Best tests after infection, miscarriage and endometriosis struggles?

Hi.

I am 37 (about to turn 38) and my husband is 35. We have one 5 year old daughter who was conceived naturally within 2 months of trying and an uneventful pregnancy. She was born via c-section because she was breach, but otherwise all was normal. When she was 1 year old I had a LEDZ procedure to remove pre-cancerous cells from my cervix and this resulted in a bad infection for which I was hospitalised and treated with antibiotics.

We began trying for a second when she was 2 years old and after a year of trying I was diagnosed with endometriosis and had surgery to remove most of it laparoscopically, which was successful. A year after this surgery we became pregnant but I miscarried at 7.5 weeks, after having seen a heartbeat just a week prior.
We continued to try again for a year and then I became pregnant again, but the embryo never developed beyond a gestational sac and I had a D&C at 7 weeks.

We then decided to try IVF. We had several tests, our blood was tested for underlying chromosomal issues, I had a 3D SIS scan and my ovarian reserve looked at, and my husband had his semen checked. Everything came back normal. My endometriosis has begun to grow back on my left ovary but I am still ovulating and it is no where else for now.

We had 13 eggs collected and 12 fertilised. 8 made it to blastocyst stage and we had one transferred (graded B+A). We’ve just found out the cycle has failed, and before we go back into a frozen cycle with our remaining embryos, I would like to know if, given my history, there are any other tests you recommend or advice to give us.

Thank you

Dear G,

What stands out very much in your history is possibility of a problem centred in the uterus.  Firstly, you have scar in your womb following the Caesarean section and this could affect implantation.  Secondly you have had problems in the cervix as well as infection.  All these suggest the problem of changes in the uterine cavity which just possibly could be treated simply.  These is no point in having IVF if the uterus is compromised, so my inclination is to suggest a hysterosalpingogram — an X-ray of the womb — with some dye.  Do not be fobbed off by other modalities of looking at the womb such as dye injection with ultrasound.  I would also consider an MRI of the uterus which might show adenomyosis — or its equivalent endometriotic deposits — in the muscle of the wall of the womb.

In my view this kind of investigation of the womb is really mandatory with such a history but often neglected or even ignored by IVF clinics.

Best wishes

Robert Winston.