IVF or natural conception after miscarriage and preterm birth?

Dear Professor Winston,

I saw you on “This Morning” recently discussing fertility issues and I am writing to you to ask for some advice. I appreciate you are very busy but would appreciate any help or advice that you might have for me.

Our history to date:

I was diagnosed with a mild form of endometriosis ten years ago when I was in my mid-twenties after having a laparoscopy and three years later after getting married myself and my husband started trying for a baby. After a year and with no success we went and had the usual tests – my tubes were clear and although my Dr could not confirm I was ovulating every month everything looked okay. My husbands results were his sperm was a little lower than they would like to see but no cause for concern as to why we had not conceived. I then went onto Clomid for six months to help with ovulation but again no success. After two years we then went onto try IVF- our first round we had 6 embryos to day 5 and had one implanted and we went onto have our son who is now 3. A year and half later, we then had a embryo transfer, however, at the nine week scan we were told we had miscarried. I then had to go to hospital to have the sac removed as it had stayed inside me.

Five months after this we were totally surprised to find out we had conceived naturally.

Unfortunately at 25 weeks ( with no complications) and while on holiday abroad, I went into premature labour – our daughter was born weighing 2lbs and had suffered a major brain haemorrhage. After enduring two big operations on her intestines we sadly lost her 7 and half weeks later in January of this year. From speaking to Doctors and Consultants here since we have returned they believe it was a bacteria or infection that I passed onto my daughter that cause her to come early.

As you can imagine this is still such a painful time for us and nothing we ever expected to happen. The Consultants have talked to us about the care plan I would receive should we decide to have another child however we are not a couple that to date decide to try and have a child and it happens. My periods are not particularly regular ranging from 35 – 42 days and I suppose what I don’t know is how likely is it that I could conceive naturally again and whether our option should be to look to try with one of the remaining four embryos we have frozen. My Dr who has been through all of this with me has recently retired and I feel at a bit of a loss on who is best to speak to about all of this – should I go back to private clinic or through my Dr. Therefore that is why I am writing to you as I found what you were talking about today really interesting and useful advice.

I apologise for writing directly as I know you are a very busy man but any help would be greatly appreciated.

Kind regards

I.

Dear I.,

Yours is a harrowing story and, in various ways, it is not at unusual. But I am sorry to read of your very unhappy experience. I think there key thing to say to you is that, while I am not at all given to offering optimistic platitudes or unrealistic hope, you stand a better than average chance of another successful pregnancy. I think I would be inclined to first get an x-rasy of the cavity of the uterus (an hysterosalpingogram) as with your history it is possible you may have some residual scarring or even a malformation. There is also the very faint possibility that the endometriosis has affected the wall of the uterus. Neither of these are particularly problematic but are frequently overlooked and relatively easily treated.

Thereafter, you have a choice 1. To try ovulation induction which is effectively given and properly monitored – possibly with a small does of FSH rather than clomiphene (which has not been so effective in your case in the past); or, 2. To have one or more of your stored embryos thawed and replaced with optimal hormonal control of your irregular cycle. But 3) I have to say that a spontaneous conception is not nearly as unlikely as I am sure you imagine – i.e. no treatment immediately. But it really is important to get your uterus checked out with the x-ray. And an x-ray is the cheapest and most effective way of doing this in my view.

My best wishes,

Robert Winston