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.

Thanks so much for sharing and so sorry for you loss. It’s such a hard grief to articulate for me, perhaps it will be easier as time goes on. I’m glad you had a positive experience with surgical, I think I will go that way despite what my fertility consultant has said ♥️

I had a d&c and also got told those risks (I also agonised over them) but tbh I’ve since had a ton of friends have d&c and then go on to have kids. I’ve never met anyone have an issue from a d&c. Plus it doesn’t seem all that unusual to have one after a medical because it doesn’t all come out. That would be terrible. I think at 13 week I’d go for the surgical. If it was 7 then medical. But it’s that bit further on. My hospital didn’t even offer medical at that stage x

I've sadly at 15 pregnancies 3 living children. First and second trimester loss. I always opted for surgical when I had the option. Quick they scan you to check plus they can take the tissue away for testing. Hugs it's so bloody awful xx

Just as a different thought and this doesn’t come from a pro life as I am completely pro choice but have you considered keeping? Please take this with love as I am soooo pro choice. I’m just putting it out there as if it is trisomy without anything else they can live happy / healthy lives. Of course I know nothing of the situation but I do know I struggled with a termination badly (it was early and posed a risk to my health). So wanted to perhaps think on the other side of it xx I’m sure either way you choose you will be fine but the hormones take 3 months to level regardless of procedure x

Thank you for sharing and so sorry for your loss. Yes, from what I’ve read medical is very different after 10
weeks when the placenta is formed. Good to know your friends and yourself has had positive experiences and hasn’t affected fertility. I’m going to go with surgical after all the feedback. ♥️

@Clangershome To be honest, posting this in the middle of the most traumatic situation I’ve ever faced is deeply insensitive. The assumption that I haven’t already spent every waking moment weighing this up is, unintentionally or not, incredibly dismissive. This isn’t a decision I’m taking lightly.

This also isn’t a straightforward trisomy situation. There is significant swelling on the brain and heart defects alongside it. The picture is far more complex than Down’s syndrome alone.

And we have first hand experience in our family. My husband’s aunt had Down’s, and she died yesterday. She had five full-time carers, she screamed constantly with frustration, she was deeply confused, and she didn’t understand she was dying. His grandmother gave up her entire life and her career to care for her. It devastated the family. His aunt never lived independently, never had an education, never had friends, never had a career, never had a partner, and never had children of her own. That is not the life I want for my child.

Our family have been through it firsthand and they have supported and encouraged our decision wholeheartedly. And frankly, someone who claims to be pro choice pushing their views onto someone in one of the most vulnerable situations of their life is disgusting.

As long as you have the tablets to soften and prepare your cervix you are very unlikely to suffer cervical damage. With an experienced surgeon the risk of ashermans is low. Make sure you are given prophylactic antibiotics afterwards though as well. I had a surgical TFMR last year at around this stage. Worst case if you do develop ashrmans there are surgeries and it’s more successful if treated earlier so if you don’t get a period afterwards for a long time or something feels wrong get a hysteroscopy but it’s so unlikely to happen 🩷

I'm so sorry you're going through this. I've had 4 missed miscarriages between 8-12 weeks and I chose surgical management for all of them. I have zero scarring and did not get ashermans. I'm also someone who lives in the tiny percentage (rare Genetic diagnosis meaning IVF is our way forward currently to try and avoid more miscarriages). I also lost a daughter at 22 weeks due to something totally unrelated and I did give birth at that stage. So I get the fear of being in the 1% because if it's happened before, What's preventing it happening again. So wanted to give a story of surgical management that went well, each and every time.

@Elenaoliviadont feel you need to justify your reasons. That Poster should be bloody ashamed of themselves. Just be kind to yourself the staff tend to be lovely and amazing. It's a terrible lonely place and tfmr is an even more isolating one as it adds another layer of grief and complicated feelings and emotions. Z

I am in no way ashamed of myself and if you read the post then anyone can see that it was was written with kindness and not a ‘pro life’ theme. I don’t care what people do with their lives but I do know TMFR is horrendous and there was no mention of any other complications other than trisomy. Believe it or not some people don’t consider another option and perhaps they would have wanted someone to offer another option if there was one at the time. My post was fine.

I’m sorry that my post causes offence

I’m so sorry you’re experiencing this. It’s so unfair when you’ve been through so much.

I haven’t been through this but did have my ivf successfully at CRGH and also have (extremely negative) experience of Homerton and I would 100% take the advice of CRGH over Homerton.

Edited to add I had a DNC after mc prior to ivf with no scarring.

I hope all goes as smoothly as it can and that your next cycle is the one. Sending you hugs and healing.

@Clangershomeshe started this thread for advice and support. If she was considering another option it would probably be on the OP. There's a place and time for your post this wasn't it!