Dear Professor Winston,

I hope you can help me, as I feel I’m getting no support currently from my doctors!

I stopped taking cerazette in April last year due to my husband and I wanting to try for a baby. We are both healthy in our late 20’s so thought nothing of it other than excitement. I was originally put on the pill at 16 years old (I began my periods very late at 15) due to intense pain that cause unbearably heavy bleeding and more often than not sickness and fainting.

Since coming off of cerazette, I discovered that the pain had not subsided in the past 12 years at all but was being masked by the pill. I was found to have an 8cm cyst on my left ovary which burst before a referral could be made, due to excessive waiting times. In October, I had a laparoscopy which found I had a tiny spot of endometrisosis but was told not to worry and I wouldn’t even be classed as having it due to it being so small. So here I am 4 months post surgery, still not pregnant but having to try with on going pain. What should I now be asking the doctors to do? Investigate the pain more or why nearly a year in I’m not falling pregnant? Could this be a sign I’m infertile?  As when I go I just get told “everything is normal” which I know it’s not and I so want to be a mum!

I am so confused any help would be most welcomed.

U.

Dear U.,

I am not sure you are entirely right in being critical of your doctors.  Where I suspect there has been a failure is in communication.  Sadly in today’s NHS, the pressure on healthcare professionals has been so much that they do not always have enough time to focus on what patients need most of all – careful communication.  This I regret is an increasing problem.  So often neither government nor NHS governance recognises how important this aspect of medical care is.

I do not think you necessarily have a problem.  The chance of the average woman of your age conceiving successfully is approximately 20% each month.  This means in practice it may be expected for roughly half of all reasonably fertile women to be pregnant after 4 to 5 months of regular sex.  So if you started trying last April, it would be extremely likely that you would not be fertile at all in the first month (the effect of the pill), so possibly your chance of getting pregnant only started in May/June and then, after ovulation you ended up with a follicular cyst, which may have prevented pregnancy for a couple more months.  You then had a laparoscopy and you were lucky. Because the waiting list worked in your favour you did not have what might well have been an unnecessary operation to remove the cyst (which could have possibly compromised your fertility).  Instead, nature came to your rescue and you have been at risk of getting pregnant since last November/December i.e three months at most.

Overall, you have possibly had no more than five or six fertile cycles and, assuming your husband is fertile, there clearly is no justification for intervention at this stage.  In a woman of under 30 (if you were my patient) I would not consider any fertility investigation or treatment until at least this summer – say around August.  Bt that time you may have had a dozen cycles when you might have got pregnant and some interevention may be justified although you could not be truly classified as being infertile if you had not been trying for at least 18 – 24 months.

Believe me, so many people like you get seriously anxious, rush into inadequate investigations, go for treatment which doesn’t immediately work, end up in an IVF clinic, have a couple of failed cycles (which is statistically the probable outcome) and then wonder what to do next – when, of course all the treatments have possibly delayed your chances of conception – failed treatment is a great contraceptive.

Keep trying!

Good luck and best wishes,

Robert Winston

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