Dear Professor Winston,
I have come across this question and answer page and found it very interesting. I really appreciate you giving people the chance to ask an expert and to get your opinion..
Both my husband and I (36years) have been together for 18 years. We don’t have any kids and started trying in 2009. I had been on the contraceptive pill for many years but came off before my 30th birthday in 2009. I currently have mild hyperextension treated with prescribed 250mg Methydopa tablets. We don’t smoke and are both of healthy weight and eat a healthy diet, but are failing to get pregnant. Please see our history below. We have had now around 8 tries of IVF all being negative. As it stands today we have 4 embryos frozen and are considering going to a private clinic as we are currently doing a self funded cycle after already having a funded cycle in 2012. We are desperate for a child – we are a happily married couple but very childless. Can you offer any advice going by my history?

  • April 2011 – Natural pregnancy miscarried at 5 weeks pregnant.

IVF treatments 2012

  • 16th June 2012 – Fresh IVF cycle – Positive. Resulted in live right ectopic pregnancy. (6weeks pregnant) proceeded to have a Laparoscopic right salpingectomy, which means removed my right fallopian tube. The remaining left tube was noted to be surrounded by adhesions and multiple filmy and Fitz hugh Curtis. – oophorectomy ask guys about this some evidence of a previous pelvic infection.
  • 24 October 2012 – left laparoscopic. (Salpingectomy) This showed normal uterine cavity. Left tube blocked and showed hydrosalpinx.
  • 27th November 2012 – Had Laparoscopic with disconnection to left hydrosalpinx and drainage of right ovaraian cyst. Salpingectomy to optimise fertility treatment. Evidence of pelvic inflammatory disease found on laparoscopy, including perihepatic and pelvic adhesions.

IVF treatments 2013

  • 2nd March 2013 – Frozen cycle failed
  • 26th May 2013 – Frozen cycle failed
  • 26th July 2013 – Complained of sharp pain on left side – US Pelvis Transvaginal scan (results pelvis to be entirely unremarkable)
  • 6th September 2014 – Hysteroscopy and biopsy

IVF treatments 2015

  • 2nd February 2015 – Fresh cycle failed
  • 11th July 2015 – Frozen cycle failed. This cycle was prescribed 25mg Presidion and baby aspirin. This cycle also found to have fluid build up on left side of fallopian tube. Was told this would not affect the treatment and this was left as it is.
    Thank you, R.

Reply…

Dear R,

Clearly, with your history, IVF is the only possible way you can get pregnant, but you don’t really give me enough information for me to judge your ovarian response to stimulation during the cycle. I think you probably should persist with IVF; I don’t think adjunctive treatments are desirable or necessary in your case, nor do I consider you need to do anything about the fluid build up in the tube.

But – you’ve clearly had significant pelvic inflammation and infection – the Fitz-Hughes Curtis adhesions around your diaphragm and liver are evidence of this and this gives rise to two thoughts. Firstly it is extremely likely you had oophoritis as well as salpingitis and this could well mean that the ovaries are not likely to perform as well. Patients like you may not produce such ‘good’ eggs I think and certainly more cycles of IVF may be necessary to achieve a pregnancy. And secondly, before you do anything else I strongly recommend a hysterosalpingogram (HSG) because in my experience, after pelvic infection, and damage in the uterus may be easier to see on a carefully done x-ray with limited quantities of dye injected in stages, than at hysteroscopy. And distortion of the uterus or adhesions in it may make IVF more problematic until that is dealt with. If you need someone to read the digital images, Genesis Research Trust is always happy to review them if you email them on.

I hope this is helpful.

Robert Winston

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