed in a similar way. Carefully done randomised controlled trials show that the average chance of a successful pregnancy after blastocyst transfer is actually only around 35%. So clearly your first transfer was more likely to fail than succeed. Given that your second embryo developed after identical stimulation of the egg and after an identical environment, you would expect the success rate to be slightly less in this cycle. This chance of failure is increased because, go course, your second embryo was exposed to a very abnormal environment which may have had some effect as well – namely freezing. Now it may also be that both embryos miscarried because they suffered from one of the really common genetic misprints which so frequently occur in human embryos. But what we know is that if you conceived at all, even if the pregnancies failed, statistically you are rather more likely to conceive with persistence.

I would argue, that having made certain you have been fully investigated first, you should not give up on what looks likely to be a successful treatment if you persist.

Best wishes
Robert Winston