Dear Professor Winston,
I am so pleased to have found a way to write to you thanks to my mother who pointed me in the direction of this site after listening to you on the radio yesterday!
I am 37 this month and my husband is 35. We are both healthy, non-smokers of a normal weight and I experience normal periods with a cycle of roughly 28 days. After trying to conceive naturally for two and a half years we decided to seek advice. After a referral from our GP to an NHS fertility consultant, we were told we were eligible for funding and went ahead with the required blood tests, semen analysis and an HSG for me (which showed both tubes patent). We were/are classified as having ‘unexplained infertility’. I was extremely interested to read what you had to say on this matter!
After my husband was told he had poor morphology we were told ICSI would be used during our treatment. However, upon both samples being collected during our fresh cycles, the clinics used IVF as the samples were classified as ‘good’.
During our first fresh cycle I responded well to the drugs and produced fourteen eggs. We ended up with three at blastocyst stage and had a single five day transfer leaving two blastocysts frozen. I started to bleed on day six and the cycle failed. Our second cycle was a double frozen embryo transfer and this resulted in a pregnancy. However, after experiencing a bleed I was referred to an Early Pregnancy Unit and diagnosed as having a Missed Miscarriage. I was about six weeks pregnant. While I’m not sure it’s relevant, I had a very complicated miscarriage which lasted about two months. My miscarriage was finally diagnosed as complete after being taken by ambulance to hospital in Austria for an emergency D & C.
We have just had our third embryo transfer after another fresh cycle. I, once again, responded well to the drugs and fifteen eggs were collected and we had a five day blastocyst transfer. We have four, day five frozen blastocysts. This morning marks the end of my two week wait and unsurprisingly my test was negative after beginning to bleed last week.
While I know our chances are relatively low because of my age, I am loathed to sit and listen to our consultant say we have once again “just been unlucky”. I feel there must be more going on and that I’m perhaps rejecting the pregnancies.
I am interested to know your opinion of ‘killer cells’ and what, if any, further tests you feel could help us.
With huge thanks for your time and attention to my letter.
Kind regards,
A

Reply..

Dear A,

Thank you for the enquiry. It is true you may have been ‘unlucky’ and so  I am not sure that your reaction is entirely realistic. As I have said on an earlier answer, a failure of a transfer from a previous stimulated cycle is, in reality, a failure of a single stimulated cycle – please read carefully my letter to C (Shall I continue with IVF?) earlier today on this website.

I would say though I cannot regard you as being completely investigated – I would have thought making sure that there is no genetically abnormal background is important as is having a laparoscopy to ensure there isn’t a subtle problem, even though your tubes are reported as ‘open’. At Genesis we are always happy to glance at your X-rays if sent digitally, because sometimes subtle changes in the hysterosalpingogram are missed.

But ultimately to have failed two stimulated cycles and a frozen embryo transfer is well within normal mathematical probability and is not necessarily at all meaningful providing there is genuinely nothing else wrong. Also the statistics show that you are not unlikely to conceive naturally even when you least expect it.

Best wishes
Robert Winston

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