Dear A and D
It was a pleasure to see you both today. You have had a lot of treatment previously and had at least five good quality embryos replaced. You achieved a biochemical pregnancy once but unfortunately have not had success otherwise.
The reason for your difficulty conceiving appears to be related to D having had a vasectomy back in 1995. There was a failed reversal and surgical sperm was needed to be utilised.
I have gone through all your notes and review[ed] the previous cycle. There has been mixed embryo and fertilisation success and D did bring up the idea of using donor sperm. I am not against this if this is something you can consider. It is difficult to know the true impact on this as to whether it will improve your chances for success. Given D's age, I would think this is playing a part and as I said it is worthwhile considering.
You are planning to proceed with a further cycle and I have put a plan in place. We will look at using a shorter cycle using an FSH dose of 250. There is the potential for over response but given previous cycles, I think the slightly increased dose will be beneficial. D will need to go through a surgical sperm extraction and as we discussed here at [clinic], we look at freezing sperm and using this when required.
We also discussed using the Colorado protocol where we use a lot of different drugs to try and improve the chances of implantation. There is a distinct lack of evidence as regards to whether this improves pregnancy rates but given you have had so much treatment I think it is worthwhile considering. As the doctors in [city] advised, you are heterozygous for factor V Leiden and we will look at giving you Heparin injections following egg pick up to see if this helps also.
I wish you all the best for your upcoming treatment. If you would like to look at using donor sperm, my nurse L is the best person to talk to.
With kind regards...