Siridovich wrote somewhere in his first tome of "The last years of the court of Tsarskoe Selo" that GD Elisabeth was very unhealthy. I do not know exactly what does he mean. I only know for sure that Ella had to take a cure in Germany (Franzenbad) in 1896. Elsewhere in their letters and diaries I remember they mentions problem with legs (blood circulation?). Then she had a chirurgical intervention in 1907, something very serious which was discussed in those forum pages. Reading the letter she zrote to the Tsar announcing her operation, I was amazed by the fact she had serious pains during years and she never complained about it, having a very active life. Can find the quote if you want. Do people of those times know something else, perhaps related to infertility? I am aslo looking for information!