Should I retry IVF after failed FETs?

Dear Professor Winston,

Last year I truly thought I was at the end of the road with my IVF journey, but now I’m not so sure, please can I ask your advice, as to whether you think I’m mad to even consider another round at 44. I have a beautiful son, aged 8 conceived naturally the first week of trying. I then suffered secondary infertility. After 2 years of trying, an HSG revealed my right fallopian tube was blocked and we were recommended to go for IVF. It worked first time, but I went into premature labour at 23 weeks and tragically my beautiful daughter was still-born. I was then referred to Professor Shennan at St Thomas’s as the reason for my premature labour was an incompetent cervix, acquired through the full-dilation ceaserean delivery of my first born. Professor Shennan placed a transabdominal ceclage in 2016, to avoid any further late losses. In 2017 I underwent FET [Frozen Embryo Transfer] 1 and I became pregnant, with a healthy heartbeat seen at 6 weeks, but missed miscarriage discovered at routine 12 week scan. I then had to have an MVA.

FET 2 and I became pregnant again, miscarried at 6 weeks, I then had to have another MVA [manual vacuum aspiration], followed by an emergency ERPC [Evacuation of Retained Products of Conception] for retained products, both times I experienced heavy bleeding and needed to be hospitalised. No chromosonal abnormalities were detected. So I was referred to St Mary’s Recurrant Miscarriage Clinic. To my surprise a uterine septum was discovered during a hysteroscopy and was resected.

FET 3, pregnant again, but resulted in a chemical pregnancy. I underwent a fresh round of IVF in 2019, responded well but only produced one blastocyst and it came back genetically abnormal. At that point I felt we could take no more. There had been so much physical trauma as well as emotional and losing our daughter was completely devastating. I no longer had hope and we stopped treatment. Though now I wish I had continued as maybe the next time would have worked, but I’ve left it a year and think it’s probably too late, as I have just turned 44 but I would appreciate your words and advice, more than I could say.

Many thanks in advance,
S

Dear S,

Heartbreaking though it may seem, calling a halt to treatment was, in my view a very good and wide decision. The odds are so heavily stacked against you and each treatment paradoxically is most likely to increase your infertility and extend your emotional turmoil too. The statistics show you have a very tiny chance of a pregnancy with more IVF and a slightly better chance if you simply have regular sex which is not interrupted by fruitless treatment. This is a story endlessly repeated and the bruising cannot stop until you have had some closure. You risk becoming what some of my colleagues call a professional patient. Whatever, this is dangerous for your well-being and possibly that of your family.

It is presumptuous for me to to tell you what to do or to predict your likelihood, but IVF possibly has between I – 2% chance of a pregnancy each time and experience suggests you have a rather better chance if you simply walk away. Its a bit like first standing under a tree where endless fruit which don’t look so bad turn out to be infested with maggots – whilst, as you reach higher, you hope eventually to pick just one fruit free of infection. Be careful not to fall off the ladder as you continue to reach.

Coming to terms with what you have is very hard but I have seen so many people really surprised, peaceful and healed when they do eventually walk away.

Best wishes,

Robert Winston

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