2 autoimmune diseases and diagnosed as unexplained infertility

Hello Doctor,
I will be 28 soon. We tried to conceive child #1 naturally for 6 months and 3 months with clomid. I have some health issues. I was diagnosed with Rheumatoid arthritis 5 years back. I stopped methotrexate to get pregnant. 3 months afer that I was found to have uterine fibroids. I had few big ones so underwent fibroid myomectomy. After the surgery I was diagnosed with hypothyroidism. My thyroid a month back was 5.5 and they upped the dose. But when i started clomid it was 2 which my RE said was fine.
After the surgery they did all the tests. All my harmones are normal. I ovulate on my own. HSG results were normal. Also hysteroscopy results are normal. I have no scar tissue. My tubes are open. Husband's sperm is also good. So they decided it is unexplained infertility.
My arthritis doctor told me that RA does not affect fertility. But in some websites I read RA patients take longer to
conceive due to low libido. I do not have that issue. Our sex life is very good. Also a website suggested that people with RA should be tested for the presence of antibodies or something. When I mentioned this to my RE he said it does not make any difference. What do you think about this?
Are there any more tests to do? Do I need to be considered different than the normal unexplained infertility patients?
Btw I am on 5mg of prednisone per day to control my arthritis.Any advice would be apprecilated.

[Elaine Brown, MD]

Hi!
I'm sorry to hear that someone so young is contending with so many medical problems.
I am not aware of any CLEAR data that suggests that RA reduces fertility.  Certainly hypothyroidism can, but it sounds as though your doctors have that under control.

I think that unexplained infertility is the most difficult type of infertility to deal with, both for doctors and patients because there is "no reason" why you should have problems.

The good news about unexplained infertility is that couples often succeed if they try long enough.

If you were my patient, I would be tempted to advise you to take a short break and enjoy each other and your "good sex life"  for a few months--sometimes it seems that couples who are not "trying" have the best success.

Then, when you wanted to resume trying, I would probably consider using Femara (clomid can actually REDUCE fertility in women who ovulate regularly) combined with IUI (intrauterine insemination).

I hope my answer is helpful.
Dr B

[berrykkiss]

Doctor please advice me.

[berrykkiss]

Doctor thanks for answering my question and understanding me. Infact my arthritis doctor suggested I cant be on prednisone for a long time due to its side effects so I dont want to take a break now.
My questions are:
Do I need to be tested for the presence of antibodies?
Also do I need post coital test?

Thanks