Dr. Edward Ramirez is the medical director of Monterey Bay IVF, a women's fertility & gynecology center located in Monterey, California. He hopes to provide those who read his infertility blog with insights into the latest advances in women's health & infertility issues. He respectfully shares his knowledge as a specialist with women and men from all over the world. Visit his center at www.montereybayivf.com
I have had fertility issues for almost 2 years now. I want to explore a natural approach to my fertility before I use more invasive procedures. What I was wondering was if it was safe to use more than one natural herb at a time or will there be interactions. The medicines that I plan to use for myself are Chasteberry, Black Cohosh, and Siberian Ginseng. For my husband he plans to use Horny Goat Weed (which is supposed to promote potency and increase sperm production) and Gotu Cola (which is supposed to promote motility).
I have asked the sales people if these herbs are safe to use together but have never gotten clear answers. I have researched the herbs and they are supposed to be effective and like I said, I want to be as holistic as possible. M. from the U.S.
Hello M. from the U.S.,
I'm afraid I cannot answer this question for you as I am a traditional medicine Physician. I would recommend that you direct your question to a naturopath practitioner or herbal pharmacist. If this remedy works, please let me know. We are always looking for ways to increase pregnancy rates in our patients.
I have blogged in the past regarding improving sperm motility/morphology with supplements such as ProXeed. One ingredient in this blend, Coenzyme Q, has been shown to have a positive effect on sperm health and two other ingredients, L-Carnitine & Acetyl-L-carnitine, have been shown to affect sperm motility. The downside is that your husband needs to be on this supplement for at least three months to see results. See this link for further information: http://www.proxeed.com/ingredients.asp
On this subject, I would caution my readers to beware of false claims. Remember, if any supplement is claiming to "cure" infertility and is not backed or proven by clear clinical trials, then the claims can be considered as false. A recent undercover probe (2010) by the GAO (Government Accountability Office) found fraudulent claims for cures abound on the internet. On a recent MSNBC report it was said: "that investigators...found that labels for some supplements claim to prevent or cure ailments like diabetes or heart disease — a clear violation of U.S. law." See this link: www.msnbc.msn.com/id/37361907/ns/health-alternative_medicine
Hi Doc, I am 28 yrs old and underwent my 1st IVF cycle this month. My infertility diagnosis was endometrioma on right ovary , the cyst was removed by laparoscopy 1.5 years back. Twelve eggs were retrieved in total from all 12 follicles that formed.
The IVF cycle yielded good quality embryos and ET was done on day 2 of egg retrieval. In which 4 embryos were put, 3 of grade A and 1 of grade B.
Post ET medicines included progesterone/estrogen support and aspirin along with Dexamethosone. Even after every thing being perfect till end my b-HCG test resulted in level if 1.50 miu and after 48 hrs it was 1.69 miu. Please suggest, according to u what could be the reason for the implantation failure even when everything seemed good.
I'm writing in from India. Thanks and regards, R.
Hello R. from India,
IVF is not a perfect technology and does not yield a 100% pregnancy rate. This is because the last two steps in the process to achieve pregnancy, embryo hatching and implantation, are things we do not have the technology to make happen. So, there is a little "chance" or "luck" with IVF. Certainly there are other possible causes of failure, such as embryo transfer technique, embryology laboratory quality, timing, endometrial thickness, immune factors, etc., but with the information that you have given me, I cannot determine if any of these might be the case. I too have young women who have perfect appearing embryos and great transfers who do not get pregnant. It stumps me, but then I remind myself that I am not dealing with a perfect technology, despite doing the absolute best that I can do (and I am pretty good at this treatment), and that GOD reserves the right for himself to produce life and determine when it happens, not me.
For you, you need to just keep trying. It will eventually happen, and usually occurs by the third attempt. Keep in mind that even a "normal" woman your age, trying for natural pregnancy does not get pregnant on her first try. The average number of times that it takes a woman under 30 to achieve natural pregnancy is 8 months (8 tries).
I was born with Perthes Disease (a disease of the hip). From the ages 5 - 15 I would have had well over 100 X-rays, concentrated on that area - most taken from above my body looking directly down at my hips.
I have never been able to keep a pregnancy beyond weeks, and tests have come back saying the last one included the extra chromosome 15. I have been under fertility treatment for 2.5 years. Tests are going to be carried out on my latest "failed pregnancy" within the next 4 weeks. The X-rays took place from 1971 - 1986. I have been in 2 long term relationships since 16 years old. (The current one being 13yrs) and there is no history of infertility in my family - all 4 siblings successfully having multiple children. I believe my eggs may have been damaged as a result of these X-Rays.
Regards. K. from Australia
Hello K. from Australia,
I have to agree that there could have been egg damage from the proximity of the X-rays that is now causing the embryos to have genetic abnormalities. There is no treatment that can be done to repair eggs, but one option you might want to consider is to do CGH in association with an IVF cycle. With CGH (Comparative Genomic Hybridization), polar body biopsies can be done on the eggs at the time of fertilization and thereby evaluate the genetic complement of the eggs. This will immediately allow you to eliminate the abnormal eggs and hope that there is a normal one that survives and can be transferred. There is always the chance that there are some good eggs left and that is the goal. It may take several IVF attempts before finding that good egg, but in the end it will be well worth it. There is no price you can put on a child.
If you don't want to go through this option, with the potential risks of failure, your alternative then would be to proceed with Donor eggs and IVF.
I was just at a National OB/GYN conference and one of the topics discuss was a new program in the U.S. called Oncofertility Consortium. This is a group of specialists in the field of infertility, oncology, therapists, etc. that are promoting fertility preservation in patients facing various cancers or treatments such as radiation, chemotherapy, etc. The reproductive outlook for women cancer patients is becoming as good as for men, who long have had the option of banking their sperm. It is our hope that patients, such as you, will undergo counseling for fertility preservation and be given the option of preserving your eggs or ovarian tissue prior to undergoing treatments. I know that this is not going to benefit you now, but we hope that it will benefit people like you in the future. For more information on this group from the American College of Ob/Gyn's website, go to: http://bit.ly/axAePh.
Thank you for your question. I will be keeping my fingers crossed for you!
Dr. Ramirez, I am 31 years old my husband is 40. We have been trying to conceive for about 3 years. I have taken Clomid about 4 different times. I have only had about 5 or 6 periods on my own in my entire life. I went to my OBGYN who put me on provera to get me to bleed then take 50mg clomid to start with. She told me that I had PCOS. In Dec of 2009 I hemorrhaged and had to have 4 units of blood. My OBGYN sent me to a oncologist who diagnosed me in Jan with complex hyperplasia with atypia and a well differentiated adenocarcinoma. They said I needed to have a hysterectomy but I want a baby really bad. They said we would have to try to reverse the condition first. They started me out on Megace then changed to Provera 15 mg a day for 1 month. I have had 3 d&c's. My last vaginal ultrasound showed everything was clear but my lining was very thin. My OBGYN stated that I could try clomid again and she put me on birth control pills which she said would help to make my lining thicker. She told me to take Nortrel birth control pills to start my period. I was on 100 mg of clomid but didn't ovulate. I haven't had a test done to check my husbands sperm because I know that I do have a problem and the test for him is too expensive. But I will have to have it done if I eventually start to ovulate and still do not get pregnant.
My OBGYN just started me on another cycle of the birth control pills and then 250mg of clomid. On the first cycle of 100 mg of clomid, I stopped taking the birth control pills when I started to bleed. Then I took the clomid on day three of bleeding. Was this wrong? Should I have kept taking the birth control pills even though I had started bleeding? I only had 2 left in the pack. I was just confused and was afraid that this might have been something to keep me from ovulating. Do you think that even though I have had the complex hyperplasia with atypia and the cancer that I can still possibly get pregnant? I also was wondering if my OBGYN said everything looked clear and I don't have the hyperplasia anymore then why can't I ovulate and get pregnant?
Thank you for your question and thank you for the very long history. You are certainly faced with a dilemma. However, you are not the first to have this problem and oncologists are very aware of what they need to do. After the Megace treatment, you should have had another D&C to make sure that the cancer was resolved. If you have not had that resolution, then that has to be done first. You don't want to be pregnant with cancer, and have that shorten your life with your new child. Also, the Megace treatment is only for very early stage cancers. If it is more advanced then do not delay the hysterectomy.They can preserve (not remove) your ovaries so that you can use a surrogate to achieve pregnancy. There have already been great successes with frozen ovarian tissue as well as frozen eggs. Do what is going to be the best for your child in the long term.
It sounds like your OB/GYN is proceeding correctly, however, you probably need to see an infertility subspecialist. If you do not respond to the 250 of Clomid, that is the maximum dose. It is time to move on, especially since time is not your friend. You should have had a basic evaluation, which included a semen analysis, before starting treatment. You don't want to waste time and energy if a Clomid-intercourse cycle is not going to work.
In terms of the birth control pill, you were correct is stopping the pill and not finishing it since your period started early. That is the key for starting the Clomid cycle.
In terms of getting pregnant, PCO is a complex but not insurmountable problem and is very common. However, most of these patients do not respond to the easy medications (Clomid, Latrezole) and have to move into the more complicated injectable medications. For that reason, I advise seeing a fertility specialist, not a general OB/GYN. In addition, you want to get pregnant as soon as possible, so that your cancer does not return. You may want to consider a treatment plan that is going to get you pregnant the efficiently.
Dr. Ramirez, I did have the D&C after the megace and Provera treatment and it showed that I no longer had the complex hyperplasia with atypia or the cancer. They let me start the fertility medicine again. I am on the Nortrel birth control pills now and when I start my period I will be starting the 250mg of clomid. My husband hasn't had the semen test done yet because we do know that I can't ovulate so it is definitely a problem of mine right now. I just couldn't afford to have the test done for him. I don't think that I can see a infertility subspecialist because my insurance won't cover it. I wouldn't be able to afford it.
I was just curious if you thought that as long as the complex hyperplasia with atypia and the cancer are gone if I should be able to ovulate and get pregnant. I started out at 262 in December when I hemorrhaged and I am now 234. I am losing weight but find that I am staying pretty much at the same weight and can't lose anymore. I also have thyroid problems and I'm on Levothyroxine. I appreciate your help. Thank you!
Hi Again T.,
I'm glad to hear that the complex hyperplasia and cancer are gone! That buys you time. However, as I explained earlier, you will need to be cycled, so don't go any prolonged period of time without having a period.
I think you can safely assume that part of your infertility problem is the lack of ovulation. It is most likely that you have a disorder called polycystic ovarian syndrome. Your increased weight is contributing to the problem, and the PCOalso causes you to increase weight. You should try to get your weight down as much as possible, close to your ideal weight. This by itself may induce your ovaries to begin ovulating on its own.
You also need to make sure that your Thyroid problem is under control and the levels are normal. This too can decrease your chances.Since financially you can't progress beyond Clomid at this point, it is certainly okay to continue trying Clomid. However, 250 mg is the maximum dose and many PCO patients do not respond to this dosage or clomid at all. In that case, you will have to go to the injectable medications, which are much more expensive, and you will definitely have to see a fertility specialist for that level of treatment.
Good luck and don't give up! It's possible that your fertility specialist may have various financial plans in place that will make it affordable for you and your husband to pursue treatment, as our center does.
I am turning 34 later this month and have been trying to get pregnant for the past 4 months. I never have any spotting during the first half of my cycle, but have had light spotting usually for 3 - 5 days before my period starts (as long as I can remember except when I was on the pill). About 7 years ago my doctor did some tests and sent me for an ultrasound and when he found nothing wrong, put me on the pill to regulate this. I stopped using the pill about 3 years ago and have lived with the light spotting (starts very, very light and gets a bit heavier each day until my real period starts - usually starts on Day 27 to 32 of my cycle).
Over the last 4 months, I've been recording basal body temperatures while trying to get pregnant. I've noticed my temperature only stays high for about 8 days. It drops usually on the 9th day and the day after that very light spotting starts. After doing my own research, I'm concerned that I may have a luteal phase defect and need some sort of progesterone to help get/maintain a pregnancy. I went to my doctor and he said I would need to try for a year regularly before determining I have a fertility problem and he doesn't think testing is necessary yet even thought I think my temperature readings and spotting indicate there may be a problem. I understand it may take a while to get pregnant, but if there is a possibility of a problem that could be helped with progesterone, I would rather find out now than wait until next year when I'll be almost 35. Especially if I do need a referral to a specialist at some point, it could be a 6 month wait to get an appointment.
Does it sound like I may have a problem (hopefully treatable) or should I continue trying for another 6 or 8 months before undergoing any testing?
Thank you very much for your help, L. from Canada
Hello L. from Canada,
I have had many letters from Canadians lamenting the fact that their Physicians are uncooperative and it is a long wait to see a specialist. You certainly have not tried long enough on your own to warrant an infertility evaluation, but I am surprised that you doc won't give you progesterone supplements. It is such a simple thing with no side effects and potentially helpful.
Yes, the BBT findings and pre-menstrual spotting are consistent with LPD. The diagnosis is made with an end cycle endometrial biopsy for dating. Since your doctor won't do that, we can make the assumption and you should go on progesterone supplements. There are many sources of natural progesterone. I believe you can even get natural progesterone creams in health food stores. I will usually prescribe the pharmaceutical versions such as Prometrium, Endometrin, Crinone or Prochieve. You have to take them starting from day #16, but the problem is that the supplementation may prevent your natural menses from starting because it is the dropping of the hormones that leads to a menses. So, you would have to do a pregnancy test to see if you are pregnant then stop the meds if you are not (you would continue them if you are).
For now, I would recommend that since none of this is easily obtainable for you, you should continue trying on your own for the next six months. If you should become pregnant, the pregnancy will produce the hormones that you require via the corpus luteum cyst that forms from ovulation.
Thank you. I really appreciate your response and think I will go to a walk in clinic next month to at least get a day 21 progesterone test to have some idea of my levels.
I started taking a B50 complex vitamin this month as some women have reported B6 helps with the luteal phase (contains 50 mg of B1, B2, B3, B6, Pantothenic Acid, Choline and Inositol; 50 mcg of B12 and Biotin; and 0.4 mg of Folate.) Would there be any known problems with these vitamins if I were to become pregnant? I am also taking a prenatal vitamin that contains very low amounts of the above noted vitamins (except for Folate which is 1 mg in the pre-natal). Again, thank you very much for your help. It is very much appreciated.
It is okay to continue those vitamins for now, but discontinue them should you become pregnant and stick with the prenatal vitamin only.
Good luck with your treatment!
Edward J. Ramirez, M.D., FACOG Executive Medical Director The Fertility and Gynecology Center Monterey Bay IVF Program http://www.montereybayivf.com/ Monterey, California, U.S.A.
This is a follow-up question from a young woman with possible PCOS in Austria, who first wrote me in March. Please view the first two questions she posed in order to fully understand the problems she and her husband face. See the March 18th blog post: http://bit.ly/cqXqAp
Dear Dr. Ramirez,
I had asked you a couple of questions two months ago, and thought of you now as we are preparing to do another IVF. I copy below what you suggested in terms of protocol for me (PCO-like stimulator), since I discussed it with my doctor and he is not sure that this kind of protocol can be done with the medicines available in Austria. You said:"Patients start at a low dose of Follistim 150IU for three days then the estradiol level is checked for response. If there is not a high response then I step up the dosage to Follistim 150IU + Menopur 75. We continue the same pattern of checking and adjusting the dosage as needed. I don't use Lupron agonist suppression (long protocol), but instead use the Antagonist Ganerelix. When the follicles are appropriate sized, I trigger with Lupron 0.5 mg instead of Ovidrel. These combination and protocol has been shown to be effective in preventing hyperstimulation syndrome"
The protocol he gave me last time (Dec. 2009) (starting on day 3 of cycle) was:Day 3-5 Gonal-f (150IU)Day 6 Gonal-f (112 IU)Day 7 Gonal-f (112 IU) + Cetrotide (one shot 0,25 mg)Day 8 Cetrotide (0,25mg) + Pergoveris shotDay 9 Cetrotide (0,25 mg) + Pergoveris shotDay 10 Cetrotide (0,25 mg) + Pergoveris shotDay 11 Cetrotide (0,25 mg) + Pergoveris shot Triggering with OvitrelleEven though this protocol was substantially reduced in quantity of medication, I still had 15 eggs and mild-hyperstimulation (enough for being 3-4 days uncomfortable to breathe and in pain and swollen all around).
The doctor is now proposing a similar protocol to this, but reducing from 150 IU to 112 IU to start and see what happens. I showed him your suggestion and he was receptive but I don't know if the medicines you suggested can't be found here or if what he is suggesting is similar to what you suggested. We are thinking of not having a treatment here anymore and moving onto a treatment in the States. In an ultrasound on day 19 of my cycle, he saw that I had ovulated recently and noted that I have/had around 15 follicles (or left overs of follicles) in my two ovaries. I was really shocked since I have been medication free for 6 months, so I didn't expect that's normal to have so many follicles on a natural cycle, he said that could mean I have a high ovarian reserve and could be a sign of why I hyperstimulate every time no matter what medicine they have given me.
Is the protocol he proposes similar to what you wrote above?
What do you think about this empty follicles in my ovaries now?
Also, he has me taking Thyrex for my thyroid (one pill of 50 mg per day) since I started treatment with him over 10 months ago because my TSH level was over 4, and he wants to keep it at around 1, but am I supposed to take this pill forever? for Hypothyroidism? That's what he said, that until I achieve a pregnancy and give birth, I should be taking that pill.
Another question: What do you think about that? My TSH has been at around 1 since i started taking the pill. Regarding my husband's sperm (CF gene), they have been using his frozen samples for all treatments, saying that the freezing and thawing act as natural selection, whatever survives is better for ICSI than trying with fresh sperm. Do you think is better to use fresh sperm for ICSI? or frozen?
Finally, we are thinking of going to a US clinic because in Austria PGD is prohibited, and for us they have been doing polar biopsy of my eggs to only transfer the embryos which fertilized with the better eggs, but as you noted in your previous emails, the embryos should be checked as well to eliminate any effect by my husband's sperm...correct?
So thank you so much for your answers, we are about to cancel the cycle here which starts in one week and move on to make an appointment in the States with you or another clinic which can take us.
Receive my warm regards, L. from Austria
I am happy, yet surprised to hear that your doctor was receptive to my suggestions. I do not dispense recommendations with the expectation that patients will share it with their Physicians. It is mainly for patient knowledge. I do not mean to intrude on that doctor-patient relationship, nor your doctor's judgement, since they usually know you better, and many doctors will be offended.
The medications Gonal-f and Follistim are the same, but made by different companies. Cetrotide is the same as Ganerelix. Gonal-f and Cetrotide are made by Serono, whereas, Follistim and Ganerelix are made by Organon. They are interchangeable. Based on the protocol you showed me, you were already on a pretty low dose protocol. Since, despite this, you hyperstimulated, I would reduce the dose further to a starting dose of 75IU or 37IU Gonal-f. I would probably fight the inclination to increase the dose above this because you seem pretty sensitive and 75IU may be all that you need to get an adequate number of mature eggs.
The Pergoveris is the same as Menopur (FSH/LH). If it is added, as your doctor did previously, he might want to reduce the dose to 37.5 IU (half-dose), but it isn't absolutely necessary. Some studies have shown decreased hyperstimulation in PCO patients when the FSH/LH is left off because PCO patients tend to have an elevation in LH production.
Once your lead follicles reach 15 mms (at least 20% of the follicles), Cetrotide should be started at 0.25 mg per day and continued until the trigger shot. The Gonal-f may need to be increased because of this ovarian suppression, and you should expect a decrease/drop in the estradiol level initially because some of the smaller follicles will stop developing due to the suppression and stop producing estradiol. That is okay and the cycle should be continued (this is contradictory to current thought, where if the estradiol drops the cycle is usually cancelled).
The trigger should NOT be HCG or Ovidrel. Instead, Lupron 0.5mg (50 mcg) should be used subcutaneously as the trigger. This has been shown, in European studies, to be just as effective as HCG but because of a shorter 1/2 life (the amount of time the drug is in your system), there is a decreased incidence of hyperstimulation.
In addition, to the above, I will also sometimes use "drifting/coasting" if it looks like the estradiol level will go above 4000 before the lead follicles are at a mature size. This requires that the doctor predict the levels on a daily basis and the drift/coast is not started until the lead follicles are at least 16 mms. You doctor should understand what this technique is. But, just in case he is not familiar with it, it is where the stimulationn with Gonal-f and/or FSH/LH is stopped but the ultrasound surveillance continues until the lead follicles reach 18-24 mms, then the trigger is given.
Finally, your doctor is correct that the TSH (thyroid hormone) levels have to be in the normal range, otherwise this can have an adverse effect on your pregnancy chances. As I said previously, PGD is the only way to rule out your husband's CF gene from the embryo, as egg polar body biopsy only evaluates the egg (your genes), and frozen sperm is just as good as fresh sperm. I am flattered that you would consider us for a second opinion, thank you. If you do decide to come to the U.S. I would certainly enjoy meeting you and your husband and be assured that our center would do anything that it can to accommodate you and help you succeed.
In closing, tell you doctor that I have had patients where I even start the Gonal-f/Follistim at 37.5IU and step up to 75 or 150IU, so he might want to consider that in you since you are so sensitive.
I was wondering what supplements and vitamins can I take to increase my chances of implantation in an IVF cycle?
Thank you! V. from the U.S.
There are no natural supplements that I know of that can help with implantation. I do add aspirin 81mg per day, Heparin and Medrol to my patients that have had implantation failures or failed IVF cycles because these meds have been shown to increase endometrial oxygenation and decreased miscarriage rates. Before you use these, however, it should be done in consultation with your IVF doctor so that you are not going against any protocols that he/she may be using.
In addition to supplements, you may want to look into doing acupuncture. While I cannot endorse the procedure on a purely scientific basis, some research has been done to see if acupuncture does have a beneficial effect with IVF patients. My patients are always given this option and a referral to local acupuncturists who specialize in infertility.
Good Day! My wife is 25, we have been trying to conceive from last three years. She got pregnant as well last march, we have gone for the checkup at 6th week and could see the heartbeat at 90bpm and was asked to have a follow up after two weeks. When we were for checkup we found it as a missed carriage (sp. miscarriage) due to no cardiac activity and eventually we have to go for the D&C procedure.
Now my concern is that, how far and the success rate /time to get pregnant after a D&C procedure? Since we have been trying so hard to get one and finally got disappointed, we are very eager to get the next soon...Please reply me, K. from Oman.
Hello K. from Oman,
The good news is that your wife got pregnant! That tells you that your body can do all the steps necessary to achieve pregnancy naturally. That is a big step because most people with infertility don't know what is going wrong. This also means that she should be able to get pregnant again.
My recommendation is NOT to do a D & C, wait up to four weeks to see if your wife will miscarry naturally and if she doesn't ask for a "medical miscarriage". This is where we use a combination of medications to induce the miscarriage. There is always the danger that an over-vigorous D&C could lead to scar tissue formation called "Asherman's syndrome." Of course, if a "medical miscarriage" is not available where you are, then the only option is a D & C.
Once the miscarriage occurs or D & C, then your doctor should follow the blood pregnancy hormone levels until they go down to "0". At that point, it will take 4-6 weeks for your wife to have another period. Once she has this, you can begin trying for pregnancy again. There is no need to wait any longer than the start of your wife's period, which an indication that her ovaries have begun functioning again.
I am 39 years old, and have a son of 5 years old whom I conceived naturally. I was born with one ovary and one fallopian tube (left ovary and fallopian tube missing).
I had a failed long protocol IVF and aborted the trial as we only had one follicle of a good size. We opted for IUI, and was unfortunate to get an infection of the womb, which turned into salpingitus. As a result my fallopian tube is now blocked.
With a decreasing AMH of about 3.5 and FSH of 10, I was advised that my chances of having a successful IVF with ICSI was very small. The clinics opinion was that we looked at egg donation. I have had two attempts this year of egg donation which have failed.
A friend of mine with an AMH of 1% and 15 FSH levels has just fallen pregnant after IVF. Although so early days yet, this has made me want to reconsider undergoing IVF/ICSI with a short protocol.
Can you give me your opinion? Many thanks in advance. S. from the U.K.
Hello S. from the U.K.
The biggest factor you have working against you in terms of IVF is your age. The biggest plus is that you have had a child in the past, which means you have secondary infertility. With secondary infertility age may play a factor. Part of what makes IVF more successful in older patients is that with IVF we are able to recruit a lot more eggs at one time. It is an increased statistical chance of finding a good egg in the group. If your ovaries don't stimulate well and the number of eggs are decreased, then the chances decrease as well. However, they don't go to zero as evidenced by your friend. I usually will not give up on an IVF cycle, even if there is only one follicle because it could contain the perfect egg and IVF is still better than IUI because more of the steps required to become pregnant are accomplished.
That being said, however, using donor eggs certainly gives you a statistically better chance of success. Remember, we are dealing with statistics here, which is just a reflection of things and not an absolute prediction. That doesn't mean that you can't get pregnant with your own eggs, it just may take many more attempts with IVF than if you used younger eggs. Last year, there was an article in a New York newspaper about a woman who delivered at child at 49 that was conceived by IVF using her own eggs. She is, of course, the oldest to be successfully pregnant with IVF using her own eggs. However, it took her two years of trying to achieve this. It would be the same for you, as long as you ovaries are still responding to stimulation. There is a chance that there is still a good egg present in your ovaries. Finding it is the difficult part.
So, certainly there is the option for you to try with your own eggs, and potentially become pregnant. The donor cycle should have worked and statistically is the better way to go, but since it didn't, I can't necessarily tout it as the best option for you. You have to be willing to attempt several tries with your own eggs, however, so as long as that is what you want and are dedicated to it, then that is the way you should go. Ultimately, it is your decision to make.
Hi there. Thank you so much for your quick response and informative opinion. It is very much appreciated.I have one final question regarding the egg donor transfers that I had. Both of them seemed to work and then overnight disappeared. Do you think that I need to check as to whether I have Hydrosalpinx, as I believe this could have an impact by fluid spilling out into the uterus cavity and could potentially kill off or dislodge the planted embryo?? The notes I have from my last ultrasound (which I had to check the thickness of the lining of the womb prior to embryo transfer) states there is no evidence of dilation of the fallopian tube?Can I also say how unique this site is to get an experts opinion on fertility, and appreciate you taking time to respond. Best S.
Evaluating the tubes for hydrosalpinx should have been part of the basic pre-IVF evaluation, because it can reduce the pregnancy rate by 50% if left intact. This is done by a comprehensive ultrasound examination, not the ones looking for follicles, or by HSG (hysterosalpingogram). It usually affects implantation, because it causes a low level endometritis (inflammation of the uterine lining.) If this has not yet been done, then I would recommend that you request it. I would also recommend that you seek a different clinic because it is something that they missed and should not have.
I am a 30 y.o who is TTC with donor sperm. I have not been diagnosed with any infertility issues at this time. My HSG test was normal. I did the first IUI with clomid, the second and third IUIs with 150 units Gonal and 5 units Lupron for 12 days each producing 6 follicles. Each follicle was greater than 15mm. I triggered with ovidel the night before insemination. My estradiol two days prior to the IUI were 2500 and 1500 respectively.
I am curious if there is something medically that could be done differently to increase the odds of conceiving. Also is it possible that I am not genetically compatible with the donor sperm? I am frustrated with not having any answers.
Please help. K. from Upstate NY
Hello K. from New York,
I don't think that "genetic incompatibility" is an issue. It does not exist. I am very, very worried about your gonal-f stimulation cycles, however. The estradiol levels of 2500 and 1500 are IVF levels, and that is where we are stimulating very strongly to get a maximum number of eggs. For an IUI cycle that is way too much stimulation. The goal with IUI is to have 3 ovulatory sized follicles (>16 mms) at the time of trigger and the minimum size needs to be 18 mms for ovulation to occur. Also, if you are only having one IUI done, it should be timed to be 33-36 hours from trigger. I prefer the two IUI technique at 24 and 48 hrs, which gets the fresh sperm into the tubes closer to ovulation.
Keep in mind that IUI is a natural process and just replacing trying with intercourse. Because of this, it has a maximum pregnancy rate of 24% per cycle, and can take up to 4 cycles to achieve pregnancy. In this case, you just need to keep trying. However, I am a little worried about the protocol that you are using. Are you seeing a fertility specialist for this? With IUI, we generally do not use Lupron suppression, but that is okay to use. It's just an extra drug and shot that you don't generally need.
I would not have given up on Clomid so quickly. It works well and is much, much less expensive than Gonal-f. The only reason I would go to Gonal or Follistim is if you did not respond to max dose Clomid (250 mg).
Hi. My name is B. I am 26 and I live in Mississippi. I was diagnosed with Stage 2 Endo in June of 2009. Within 4 months of the lap (performed in June) I was already experiencing high levels of pain during urination, bowel movements and intercourse. My doctor had previously recommended Lupron, but I had declined so I went on continuous birth control. I still had high amounts of pain on a regular basis. I decided to do the treatment after the pain returned so quickly.
While on the shots, I didn't experience nearly as many hot flashes as I had expected and I only gained about 12 -15 lbs. I had my last shot about 27 days ago (3.75mg) and I want to know what I can expect.
When should I start having a cycle again? Also, I have had some mild-moderate pain during the last 3 months of my treatment and occasionally what felt like menstrual cramps. My doctor said he thought it was probably scar tissue.
Any thoughts on the pain I experienced during the second half of my treatment? Any thoughts on my statistical time frame for the possibility of having a family vs. infertility. My boyfriend is very cynical and doesn't believe my best chance at a family is within the next two years. How adamant should I be about going for it considering my circumstances? Thank you!
Hello B. from Mississippi, let me answer your questions in sequence:
1. In general, the normal cycle will resume within 3 months of the last month of Lupron injections. That means, give yourself three months after the one month from the injection.
2. I can't explain the pain that you had in the last 3 months of treatment. Scar tissue is a possibility but the symptom is so nonspecific that I can't give a more definite answer.
3. In general, I advise patients to begin trying for pregnancy immediately after completing a Lupron treatment because there is a 6 month window before the endometriosis will return and inhibit fertility. If you are not in the position to try for pregnancy right away, then you should follow the Lupron with some type of prophylactic treatment to prevent the immediate return of the endometriosis. I recommend Depo provera but if you don't want to take this, then a low estrogen dose, high progesterone birth control pill is second best. Do not use a high dose estrogen pill (30mcg or greater) because the estrogen feeds the endometriosis. Again, Depo provera is my preference.
4. Lastly, I hope you don't mind this piece of advice: You should never insist on having a child with a partner. It needs to be a mutually acceptable proposition. Having a child is a life-changing event. You want your situation to be stable before then.
My husband and I suffer from idiopathic infertility. My husband was diagnosed positive ASA with MAR direct (90% bounded spermatozoids) and indirect (80% bounded spermatozoids) method, all results are good. He went to urologist, and since he couldn't find cause for it he sent him to do ELISA test from serum which came up negative. For past two years he repeated these tests several times in different laboratories, every time with same results - MAR positive and ELISA negative. The urologist refused to give him any medical treatment since results are confusing.
How is this possible? Which of these tests is more reliable?
S. from Serbia
Hello S. from Serbia,
I assume you have gone through an infertility evaluation as well, and that the results cleared you of any problems. Since your husband's sperm shows antisperm antibodies, you should just proceed from there. I think you have done enough repeat tests, and there is NO treatment that a Urologist can do to change that, unfortunately. With antisperm antibodies, your husband is forming antibodies that attach to the sperm and prevent them from being able to fertilize an egg. This leads to a functional defect.
The treatment of choice in this regard, and for this problem, is to undergo ICSI in conjunction with IVF so that the sperm can be washed and the antibodies removed. This can be done for IUI but does not work as well. Once the sperm are washed, they can then be injected into the eggs for fertilization to take effect.
I cannot explain or debate the effectiveness of these testing methods, as I am not a biochemist and not well versed on these testing methods.
Good luck and do not hesitate to continue trying by proceeding to assisted reproductive techniques,