Questioner: Lisa
Subject: How Many IVF Cycles
Question:
Hi Dr Ramirez, I am 42, FSH 6. I have failed 2 cycles of IVF.
First cycle got 6 eggs, second cycle got 10 eggs. 3 were fertilized each time with quality being from poor to good. I am about to start my third cycle of IVF. How many cycles should I try with my own eggs before giving up? Is there a point when my efforts are considered futile?
Answer:
Hello,
How long you continue will depend on you; How long can you tolerate the failures and how many times you can afford. Since the pregnancy rates at your age are around 25% per attempt, that means that there is a chance of getting pregnant. The problem you are facing is overcoming the age effects on your eggs. As long as your ovaries still stimulate, then you have a chance. The most cycles I have ever seen was in a patient that tried with her own eggs for 13 tries. She finally got pregnant and delivered healthy twins, and she was your age. After 42, however, pregnancies are rare so in general we do not recommend them. At that point you should go to donor eggs.
If you don't want to keep trying with your own eggs, or you've reached the end based on answers to the above two questions, then your best bet is donor eggs. I recently had a patient your age who tried with her own eggs for three tries. We had one chemical pregnancy. She then, because of financial restrictions, decided to try one last time with donor eggs. She was successful in that first try and is currently pregnant with twins.
The point where things are "futile" is if your ovaries no longer respond, and/or your egg/embryo quality is poor. At that point, you should no longer try with your own eggs. Until then, miracles can happen.
I hope this helps,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
http://www.blogger.com/www.montereybayivf.com
Monterey, California, U.S.A.
Saturday, June 27, 2009
Recurring Blighted Ovums after Healthy Pregnancies
Questioner: Tiffany
Subject: Recurring Blighted Ovums after Healthy Pregnancies
Question:
Hello Dr.
My name is Tiffany and my husband and I have had three healthy babies. I don't have any problems getting pregnant, however after my last child was born in Nov. 06, I had to have my gallbladder removed in 07. In 2008 and now again in 2009 I had two blighted ovums back to back and neither of them miscarried on their own. I have a few questions: first of all, can gallbladder surgery do something to your body to cause blighted ovums? Usually multiple recurrent miscarriages occur in people that have not had healthy babies before. What can cause a couple who have had no fertility problems in the past to all of a sudden have blighted ovums? Will I be able to have another baby again? What tests do you recommend to find out the cause of these consecutive blighted ovums?
Thank you,
Tiffany
Answer:
Hello,
Let me answer your questions in sequence:
1. No gallbladder surgery does nothing to your fertility or chances of pregnancy.
2. Blighted ovums are due to an abnormality with the pregnancy. Usually it is because there is a major genetic abnormality caused by the development of the fetus. Therefore, the fetus does not develop. Because the placenta develops and the gestational sac, the body does not recognize that the pregnancy is abnormal (i.e. doesn't have a fetus) and so does not terminate the pregnancy. For that reason natural miscarriage does not occur. Miscarriages occur in up to 40% of pregnancies, regardless of whether or not you have been pregnant before. That is the risk with each pregnancy.
3. 85% of women that have recurrent miscarriages will eventually have a successful pregnancy, so you don't need to worry.
4. I would recommend that you and your husband have genetic/ chromosomal testing done to make sure you are not carrying something that is passing to the fetus. It is a simple blood test. That is the only testing I would recommend at this time.
Sincerely,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
http://www.blogger.com/www.montereybayivf.com
Monterey, California, U.S.A.
Subject: Recurring Blighted Ovums after Healthy Pregnancies
Question:
Hello Dr.
My name is Tiffany and my husband and I have had three healthy babies. I don't have any problems getting pregnant, however after my last child was born in Nov. 06, I had to have my gallbladder removed in 07. In 2008 and now again in 2009 I had two blighted ovums back to back and neither of them miscarried on their own. I have a few questions: first of all, can gallbladder surgery do something to your body to cause blighted ovums? Usually multiple recurrent miscarriages occur in people that have not had healthy babies before. What can cause a couple who have had no fertility problems in the past to all of a sudden have blighted ovums? Will I be able to have another baby again? What tests do you recommend to find out the cause of these consecutive blighted ovums?
Thank you,
Tiffany
Answer:
Hello,
Let me answer your questions in sequence:
1. No gallbladder surgery does nothing to your fertility or chances of pregnancy.
2. Blighted ovums are due to an abnormality with the pregnancy. Usually it is because there is a major genetic abnormality caused by the development of the fetus. Therefore, the fetus does not develop. Because the placenta develops and the gestational sac, the body does not recognize that the pregnancy is abnormal (i.e. doesn't have a fetus) and so does not terminate the pregnancy. For that reason natural miscarriage does not occur. Miscarriages occur in up to 40% of pregnancies, regardless of whether or not you have been pregnant before. That is the risk with each pregnancy.
3. 85% of women that have recurrent miscarriages will eventually have a successful pregnancy, so you don't need to worry.
4. I would recommend that you and your husband have genetic/ chromosomal testing done to make sure you are not carrying something that is passing to the fetus. It is a simple blood test. That is the only testing I would recommend at this time.
Sincerely,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
http://www.blogger.com/www.montereybayivf.com
Monterey, California, U.S.A.
New Blog Format
Just to let everyone know, after a long hiatus, I have returned to this blog and plan to do something new. I am a expert on a site called AllExperts.com, which provides free questions to experts in various fields. I am the expert for the field of Women's Health and Infertility. I have been a part of this for quite a while now, and have been answering questions from all over the world. I thought you might be interested in reading some of these letters and answers. It will enhance the information I provide to readers. I have therefore decided to put some of these questions and answers on my blog for you to read and comment on. I hope it is helpful and interesting. I get these questions daily, so will be placing them here as often as I can. Here's the first one:
Hello, Thank you so much for taking the time to answer my quetions.
I am a 29 year old Type 1, Insulin dependant Diabetic tyring to conceive for 16 months. I was diagnosed in 2005. I have about 6 periods a year that last between 10 and 20 days. They are also getting worse, currently I have been bleeding for 30 days! After 1 year of trying unsuccessfully my family doctor referred me to an ob/gyn who diagnosed me with PCOS based on blood tests, ultrasound, irregular periods and hirsutism. The new doctor was unsure of whether or not to prescribe Metformin to help stimulate ovulation because I am already taking Insulin. She was unsure what impact it would have on my blood sugar. She ordered blood work to verify if I have ovulated, but I have been unable to do it because of the continuous bleeding. She also suggested testing for tubal blockage, but that has not happend yet. I live in Northern Canada and the nearest fertility clinic is an 8 hour drive.
My questions are: Is it worth trying Metformin or should I go directly to Clomid? Should I consult an RE now and travel to see them or will my ob/gyn be able to help?
My next appointment with the doctor is 2 months from now, should I proceed with contacting an RE before then?
Again, thanks so much for your help.
Answer:
Hello,
If you are requiring insulin, then you are not a PCOD with insulin resistance. Those type of patients make insulin, and their serum levels are elevated, but the insulin is not getting into the cells, hence the diabetes. You absolutely should NOT go on metformin!!!
You are more complex than your general Ob/Gyn doctor. You need to see an RE or infertility specialist. Most PCOD patients do not respond to Clomid and either need to use a combination protocol or straight injectables.
Sincerely,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
http://www.blogger.com/www.montereybayivf.com
Monterey, California, U.S.A.
Hello, Thank you so much for taking the time to answer my quetions.
I am a 29 year old Type 1, Insulin dependant Diabetic tyring to conceive for 16 months. I was diagnosed in 2005. I have about 6 periods a year that last between 10 and 20 days. They are also getting worse, currently I have been bleeding for 30 days! After 1 year of trying unsuccessfully my family doctor referred me to an ob/gyn who diagnosed me with PCOS based on blood tests, ultrasound, irregular periods and hirsutism. The new doctor was unsure of whether or not to prescribe Metformin to help stimulate ovulation because I am already taking Insulin. She was unsure what impact it would have on my blood sugar. She ordered blood work to verify if I have ovulated, but I have been unable to do it because of the continuous bleeding. She also suggested testing for tubal blockage, but that has not happend yet. I live in Northern Canada and the nearest fertility clinic is an 8 hour drive.
My questions are: Is it worth trying Metformin or should I go directly to Clomid? Should I consult an RE now and travel to see them or will my ob/gyn be able to help?
My next appointment with the doctor is 2 months from now, should I proceed with contacting an RE before then?
Again, thanks so much for your help.
Answer:
Hello,
If you are requiring insulin, then you are not a PCOD with insulin resistance. Those type of patients make insulin, and their serum levels are elevated, but the insulin is not getting into the cells, hence the diabetes. You absolutely should NOT go on metformin!!!
You are more complex than your general Ob/Gyn doctor. You need to see an RE or infertility specialist. Most PCOD patients do not respond to Clomid and either need to use a combination protocol or straight injectables.
Sincerely,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
http://www.blogger.com/www.montereybayivf.com
Monterey, California, U.S.A.
Subscribe to:
Posts (Atom)
LinkWithin
