Dear Professor Winston
I am a 32 yr old mummy to a healthy 2 yr 4 month old little girl. It took me about 18 months to conceive with her. After being diagnosed with an underactive thyroid in April 2012, I conceived the very next cycle after starting on thyroxine. I have not prevented the chance of conceiving since she was born and have been actively trying for over 12 months now. In October I suffered an early miscarriage. The doctor has done day 21 tests which all came back normal. I have since had pregnancy symptoms a couple of cycles and a faint positive test, but my period then arrives around a week late. My doctor won’t do anything until 12 months from my miscarriage in October. I feel as though something is not quite there in the process though and that the chances of me conceiving are very low. My cycles vary from 30-37 days, but I started acupuncture this month and my cycle has reduced to 29 days. I’m not sure if its a coincidence, or related to the acupuncture. I have had issues with my periods and cycles since I was about 15 and have been ‘branded’ PCOS then ‘unbranded’ after my thyroid was found to be underactive. I have also been told I have a bicornuate uterus, but then in a subsequent scan told its not that bad. It was bad enough to be monitored throughout my entire pregnancy with my daughter though. You can probably guess that I get mixed answers from various experts and I’m becoming increasingly anxious that being blessed with my daughter is the end of the fertility road for me and my husband. Should I wait until October for my doctor to consider further tests or should I be asking for a second opinion? I have looked into private tests, which is probably my only option. Thank you for taking the time to read this. C

Dear C,

I think you have a right to be investigated under the NHS and would be inclined, if I were you to insist on this as far as you can. In particular, I would want to know more detail about your uterus and whether the deformity which has been reported is really present. The best way of identifying this is not by a scan, but by an HSG (hysterosalpingogram) and this x-ray will show how much of a septum you have. If it is substantial then this is very easy to remove, generally as a day-case under general anaesthesia, providing your surgeon has experience of this problem. Also, you clearly have some problem with ovulation and although you say this seems to cleared with acupuncture I am unaware of good published evidence that will improve you chances – so induction of ovulation is very likely to help you.

I think you may need to ask your doctor on what basis he refuses to do anything until October – there is a good case for implementing some treatment (not IVF) now.

Best wishes
Robert Winston

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