Dear Professor Robert Winston
I am a single 39 female who has under gone x4 IUI and x4 IVF with donor sperm (4 different donors). X3 IvF were antag cycles and had a endometrium scratch each time. My last IVF was a long cycle with entermetrial scratch and embyro glue was used. Each IVF cycle has produced approximately 10 eggs of which 3 got to blastocyst on day 5 (non have ever been frozen). I have always had x2 embryos put back on day 5, then commenced cyclogest pessaries 400mg bd, & 25mg prednisolone tablets. All IVF cycles have been gonal f and ovriette, with the long cycle also using provera and buserelin. I have paid privately and remained with the same clinic each time
I have a diagnosis of hypothyroidism (8 years) and treated with 175mcg of levothyroxine. I have 200mg of ferrous sulphate too. All cycles I have taken preconception folic acid. I have an anterior uterine fibroid which now measures 6cm (but apparently does not indent the uterine cavity). At the start of treatment in 2013 the fibroid measured 50x46mm. When seen by the gynaecology consultant in an NHS hospital I was told the risk of removing this fibroid would probably result in a hysterectomy! Apparently, during this last cycle the consultants found it difficult to reach my left ovary due to the fibroid!
I am wondering that after x8 privately funded cycles with no positive pregnancy tests am I likely to become a mother if i go ahead with future cycles? Which cycle should i do again or do I go for a double donation and would my chances of becoming pregnant be greater or should i look at adoption? I also wonder if my fibroid or my hypothyroidism is the issue? My GP, previous gynaecology consultant and the fertility clinic, have all felt neither are the issue, but I obviously have implantation issues, but no suggestions given! I have recently been referred back to the gynaecology team and I am awaiting an appointment (which I’m sure will result in surgery). I have previously had one fibroid removed, and this one looked at twice under GA.
I have lost 7.5stone over the last three years, kept active, eat fairly healthily and try to stay stress free! I completed fertility reflexology and reduced my swimming and excerise on all attempts. My BMI this last round was 28, I’m 175cm tall.
I would be extremely grateful for any advice you may be able to offer me.
Kind regards, A.

Reply….

Dear A,

I can’t pretend that I can give you very hopeful advice. Obviously I don’t have all the facts here, so need to tread carefully, but a key feature in my view is the history that you already have had at least one fibroid removed surgically and that you still have a sizeable fibroid in your uterus which is clearly causing considerable distortion. If the consultant feels that a myomectomy is likely to end with a hysterectomy you can be fairly sure that your uterus is likely to be significantly compromised. You are committed therefore to repeated attempts at replacing embryos or blastocysts into a uterus which is likely to be really abnormal.

If you are really desperate to to continue trying, I would really want to look very carefully at a hysterosalpingogram to assess your uterus and its cavity, and possibly an MRI as well. Then a decision has to be taken whether to have another attempt at removing any significant fibroids – there may well be more than one. But I must tell you that repeat myomectomy has a very poor success rate, particularly in women who are overweight.

You have done really brilliantly to lose so much weight but in truth (I am sorry to go on about this) your BMI is too high. I do understand that you may be slightly hypothyroid but with the medication you are taking I doubt whether this is very relevant to the results of IVF, or that you are somewhat overweight still.

There are some gynaecologists who do have particular interest and expertise in removing fibroids in people like yourself using what is effectively a microsurgical approach. But even so, the outlook is poor at best and I suspect you are beginning to realise that will need to look at different options at this stage in your life. I don’t find it easy to say all this to you but I think that unless the fibroid(s) you have is/are operable IVF is not an option which I feel comfortable about recommending.

My best wishes
Robert Winston

One Comment

  1. A

    Thank you for your response. I will await my appointment to see the gynaecology consultant in 10days time and ask for a MRI of the abdomen. The fertility clinic felt that if the fibroids are sorted, then they’d suggest double donation (even though this still doesn’t guarantee pregnancy), and definitely no future attempts of antagonist cycles.

    I will endeavour to continue losing weight. I have previously had a HyCoSy (Hysterosalpingo-contrast-sonography) and that showed no problems.

    Thank you for your advice.
    A

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