How a tiny scratch gave Laura a baby after years of trying
ME & MY OPERATION WOMB SCRATCH FOR INFERTILITY
AROUND one couple in six experiences fertility problems. Laura Washington, 32, a hairdresser from Cannock, Staffordshire, underwent a new procedure and is now a mother of one, as she tells ADRIAN MONTI.
THE PATIENT
After Chris and I married in 2005, we immediately started trying for a baby. Chris, who is in the military, worked away for long spells, so there would be several weeks when we couldn’t try but, after a while, it was obvious I wasn’t getting pregnant.
In spring 2008, I went to see my GP, who referred me to hospital for tests — which revealed that I had polycystic ovary syndrome (PCOS). this meant that my hormones were out of balance (I had too much testosterone), which, in turn, meant I wasn’t ovulating properly.
I’d had bowel surgery as a baby, too, and, as a result of this, my fallopian tubes had been slightly moved.
I was told that because of these complications, my chances of conceiving normally were low.
We had always wanted to start a family as soon as we were married — I had seen myself as a mum — and not being able to have children easily was something we had never thought would be an issue, so it was a big blow.
Doctors said our best chance was in-vitro fertilisation (IVf), where the egg and sperm are collected and fertilised in a lab, then the embryos are transferred into the womb. We started IVf on the NHS at the Midland fertility Clinic in february 2011, and two embryos were transferred into my womb.
the first attempt failed and so did a second one six months later. Chris and I were devastated, but determined to carry on trying.
Butwe weren’t eligible for any more NHS treatment, so we had to go private at the clinic. that attempt failed, too. We were both heartbroken again. Having a baby was now always on my mind — the harder it seemed to be to have one, the tougher it was to accept.
Over the next year, I underwent more investigations to see what was stopping me getting pregnant. ultrasound scans showed that I also had hydrosalpinx, where the fallopian tubes retain toxic fluid that would stop embryos developing — so I had the fluid removed.
towards the end of 2014, we decided to give IVf one last chance. Heidi Birch, a specialist nurse at Midland fertility who had been treating me from the start, suggested trying a new procedure called an endometrial scratch.
She explained that it involved scratching the uterus wall with a 10 in plastic tube and might help the embryo stick better.
After all that we’d gone through already, I was happy to try it.
the scratch was done five weeks before my egg collection. Heidi inserted a catheter via my vagina and then used it to make small scratches on my uterus wall. It was slightly painful, but the whole thing only lasted ten minutes. I was allowed to drive myself home an hour afterwards and had no pain.
In December 2014, I had my eggs collected and fertilised, and the embryos were replanted into my womb. Just over a week later, on Christmas morning, I felt slightly sick and had a feeling that I was pregnant. I did a home pregnancy test and it came out positive — we were elated, but knew we still had a long way to go.
I tried to enjoy my pregnancy but after the miscarriages, I was terrified that something might go wrong. I had a planned Caesarean and Amber was born on August 27 last year at just under 39 weeks, weighing 7lb 7oz.
It was amazing to hold her for the first time. It’s incredible that the tiny scratch might have played a large part in us becoming parents.
THE SPECIALIST
Heidi BircH is a nurse specialist and director of nursing services at Midland Fertility in Tamworth, Staffordshire. eVerY year, around 52,000 uK women undergo IVf. today, 2 per cent of all babies born in the uK are conceived in this way.
there are many reasons why IVf may not work, including genetic issues and autoimmune conditions where the woman’s immune system rejects the embryo, as it considers it a foreign body. But often, the failure is unexplained.
In the past three years, a simple technique has been developed which, trials have shown, can increase the success rates of IVf.
It’s known as endometrial scratching, where a tiny part of the uterus wall is deliberately disturbed. essentially, it was discovered by accident.
Doctors had found that some women who’d had a dilation and curettage (D&C), a procedure where tissue from the womb lining is removed to identify what their infertility problem could be, became pregnant the next month.
A D&C is similar to what we now do with the ‘scratch’ technique.
One theory is that scratching the lining causes a repair reaction, where the body releases growth factors and stem cells in the uterus, which then help the embryo to implant and develop.
Some studies have also suggested the scratching ‘switches on’ the genes responsible for ensuring the embryo implants onto the uterus wall. there are ongoing trials in the uK and around the world to identify exactly why it works.
As an experienced fertility nurse, I’m qualified to carry out many procedures that are usually reserved for doctors. I am one of the few nurses in europe to do endometrial scratches.
It’s available at many of the 82 uK IVf clinics, but not yet on the NHS because it’s so new. We carry out endometrial scratches on roughly 20 per cent of our IVf patients — women who had goodquality embryos, but who either didn’t get pregnant or experienced early miscarriage for any reason.
THeprocedure is done on day 21 of a typical 28- day menstrual cycle, just after ovulation and a few days before the period is due, a month before IVf treatment. this gives the uterus time to generate stem cells before the embryo transfer.
Patients are advised to take two paracetamol tablets beforehand to take the edge off the slight pain.
A sterile tube — a catheter — is gently inserted through the cervix and into the uterus.
using an ultrasound scan, I can see where I am. When the catheter is in position on the uterus lining, I make four scratches, each a few millimetres long.
Because the catheter is hollow, it creates slight suction when placed on the surface, which pulls little parts of lining away from the uterus wall as I move it — this combined with the pointed end of the catheter creates the scratches.
Patients usually feel slight discomfort and cramps similar to period pain. However, this stops after I withdraw the catheter. Some women get slight spotting, so I advise them all to wear a sanitary towel for 24 hours afterwards.
It’s impossible to say whether the scratch was the main reason why Laura had Amber.
It’s probably a combination of factors in her treatment.
We only offer it after the second IVf attempt, as there is not enough evidence of improved pregnancy rates on a first cycle.
It’s an interesting development, though. It could address the problem of good-quality embryos failing to implant and clearly can lead to a successful pregnancy.
WHAT ARE THE RISKS?
tHere is a risk of infection, which is always the case when something — in this case, a sterile catheter — is put into the body. Antibiotics are given beforehand to prevent this.
there is also a small risk that the patient could faint.
But because the patient isn’t sedated, they can indicate how painful the procedure is. this makes perforating the uterus very unlikely.
Professor Siobhan Quenby, a consultant obstetrician at Coventry’s university Hospital, says: ‘the endometrial scratch could play a useful role in helping women undergo successful IVf but, at present, it’s still unclear how useful it is.
‘Some trials find it’s helpful, while others have shown no obvious benefit. We don’t think it does any harm — but we are not sure at this stage if it helps, either.’
AT MidlAnd Fertility, the scratch costs £215.