File note

I reviewed A and D on 12 March. Unfortunately, the most recent IVF cycle resulted in the transfer of two embryos without pregnancy occurring. I have reviewed the details of their history since D's vasectomy in 1995 and reversal in 2005. On the four occasions they proceeded to IVF the first three resulted in satisfactory fertilisation (3:5, 5:6 and 2:3 oocytes fertilised). On the most recent occasion only 3:9 oocytes fertilised. There have been good quality embryos transferred now on five occasions, with one early pregnancy achieved but unfortunately early miscarriage.

In these circumstances, there is the possibility of a factory compromising implantation for which I have asked that both partners proceed to chromosome analysis, and that A undergo blood tests to look for immune and blood clotting disorders that may compromise implantation. I think it also worthwhile proceeding to a saline infusion scan to assess if there could be some underlying endometrial or uterine anomaly not evident on previous scanning.

Thereafter, if there were concerns on the above, I think to review and discuss this is appropriate. However, we have discussed the merits of further IVF or consideration of treatment such as donor insemination or the use of donor oocytes. It may well be that there is an egg factor compromising the quality of embryos now, but this is not possible to say based upon the above information aside from the most recent cycle with only 3:9 fertilising. With this in mind, it would be possible to consider further IVF, but realise that the likelihood of pregnancy is reduced now there has been four treatments. No plan has been made at this stage, and I will await the above results and review them should there be any concerns. Although stressful to them to consider these issues, I still believe they have a reasonable chance of achieving an ongoing pregnancy and I will keep you informed of their progress.

Yours sincerely...