A Big List of Fertility Questions and Answers
Hello Again to Everyone.
Monica asked about DES exposure. Most women who were exposed to DES do not have any problems with their uterus or cervix, but a very small percentage of exposed women do. You definitely need a HSG and may need to be followed by a high risk OB if the cervix or uterus is abnormal. The older fertility doctors have a little more experience, as DES was mostly phased out by the early 70’s.
Sophia asked about what to do next after 6 failed ICSI attempts. You need to be in the best clinic available to you. You could consider travelling for a second opinion.
Mandy asked about Clomid vs Metformin. In general, I use more Clomid than Metformin. If you do not ovulate, but do on Metformin, and got pregnant easily, great, sounds good, use it again. If it took you a while consider Clomid. Doctors differ on when to stop Metformin during pregnancy, and it may depend on the severity of your case of PCO. I do not think you caused the miscarriage by changing the Metformin dose.
Laura asked if ICSI is safe. We will not know the specifics for decades. So far it looks relatively safe. You need to speak to your doctor and carefully read the consent forms.
Niki asked about her lining. Really sorry to hear of your struggle. If it’s 6, it’s 6. It probably was not much different when you last became pregnant. It can happen.
Gosiael asked about a short follicular phase and IVF. It seems you need a different protocol. Ask about trying something completely different. Lupron, low or microdose is a good suggestion. Do not give up yet, it’s too soon.
Sperm of 20 million and 20% motility: repeat the test. You have all of the options available to you. IVF may be your best shot if the sperm counts remain consistent.
Veronica asked about ICSI in a natural cycle. You can do whatever you want, but a natural cycle, while it may be successful, has a very low pregnancy rate. Your lining is fine. If your last protocol gave you your best results, yes do the same again.
M asked about IVF for a low sperm count after vas reversal. I think the microflare is a good protocol. It’s hard to say if I think it’s best for you. It seems you did pretty well with your last, but without seeing the whole cycle I can’t say for sure. To go from cancelled to 12 eggs is quite good. Ask your doctor about keeping the same protocol but going a little longer before your hCG.
Anonymous asked about a strange clomid cycle. I agree, your cycle is off, I don’t know why. Ask your doctor about moving straight to the injections.
A period after taking injectables, for IUI or IVF, can be heavier than usual. This is because the injections give you more follicles, which raise your estrogen, which gives you more of a lining to shed.
Rachael asked if it’s ok to do acupuncture. Fine with me.
Emily asked about being on Metformin for 8 months. What’s the crime in putting you on clomid? You can take both. Most doctors do not follow insulin levels in their Metformin patients. Sounds like time is just passing buy.
Blastocyst is coming.
MK: Yes, FSH levels drawn on day 23 are not useful. Your later progesterone levels look fine.
Sandy asked about PCO and miscarriage. For every doctor who says there is a connection, there is another who says the opposite. If you ovulate regularly on your treatment and you easily conceived, there is no reason to believe it can’t happen quickly again. If it took you a long time to get pregnant, you can consider getting more aggressive this time.
Kristina asked about mildly elevated THS levels, otherwise known as subclinical hypothyroidism. Your doctor is probably right, your levels are not a problem. However there are tons of endocrinologists who disagree, and would treat you with thyroid medication. In the past I did not give medication to people like you, however I got so much flack from the endocrinologists I just gave in and started treating. You can see an endocrinologist for a second opinion.
Mr and Mrs Oldham have a sperm count of 6.5 million. If your count remains in this range, IVF is by far the way to go. You can explore other options, but your highest odds will be with IVF and ICSI.
Christine got 3 opinions and it paid off! Thank you Christine for your kind words. This is the reason I do the blog. Spread the word.
Arpee: Thank you, a search function on the blog is a great idea. I will give it a shot.
Megan has had 3 miscarriages. She has 6 frozen embryos, but had become pregnant on her own. She doesn’t know if she will have a lower chance of miscarriage if she does the frozens or tries naturally. Theoretically, in a frozen cycle you are putting more than one in, so if one embryo is abnormal, maybe one of the other ones are ok, lowering your odds of miscarraige. This effect is probably minimal but may hold true. In general I don’t like PGD, but you may want to at least consider this for your remaining embryos to lower your odds of miscarriage. No matter how you become pregnant, unless there is something else in your history, your odds of having a baby in your next pregnancy are 70% (unless you are in your 40's, then your odds are a little lower).
Chris was told to take 6 months of lupron for her adenomyosis. Get another opinion. It depends on the severity of your case. I would give 6 months of lupron only in the most extreme cases. 6 months is a lot of time to lose.
Trixie has a 10 day luteal phase. This is probably too short. A little progesterone may do. Ask your doctor.
Rose has a high estrogen on day 3, but has been taking estrogen. I don’t know if you need estrogen, but if you do, try repeating your bloods on day 4 and maybe 5. You may be able to start your cycle even though it’s later than day 3. You may have estrogen in your system left over giving you this high reading.
Someone with Klinefelters has never had a semen analysis. Yes, you need this test. If there is no sperm, find a good reproductive urologist and consider the biopsy. Ask about doing the biopsy and IVF at the same time. Many times there is a minute amount of sperm, enough for icsi, but not enough to freeze.
More to come, and please read disclaimer 5.17.06.
Dr. Licciardi
Monica asked about DES exposure. Most women who were exposed to DES do not have any problems with their uterus or cervix, but a very small percentage of exposed women do. You definitely need a HSG and may need to be followed by a high risk OB if the cervix or uterus is abnormal. The older fertility doctors have a little more experience, as DES was mostly phased out by the early 70’s.
Sophia asked about what to do next after 6 failed ICSI attempts. You need to be in the best clinic available to you. You could consider travelling for a second opinion.
Mandy asked about Clomid vs Metformin. In general, I use more Clomid than Metformin. If you do not ovulate, but do on Metformin, and got pregnant easily, great, sounds good, use it again. If it took you a while consider Clomid. Doctors differ on when to stop Metformin during pregnancy, and it may depend on the severity of your case of PCO. I do not think you caused the miscarriage by changing the Metformin dose.
Laura asked if ICSI is safe. We will not know the specifics for decades. So far it looks relatively safe. You need to speak to your doctor and carefully read the consent forms.
Niki asked about her lining. Really sorry to hear of your struggle. If it’s 6, it’s 6. It probably was not much different when you last became pregnant. It can happen.
Gosiael asked about a short follicular phase and IVF. It seems you need a different protocol. Ask about trying something completely different. Lupron, low or microdose is a good suggestion. Do not give up yet, it’s too soon.
Sperm of 20 million and 20% motility: repeat the test. You have all of the options available to you. IVF may be your best shot if the sperm counts remain consistent.
Veronica asked about ICSI in a natural cycle. You can do whatever you want, but a natural cycle, while it may be successful, has a very low pregnancy rate. Your lining is fine. If your last protocol gave you your best results, yes do the same again.
M asked about IVF for a low sperm count after vas reversal. I think the microflare is a good protocol. It’s hard to say if I think it’s best for you. It seems you did pretty well with your last, but without seeing the whole cycle I can’t say for sure. To go from cancelled to 12 eggs is quite good. Ask your doctor about keeping the same protocol but going a little longer before your hCG.
Anonymous asked about a strange clomid cycle. I agree, your cycle is off, I don’t know why. Ask your doctor about moving straight to the injections.
A period after taking injectables, for IUI or IVF, can be heavier than usual. This is because the injections give you more follicles, which raise your estrogen, which gives you more of a lining to shed.
Rachael asked if it’s ok to do acupuncture. Fine with me.
Emily asked about being on Metformin for 8 months. What’s the crime in putting you on clomid? You can take both. Most doctors do not follow insulin levels in their Metformin patients. Sounds like time is just passing buy.
Blastocyst is coming.
MK: Yes, FSH levels drawn on day 23 are not useful. Your later progesterone levels look fine.
Sandy asked about PCO and miscarriage. For every doctor who says there is a connection, there is another who says the opposite. If you ovulate regularly on your treatment and you easily conceived, there is no reason to believe it can’t happen quickly again. If it took you a long time to get pregnant, you can consider getting more aggressive this time.
Kristina asked about mildly elevated THS levels, otherwise known as subclinical hypothyroidism. Your doctor is probably right, your levels are not a problem. However there are tons of endocrinologists who disagree, and would treat you with thyroid medication. In the past I did not give medication to people like you, however I got so much flack from the endocrinologists I just gave in and started treating. You can see an endocrinologist for a second opinion.
Mr and Mrs Oldham have a sperm count of 6.5 million. If your count remains in this range, IVF is by far the way to go. You can explore other options, but your highest odds will be with IVF and ICSI.
Christine got 3 opinions and it paid off! Thank you Christine for your kind words. This is the reason I do the blog. Spread the word.
Arpee: Thank you, a search function on the blog is a great idea. I will give it a shot.
Megan has had 3 miscarriages. She has 6 frozen embryos, but had become pregnant on her own. She doesn’t know if she will have a lower chance of miscarriage if she does the frozens or tries naturally. Theoretically, in a frozen cycle you are putting more than one in, so if one embryo is abnormal, maybe one of the other ones are ok, lowering your odds of miscarraige. This effect is probably minimal but may hold true. In general I don’t like PGD, but you may want to at least consider this for your remaining embryos to lower your odds of miscarriage. No matter how you become pregnant, unless there is something else in your history, your odds of having a baby in your next pregnancy are 70% (unless you are in your 40's, then your odds are a little lower).
Chris was told to take 6 months of lupron for her adenomyosis. Get another opinion. It depends on the severity of your case. I would give 6 months of lupron only in the most extreme cases. 6 months is a lot of time to lose.
Trixie has a 10 day luteal phase. This is probably too short. A little progesterone may do. Ask your doctor.
Rose has a high estrogen on day 3, but has been taking estrogen. I don’t know if you need estrogen, but if you do, try repeating your bloods on day 4 and maybe 5. You may be able to start your cycle even though it’s later than day 3. You may have estrogen in your system left over giving you this high reading.
Someone with Klinefelters has never had a semen analysis. Yes, you need this test. If there is no sperm, find a good reproductive urologist and consider the biopsy. Ask about doing the biopsy and IVF at the same time. Many times there is a minute amount of sperm, enough for icsi, but not enough to freeze.
More to come, and please read disclaimer 5.17.06.
Dr. Licciardi
posted by Dr. Licciardi at 5:06 AM
25 Comments:
Thanks for this blog. I went through an infertility battle and am now nine weeks pregnant. I love reading your blog. It's so interesting to see things from a doctors point of view. I do have a personal question if you don't mind answering it. What made you decide to become an RE?
I really cannot express to you how much this blog has meant to me and my family, even though we've only been reading for a few weeks. I have recently been told by two dr.s that I have PCOS (two ultrasounds and bloodwork) and we are now repeating bloodwork during my next menstruation. I did take prometrium for one month based on my first dr's recommendation, but the 2nd asked me to stop so we could repeat the bloodwork with fasting and during menstruation. I had extremely heavy periods and lots of clotting on prometrium when it got to the 7th day of my 12 day cycle - is that normal? Either way we're retesting to see if there is a new plan.
Also, my husband had one sperm analysis which revealed 3.5% motility. He was taking rogaine at the time and had been for a few years - do you think this could have that much of an effect? We're retesting that too next month (once we have more time for this to leave his system).
Just interested in your thoughts if you have time.
THANKS again - you're a great help to so many of us with fertility difficulties.
Hi Dr. Liacciardi,
I love your blog and really appreciate the service you are providing to all of the women going through infertility treatments.
I've been ttc for a couple of years. Two years ago CD3 FSH was 13, last year it was 15.5. I just took it this month and it was 1.9! That was an unbelievable result so they ran the test again and it came back the same. (I have been off meds for 6 weeks leading up to the test.) What are your thoughts about this? Could a body rebound like this or perhaps this is an aberration? I was wondering if perhaps the last 6 months of hormones / fertility meds could have a healing or reawakening affect on my reproductive / endocrine system.
My RE said that he would continue to treat me based on my highest FSH and therefore doesn't plan to change the protocol. Would you recommend any adjustment in protocol based on the result or would you do the same as my RE?
Thanks for your thoughts!!
Dr. Liacciardi - I love reading your blog and everytime something new comes up on our journey I go back to your blog archives and find what you think about it.
Here is my story - 29 years old, FSH 11, husband -30 years old, low count, motility and morphology, 31%fragmentation on SCSA. IVF #1 (long lupron protocol, 375 follistim, 75 menopur) retrieved 5 eggs, 4 mature, 2 fertilzed , one stopped growing at 2 cells, one stopped at 6 cells on day 3 - no transfer. Diagnosis is egg quality issues and sperm issues. What would you do next? I am doing acupuncture and TCM herbs to try to improve egg quality.
Stephanie
I really like your blog. We need more open communication from REs like you. I was wondering if you could comment on progesterone levels after an IVF retrieval. I'm an acupuncturist treating infertility and wonder about the efficacy and the reason for progesterone supplementation.
Do the follicles that become the corpus luteum get damaged during the retrieval and does that affect progesterone levels? Also, I wonder if progesterone levels could actually be higher than a natural cycle because of the increased number of follicles forming the corpus luteum.
Lastly, do you know of any research that shows that progesterone suppositories or injections help improve success rates? I havent' been able to find any clinical studies and would be interested in your opinion. Thank you!
Dr. Liacciardi, I am wondering what your thoughts are on successful IVF after many tubal pregnancies? I only have 1 tube left and am 42 years old, wanting to become a gestational surrogate mother. I had successful IVF with one cycle when I was 32. A nurse has said my chances are high for tubal pregnancies with IVF but that doesn't sound right to me. Your opinion?
Thanks so much, Melinda Landers
First, I really want to thank you for your blog. I can't tell you how helpful and encouraging it is to read!
My husband has low count and morphology. No problems on my end (at first). We did 2 failed IUIs. My Progesterone was low last month so I did a round of Clomid and am now on Progesterone. Had my 3rd failed IUI on Clomid. Do you think it's worth trying IUI one more month or is it better to go ahead and move on to IVF? Thanks again!
Dr. L, Thanks so much for taking the time to provide this service - it is truly a help. I have a complicated situation - have been pregnant three times in last year - once after IVF, 2xs naturally (surprises). Lost all three pregs due to aneuploidy. One other IVF was a failure. I wrote before - I have 6 frozen embryos at 2pn stage. Discovered a couple of months ago that my husband has been drinking since our first loss to deal with his emotions and hiding this from me (approx. 5 to 10 drinks per night). He has also been using chewing tobacco secretly to deal with stress (meanwhile i've been on an organic vegan diet, gave up aspartame, caffeine, etc). Our frozen embryos were collected during this period of use (he thinks he was drinking around 5 drinks at that time). As soon as he confided in me, I took him to detox, he is now in outpt treatment, and we are moving forward with marriage counseling. But I am wondering about the frozen embryos...should we discard them? I have read research in animals and epidemiological data suggesting learning and memory deficits, hyperactivity, potential physical malformations, and an increased risk of m/c. Please let us know if in your clinical judgment the frozens are "safe" to use or if we should start out fresh again (i'm leaning toward the latter once he has acheived a few months of abstinence). If we were to go forward with fresh, any issues with him being on Antabuse and Lexapro? He's also currently on nicotine gum (12 mg/day), but I'm hoping he will continue to taper this. Thank you for your thoughts. M
Dr. Licciardi, I really want to thank you for this informative blog, it is really very helpful and encouraging to read it.
I am a 40 years old woman who has been trying to bear children for the past 3 years. My FSH level is 28 and I have performed 3 ICSI with poor response. We now decided to proceed with donor eggs. My question is as follows. For two cycles I took estrogen pills with 20 ml of DARONDA in order to thicken the endometrium. Both times my period came at the 10th and 11th day respectively. What is the explanation for the premature period? My doctor suggested patches for the next try. Have you experienced such a case before and could you response what would be.
Thanking you in advance.
Helen
Greece
Hi. Is this where to ask a question?
I'm 35 and heading into our 4th year of TTC with secondary infertility, with 2 failed pregnancies. We have no sperm issues and my diagnosis in "unexplained". My next cycle is going to be Lupron, Bravelle and Ovidrel with IUI #12. It's my last chance as I can't afford IVF. Does that seem right?
Dr. Liacciardi,
Should I seek treatment elsewhere? After one failed IVF and one failed FET I have only had a sonohystogram, no HSG to date. Before FET #1 I asked my Dr. if I needed further testing, he said no since we were just dealing with MFI. I switched doctors within the same practice and the new Dr. has suggested an HSG to check for hydrosalpinx before IVF #2. I feel like this should have been done at least before the FET and am considering treatment out of state due to limited options.
Hi Dr. Liacciardi,
I've been a faithful reader of your blog for a while now and I am so glad there are people like you who love their job so much they blog about it. You are like the lifeline to most of us women, you give us hope and most of all information.
I have a quick question, i have not been preventing with my previous partner for 4 1/2 years, never conceived- now im with my second partner, trying to conceive, am charting, using OPK's, did Hormone tests : Prolactin, P4, E2, TSH, FSH, LH and an HSG. My gyno has me on clomid for the first time- i understand I should give it time, but let's say I am not taking clomid, what else can i get tested for or do to find out what my problem is? I've never had any history with any pains in any time of my cycles, i have a cycle ranging between 29-35 days. I have a period every cycle, and i know i am ovulating.
HELP!
-NINA-CT-NYC
forgot to tell you that my hormone tests came back normal except the progesterone, it came back at 6.6
Is that the reason i haven't been able to conceive?
-Nina-CT-NYC
Hi Dr. Liacciardi,
I wanted to check in I've asked a few questions in the past and my last one was in May. Our cycle that month did not take and we had to take off June because of cysts. We had been doing FSH IUI's and increased our dose a bit in July and it worked. I'm now 11 weeks pregnant and everything looks good. Thanks for all the great advice!!
Della in Cali
This post has been removed by the author.
Hi Dr. Licciardi,
I'm a regular reader of your blog and I cannot find the words to tell you what a blessing it has been through all the turmoil that I have been facing with infertility. I just had a 2nd round of failed IVF. I'm 30 years old and the diagnosis was that of the 12 eggs retrieved, none moved past the M1 stage of maturation and by the time of ICSI, only 6 fertilized and even those didn't look all that great. My RE has suggested doubling the HCG to 20k units, but doesn't have high hopes it will help.
Is this the end of the road for me Doc? Should I give up on me?
Thanks for being a ray of hope!
Julie
I was wondering whether you think it would be worth it for me to try IVF. I have PCOS, and am 42. I recently tried two rounds of Follistim with IUIs, the first one ending in a very early miscarriage and the second one unsucessful. My CCT results in January were fine. I will be 43 in December. IVF is not covered by my insurance, so we would probably only do it once. Should I bother, and if so is there anything I can do to increase my chances?
Dr. Liaccardia, thank you so much for taking time out of your incredibly busy schedule to answer your readers questions! I very much appreciate you answering mine. I did a 2nd FET and had a chemical, so you are right (and in agreement with my RE) that this type of lining works for me! I'm doing FET #3 on 9/23 and will transfer 2 hatching blasts. We're hoping that one of those sticks! Again thank you so much for your condolences and your encouragment! Your willingness to share your expertise is greatly appreciated!
Dr. Licciardi,
It would be great if you could do a post on the failure of eggs to mature being a major cause of female infertility. Rare and quite difficult to diagnose, it has also been very frustrating that there's no literature or research widely available on this. Although I have an average antral follicle count (11-12), no blocked tubes, no endo, no pcos, etc. it was devastating to learn only after the 2nd round of failed IVF cycle that the eggs never reach beyond the M1 stage of maturation despite a prolonged stimulation protocol (300 units FSH for 12 days).
Even though it might be the end of the road for conceiving with my own eggs, it would atleast be heartening to know more about what causes this (could it be genetic) and if there is any research being done on this... and yes, IF there is any hope at all?
Thanks and Best Regards,
Julie
This post has been removed by a blog administrator.
Dr. Liccardi, So happy to have found your blog. Not sure if you remember me. I came to you for a second opinion. We had decided on injectibles, but I was mid-cycle. I asked if I could do a natural IUI. I had just come off 2 failed clomid cycles with another RE.
6 week ultrasound we saw 1 heartbeat, 7 week ultrasound, twins!! Maya and Thomas will be 3 in December! You were my good luck charm :)
Thanks,
Stacy
Quick question about estrogen.I'm on my second ivf cycle, I am 38. The first produced 24 mature and we ended up with 3 blasts (pregnancy on fet but miscarriage) ivf (2 blasts failed). First protocol was antagonist now on agonist they lowered my dose to 175 puregon from 200, but both times my estrogen has gotten really high. I'm now on day 10 of stims (puregon 100 now)and it is 15,000 (Can.measure)last time before I triggered it was 22,000. Why is it so high (i have 20 follicles) and why does reducing meds seem to have no effect? Does high estrogen effect the quality of the eggs? Should the cycle be cancelled or should the embryos be frozen?
This post has been removed by the author.
Just wanted to add, I meant unmedicated IUI, the cycle I conceived with you as my Dr. No shots or anything, just monitoring of my blood to see when I ovulate. I was on metformin at the time also.
I love learning about so many things on the blog, I already have come across 2 things to send on to my friends who are having some fertility issues.
Thanks, Stacy
There are nicotine replacement therapies available in the market, namely, nicotine gums, lozenges, patches et al that can help you overcome nicotine addiction. You can try out these therapies according to the doctor’s suggestions but they fail to yield desired results, chantix is definitely there to help you quit smoking. For more information on chantix, visit http://www.chantixmagic.com.
Post a Comment
<< Home