Dear A and D
It was really nice to see you both again today. We went through your most recent IVF cycle. Unfortunately we did not have success with the fresh embryo but we have one further remaining in the laboratory which is a good result.
I went through your history in some detail to really try and establish whether we may be missing something. In summary, my feeling is that before replacing this last embryo we should look at performing a laparoscopy and hysteroscopy to see if there are any factors inside the pelvis and uterus which could be impacting on your chances of success. I am highly suspicious of endometriosis and this can affect implantation through outer gene expression. What I mean by that is that the uterus does not recognise the embryo as appropriately as it should.
I have referred you to [hospital]. Please come to see me here following the operation and we will look at proceeding with the frozen embryo to try and gain the benefit of the hysteroscopy in terms of the endometrial scratch.
Fingers crossed we get the right result.
All the best and kind regards...