Dear Professor Winston

Thank you so much for offering this service! My husband (45) and I (35) have been trying to conceive for nearly 3 years. We fell pregnant once naturally, but this turned out to be a blighted ovum. Last year we visited a reputable IVF clinic here in Dubai where we live. We discovered a number of issues as a result of this initial consultation: 1) my husband has a low sperm count, 2) I have a very low AMH level 2.49 (Pmol/L) and 3) my TSH levels were elevated, 3.52 and thyroid antibodies were high (Anti-Tg) 1044 (aTPO) 556.7 and have since been diagnosed with Hashimoto’s disease. We started one round of IVF in May which was cancelled due to lack a lack of response to the drugs, even though I was on the highest dosage of Gonal f (350). We then completed a full IVF cycle in September, which was successful, even though they only retrieved 4 eggs, 2 survived, but again this resulted in a blighted ovum. We have both tried to stick to a healthy balanced diet, I take various different supplements, including DHEA and I have tried acupuncture. My question is am I a lost cause! I am considering coming back to the UK for more IVF but wonder, due to my age and low AMH levels, whether IVF will EVER be successful and do you think the thyroid issues/hashimotos is a reason for continued blighted ovums? Many, many thanks for your trusted opinions.L

Reply…

Dear L,

I cannot answer your questions with clarity. But firstly, I would be wary of relying too much on what seems a low AMH level. Firstly, this is not, as I have said before, not an entirely reliable assay and that may be particularly true in Dubai – the result may depend on how the blood is stored, for example. Secondly, your thyroiditis may be key to the poor response and perhaps, if your thyroid replacement therapy is really successfully managed, your ovarian response may be better both in a natural cycle and with IVF. Thirdly, it isn’t clear from your email how good or bad your husband’s sperm count is. It seems that the sperm achieved fertilisation; if that was without ICSI then presumably there must some chance of natural fertilisation without IVF. Lastly, I know of no evidence that DHEA or acupuncture would be likely to make a significant difference to your fertility.

I have very little information from you – for example, even basic information about your cycle would give a bit of a clue about ovarian function. Nor have I examined you. But the fact that you seem to have got pregnant twice would indicate there must still be a chance of getting pregnant but I can’t tell you whether there is enough here to justify a return trip to the UK for treatment. I think I would concentrate on the thyroid problem first.

Best wishes
Robert Winston

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