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