44 Yr. Old Has Clomid Challenge Test

Question:

Hi Dr. Ramirez,

I'm 44 yrs. old and recently had a clomiphene citrate challenge test with two ultrasounds. I took 100 mg. of Clomiphene Citrate from days 5-9.

The results are as follows: Before Clomiphene Citrate: FSH 5.5, Estradiol 131, with a baseline vaginal ultrasound showing one follicular at 4.2mm in right ovary(I believe) and endometrial lining 4.39, could not locate left ovary. Then, after taking last cc pill another blood test on 11/14 showing FSH of 27.6 and Estradiol of 90. Then, another ultrasound on 11/16 showing two follicles, 10.0 mm, 10.2 mm, in right ovary and 6mm in left ovary, with endometrial lining of 8.2 mm.

What are my options? Should I pursue taking HCG shots or other fertility drugs using my own eggs? Should I pursue donor eggs? My sister is willing to donate her eggs, she recently had a normal, healthy baby boy 10 months ago and she is 41 years old. Thank you in advance for your answers.

Answer:

Thank you for your question.

The purpose of the Clomid challenge test is to evaluate if the ovaries will respond well to stimulation. The Clomid is used for stimulation. A "positive" test is when there is an elevation of the FSH level on cycle day# 11. This shows that there is significant resistance to stimulation and the ovary will probably not stimulate well. The only way to overcome the "age" factor is to get lots of eggs from the ovary. If only a few eggs are retrieved, then the chances for success decrease significantly. Your ovaries are still working, which means that you can be stimulated to get a few (1-3) eggs, but the chances for pregnancy are not good. I do have patients try this but it is with this clear understanding. Most patients do want to try at least once on their own. As I tell them, there are always exceptions to the rule and you only need one good egg, so from an emotional and psychological point of view, it might be worth the try. Expect the worst, however.

Donor eggs is probably your best chance for pregnancy from a statistical point of view. Although your sister was recently successful, she is not the best donor candidate. IVF pregnancy rates are very dependent on the eggs retrieved. If you are going to use a donor, you want the best eggs that you can get. For that reason, we recommend donors that are under the age of 35 years old. The other problem with older eggs is the risk of genetic abnormalities, such as Down's syndrome. You would have a risk of 1:50 for this syndrome with your sister's eggs. I am sure that both you and she would be crushed if that happened. Therefore, I would recommend that you consider an anonymous donor under the age of 35.

I hope this helps,

Sincerely,

Edward J. Ramirez, M.D., FACOG

Executive Medical Director

The Fertility and Gynecology Center

Monterey Bay IVF Program

www.montereybayivf.com

Increasing Sperm Count

In my capacity as volunteer infertility expert on About.com's All Expert site, I get questions from all over the world. Here is one from Egypt that many of you might relate to, regarding male infertility as a factor in reproductive failure.

Question:

Hi sir,

I am 28 years old man from Egypt. I got married from 7 months ago. My wife still not pregnant. So recently I did a semen analysis and I got the following result:

Sperm count is 18.4 million (regular is 20 million)
Abnormal morphology is 79% while regular is less than 70%
But sperm motility and volume is ok

My question is:
What is your suggestion or prescription to increase the number of sperms and to enhance the shape of it?

Thank you!

Answer:
Hello,

Unfortunately there are not a lot of options for the treatment of sperm defects, but here are a couple of suggestions. Sperm morphology is determined by the actual production of the sperm at the testicular level. Very little is known as to what controls that production, and therefore, what could be causing your sperm to be formed abnormally. It could be genetic predisposition or an environmental toxin such as pesticides, radiation exposure, medication or the like. Your count is probably adequate because it is borderline normal, but fertilization won't occur if most of the sperm are abnormal.
The ideal treatment would be to do IVF (in vitro fertilization) with ICSI (intracytoplasmic sperm injection) because a minimum amount of normal sperm will be required in that case. But if you want to continue to try naturally, here are two options:

1. Proxeed, Fertility Blend or Fertilaidmen which can be ordered via the internet (one such site is: http://www.fertilaid.com/male-fertility.asp ). These are vitamin supplements with ingredients that are supposed to enhance sperm production and motility, and possibly morphology. You will need to use it everyday, as recommended, for at least three months to see an effect since sperm production is in 90 day cycles (that is the sperm forming today won't come out for 90 days).
2. Clomiphene citrate, a fertility medication used mostly in women, can also be used in men. In general it is used to increase sperm count, which in your case, may get you to produce enough normal sperm to lead to pregnancy. You would need to take 1 tablet (50 mg) per day. Again, you will have to use it for a minimum of 90 days before you can see an effect.

Because of your sperm problems, you might want to consider insemination (IUI) as a treatment as well, again, to get the maximum number of normal sperm inot the tube for fertilization.

Good luck,


Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
Monterey, California, U.S.A.

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