Help! TFMR at 13 weeks from IVF. Medical vs Surgical? Private fertility CRGH advice vs nhs Hospital.

[Elenaolivia]

Hi everyone! I’m posting here because I am completely broken and overwhelmed. I’m currently 13 weeks pregnant after a long and difficult IVF journey. This is my only way to have a baby, and I’ve already been so "statistically unlucky".

We’ve just had a diagnosis of Trisomy (confirmed via CVS and full-spectrum bloods). I now have to navigate a termination, and I’m getting completely conflicting advice from my doctors and I don’t know who to trust.

Fertility Doctor:
My fertility consultant at CRGH is strongly pushing for a medical abortion. They are worried that a surgical (D&E) procedure at 13 weeks carries a risk of scarring the uterine lining (Asherman’s) or damaging the cervix, which would mean needing a stitch (cerclage) in any future IVF pregnancies. They want to protect the "environment" for my future transfers at all costs.
However, the NHS hospital (Homerton) says most people go surgical at this stage because it’s quicker and more definitive.

My Dilemma:

1. The Mental Aspect: I feel like surgical would be much better for me mentally. I want it to be "one and done" so I can have closure and start to heal. I’m petrified of the "mini-labor" at 13 weeks and having to be "present" for the physical process of the medical route.
2. The Timeline: I know that medical takes significantly longer. I’m told I could be bleeding for up to 4 weeks, and there is a 10% risk of retained tissue which would delay my next IVF cycle even longer. I want to reset my hCG and get back to IVF ASAP.
3. The Risk: Despite the mental benefits of surgery, I am terrified of being that "unlucky 1%" who ends up with a damaged cervix or a perforated uterus, especially since my IVF doctor is so against it.

I want the quickest but safest route back to IVF. I can't bear the thought of "breaking" my uterus and ruining my only chance at a baby, but I also don't know if I can cope with the long, drawn-out trauma of the medical route. Has anyone else been through this with CRGH or another IVF clinic? • Did you go medical or surgical at 13 weeks? • Did you find surgery better for your mental health, or was the risk of scarring too high? • How long did it take for your hCG to return to normal so you could go again? • If you went surgical, did it actually affect your next transfer or pregnancy?

I feel like I’m choosing between my mental sanity and my future fertility. Any advice or experiences would be so appreciated. xx

I am so so sorry you're going through this. I had a termination at 16 weeks last December and whilst it was the right thing to do was a devastating experience, so I hope you have a lot of support. I was also encouraged by the hospital to go down the surgical route and was pretty torn, but they told me there was a high chance I would need a D&C for the placenta in any case if I went down the medical route as they don't usually come out at that gestation. I was also terrified of scarring and the consultant who did it reassured me that the statistics around scarring are much lower these days due to the technique (much lower than 1%). It is such a sad and difficult experience, I would honestly go for whatever you feel is the least bad option. If you check out reddit you will find lots of people sharing their experiences of both procedures and there is much support there. Sending you so much love and strength, as many people said to me at the time, you will get through this.