Recurrent miscarriages and now fertility issues

Dear Robert
I’m over the moon to find this service!
I am a 37 year old lady with a history of recurrent miscarriages (no live births) who has been diagnosed as being heterozygous for the Prothrombin Gene Mutation. I also have hypothyroidism which is treated with 125mcg Levothyroxine daily and pernicious anaemia also treated every 12 weeks with B12 injections. Since my last traumatic miscarriage at 12 weeks at Christmas 2013 I have been unable to conceive and have been experiencing a low left pain which can sometimes be quite severe. I am about to have a lap & dye and have been told my symptoms sound like endometriosis. I am now attending a local nhs fertility clinic and have paid to have an AMH level test (on the advice of my consultant) which has come back at 3.9. I’m devastated as he told me this level is not good news. I am yet to have my follow up appointment about the AMH levels (something which I am now worrying about) but have also been given a list of 5 clinics to choose from for IVF treatment. This is where our quest got tricky! Looking at the clinics and trying to decipher which is the best to use is a minefield. I do not know which way to turn to understand results that are published on the websites.
I have been given five choices are but where do I start? Can I get a recommendation from anyone?
I have so many questions and I’m unsure where to turn to get an unbiased opinion.
Sorry that I have rambled on and I just want to applaud you for having this website! It’s somewhere for me at least to start.
Best wishes and warmest regards, A

Dear A,

It isn’t entirely clear to me why you think you need IVF. You were, after all, getting pregnant previously. Nor am I convinced you have endometriosis. I agree it is a possibility but I must tell you that before you have any treatment it would be idiotic not to get a well-defined diagnosis first. I would certainly get the laparoscopy done and would also strongly recommend an hysterosalpingogram as well because that will outline the contours of the uterus on the inside much better than any other investigation and may throw some light on the miscarriages and why you are no longer getting pregnant spontaneously. You say that you had a ‘traumatic miscarriage’ at 12 weeks – was it traumatic just because of the understandable emotional impact or was it because that you had some kind of complications. Have your periods changed in some way since the miscarriage? Any symptoms could give important clues.

Also you mention AMH – it seems to me that you are allowing a potentially low result to railroad you into IVF. This is a mistake – read my other comments about AMH on this website; this result of yours is not necessarily the death-knell of fertility.

Please get fully investigated first, and then if really indicated, consider IVF – the results will not be better if you rush into it before the few months it will take to get some clarity.

Incidentally, I repeatedly make it clear that I do not offer advice about which clinic to attend. If I did, I would destroy any reputation this website and research unit has for total impartiality. I would break that rule if I felt that there was only one clinic or practitioner with the precise expertise needed to treat a particular condition successfully, but so far that has never been an issue.

My best wishes
Robert Winston