Dear Lord Winston

I am a 39 years old woman with one daughter of 4 years old. My husband and I have been trying to get pregnant naturally for more than two years and it has not been possible. Last year we started a fertility treatment (ovulation stimulation) at a fertility clinic in Zurich – where we used to lived. All our tests (hormonals and physical) were fine but after the third treatment we moved to London (for professional reasons) and the fertility clinic in Zurich recommended us to start using IVF as it would be more efficient. I could send all the tests and treatment that I received at the fertility clinic in Zurich. Now in London we have gone to another private fertility clinic explaining the above. This fertility clinic did all the standard tests again, as it was its rule, and found out that my immune system is preventing me from getting pregnant. The suggestion is to start a treatment with a medicine called Humira, which they mentioned is a very strong medicine but that in the majority of their cases it has made conception possible. I could send you all the tests and letters so far done with the fertility clinic in London. Now, I turn to you as I would really appreciate if you could kindly enlighten me with the following. A second opinion is always good and advantegous. 1.- Do you know whether Humira is clinically proven to increase fertility? I am extremely afraid about this medicine. 2.- Should the clinic do any other tests in order to avoid Humira and find a physical problem that I might have? Looking forward to hearing from you. Kind regards, I.

Reply…

Dear I,

Humira (adalimumab) is a powerful drug affecting the immune system and is used for certain forms of severe arthritis and for some bowel disorders. I suspect the manufacturers would be unhappy to hear that it has been recommended in your case and certainly could not take responsibility if anything went wrong as a result of its use.

Whilst it is an excellent drug under proper supervision for fairly severe rheumatoid and bowel disorders, you should be aware that:

1. It can reduce your response to infections caused by viruses as well as fungi and bacteria.
2. It occasionally can affect liver function.
3. Its use predisposes to various rare forms of cancer and to skin cancers.
4. Allergic responses are not uncommon, including rash and breathing disorders.
5. I have encountered patients who had neurological symptoms after its use.

But above all, there is no statistical evidence based on published randomised trials that it would be of the slightest benefit to patients with your clinical background undergoing IVF. I simply do not believe the statement that ‘….in the majority of [this clinic’s] cases it has made conception possible …..’

My advice would be to go to a different IVF clinic (assuming you need IVF at all and that you have had both a normal HSG and laparoscopy first).

Best wishes
Robert Winston

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