There’s been a lot of discussion today, so taking the topics in turn:
RMT: The official minimum seems to be 3mm. Mine was 6mm, so I was comfortably above that. However, at my follow-up consultation — when I was still bleeding 3 weeks after surgery and asking various “what if” questions — I asked whether I could have the procedure again if it hadn’t worked. The surgeon said that because 6mm is generally considered the minimum if you want to preserve future fertility, he would be reluctant to shave away any more tissue.
I later looked into this myself and found there’s actually no real consensus. Some surgeons seem comfortable with 3mm, others prefer 6mm. Personally, if mine had only been 3mm, I would probably have opted for laparoscopy instead, but that’s because I’m fairly risk-averse.
Re how I decided to go for surgery rather than just transferring embryos: it was never really a choice framed like that for me. I always wanted further investigations and/or surgery, but my IVF clinic repeatedly talked me out of it — before IVF, after the first failed transfer, and attempted to do so again after the second failed transfer.
After the first failure, I remember calling the clinic furious and wanting to change consultant, but they talked me out of that too. After the second failure, I think the consultant was worried about how I’d react. In reality, I was calm and polite, but firm that I wanted proper investigations.
Another consultant at the same clinic did a hysteroscopy and laparoscopy. They found nothing except a tiny amount of endometriosis, and I was told the niche was “fine”. His recommendation was simply to do another transfer and add blood thinners. That was the point where I completely lost trust in the clinic and went elsewhere for advice.
Even though I’ll still need to use them for transfers because my embryos are stored there, I will never again trust them on decisions about whether, when, or how to transfer embryos.
IVF team adamant the niche wasn’t to blame: my fertility consultant looked directly at the niche during hysteroscopy and told me to my face that it was absolutely fine and not responsible for my infertility or spotting. Personally, I would be cautious about taking IVF clinic advice on this type of issue. They are specialists in IVF, not niche repair, and they can sometimes be very blinkered outside their specific area of expertise. There’s also an unavoidable financial incentive to keep transferring embryos rather than stopping to investigate underlying issues.
Pregnancy rates after surgery: my understanding is that there really aren’t any reliable figures. The studies are all very small (often fewer than 100 patients) and results are mixed. So I’d be wary of anyone confidently quoting blanket success rates like “60%” without properly qualifying where that number comes from.
EndomeTRIO: I had the EMMA and ALICE tests while still at the fertility clinic. In hindsight, I think they were largely pointless — especially EMMA. I also asked for ReceptivaDX, which would also have looked at CD138, but was talked out of it. That’s the one I now think may actually have been worthwhile.
Consultants saying one thing and then changing it later: I’ve had this happen multiple times. I record every consultation on my phone (with permission — I usually say my husband can’t attend and wants to listen later, which tends to make it feel less confrontational). Originally I did this just so I could properly process and understand everything afterwards, but increasingly I do it so I can double-check I am being given sound advice.
For example, one consultant recommended blood thinners for a future transfer. When I researched it afterwards, I found there’s basically no evidence base for using them in my situation. A different consultant later described it as more of a “throw everything at the wall and see what sticks” approach.
On the question of how many procedures a surgeon has performed: I didn’t ask, and I wish I had. If I ever need another procedure, I absolutely will ask. Don’t feel embarrassed about questioning or challenging consultants — advocate for yourself and don’t worry about hurting their feelings.
Symptom update: Thanks for asking, unfortunately my last period wasn’t much better. It was very similar to the first post-op cycle, although there was a slight improvement in that I didn’t get fresh bleeding after the period had ended — only light brown spotting. I’m going to wait until after the third cycle before deciding whether to have someone take another look at it.