Posted by: LL | 2009/02/27

Am I the problem?

Im 34, was in a relationship with man1 for 14 years &  we had no children even though I was off contraception for almost 6 years of that relationship.
I have been with man2 for almost 3 years, not on any contraception and still no children!
I have been tested to see if my tubes are blocked, they are not. Ive had blood taken to see if Im ovulating, and I am.

What could be the problem? Am I the problem? What else can I do to see if its me? Im assuming its me because I am the common denominator between two different men!!

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Our expert says:
Expert ImageFertility expert

Dear LL

Since male fertility problems are on the increase and although unlikely one cannot categorically exclude a male factor simply on the bases of what has been stated. As a first line investigation I would still recommend a semen analysis be done and should this be normal it would clearly place the problem with you. The possibility of endometriosis or poor egg quality should then be considered and be investigated for. The option of in-vitro fertilization should be considered in such cases of unexplained infertility since there is often a fertilization problem responsible. The rare possibility of empty follicle syndrome should also be considered in which all the signs of ovulation maybe present but no actual egg is released and hence no conception occurs. Another rare possibility is the luteinized unraptured follicle syndrome, which present in a similar manner and in this case the egg remain trapped within the ovary despite all the other signs of ovulation.

Answered by: Dr M.I. Cassim

The information provided does not constitute a diagnosis of your condition. You should consult a medical practitioner or other appropriate health care professional for a physical exmanication, diagnosis and formal advice. Health24 and the expert accept no responsibility or liability for any damage or personal harm you may suffer resulting from making use of this content.

Our users say:
Posted by: HopecanHelp | 2009/02/27

Hi LL, have yourself tested for Immunological infertility. I was tested postive after trying for a long time, and we are going to do our first IVF treatment now.
Immune system disorders may lead to reproductive failure at different stages of reproductive process: unexplained infertility, recurrent IVF or ICSI failures and recurrent miscarriage.

The immune system consists of immune cells and cell products (cytokines). Among the many different immune cells, two of these are associated with infertility, recurrent implantation failures and recurrent miscarriages. These are CD 56 (natural killer cells) which produce toxic cytokines including tumour necrosis factor (TNF) alpha and CD19 which produce antibodies to hormones such as HCG, progesterone etc.

Antibodies are substances produced by B lymphocytes (type of immune cells) that circulate in the blood and body tissues, and which normally protect the body from invasion by foreign bodies such as bacteria and viruses, in order to prevent the body from getting an infection. For unknown reasons the body may develop antibodies to its own cells.

Antisperm antibodies can be present in either or both partners. It can be present either in the blood or in the genital tract secretions such as cervical mucus and ejaculate. There are different types of antibodies e.g. IgG, IgA and IgM. Antisperm antibodies in the ejaculate will make the sperm ineffective by making them stick together and preventing them from being released. In the female, antisperm antibodies may interfere with the process of sperm transport and fertilization. Incidence 1-2%. The cause of antisperm antibodies is unknown, but there are associations with genital infection, trauma to the testicles, varicocele, vasectomy and after reversal of vasectomy.
DQ alpha matching in the couple: Each person inherits two DQ numbers from his or her prospective parents. A pregnancy is recognised as foreign because the fathers HLA antigen is different from that of the mother. The mother makes blocking antibodies that attach to and camouflage the placenta (protecting antibodies). If the father‘ s HLA is too similar to that of the mother, the embryo will not be protected because it will not be able to differentiate itself from that of the mother, leading to lack of blocking antibodies to protect the fetus and the pregnancy may fail.
Antiphospholipids antibodies syndrome: Phospholipids are present on the cell membranes of all cells  they are glue molecules which play an important role in embryo implantation. Antiphospholipuid antibodies cause the woman’ s blood to clot quickly cutting off blood supply to the baby.
A mother may develop antibodies to her baby' s DNA or DNA breakdown products such as ANA.
Excess Natural Killer cells and or CD 19 cells: Natural killer cells are good because they protect the body from developing cancer, infection etc. However excess or hyperactive NK cells can damage the cells which make the placenta and the endocrine system that produce hormones essential for pregnancy.
Good luck!!!

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