Dear Professor Winston
I would be so greatful for any advice. I have been trying to conceive for 8 years. As my husband had a vasectomy we were advised by our GP to try IVF opposed to a reversal. This we did- three times (egg sharing) but we were unsuccessful. My husband then had a reversal which we had to privately fund (and are still paying the credit cards) but I was so driven by desperation I would have done anything and still would. His reversal worked and I had an ectopic pregnancy a few months later (treated with methyltrexate). I have also had miscarriage a year later and another in 2013. I always start to bleed 3-4 days after an ovulation stick shows a peak but I also get a positive pregnancy test so soon which I can never understand. My cycle is now all over the place and don’t have periods often or ovulate. I have been under the NHS for years and have seen a different person each time -they have just prescribed me clomid at different strengths over a year which didn’t induce ovulation (one consultant said I was wasting her time and I would never get pregnant naturally without IVF. On being told this I broke down so she then prescribed me clomid again. I then tried tamoxifen privately which worked when I had my last miscarriage. Since then I have had a clear laparoscopy on the NHS and 6 months of tamoxifen which didn’t work. I have had to wait a year for my next NHS appointment and have seen someone else who advised to start again from scratch with blood tests. I am just so down- this has consumed my life for years and I feel physical panic that I will never be a mum. I now feel in limbo because I can’t have any blood tests till day 3-4 of my cycle but haven’t had a period since June. Please could you advise me what I should do next. Do you think my only chance is IVF? I feel that time is slipping away for me. I would be grateful for any advice.
Thank you, A


Dear A,

I feel embarrassed and angry that you are in this position. I hope everybody will read your letter on this website – your sad letter focuses on so many issues that I have to answer your enquiry even though I don’t have clear advice which I can usefully give. It would be helpful to have answers to a few questions.

1. Fiirstly, let me be clear – the advice to go for IVF rather than vasectomy reversal. GPs really do need to make sure that they are giving the right information. Their responsibility is to be much more aware of the issues surrounding infertility and to protect their patients from inappropriate treatment as well as ensuring a proper referral. I know that infertility doesn’t kill anybody but it is common and GPs need to be able to take it much more seriously. In experienced hands vasectomy reversal is highly successful with at least a 60 – 70% success rate. And of course, this means a potentially permanent restoration of fertility. Indeed, if done using microsurgery some surgeons get over 80 per cent. My colleague and friend in the USA, Sherman Silber, gets this high success rate even in less good cases. So the first thing to say is that before going for IVF, you should have had the advice to seek the attention of a good male specialist, an andrologist. Far too many patients are shoved straight into IVF without this kind of specialist advice first.

2. It would be interesting to know how IVF was done. Did they aspirate sperm from the testis, or explore your husband’s testicle under anaesthesia? Or did you have donor sperm? How much did this all cost?
3. What is your age? Are you overweight? How do you know you are not ovulating?
4. What blood tests have you had recently – in particular, FSH, AMH. Have you ever had a hysterosalpingogram to make sure the inside of the uterus is healthy?

If you could let me have some details, I’ll see if I can offer any reassurance or advice.

Best wishes
Robert Winston

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