Is my body rejecting my husband’s sperm?

Dear I.,

I doubt whether your body is really rejecting your husband’s sperm. Such instances are rare, particularly if you have already been pregnant by your husband previously.  And in any case, there are various tests that can be done before IVF which illustrate whether you are likely to to have an immune or chemical problem of this kind. There are various reasons why fertilisation can fail and many of these reasons may be down to problems in the laboratory, or possibly the stimulation regime that was used, rather than some issue which has developed in your body.

But your email raises what I consider to be a crucial problem.  To be fair, I do not know what investigations you have had following your failure to conceive after the last pregnancy and before this unfortunate IVF cycle.  But in my view nobody should have IVF before serious attempts to elucidate the possible cause of any couple’s infertility.  If you read my little book (all profits to the Genesis Research Trust charity) published by Quadrille Press – The Essential Fertility Guide, you will see that a standard maxim of good medicine is to make a diagnosis before treatment is started, not afterwards.  There are many different causes of infertility and each of them will usually be much better treated by finding the specific cause of the problem and rectifying that.  Infertility is merely a symptom of something wrong, not in itself a disease.

So for example, if you go to your doctor with chest pain, and ask for open heart surgery, he should point out out that pain in the chest in only a symptom.  The pain might be due to a broken rib, bronchitis, spinal disease, lung cancer, heart problems or a viral infection, for example.  Each will require different treatment for a cure.  But nowadays, because IVF has such a high profile in the media and some professionals (even some involved in IVF clinics) have inadequate understanding of the many other causes of infertility, far too many patients may be likely to receive IVF before adequate investigation.  And because most IVF cycles end in failure, rather than with a successful live birth, at the end of a complex, psychologically demanding and expensive treatment a patient such as yourself may be left empty-handed, puzzled and sad.

Now of course, I do not know what investigations you may have had, or not had.  Nor do I know anything about your basic health – for example your current weight.  But certainly if you had previously had a live birth with the same partner, it is going to be rather unlikely there is a sperm problem.  But it could well be that you have a problem in your tubes, for example, as a result of infection of some kind after your delivery.  Such episodes are quite common and often go unnoticed.  Equally, if your delivery was traumatic in some way, or you needed a Caesarean section for example, it is just possible there may be something in your uterus – perhaps adhesions – which could need quite simple treatment.  So as a very basic assessment, before any IVF I would want to see a hysterosalpingogram (an x-ray of the tubes and uterus – not an ultrasound assessment, by the way, as this does not always give adequate information) and possibly also a laparoscopy.    Now I fully understand that if done privately (though both should be available under the NHS) these are added expenses.  But believe me, this is cheaper than going through a failed IVF cycle and a great deal less demanding.

Now clearly the comments I have made may not be relevant to your care specifically.  But many other people may read this website and may be in a not too dissimilar situation.  So this letter is written to anybody with what is commonly called “secondary infertility” – infertility after having been previously pregnant.  And if you are prepared to tell me a bit more about your general health and what tests you have already had, I may just possibly be able to suggest some further course of action.

With best wishes

Robert Winston