Dear Professor Winston,
I am a 36 year old woman and my husband and I have been trying to conceive for about 3 years. About a year ago I was diagnosed with large fibroids on the outside of my uterus. It was discovered (through a HSG) that they were blocking one of my fallopian tubes and distorting my uterus. I was also diagnosed with a low AMH level of 2.47 and high FSH level of 13.5 IU/L. In Feb this year I had an open myomectomy to remove the fibroids, which was successful. The consultant then advised us to wait for 6 months and then to try to conceive for 1 year before further fertility investigations. After the operation I have had a regular 30 day cycle each month and I am fairly sure that I ovulate on day 14/15.
We are now 3 months into trying and so far we have been unsuccessful – we try to have sex every other day or at least 3 times a week. I am concerned that each month that passes I am getting older and the chances of natural conception are reducing. In your opinion do you think we should wait till the year is finished before considering further treatment?
If we wait until the year has finished and I still have not conceived do you think I should consider straight away to try to conceive with a donor egg or to try IVF?
I have read that “mild or natural IVF” has a better than average success rate for women with low AMH and high FSH levels and that are aged between 35 – 37. Do you believe this to be the case? Is it worth considering this option?
I would appreciate your advice very much as I think about these issues most days and wonder if I am doing all that I can to improve my chances to conceive. I will gladly donate to the Genesis Research Trust. A


Dear A,

Forgive me but I cannot pretend that the outlook is that good. I think that on the whole I would be inclined to go for IVF sooner rather than later. I am very unconvinced that so-called ‘mild IVF’ would be an advantage. I think there is some evidence that the success rates of this approach are exaggerated because many women may have cancelled cycles after commencing this treatment but before collecting an egg and culturing an embryo. If no attempt at egg collection is made, or if eggs are not collected, no IVF has taken place which means that the abandoned cycle may not be registered as a failed IVF cycle and may not even be reported to the Human Fertilisation and Embryology Authority. I regret that I have these suspicions but of course such practices are likely to give a false impression of success. In any case, until you have a stimulated cycle you do not know what your response is likely to be and it is possible it may be better than you predict. Unfortunately, your hormone levels, as you know are not encouraging.

As to natural conception, normally I would be more optimistic but you have been trying already and it could be that you have pelvic adhesions which may involve the tubes or ovaries. This is pretty common after removal of large fibroids and the description you give me is a bit of a concern to me.

As to donor egg treatment that could always be a back up at a later date if your uterus is not too scarred after the fibroids and their removal.

My very best wishes
Robert Winston

Leave your thought