Mail fra Dr. Gibb, (London)

Da har jeg fått en ny e-post fra Det Store Utland.  Denne gang fra en Dr. Gibb i London. Det er jo ikke så innmari langt unna ihvertfall.  Føler ikke svaret er like entydig positivt som fra Dr. Haney, selv om han gir oss en ca 80% sjangs. I tillegg er han bekymret for vekten, og jeg forsøker virkelig å komme meg lengre ned igjen. Det som virkelig er positivt er jo at han svarer ganske direkte på spørsmålene mine (samme mail som til Dr. Haney). det er jo langt billigere enn i Chicago hos Dr. Haney, men her må jeg regne med å bli lengre.
Mange avveininger som må taes.

Har fått time på Riksen 22. juni. har bestemt meg for å ta med de e-post-svarene jeg har fått frem til da, i tillegg til noe annen info jeg har funnet på nettet.

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Dear esmeralda,
Thank you for your email. I am sorry to hear you have had such difficulties carrying a pregnancy. I believe TAC must be the answer for you. By the way we call it cervical weakness not cervical incompetence. It does not sound as bad!
I am not surprised there is no one doing it in Norway. Ten years ago I flew to Sweden, Gothenburg, to do one. To call someone a little experienced I would expect them to have done 10 cases. Very few doctors have done this. I have done about 200.
I have some concerns about bicornuate uterus which is associated sometimes with an abnormal cervix rendering it weak. I much prefer to do it during pregnancy as in 95% of my cases. I believe it is easier to do in pregnancy although by definition there is a risk of precipitating miscarriage. I think it is easier to get to the right place as the organs enlarge in pregnancy. I think it may also compromise natural fertility. I do the procedure at 11-12 weeks just after the scan to check that the baby is normal. It involves general anaesthesia and a three night stay in hospital. I think you would need to stay a further ten days in London. I have a concern about your body weight. The operation is technically more difficult if your tummy wall is thick. It would be good, essential, if you could lose more weight. In your case I would not be particularly concerned to give progesterone treatment. There is no limit to the time after the last loss that the TAC can be placed. As far as the interval to IVF that is something you would have to ask the IVF doctors.
I do believe gravity can play a role with the weak cervix. I would be advising you about some limited rest soon after the procedure. I do not agree with what you have been told about this.
I think you have a good (80%) chance of a successful pregnancy after a TAC is done. It should be placed at about 12 weeks. It is not impossible for me to travel to Norway to do this but it is difficult. I would have to find the time in my schedule. I would have to have approval from the Norwegian authorities to operate. It would be useful to operate with a Norwegian colleague who can then continue the care. It is always difficult to operate in an unfamiliar environment where I am not acquainted with the instruments and staff. It is obviously easier for me if you come to London. Overall you would have to stay at least two weeks. Ideally I would like to meet you in advance for assessment. You would have to make a separate trip which, at a push, could be a day trip. The cost of the procedure and the hospital stay along with all the doctor’s fees would be approximately £9000. Obviously you would require accommodation for the following ten days. There are local hotels with reasonable rates.
I hope this information is helpful and I await hearing from you.

Kind regards

Donald Gibb