"My experience of assisted conception "

About: Ninewells Hospital / Gynaecology Ninewells Hospital / Maternity care

(as the patient),

In 2011 my husband and I decided to try for a baby. I'd been on the pill for over 10 years and when after a few months my periods had not returned I visited my GP. She carried out various blood tests and said it would be a "time" thing and I should return to normal given a few more months. Thankfully about 5 months later my cycle returned however it was unpredictable and erratic. After another 7 months, my GP agreed to refer myself and my husband to Assisted Conception (ACU).

My husbands tests came back normal so we were asked to come in for a chat with a doctor where it was agreed I would have a hysterosalpingogram (HSG). I was to phone to book this when my next period started.

I called a couple of weeks later when I began bleeding and was given an appointment for a few days later.

On attending I was asked if I thought I could be pregnant to which I replied no, especially as I had been bleeding. I was not asked if I'd done a pregnancy test and was not offered one.

After waiting an hour over my appointment time for the doctor to arrive I was seen and the HSG was carried out. The doctor said she could see a blockage and thought that could be the cause of my problems stating that it could be a polyp.

I was seen later that week and it was arranged that I would have a laperoscopy.

Just before my appointment a couple of weeks later, I felt unwell and for some reason decided to do a pregnancy test. To my snitch it was positive!

I knew that I conceived before the HSG because I'd been bleeding on and off since the procedure.

I called ACU and was called in for a scan. The doctor assessing me decided the pregnancy looked small for dates therefore I was going to miscarry. She gave us a leaflet about miscarriage and sent us away but booked a check up scan for two weeks later.

Those two weeks were the worst of my life. I didn't know if I was pregnant or losing my baby.

At the follow up scan, I couldn't look at the screen and was shocked to be told I had a baby measuring about 6 weeks (smaller than my dates but not by much).

I was told it was good I didn't need assistance to conceive and that I should get in touch with my GP surgery to see a midwife,

As I was still bleeding intermittently I wanted to see a midwife sooner rather than later.

With a lot of pushing, I was finally given a booking appointment with a midwife at DMU.

I was told by the midwife that although I was there for a booking appointment, it was "early days at 7 weeks and something could still go wrong". I was upset by that comment as I had already been through so many emotions. The midwife tried to arrange a scan with early pregnancy unit but they were reluctant to see me as ACU had done a scan. As I'd had continued bleeding they agreed to see me the next week.

Waiting for that scan, I began to get a feeling my baby had died. The few pregnancy symptoms I had began to disappear. Sure enough, at the scan, my fears were confirmed.

The midwife who saw us was lovely. She comforted my husband and I and discussed our options. After the horrendous time I had had, I agreed to have surgery the next day to remove my dead baby.

After the surgery we had a debrief at ACU. The doctor concluded that we would never know if the HSG caused the miscarriage but agreed that it might have contributed.

We were advised to go away and try to conceive for a few months before seeing ACU again.

In that time, I didn't conceive. It was advised when I returned to ACU that I should have another HSG. Due to the circumstances last time, we were advised to abstain which we did, but I also did a test prior to the HSG.

Again, I was asked if I thought I could be pregnant but not offered a test. The doctor was lovely and I explained what happened last time and she was very sympathetic.

Thankfully, my second HSG was clear. When I was seen at ACU the next day I was prescribed clomid for 6 months to help me ovulate as it was thought I wasn't ovulating properly.

Thankfully for me, I responded well to the clomid and fell pregnant the first cycle, finding out I was pregnant on the due date of the baby I lost!

I began to bleed around 6 weeks so ACU brought forward my scan by a couple of days. Thankfully all was well with our baby.

I had my booking appointment but self referred a couple of weeks later to early pregnancy for reassurance due to a little instance of bleeding. Again there was reluctance to see me but I was able to get a scan and my little baby was just fine.

My previous experience prevented me enjoying my pregnancy as much as I would have liked to but I gave birth to a beautiful baby girl in January 2014 and she is just perfect.

I want to highlight my experience as I believe that women are still being given HSGs without being offered a pregnancy test first. I know people often scoff at those who say they don't know they were pregnant but given we had been trying for so long and had been bleeding there was no indication to me that I was pregnant. I'm sure that it would be much safer to offer a test to be sure a woman is not pregnant before a HSG.

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Responses

Response from Caroline Hiscox, Associate Nurse Director, NHS Tayside

Dear JH19,

I very much appreciate you sharing your experience with us and particularly for taking the time to highlight the comforting care that the midwife provided as well as the aspects of care that we could improve upon. May I please take this opportunity to apologise that the midwife at your booking appointment upset you. NHS Tayside expects that staff are sensitive to individuals needs and provide the best service possible every time.

I was saddened to read about the loss of your baby through miscarriage and I am very disappointed to learn about your experience of the ACU service and that this experience impacted on the enjoyment of your subsequent pregnancy. The staff in ACU remembered your story and the issues highlighted by your case were discussed at the time to ensure learning was identified and shared.

Thank you for giving us this opportunity to improve the care we deliver by sharing your story and for letting us know about the birth of your daughter in January, congratulations.

Should you find it helpful, we would be happy to arrange a meeting to discuss any aspect of your care in more detail. If you wish please get in touch with Ms Janice Ramsay, Head of Nursing Gynaecology who can be contacted through the Patient Feedback Team at feedback.tayside@nhs.net.

Kind regards

Caroline McQuillian

Associate Nurse Director

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