Dear Lord Winston,
I just wanted to say a very big genuine –from the bottom of my heart- thank you.
I followed your advice and asked my GP to have a look at my immune system, which he did. One of the tests he did came back as positive. I won’t bore you with what happened after but long story short, I am 14 weeks pregnant after 4 long years.
We had the first scan at 12 weeks and all seemed well.
No need for IVF or steroid injections or expensive treatments.
I would have probably started IVF months ago if it wasn’t for your advice so thank you so, so much.
 
Warm regards
E.

Dear E,

I am very glad that things have worked out for you.

Best wishes and a happy Christmas
Robert Winston

The full correspondence is detailed below for others who may benefit.
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 when 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 system 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 a more logic 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% abnormality. So far never a confirmed miscarriage as I’ve stopped doing tests but so far 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 pounds) though they postponed it now 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 husbands 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 worst?

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

Reply…

Dear Robert,

Don’t apologise, I am happy you are being blunt and thank you for replying so soon. The only antibiotics I have had in my life were in Central America when I was 18 years old for a period of 6 weeks for a urinary tract infection. In the end I went to hospital, showed all the different types I had been taken to a doctor and they told me if it didn’t clear up with the final course she prescribed, I had to be admitted in hospital because she was concerned about developing a kidney infection. It did. I have mentioned this to the GUM doctor once as I suddenly worried this antibiotics “fest” but he didn’t seem to be impressed or worried.

The treatment for this candida glabatra I have been given is the occasional oral tablet and lots of pessaries. I went back to the GUM clinic yesterday for some advice. The doctor said she could not see any thrush at all, no signs of anything “wrong” though the initial results came back as profuse again. As I am a-symptomatic now, she was reluctant to prescribe me anything but did give me some oral tablets. She also stated that she could not see this would cause any issues for conceiving. With regards to the diet; I have made some slight changes though I have got quite a balanced diet anyway.

There is a history of thyroid problems, bowel problems (cancer, diverticulitis, Crohn’s) diabetes in my family. I have been tested for diabetes years ago and I have not got it.

When we asked for further details about the morphology the reply continues to be “the lab guys are clearly not worried about it otherwise they would not suggest you are suitable for a normal cycle of IVF” and/or “they don’t foresee any problems”. I checked and there are andrologists in the clinic we attend so I’d like to think they would tell us if there is anything else to investigate. Or could it be that they think that if the morphology does turn out to be a major issue they cannot do anything about it anyway so what’s the point of further investing their time and resources on it beforehand? It just feels like a unsatisfactory reply to our questions. If anything is wrong, I’d rather know it before I inject myself full with hormones.

I moved from the Netherlands 6 years ago to the UK and we are thinking of moving there at some point. I am positive the fertility “business” there is pretty similar but I do have a bit more faith in the whole process there (I am not saying this is fair, this is simply a gut feeling). So perhaps if we make a move to a different clinic, it will be likely to one there.

Thanks again for your very quick reply, I genuinely appreciate it and will have a think how to best approach all this. Even though it has been almost 4 years since I have stopped the pill, I definitely don’t feel the need to rush into anything before it feels like the most sensible option.

Warm regards
E.

Reply…

Dear E,

One thought that did occur to me afterwards is whether there might be a minor problem with your immune system. It might just be worth getting your immune status checked. Not uncommonly, some people are deficient in one of the immune proteins which can protect you against infection. This could be done through your GP under the NHS.

Best wishes
Robert Winston

Leave your thought