Fertility investigation required before IVF

Dear Professor Winston

I am 34 years old my partner is 38. We have a 4 year old son who we easily conceived. We have now been trying for another baby for 3 and half years. My partners sperm count was low (7 million) but this went back up to 50 million when tested again. The hospital have diagnosed us with unexplained secondary infertility. We were due to have IUI in Feb 2014 but in Jan 2014 I was diagnosed with coeliac disease. I have been on gluten-free diet since my biopsy in Feb 2014. I am unsure whether to go ahead with IUI in Aug 2014 having had 6 months of being on gluten-free diet or wait longer so my body is more recovered. We are still trying to conceive now as I feel so desperate for a baby and conscious of my age. My consultant said that I should go ahead with IUI in Aug without taking clomid and do this just once before going on to IVF due to my age. She said that she knows little about connection between coeliac disease and infertility. I dont know what to do. Am I likely to conceive naturally still or will this take a long time? My consultant has said that the longer I try to conceive naturally the less likely treatment will work? Should I take more than normal dose of folic acid now? Is IUI likely to be successful or would IVF be better option for us? Any advice greatly appreciated. Thankyou E

Dear E,

Firstly, coeliac disease is quite unlikely to be why you are finding difficulty in getting pregnant. Secondly, it not true that the longer you try to conceive naturally the less likely treatment will work. What is much more likely is that there is real cause (after over three years) for your secondary infertility – secondary because you got pregnant normally before.

I would want to know to at least some questions, for example whether:-
a) your periods have changed in character at all since your pregnancy?
b) whether your delivery was complicated in any way – for example a forceps delivery, Caesarean section, haemorrhage or infection?
c) whether you have any pelvic pain or discomfort since your delivery which didn’t used to experience?
d) whether your husband has any risk factors – for example smoking, or heavy alcohol usage?
e) any other illnesses or operations, such as appendicitis?
f) has there been a change in your body weight?

Whatever, you need proper fertility investigation before any treatment with IUI or IVF, to try to make a diagnosis. This should include several sperm counts over a few months, hormone tests, a womb x-ray and unquestionably a laparoscopy. All these should be freely available to you under the NHS. I cannot emphasise enough how valuable it is to try to make a diagnosis about the cause of your infertility BEFORE any treatment. Infertility is merely a symptom of something wrong. If you had any other symptoms of disease – for example pain in the chest, you would not dream of going straight for heart surgery, or having a lung removed, or your gall bladder operated upon until you have had tests to reveal that your symptoms are not due to chronic indigestion, a broken rib, a chronic chest infection, and so on. Yet so often people who have the symptom of infertility are just shunted straight off to have IVF when it is not the most appropriate treatment.

Good luck,

Robert Winston