QB-2022-000824 - [2025] EWHC 1610 (KB)

The experts agree that the Claimant is not infertile, as she has conceived twice since the events of 2016 which shows that her remaining right fallopian tube is functional for the purposes of conception. However both Mr Magos and Mr Slack consider that the failure to provide timely diagnosis and treatment will not, on balance, mean that she will require IVF treatment if she wishes to add to her family in the future, whereas Mr Raine-Fenning considers that it likely she will.

Mr Raine-Fenning’s opinion is that 80-90% of couples conceive within one year of trying, and 50% of those who do not, conceive the following year. For that reason, he explained in oral evidence, IVF is generally recommended, under NICE guidelines, after two years of trying for those with no known explanation for fertility problems, and after one year for those, like the Claimant, who are sub-fertile for a known reason. He notes that it is unclear how long the Claimant took to conceive both previous pregnancies, as she was taking the contraceptive pill for some of the time, but estimates that from a review of the records that was at least two years on the first occasion and over 12 months up to 18 months on the second occasion.

However, he notes that the loss of one fallopian tube reduces conception rates to about 60-70%, but only if the one remaining tube is normal, and there is a normal pelvis. In this case, there is a damaged fallopian tube and adhesions with an obliterated Pouch of Douglas, into which the egg is often released. His evidence is that a fallopian tube not only needs to be patent, but also functional, so it has a normal relationship with the ovary and can pick up the egg at ovulation. He explains that a fallopian tube is lined by cilia which aid the passage of sperm, the egg and, if fertilisation occurs, the embryo. His evidence is that these cilia are likely to have been damaged by the extensive infection and inflammation that was present because of the delayed diagnosis of the PID.

Mr Raine-Fenning also notes that the Claimant’s dyspareunia is also likely to reduce how often she has sex. For all these reasons he considers that “all reproductive medicine experts would agree that she has a  50% chance of conceiving naturally and so it is more likely than not that she will require IVF”. He further noted that IVF will reduce her risk of ectopic pregnancy which all the experts agree has been increased by the PID. Mr Raine-Fenning’s opinion is that this risk is 2% with IVF, but the Claimant’s risk of ectopic pregnancy if she conceives naturally is much higher and probably around 20-25%. In fact there is literature before me (Pelvic Inflammatory Disease: Medscape 2019, Tough DeSapri, Karjane et al, 2019) which states that the risk of ectopic pregnancy is increased 15-50% in women with a history of PID. Mr Slack accepted Mr Raine-Fenning’s analysis both of the chances of conception and of the risks of ectopic pregnancy in cross-examination saying “Of course I do. I’m not an expert in IVF or fertility and I accept he is”.

Mr Magos’s oral evidence was that IVF is both stressful and not very successful, and he would advise the Claimant to try to conceive naturally. He said that she is of proven fertility, that women who have had a pregnancy have an almost doubled chance of conception than someone who has never been pregnant, and an even better chance if they have conceived twice. He considers that the prognosis is good, even if it may take a little longer than someone without a single fallopian tube and adhesions. In relation to the damaged remaining fallopian tube, he says the best test of tubal function is pregnancy, and she has become pregnant twice. In cross-examination he criticised Mr Raine-Fenning’s evidence that the fact that the Claimant has been pregnant twice does not alter his percentage chance of a natural conception saying “logically, she is in a much better prognostic category” and “her pregnancies are strong evidence that [the right ovary and right fallopian tube] are not totally caught up in adhesions”, but accepted that he had no experience in IVF and would defer to a fertility expert. I am satisfied that Mr Raine-Fenning is such a fertility expert.