Dear Professor Winston,
I would love to hear your view. Apologies if you have already answered a question like mine. I could not find it so far. I am a 34 year old woman, married to a 33 year old man and we would love to have a child together. I had been on the pill for about 14 years until I stopped 4 years ago. We went to our local fertility clinic approx 2 years ago and discharged ourselves when told that there was no reason for us not to conceive naturally. My tubes are not blocked, no signs of endometriosis, I’m ovulating normally, not overweight, have a pretty healthy lifestyle. My husband sperm samples varied from 50-140 million and according to the consultant they are “quick and strong swimmers” though the abnormality is 100%. They kept saying that this is not an issue though – they keep not telling us what type of abnormality his sperm cells have and claim that quality is not as important as the quantity and mobility is good. I deliberately don’t go on all these forums etc to read what others say about this as but surely quality does matter? About 3 years ago I had a sudden and very stereotypical symptomatic case of vaginal thrush. Treatment I got over the counter didn’t help. According to the GP I didn’t have thrush so I went to the GUM clinic. The result was that I had a profuse case of it. I started to get treatment. My obvious symptoms got less for a while but the results kept being ‘profuse’. If anything, it felt worse after treatment. I kept telling the doctor this but he was convinced it would go and I needed to persevere. At some point, my only remaining symptom was a burning feeling during sex, hence I kept going back. Clearly not helpful when trying to conceive. Treatment varied from 3 weekly pessaries to oral tablets etc. After 18 months I was so fed up that I asked for further testing. It came back it was candida glabatra. I was told the treatment given to me was not actually going to work. The doctor told me he didn’t know what to do. During that time I’d started accupuncture which I find relaxing, it improves my sleep patterns and I have always had bad IBS symptoms which have got a lot less. I stopped the pessaries and the pain finally is gone for about 6 months. We have gone back to the fertility clinic. Recent test showed I still got a profuse infection. I explained my history and my reluctance to use treatment again but they still advised me to use the over the counter stuff. It feels the symptoms have flared up again which is incredibly frustrating. They admit that they simply don’t know what to do with it nor can tell me if it affects anything. I am not convinced this is the case. The acupuncturist (who has actually worked in hospital for years as a doctor) says the fact this infection is there is an indication the conditions there are such that it allows this fungus to grow, likely influencing conceiving and he feels it is worth further investigating rather than just ignoring it. This sounds like more logical reasoning to me. My recent tests show that I got 10 follicles on one side, 11 on the other, AMH levels were low; 11.9. Husbands sample still 100% abnormal. So far I have never had a confirmed miscarriage as I’ve stopped doing tests but we have had a few cycles which were different/longer/bleeding a lot heavier and painful etc. I am booked in for the NK killer cells test recommended by the clinic (£350) though they postponed it due to this infection. I am not overly keen on starting IVF to be honest. I feel the whole ‘unexplained infertility’ diagnosis is a lazy one considering how little they seem to further want to investigate clear indicators (in my layman’s eyes): my husband’s poor quality of sperm and my profuse yeast infection. Is this unreasonable? I don’t know where to start as I find it difficult to challenge or question a medical professional if they clearly have got this “blasé” attitude and conviction that my concerns are unnecessary. Maybe they are but I’d appreciate an independent opinion. Thank you in advance for making time to read this, warm regards, E.

Reply…

Dear E,

I would say you are being eminently reasonable. Firstly you need to know that thrush is extremely common, generally harmless but unpleasant, and often very persistent (which is why there is a multiplicity of treatments available). However, I would say that I have never seen such bad thrush that infertility follows. I suppose it is just possible that you have secondary infection with another organism which has blocked or damaged your tubes but a laparosopy was normal so this seems at best a remote possibility. One issue, though, is why you get recurrent thrush? Do you take antibiotics, for example which can reduce your resistance to fungal infection? Is there any evidence that you have diabetes – often predisposes to thrush infections? Have the doctors made every attempt to rid your gut of any thrush as this could reinfect you? And are there any diets you take which improve your fungal infections (or make the thrush worse)?

But it seems to me that the urgent thing is to make absolutely certain of your husband’s fertility. It is ridiculous on the face of it to say the sperm are abnormal without giving you fuller information. Of course quality matters. And yes, whilst IVF might confirm whether there is a problem with fertilisation, this is an incredibly expensive way of making a diagnosis. My first thought is that you should see an andrologist – a male fertility expert – they do exist and they can give you a much better idea of what may be needed. By the way – there is no evidence that the NK test is of any value at all – I cannot advise you to spend this money; it seems a complete waste. The very fact that you are being advised to have this worries me that basic tests which you should undoubtedly have are being ignored – it is even possible you may feel safer by changing the clinic you attend.

Sorry to be so blunt
With warmest wishes
Robert Winston

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