Question:
Hi:
This might sound like a silly question, but here goes. My husband and I have been trying to conceive. A friend of mine recently told me that if a female has an orgasm either during or after the male ejaculates, this can improve the odds of conception as the contractions of the uterus that occur with orgasm help tip the cervix towards where the pooled sperm and propel the sperm into the uterus. However, she continued, if a female ejaculates before the male her vaginal fluid can actually harm her chances of getting pregnant. When my husband and I have intercourse, he will always allow me to reach orgasm first and only then will let go. I'm just wondering whether my friends' info is just an old wive's tale or is scientifically proven. Could the fact that I have an orgasm prior to my husband's ejaculation stopping us from conceiving? I enjoy my current sex life very much but would switch things up a bit if need be :)
Answer:
Hello,
I'm afraid your friend's recommendation is a new one for me. It is neither scientific nor logical. It is possible that orgasm would help with sperm motility into the cervix, by virtue of uterine contractions, but that is not a necessity. Many women do not have orgasm and still get pregnant. Also, the fluid within the vagina and cervix are conducive to sperm survival, if it is the appropriate time in the cycle.
My only recommendation is for you to continue to enjoy your sexual activity and technique. If you are trying to conceive then timing is the key, not position, climax or resting after. If you don't' achieve pregnancy by 1 year and have been timing the cycles well and ovulate, then something else is wrong. You should then seek an evaluation.
Interestingly, at the turn of the 20th century, doctors used to manually induce orgasm i.e. masturbate the patient, as a treatment for infertility, PMS and other female disorders. Of course, it didn't work too well so we don't do that anymore. Just thought you might enjoy that bit of trivia. :)
Sincerely,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
Sunday, July 19, 2009
Wednesday, July 1, 2009
Pregnancy After Tubal Ligation
Questioner: genna
Subject: what are my chances of having another child
Question:
when i had my tubes tied after having my second child i was only 24yrs and the doctor said that within five yrs their was a chance that my body will heal and the tube will go back the way they was is that true is it true for the body to heal its self and is their anything i could do to try and conceive again?
Answer:
Hello,
If the tubal ligation was successful, the tubes will not "grow" back or "heal itself". That is the purpose of a tubal ligation. It is a permanent sterilization method. Because of your age, I would not have done a tubal on you. You were much too young.
You have two options for getting pregnant: (1) tubal reversal surgery. This is a microscopic surgery whereby the tubes are repaired and sutured back together. If it is successful, then you would have the ability to become pregnant naturally and repeatedly. You will need to use contraception again to prevent pregnancy if you don't want more kids. In the best hands, the chances of pregnancy are up to 70% per year of trying. The down side is you won't know until after the procedure has been done and the risks are that the tubes will scar together, or you will get a pregnancy that lodges in the tubes (called an ectopic pregnancy), which is a surgical emergency. Also, whether or not it can be repaired is dependent on the method that was used in the tubal ligation to begin with. The more damage that was done to the tube, the less repairable it is.(2) In Vitro Fertilization. In this case, the ovaries are stimulated and the eggs are removed directly from the ovaries. Fertilization and embryo development then occurs outside of the body in a specialized laboratory. The tubes are bypassed with this procedure. In general, it has a much higher pregnancy rate per attempt. In under 35 years old, you would have a 60-70% chance of pregnancy with each attempt. Nowadays, most people will do IVF because of the higher chances of success.
Both cost approximately the same so most will go to IVF. Beware of doctors that do tubal reversals but don't do IVF in their centers. They usually will counsel to do the surgery but not counsel regarding the option of IVF. On the other hand, most IVF centers will do both, but beware of the ones that don't even mention the surgery.
Good Luck,
Edward J. Ramirez, M.D., FACOG
Subject: what are my chances of having another child
Question:
when i had my tubes tied after having my second child i was only 24yrs and the doctor said that within five yrs their was a chance that my body will heal and the tube will go back the way they was is that true is it true for the body to heal its self and is their anything i could do to try and conceive again?
Answer:
Hello,
If the tubal ligation was successful, the tubes will not "grow" back or "heal itself". That is the purpose of a tubal ligation. It is a permanent sterilization method. Because of your age, I would not have done a tubal on you. You were much too young.
You have two options for getting pregnant: (1) tubal reversal surgery. This is a microscopic surgery whereby the tubes are repaired and sutured back together. If it is successful, then you would have the ability to become pregnant naturally and repeatedly. You will need to use contraception again to prevent pregnancy if you don't want more kids. In the best hands, the chances of pregnancy are up to 70% per year of trying. The down side is you won't know until after the procedure has been done and the risks are that the tubes will scar together, or you will get a pregnancy that lodges in the tubes (called an ectopic pregnancy), which is a surgical emergency. Also, whether or not it can be repaired is dependent on the method that was used in the tubal ligation to begin with. The more damage that was done to the tube, the less repairable it is.(2) In Vitro Fertilization. In this case, the ovaries are stimulated and the eggs are removed directly from the ovaries. Fertilization and embryo development then occurs outside of the body in a specialized laboratory. The tubes are bypassed with this procedure. In general, it has a much higher pregnancy rate per attempt. In under 35 years old, you would have a 60-70% chance of pregnancy with each attempt. Nowadays, most people will do IVF because of the higher chances of success.
Both cost approximately the same so most will go to IVF. Beware of doctors that do tubal reversals but don't do IVF in their centers. They usually will counsel to do the surgery but not counsel regarding the option of IVF. On the other hand, most IVF centers will do both, but beware of the ones that don't even mention the surgery.
Good Luck,
Edward J. Ramirez, M.D., FACOG
Irregular Menstrual Cycles and Progesterone
Questioner: Cat
Subject: progesterone cream and spotting
Question:
Hi Edward, you have helped me before and I have another question. I am currently using progesterone cream (after having post pill amenorrhea) 14 days on and 14 days off. Last month I started my period early (on day 8 of the cream)n and it consisted of brown and back blood. This month I am having spotting again on day 7 of the cream, brown again. Why did my period never turn into an actual "red" period last month? And why does it keep starting early? Shouldn't it start a few days after I stop the cream (the drop in progesterone triggers period)? Thanks for any help you can give me!
Answer:
Hello,
The treatment you are receiving may not be appropriate for your problem and now you are having "breakthrough bleeding" from the progesterone. The cyclic progesterone only works if you have ovarian function that produces some estrogen and grows an endometrial lining. If that doesn't happen, then the progesterone will not work appropriately and you will have the BTB.
Post-pill amenorrhea is a description and not a diagnosis. More than likely you reverted to your normal ovarian function after stopping the pill and that "normal" function was an ovarian dysfunction. That is, the ovary was not previously working properly so it went back to not working properly. The most common ovarian dysfunction is PCOD. In this case, the hormone precursors, fSH and LH don't get processed correctly within the ovary and so estrogen and progesterone are not created, mainly because the ovary does not go through an ovulatory cycle. Because estrogen is not adequately created, the endometrial lining is not developed and hence, there is nothing to bleeding after progesterone, or very little to bleed. In this case, you should be on the birth control pill to cycle you normally, not progesterone. If you are trying for pregnancy, then you need to go on a fertility medication to stimulate your ovary to ovulate. The best birth control pill for PCOD patients is called Yasmin or Yaz because the progesterone component, blocks the testosterone receptors, which is a hallmark of this abnormality (elevated testosterone).
Sincerely,
Edward J. Ramirez, M.D., FACOG
Subject: progesterone cream and spotting
Question:
Hi Edward, you have helped me before and I have another question. I am currently using progesterone cream (after having post pill amenorrhea) 14 days on and 14 days off. Last month I started my period early (on day 8 of the cream)n and it consisted of brown and back blood. This month I am having spotting again on day 7 of the cream, brown again. Why did my period never turn into an actual "red" period last month? And why does it keep starting early? Shouldn't it start a few days after I stop the cream (the drop in progesterone triggers period)? Thanks for any help you can give me!
Answer:
Hello,
The treatment you are receiving may not be appropriate for your problem and now you are having "breakthrough bleeding" from the progesterone. The cyclic progesterone only works if you have ovarian function that produces some estrogen and grows an endometrial lining. If that doesn't happen, then the progesterone will not work appropriately and you will have the BTB.
Post-pill amenorrhea is a description and not a diagnosis. More than likely you reverted to your normal ovarian function after stopping the pill and that "normal" function was an ovarian dysfunction. That is, the ovary was not previously working properly so it went back to not working properly. The most common ovarian dysfunction is PCOD. In this case, the hormone precursors, fSH and LH don't get processed correctly within the ovary and so estrogen and progesterone are not created, mainly because the ovary does not go through an ovulatory cycle. Because estrogen is not adequately created, the endometrial lining is not developed and hence, there is nothing to bleeding after progesterone, or very little to bleed. In this case, you should be on the birth control pill to cycle you normally, not progesterone. If you are trying for pregnancy, then you need to go on a fertility medication to stimulate your ovary to ovulate. The best birth control pill for PCOD patients is called Yasmin or Yaz because the progesterone component, blocks the testosterone receptors, which is a hallmark of this abnormality (elevated testosterone).
Sincerely,
Edward J. Ramirez, M.D., FACOG
Failed IVF Question
Questioner: Claudia
Subject: 2nd failed IVF - what now?
Question:
Good afternoon Dr. Ramirez,
I had my 1st failed IVF (10.08) on the flare lupron protocol: 7 eggs retrieved, 5 mature, 4 fertilized, 1 blast + 1 morula d5t, ICSI and assisted hatching.... chemical pregnancy
Yesterday, I experienced my 2nd IVF failure using an antagonist protocol (Ganirelix): 16 eggs retrieved, 13 mature, 10 fertilized, 3 (8 cells grade 1 & 2) and 1 (7 cell grade 2) embryos d3t, ICSI.... BFN
I just turned 39 yrs old and I'm intimidated about future IVF cycles before I don't have clarity on the issues that may have gone wrong? We were diagnosed with unexplained infertility and advanced maternal age, however, I produced a good # of eggs the 2nd time, my uterus lining was above 9 mm each time, I have open tubes and no thyroid, CF issues (tested 08/08).
I'm just wondering if you have any additional tests in mind or suggestions I could consider before going into another round? I really appreciate your response, thanks beforehand.
Claudia
Answer:
Hello,
It sounds like both IVF cycles went well as far as the controllable aspects of the treatment. The second cycle was better because of a higher yield. In the second cycle, out of the 10 fertilized, only four were of reasonable quality. That is the "age factor." We know that with increasing age, less of the eggs will be internally good and lead to abnormal embryos. Despite the fact that your transferred embryos looked good, they still have a high probability of being chromosomally abnormal, hence the chemical pregnancy and failure. This is what happens with age. You need to understand this because, the age problem is not reversible. What it means is that you have to keep trying until there is finally a good egg that makes a good embryo leading to pregnancy. It will eventually happen, it will just be harder. If you want a shorter course (i.e. less attempts), then donor eggs would be the only alternative, but the chances of pregnancy will be higher (73% per attempt this year in our clinic).
The protocol I use with my older patients, especially if they have failed previously, is to use a high protocol (I call it C8c which stands for a continuous 8 amp (600IU) antagonist protocol (the c was for Cetrotide but now I use Ganerelix). The 8 amps is broken down into 450IU of Follistim and 150IU of Menopur on a daily basis.
I also add the following:
Medrol 16 mg per day
Climara patch 0.2 mg per day starting at retrieval
Heparin 2000 Units twice per day starting at the beginning
Aspirin 81 mg per day starting at the beginning
Progesterone 50 mg injections starting at retrieval
Endometrin 100 mg twice per day starting after transfer
Your docs may have their own protocol for previous failures, or may not want to do this same protocol, but it is an option.
These do not treat abnormal eggs nor make them better. They do help with implantation, however, and reduce the immune response a little. That is why I use them. It is a full court press protocol. The bottom line is to keep trying. That is the only way you are going to be successful in the end. If you don't try, you definitely won't be successful with IVF.
Sincerely,
Edward J. Ramirez, M.D., FACOG
Subject: 2nd failed IVF - what now?
Question:
Good afternoon Dr. Ramirez,
I had my 1st failed IVF (10.08) on the flare lupron protocol: 7 eggs retrieved, 5 mature, 4 fertilized, 1 blast + 1 morula d5t, ICSI and assisted hatching.... chemical pregnancy
Yesterday, I experienced my 2nd IVF failure using an antagonist protocol (Ganirelix): 16 eggs retrieved, 13 mature, 10 fertilized, 3 (8 cells grade 1 & 2) and 1 (7 cell grade 2) embryos d3t, ICSI.... BFN
I just turned 39 yrs old and I'm intimidated about future IVF cycles before I don't have clarity on the issues that may have gone wrong? We were diagnosed with unexplained infertility and advanced maternal age, however, I produced a good # of eggs the 2nd time, my uterus lining was above 9 mm each time, I have open tubes and no thyroid, CF issues (tested 08/08).
I'm just wondering if you have any additional tests in mind or suggestions I could consider before going into another round? I really appreciate your response, thanks beforehand.
Claudia
Answer:
Hello,
It sounds like both IVF cycles went well as far as the controllable aspects of the treatment. The second cycle was better because of a higher yield. In the second cycle, out of the 10 fertilized, only four were of reasonable quality. That is the "age factor." We know that with increasing age, less of the eggs will be internally good and lead to abnormal embryos. Despite the fact that your transferred embryos looked good, they still have a high probability of being chromosomally abnormal, hence the chemical pregnancy and failure. This is what happens with age. You need to understand this because, the age problem is not reversible. What it means is that you have to keep trying until there is finally a good egg that makes a good embryo leading to pregnancy. It will eventually happen, it will just be harder. If you want a shorter course (i.e. less attempts), then donor eggs would be the only alternative, but the chances of pregnancy will be higher (73% per attempt this year in our clinic).
The protocol I use with my older patients, especially if they have failed previously, is to use a high protocol (I call it C8c which stands for a continuous 8 amp (600IU) antagonist protocol (the c was for Cetrotide but now I use Ganerelix). The 8 amps is broken down into 450IU of Follistim and 150IU of Menopur on a daily basis.
I also add the following:
Medrol 16 mg per day
Climara patch 0.2 mg per day starting at retrieval
Heparin 2000 Units twice per day starting at the beginning
Aspirin 81 mg per day starting at the beginning
Progesterone 50 mg injections starting at retrieval
Endometrin 100 mg twice per day starting after transfer
Your docs may have their own protocol for previous failures, or may not want to do this same protocol, but it is an option.
These do not treat abnormal eggs nor make them better. They do help with implantation, however, and reduce the immune response a little. That is why I use them. It is a full court press protocol. The bottom line is to keep trying. That is the only way you are going to be successful in the end. If you don't try, you definitely won't be successful with IVF.
Sincerely,
Edward J. Ramirez, M.D., FACOG
Saturday, June 27, 2009
How Many IVF Cycles at 42 years old?
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.
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.
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.
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