Is it because of my age and my arthritis that I cannot get pregnant?

Dear Professor Winston,

I am 42 trying for 3rd baby for 4 years now. Natural conceptions/births in 2003 & 2007. 2 miscarriages since trying. I have rheumatoid arthritis on Humira. (advised by my rheumatologist that Humira is fine while ttc and until the 3rd trimester) Been to see Fertility Consultant advised I have low ovarian reserves. Scan indicated anteverted uterus with normal cavity shape and an endometrial thickness of 8.9mm. Both ovaries appear accessible, the right ovary had one antral follicle and the left had four. low ovarian reserve AMH result was 3.5.
She tried to sell me IVF straight away, but I asked about why I’m struggling to conceive and the only twice I have, I have miscarried, she said it could be my auto immune disease and my age. My clock is ticking I don’t have long left at all and I’m really unsure if to go down the fertility route? is it my arthritis and age do you think? I’m Healthy otherwise and keep fit, since being on Humira my arthritis has been stable and only get very rare flare ups.
Im 5.2  weighing 8st.10,

Please can you give me any advice.

Many Thanks.

O.

Dear O.

You do not tell me whether or not if you have had your FSH levels tested. In this situation the FSH might be quite informative. If is raised it strongly suggests but whatever treatment you undertake including IVF is rather unlikely work. And if it does you are probably more likely to miscarry than not. I agree that there is no harm in carrying on taking the Humira until towards the end of pregnancy but I think it unlikely that pregnancy will happen. Statistically, with a low AMH result such as yours, the history of autoimmune disease and your age, means that at best you have substantially less than a 10% chance of getting pregnant. I regret to say that judging from the results in other clinics with which I have been associated, the chance of a live birth after treatment that is probably no more than 3%. I would think very carefully about going through IVF now, whatever your circumstances (and if they have changed) as you have already had two children but more than 10 years ago.

I’m really sorry to give you this disappointing news but I suspect you already had a strong feeling about this from the way you phrased your letter. I don’t suppose for moment that IVF treatment will harm you, but I agree it would be unwise to be persuaded to undergo this treatment whilst there is still a small chance of a natural pregnancy.

Best wishes

Robert Winston