Dear Professor Winston,
I am 36, I have PCOS and I had my daughter in 2012 with the help of ovulation induction (Menopur and Pregnyl injections). We’ve been trying for a sibling since December 2013.
My husband was diagnosed with a low sperm count (previously was very good), we have had 3 rounds of clomid, x3 IUI resulting in one chemical pregnancy at 5 weeks, a miraculous spontaneous pregnancy but ending in a chemical pregnancy then recently x1 ICSI round and again a chemical pregnancy at 4 weeks, 5 days. I’ve no blood thining issues, thyroid is normal and I’ve had a hysteroscopy which was normal.
We have three top grade, 5 day blastocysts left, before using these I want to know if you would advise if any other investigations are needed. Or what our next steps should be.
Thank you for your time.
Regards K.

Reply…

Dear K,

I wonder – if your delivery was complicated in any way – forceps, Caesarean section or any fever afterwards, there is always the faint possibility of intrauterine adhesions or deformity which could just be missed on hysteroscopy. I have never favour hysteroscopy over an x-ray of the uterus (hysterosalpingogram) because I think this can often reveal things easy to miss with the distorted view down a telescope. Most practitioners don’t agree with me. But it is cheap and could be worth consideration before transfer of your remaining embryos. Also in your case, given your endocrine problem carefiul management of your hormonal status up to transfer could be important but your clinic, I am sure, will fully understand that.

I am glad you are not considering any immune therapy – in my view, of totally unproven value and expensive.

very best wishes
Robert Winston

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