Infertility Questions and Answers: Almost Caught Up
Anonymous asked about really trying to nail down the best progesterone for her IVF attempts. She failed one fresh cycle and 2 frozen cycles. She tried the injections and cream and Crinone. Her latest problem is she bled on Crinone, and had a thin lining in the luteal phase, and now is scheduled for a biopsy on Crinone.
Why? Crinone may be a good drug for some, but in your case it does not work. Why do a biopsy when you already know this drug gives you problems? I have never done an ultrasound in the luteal phase to check the lining. Maybe your doctor is on to something, but for most of us it’s all about the lining before your progesterone(ie we check in the follicular phase). Your problem highlights the reality that progesterone in oil, as difficult as it is, gives consistent results. If vaginal progesterone is your only option, and Crinone does not work out, you can consider old fashioned progesterone suppositories.
Anonymous asked about not getting her period after lupron.
This commonly happens. You odds of pregnancy will be based on your clinic’s success rates. Remember it’s the age you were when the embryos were frozen, not your age now.
Wannabmomma has PCO and has tried 5 clomid cycles with intercourse, no luck yet. She is 26 yo.
It is almost time to move to the injections. Most of us make your limit 6 cycles, fewer if you have regular cycles on your own. But, you are only 26, so you could consider a couple more with insemination. I really think this can be up to you.
Big Childwish has a significant miscarriage problem. She has had 4 consecutive miscarriages at about 7 weeks, all with a sac but no fetal pole. All of her testing is normal. She tried the blood thinner.
I am assuming you had a hysterogram, if not you need it. I am not sure if you have had a d and c with any of the pregnancies? This would tell you about the chromosomes of the fetus, possible giving you more information about the causes of your problems. Otherwise it may depend on your age. If you are younger, your chance of a baby in your next pregnany is still over 50%. If you are older, your odds are much lower.
Katie has PCO, did an IVF cycle with 7 eggs, 5 fertilized and 2 embryos for transfer on day 3, one 4 cell and one 5 cell.
OK, there are some positive things here. I like the way your doctor was cautious stimulation, and you do make eggs and embryos. You can use the information to improve your next try. First a little more drug will be OK. You don’t need to make 30 eggs, but 15 may be better than 7. If you are at a clinic with a 26% pregnancy rate, but can travel to a clinic with a 49% pregnancy rate, I say travel. If your clinic treats 100 patients, 74 will not get pregnant. If the other clinic treats 100 patients, 51 will not get pregnant. That’s a big difference.
Alibee has a complicated history. She has a unicornuate uterus with a normal tube and 2 ovaries. She has a fairly large fibroid. She has done 5 FSH iui cycles and 1 fresh IVF cycle and 3 FETs, and maybe more more fresh IVFs?
It sounds like your fresh IVF cycles were excellent because you had so many frozen embryos. It’s hard to prognosticate your future after failing frozen cycles. They just do not work as well as the fresh. They are worth doing, but if they don’t work, it’s hard to say things are bad. Your last fresh IVF cycle yielded very nice embryos. So why no pregnancy? Can it be your uterus? Possibly. Most women with a unicornuate uterus are not infertile, but there are a few who have trouble implanting, we don’t know why. Is it just bad luck with IVF? Possibly, but why are you not getting pregnant on your own? This is going to be a case of trying again, if you wish. Should you consider a carrier? It should be a consideration, but of course even that is not a guarantee.
Emily has unexplained infertility and has started clomid. Her first try did not work. She asked about some recent press concerning a terrible article about clomid not working for unexplained infertility.
That will be another blog, but they are wrong. There have been many many studies showing clomid does work. Just remember the odds, which are 8% per try in women with regular cycles. So you are on the right track, I hope it works out.
Jen seems to be hanging in there with her endometriosis progression and pain. Keep us posted.
Anonymous is concerned because her first IVF cycle worked and her second did not. She is worried about the 8% morphology.
This is not the issue. Morphology will not lower IVF pregnancy rates. It’s common that success in the first cycle causes fear when the second cycle does not work. Stick with it. Even in the best clinics, odds are 50% for young women, meaning it’s a 50% failure rate.
Amelia’s husband has an inversion in chromosome 1, causing low sperm counts. She asked about IVF with PGD.
This all depends on what your needs are, and the advice of a counselor. Of course you need to ask about the problems associated with this inversion. Is it just a low sperm count, or are you at risk for a miscarriage or even an abnormal child? You also need to be informed about the costs and success and failure rates of doing the IVF with PGD. In addition, you need to ask about the error rate of your PGD procedure.
Singh did 2 IVF cycles. The first resulted in 10 eggs, but 8 fertilized with more than 1 sperm (polyspermy). Her second cycle she did ICSI and did not have polyspermy. She is wondering if the polyspermy means her overall egg quality is bad, leading to a failure in her second IVF cycle.
We do not know if your problem is egg related, or related to a lab issue. Since you say you had nice embryos in your second cycle, your eggs are probably fine.
EMLU has severe endometriosis. Had Twins with her first IVF cycle, but has since had 2 fresh cycles, and then a frozen cycle revealed fluid in the uterus so the cycle was cancelled. She still has fluid in her uterus and a biopsy revealed endometritis.
Fluid in the uterus is a very difficult problem. I have a few patients with this and it’s tough. In your case you may want to a have a hysterogram (after the endometritis is cured) to be sure you do not have a hydrosalpinx, as this is the most common cause for fluid. You have another possible cause: endometriosis. Some women with advanced endometriosis also have adenomyosis (endometriosis of the uteris) and this can cause fluid. Definitely get treatment for your endometritis. However, most cases on biopsy are not really endometritis, it depends how quick your pathologists are to make the diagnosis. Some overdo it.
Anonymous has unexplained infertility and failed 6 months of clomid.
I would say that’s enough clomid, and you should consider FSH iui or IVF.
I agree with Christine
Beth asked about clomid for raising sperm counts.
It depends why the sperm counts are low. If his FSH is present but low, clomid may help, but that’s a really rare cause for low sperm counts. If his hormones are normal, clomid probably will not help. In fact some doctors think clomid lowers sperm counts by raising men’s estrogen levels. In any event, it’s ok to try some of these things, but don’t waste time waiting for results. Move on with your plan of action in the meantime.
Anonymous had a low progesterone and was put on clomid. So far so good. Then her luteal phase was only 10 days on clomid, and now she thinks she has not ovulated on clomid.
OK, see if you can get office monitoring on the clomid. Ask about getting an hCG shot once your follicle has reached 18-20 mm. This should straighten everything out. If monitoring shows that your cycle is not behaving properly, switch from clomid.
Anonymous is 27, but only got 3 eggs at her IVF cycle. Her doctor was overly cautious with the dose of drug.
OK, so now you know, you need more drug. It sounds like you had at least one nice embryo, so with more eggs you will get more nice embryos and have a much better chance of pregnant. I am optimistic.
Anonymous had infertility, tried clomid, and got pregnant with FSH iui. She miscarried twins at 6 weeks. She is a carrier for factor V.
It sounds like you are doing all of the right things. You just have to wait for the results of all of your tests. I hope it works out.
Mrs C was told she needed IVF because her husband had 1% morphology.
He was wrong, she was right. She got pregnant on her own.
Pam is 40, and failed 2 fresh donor cycles, with 2 good donors and nice embryos. She failed the frozen cycle and has 3 frozens left.
This could be bad luck or fair medical care. I can’t tell. You want to be sure you have had a hysterosalpingogram after your myomectomy. Make sure your doctor reads the films. After that it’s too hard to say form the blog what’s going on with you. Check the delivery rates form your clinic for DE. Most good centers are at least 50-60%.
I can’t comment on one article showing success with a strange therapy in a small number of patients. Let’s give it more time.
MiraclesdDHappen: 26 yo, trying for 7 years, 6 failed clomid.
We are all sorry to hear your still are not pregnant, but it’s time to move on. It’s either FSH iui or IVF. It can happen, it’s just going to take more work.
See you next time, and please read disclaimer 5/17/06/.
Dr. Licciardi
Why? Crinone may be a good drug for some, but in your case it does not work. Why do a biopsy when you already know this drug gives you problems? I have never done an ultrasound in the luteal phase to check the lining. Maybe your doctor is on to something, but for most of us it’s all about the lining before your progesterone(ie we check in the follicular phase). Your problem highlights the reality that progesterone in oil, as difficult as it is, gives consistent results. If vaginal progesterone is your only option, and Crinone does not work out, you can consider old fashioned progesterone suppositories.
Anonymous asked about not getting her period after lupron.
This commonly happens. You odds of pregnancy will be based on your clinic’s success rates. Remember it’s the age you were when the embryos were frozen, not your age now.
Wannabmomma has PCO and has tried 5 clomid cycles with intercourse, no luck yet. She is 26 yo.
It is almost time to move to the injections. Most of us make your limit 6 cycles, fewer if you have regular cycles on your own. But, you are only 26, so you could consider a couple more with insemination. I really think this can be up to you.
Big Childwish has a significant miscarriage problem. She has had 4 consecutive miscarriages at about 7 weeks, all with a sac but no fetal pole. All of her testing is normal. She tried the blood thinner.
I am assuming you had a hysterogram, if not you need it. I am not sure if you have had a d and c with any of the pregnancies? This would tell you about the chromosomes of the fetus, possible giving you more information about the causes of your problems. Otherwise it may depend on your age. If you are younger, your chance of a baby in your next pregnany is still over 50%. If you are older, your odds are much lower.
Katie has PCO, did an IVF cycle with 7 eggs, 5 fertilized and 2 embryos for transfer on day 3, one 4 cell and one 5 cell.
OK, there are some positive things here. I like the way your doctor was cautious stimulation, and you do make eggs and embryos. You can use the information to improve your next try. First a little more drug will be OK. You don’t need to make 30 eggs, but 15 may be better than 7. If you are at a clinic with a 26% pregnancy rate, but can travel to a clinic with a 49% pregnancy rate, I say travel. If your clinic treats 100 patients, 74 will not get pregnant. If the other clinic treats 100 patients, 51 will not get pregnant. That’s a big difference.
Alibee has a complicated history. She has a unicornuate uterus with a normal tube and 2 ovaries. She has a fairly large fibroid. She has done 5 FSH iui cycles and 1 fresh IVF cycle and 3 FETs, and maybe more more fresh IVFs?
It sounds like your fresh IVF cycles were excellent because you had so many frozen embryos. It’s hard to prognosticate your future after failing frozen cycles. They just do not work as well as the fresh. They are worth doing, but if they don’t work, it’s hard to say things are bad. Your last fresh IVF cycle yielded very nice embryos. So why no pregnancy? Can it be your uterus? Possibly. Most women with a unicornuate uterus are not infertile, but there are a few who have trouble implanting, we don’t know why. Is it just bad luck with IVF? Possibly, but why are you not getting pregnant on your own? This is going to be a case of trying again, if you wish. Should you consider a carrier? It should be a consideration, but of course even that is not a guarantee.
Emily has unexplained infertility and has started clomid. Her first try did not work. She asked about some recent press concerning a terrible article about clomid not working for unexplained infertility.
That will be another blog, but they are wrong. There have been many many studies showing clomid does work. Just remember the odds, which are 8% per try in women with regular cycles. So you are on the right track, I hope it works out.
Jen seems to be hanging in there with her endometriosis progression and pain. Keep us posted.
Anonymous is concerned because her first IVF cycle worked and her second did not. She is worried about the 8% morphology.
This is not the issue. Morphology will not lower IVF pregnancy rates. It’s common that success in the first cycle causes fear when the second cycle does not work. Stick with it. Even in the best clinics, odds are 50% for young women, meaning it’s a 50% failure rate.
Amelia’s husband has an inversion in chromosome 1, causing low sperm counts. She asked about IVF with PGD.
This all depends on what your needs are, and the advice of a counselor. Of course you need to ask about the problems associated with this inversion. Is it just a low sperm count, or are you at risk for a miscarriage or even an abnormal child? You also need to be informed about the costs and success and failure rates of doing the IVF with PGD. In addition, you need to ask about the error rate of your PGD procedure.
Singh did 2 IVF cycles. The first resulted in 10 eggs, but 8 fertilized with more than 1 sperm (polyspermy). Her second cycle she did ICSI and did not have polyspermy. She is wondering if the polyspermy means her overall egg quality is bad, leading to a failure in her second IVF cycle.
We do not know if your problem is egg related, or related to a lab issue. Since you say you had nice embryos in your second cycle, your eggs are probably fine.
EMLU has severe endometriosis. Had Twins with her first IVF cycle, but has since had 2 fresh cycles, and then a frozen cycle revealed fluid in the uterus so the cycle was cancelled. She still has fluid in her uterus and a biopsy revealed endometritis.
Fluid in the uterus is a very difficult problem. I have a few patients with this and it’s tough. In your case you may want to a have a hysterogram (after the endometritis is cured) to be sure you do not have a hydrosalpinx, as this is the most common cause for fluid. You have another possible cause: endometriosis. Some women with advanced endometriosis also have adenomyosis (endometriosis of the uteris) and this can cause fluid. Definitely get treatment for your endometritis. However, most cases on biopsy are not really endometritis, it depends how quick your pathologists are to make the diagnosis. Some overdo it.
Anonymous has unexplained infertility and failed 6 months of clomid.
I would say that’s enough clomid, and you should consider FSH iui or IVF.
I agree with Christine
Beth asked about clomid for raising sperm counts.
It depends why the sperm counts are low. If his FSH is present but low, clomid may help, but that’s a really rare cause for low sperm counts. If his hormones are normal, clomid probably will not help. In fact some doctors think clomid lowers sperm counts by raising men’s estrogen levels. In any event, it’s ok to try some of these things, but don’t waste time waiting for results. Move on with your plan of action in the meantime.
Anonymous had a low progesterone and was put on clomid. So far so good. Then her luteal phase was only 10 days on clomid, and now she thinks she has not ovulated on clomid.
OK, see if you can get office monitoring on the clomid. Ask about getting an hCG shot once your follicle has reached 18-20 mm. This should straighten everything out. If monitoring shows that your cycle is not behaving properly, switch from clomid.
Anonymous is 27, but only got 3 eggs at her IVF cycle. Her doctor was overly cautious with the dose of drug.
OK, so now you know, you need more drug. It sounds like you had at least one nice embryo, so with more eggs you will get more nice embryos and have a much better chance of pregnant. I am optimistic.
Anonymous had infertility, tried clomid, and got pregnant with FSH iui. She miscarried twins at 6 weeks. She is a carrier for factor V.
It sounds like you are doing all of the right things. You just have to wait for the results of all of your tests. I hope it works out.
Mrs C was told she needed IVF because her husband had 1% morphology.
He was wrong, she was right. She got pregnant on her own.
Pam is 40, and failed 2 fresh donor cycles, with 2 good donors and nice embryos. She failed the frozen cycle and has 3 frozens left.
This could be bad luck or fair medical care. I can’t tell. You want to be sure you have had a hysterosalpingogram after your myomectomy. Make sure your doctor reads the films. After that it’s too hard to say form the blog what’s going on with you. Check the delivery rates form your clinic for DE. Most good centers are at least 50-60%.
I can’t comment on one article showing success with a strange therapy in a small number of patients. Let’s give it more time.
MiraclesdDHappen: 26 yo, trying for 7 years, 6 failed clomid.
We are all sorry to hear your still are not pregnant, but it’s time to move on. It’s either FSH iui or IVF. It can happen, it’s just going to take more work.
See you next time, and please read disclaimer 5/17/06/.
Dr. Licciardi
posted by Dr. Licciardi at 7:38 PM
43 Comments:
Again thank you for all that you do! I had 19 eggs retrieved, 16 were mature and fertilized & we ended up with 8 blasts. All were graded high (mainly As and a couple of Bs) and all were frozen due to lining issues. We've done 3 FETs transferring 2 blasts in each and got pregnant with each. FET #1 resulted in late son. FET #2 & 3 were chemical pregnancies. 2 frosties left. I have thin linings on max estrogen and viagra. We are considering using a gestational carrier due to RPL and potential for recurrent preeclampsia. I know that RPL can be caused my embryo problems among other things. I understand that even the best looking embryos are not always chromosomally perfect. I worry about moving to surrogacy laboring under the assumption that my uterus is the problem and not the embryos. I don't want to do PGD. Any thoughts?
Hello Dr., I am 28 years old and have been diagnosed with PCOS and Stage II-III endometriosis. I have had a laparascopy in July and had the endometriosis removed as well as 4 polyps. I am currently on my 3rd IUI & gonal f cycle (dose 112.5 day 3-8, day 9-11 dose was 37.5). i have 3 mature follicles and have had a double HCG trigger today and will have 2 iuis, one tomorrow and another the day after. I have never been pregnant, and have been seeing my current doctor for 1.5 years (have been TTC naturally, but no ovulation for a year before this). I have also been on clomid (approx. 8 cycles), and now am on my last cycle of gonal f and iui, before advised to now move on to ivf. I am getting pretty frustrated and am wondering what your thoughts are on moving onto IVF and if there could be any other problems at play? Any hope that I will conceive one day?
Thank you so much for taking the time to answer my question about the miscarriages. I did had a D & C for 3 times, but they only checked the chromosomes the last time, and I don't have the testresults of that one yet. I did have a hysterogram, that was all oke. I'm 32 years old, is that younger or older ;-) Or just in between? What are my chances, you think?
thanks, i've since made an appointment for november 20th with the RE in my area.
Hi Doctor,
Hope you're well. I have 3 quick questions. I have been ttc for 6 yrs. I have done all initial tests all came back normal, i ovulate regularly, no problem whatsoever BUT...
My pap smear (1st time ever) came back as 'incomplete'- my doc explained that they found one cell and couldn't find the other and that I shouldn't worry and they'll do another test after a year... that concerns me.
Second question: I often get a burning sensation near the opening of my vagina, sometimes, numbness after sex... could that be a sign of Antisperm Antibodies? (Also I have never ever ever gotten EWCM- could that be a sole reason for infertility?)
Third question:
can either of the reasons of my infertility lie within the mysteriously abnormal pap? and the burning sensation after sex? or the absence of EWCM?
thanks for answering
Keri
Doctor- I have been reading your blog for quite some time now. I am 35 years old and a year ago was diagnosed with a uterine septum. I had a lap/hyst to correct. My RE said it was a very thin fibrous septum that extended about half way down my uterus. He thought because of the fibrous tissue it could be the reason I was not getting pregnant (as implantation could have been a problem). He removed the septum and said to wait 3 months to try to get pregnant on our own, and to come back if I was not pregnant in a few months time after that. My husband was tested and his sperm analysis came back normal. However, 3 months later I was diagnosed with thyroid cancer and had to have surgery so TTC has been on the back burner. My doctor has now cleared us to begin trying again (we have for 2 months now) but have not been successful. My cycle is and has always been 26 days on the dot and ovulation kits say I ovulate on or around days 11-13. Do you think its time to move on to other fertility treatment? I will be 36 in march. What would your next steps be? Thanks. Diana
Hi Doctor, I'm 30 years old, and went off birth control (Ortho-tricyclen) last May after being on it for 11 years. I have not had a period since. In August, I went to my obgyn to discuss, and she ran a series of hormone tests. All the bloodwork came back within normal range (e.g., no thyroid condition, no premature ovarian failure...). She then prescribed Prometrium to induce bleeding, and I had a very light flow/spotting for 3 days right after I finished the 10 day course in early September. Again, since then I have not ovulated or had any bleeding. I should note that I'm athletic, 5'3" and 110 pounds (I mention this because my mom is convinced that I should gain weight; my doctor has said she is not concerned about weight/working out being an issue). She has now scheduled an SIS (I did have Cryosurgery in 1998after an abnormal pap - mild dysplasia due to HPV which has not recurred since; all normal annuals/paps), and I have an annual pap/exam approaching. My husband is also 30, and we're both anxious to begin "trying." I also realize that this process could take some time for us. Should I seek out a RE? Ask my obgyn for a more aggressive approach? Or are we still in the beginning stages of seeing what might be the problem? It seems that a lot of women are prscribed Clomid fairly quickly, and although I appreciate my doctor's approach, I feel like I'm already hearing the clock ticking. Any advice you have would be appreciated.
Hi. Brief history: diagnosed with PCOS, had a molar pregnancy (natural) two years ago treated with two D&Cs and a course of IM methotrexate. Since then I have done 6 IUI cycles and one IVF. I have no thyroid conditions, no insulin resistance, however, my lining never gets above 7.5mm.
The IVF I did Gonal F and Lupron. 19 Follicles were retrieved, but only 10 were mature. Husband's sperm was different than baseline and they had to do ICSI when it was not planned (so eggs were injected late). Of the 10 that were injected, only 6 fertlized. For three day transfer embryos did not look good. They put back 1 4 cell grade B and 2 4 cell grade C. None made it to freeze.
My question is: is it time to get a second opinion, or does this cycle provide valuable info that makes it worth doing a second IVF with this clinic? Should I be concerned about my lining, if so, how can I thicken it?
Thanks, April
Hi Dr. Licciardi,
I'd like to ask a question based on a response posted to someone in this post... you remarked to someone that not getting your period back after lupron can happen...meaning not getting it back ever??
i'm 28 yrs old and went through 3 injections (1 per month for 3 months) of lupron for endometriosis. i'm feeling better than i have in a long time, but my period hasn't come back and my husband and I are ready to start trying. i had a lap almost a yr ago and the endo was found to be minor (even though my pain was major) and there was a clementine sized fibroid which my Dr left alone...after the surgery it became a grape size fibroid and following the lupron it's gone entirely.
My last lupron shot was almost 8 weeks ago. After using Dr Google (bad idea...) online it sounds like 12 weeks may be the norm for your period to come back but my Dr made it sound like a month after the last shot it should come back. I'm unfortunately playing phone tag with my doctor so your feedback would be greatly appreciated. I think my Dr's plan is for us to start trying on our own when the lupron wears off (hopefully soon! i never thought i'd be so desperate for my period!) and after 3 months i'd go on clomid or something to up the chances of conceiving each month...
Thoughts? Thank you in advance!
Hello Dr. I am the 28 year old anonymous 2nd post...just wanted to give you some extra information about this cycle. I eneded up ovulating 6 mature follicles and did two iuis and my husband's count was between 70 and 80 million, with 93% morphology both times. I am praying this is our BFP cycle. If this doesn't work, my dr. had advised IVF. Any insight? Or advice for the 2ww?Thank you so much for your time and advice. I greatly appreciate it. Thanks. From, DPFP (Desperately Praying For A Positive)
Hi Dr. Licciardi
Can you share what you know about whether IVF babies tend to be born early and at a lower birth weight than naturally concieved babies?
Thanks as always
Christine
Hi Dr. Licciardi,
I have a question about the timing of an IVF cycle with age.
I am 34, going to be 35 in Jan. We did one IVF back in 06, transferred 2 blasts, and I got pg with 1 baby. Yea! We are now TTC#2. We tried a FET this summer with our left over blasts from IVF#1 and it failed. So, we are looking at doing another fresh cycle. My RE had me repeat my cycle day 3 levels since it was done way back in 05. Everything was fine. My husband and I were planning on our fresh IVF for the summer (since I am a teacher and off so I wouldn't need to take off work for monitoring), but the RE suggested we not wait until summer and go ahead and do it now since my levels are good. He said that levels of women my age can change rapidly and that in the summer my levels might not be where they need to be. Do you agree? Should we go ahead and cycle now or would it be ok to wait until the summer?
Thank you!
Hello Dr. L: interested to hear your ideas abt me. 36. ttc 1 1/2 yrs. endo stage iv. lap surgery 2006. One natural conception/ miscarriage 8 weeks 2006. One healthy pregnancy ten yrs ago. FSH normal varied between 5.5-8.9, currently 5.6. AMH test very low .88.
two failed ivf cycles. poor response:
Cycle #1 (bcp, lupron, gonal f 300; menopur 150) low e2-- supplemented by estrace after transfer. 3 fertilized w icsi, only 2 embies for three day transfer, 4 & 6 cell poor quality, no success
Cycle Ivf #2: bcp, microdose lupron, 300 gonal f, 150 menopur; low response 5 eggs, 3 fertilized w icsi-day three transfer of one eight cell & one 7 cell. Low e2 1000.
Two months dietary changes, no caffeine, accupuncture
Cycle ivf #3: fsh lower 5.6; LH 44 day 2: antagonist cycle: gonal f 450 & repronex 150 for 10 days, ganilrex started day 4: better response --13 follies!!!!!!! 11 eggs retrieved, 8 ICSI; six fertilized: day 3 transferred: one 12 cell --told it was growing too fast, do not understand; one 6 cell; one 7 cell, all fair quality; other three embies discarded at 5 cells, 4 cells, 2 cells. WAITING.
Feeling down that the embies were only far. Have been told I have DOR and am a low responder/ poor responder. Not a lot of improvement in the end --on the day of transfer. If this cycle doesnt work-would it make sense to continue to work w this same protocal?
Thanks for your advice, Leila
Can you please elaborate on one of the following response you gave to someone?:
Anonymous has unexplained infertility and failed 6 months of clomid.
I would say that’s enough clomid, and you should consider FSH iui or IVF.
I em especially interested in why you recommend FSH IUI and not just natural IUI. Thanks!
Dear Doc,
Thanks for this great blog. I am 42 had FSH of 18 (I was only tested once), My IVF cyle was started a month ago. They put me on 20 units of Suprefact from day 1 of cycle for 14 days ( on day 12 E2 was at 38) before my period appeared. Then they put me on 750 units of Menogon a day plus 15 units of Lupron for 5 days of stimulation. I had only 3 eggs and they were small and on day 6 of stimulation they took me off Suprefact and the next day my IVF cycle was cancelled. The doctor said it was poor ovarian response due to age and she said there was no point in doing anymore cycles for me. I would love to hear your opinion. Is there any possibility I may have been oversuppressed at all?
I found your blog while searching for some information on what I am going through with clomid. I am 30 years old, and have one daughter, and we were able to get pregnant with her without any fertility medicine. However, we have been TTC baby #2 for 11 months now. I have always had very irregular cycles. My doctor tested my progesterone, and it ends up I wasn't ovulating on a regular basis. We are now on our second cycle of clomid (50mg). Clomid is making me ovulated; however, it has been difficult to figure out when I am ovulating becuase of the lack of cervical mucous I am having. I know this is a side effect from clomid, but my question is... Is there anything I can do to help increase my cervical mucous while on clomid. I really haven't had any other major side effects. Also, can I still get pregnant if my cervival mucous has decreased?
Thanks in advance.
Hi Dr. Licardi. I have enjoyed reading your blog. I am 32, been TTC for over 1 1/2 years. I have done 2 natural clomid cycles, 3 unsuccessful injectable/IUI's, and 1 unsuccessful IVF. My IVF cycle resulted in 9 eggs, 7 were mature, all fertilized, but we ended up with 5 embryos ranging from 2-8 cells at day 3. There was no progress between day 3 and day 4, but we transferred all 5 on day 4 anyway- the cycle failed. My doc suspected endo and did a lap which showed mild-moderate endo, some of which was on my ovaries. We are going to do another IUI cycle next month (because we're at our insurance max) and then if that doesn't work we will do another IVF in Jan. My questions is, what else can be the cause of poor embryo quality or development? I am hopeful that the lap will improve our chances, but I know it is not guaranteed and I'm just wondering if there is something else going on. My FSH was normal, BTW. Thanks.
Hi,
Thank you for having this blog. I have a question. I was recently diagnosed with stage 3-4 endo from a laparoscopy. It never bothered me on a daily basis (or even monthly!) and I didn't even notice it until my ob/gyn (who is also an RE) found it. Anyways, at my post-op "What did we find" appointment, my doctor said that he wanted to treat this aggressively. He said that DH and I should TTC right away, or we risk having problems when we do try. My other option is to go on Lupron for 9 months and then TTC.
This is where I get frustrated. DH and I aren't ready to TTC (financially and emotionally). Are these really our ONLY two options? Can't I just take BCPs for another year and use those hormones to control the endo? Why do I have to go on Lupron? The side effects freak me out and I don't like the idea of any of them. I figured since I was on BCPs for about 10 years and never noticed any type of endo pain, it should be okay for one more year.
Will the endo really grow back that quickly and will it grow back immediately to stage 3-4? I have an appointment with my ob/gyn and I'll ask him these questions too, of course. I appreciate any help you can offer.
Hi Dr.,
We have had our first FSH cycle, one insemination yesterday and the other one today, as this is the protocole of the clinic we go to. On the first day
my husband got 13 million, but on the second only 8. I put this down
to having had sex. Do you advise against it? I mean, is it preferable to be abstinent during the 24 hours between the two inseminations?
Dr. Licciardi -
My wife and just just got the first round of tests after trying to get pregnant for a year.
Ages: Me 34, her 30
No diseases, healthy eating habits, normal weight, we both exercise regularly.
We seem to have 3 factors:
1. Her HSG showed one tube blocked. They've schedule her for a laparoscopy to check it out.
2. Irregular periods. Ovulation kits have been positive quite regularly, but her cycle is close to 40 days. Our web research has shown that this may make her a good candidate for Clomid.
3. Me - "bad" morphology. I actually found your blog post on "Morphology Mythology" by googling on this word to find out what it was. I don't have the exact counts or percentages, but all other parts of the semen analysis were deemed "normal" by the clinic.
The OB/GYN has referred us to the clinic here at UNC-Chapel Hill but has already mentioned IVF. It sounds to me that this may be a bit too much too fast if I'm reading your position correctly. Thoughts?
Hi Dr Liccardi, I am SOOO happy to have found your blog. I am from Australia so some terminology may be different - any help that you could provide would be much, much appreciated!!
About me:
I am 37 years old, my hustband is 31 and has had a vasectomy which is why we started IVF in the first place. I have a bicornate uterus, one kidney and factor V leiden & am overweight with a bmi of 37.
About the IVF ICSI cycles:
We have had 4 failed cycles.
Cycle one: Long protocol (no birth control pill because of the factor V) with 220 IU Puregon (Follistim is the equivalent in the US I believe). Cycle cancelled after first US due to poor response (on giant follicle)
Cycle Two: Antagonist protocol with Orgalutran (I believe that the US equiv is Antagon), 375 IU of Puregon - 3 follicles at US, no eggs at egg pick up
Cycle Three: Antagonist protocol with Orgalutran, 450 IU Puregon(highest legal limit in Australia) - 3 follicles at US, 1 egg retrieved at pick up, fertilised and transferred day 3, negative.
Cycle Four: DHEA 20mg per day for 3 months prior. Antagonist protocol with Synarel (nafarelin acetate), 450 IU Puregon, 10 follicles at US, 6 eggs retrieved at EPU, 2 fertilised and transferred day 2 (both good quality), negative.
My husband and I are having a break from IVF until March 09 so that we can both get healthier and bring our BMI's down significantly. So my questions are:
Is there anything that you can think of that could increase our chances?
Are there any specific questions I should be asking my Fertility Specialist?
I have had very painful periods since I was young - do you see any benefit for me having a laparoscopy?
Could the factor V leiden inhibit embryo implantation?
Would it be a good idea for husband to have a vasectomy reversal?
Thanks again for such a wonderful blog!!
Dr. Licciardi, I see that someone has already asked you about your ideas on NaPro Technology, and that you responded that you have no comment on this new women's health science. As a new Practitioner of the Creighton Model System myself, I urge you to become more educated on this amazing technology which is 1 1/2 to 3 times more successful than IVF. You may want to read the newly published medical research article from Dr. Phil Boyle's clinic in Galway (statistics that are even more astounding considering that surgical intervention was not available during this research, and more than half of the patients involved had already tried and failed IVF).
Here is the article online:
http://www.jabfm.org/cgi/content/full/21/5/375?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=Outcomes%2C+NaPro&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT
The success of NaPro Technology cannot be ignored! Infertility and recurrent miscarriage, as you know, has become more and more prevalent in our society- - we professionals of fertility care should work together to promote the very best HEALTH solutions to these problems. Thank you for doing your part to help infertile couples.
Dr. Licciardi, I am 29 years old, in a lesbian relationship and on my 13th try over a 2 year period. I've been given the dreaded "unexplained infertility" diagnosis!!!
Cycles 1-5 we used a known donor and did ici's at home with fresh sperm. Cycles 6-9 we did ici's at home with frozen sperm. Cycles 10-12 we moved to IUI's at the RE's office with frozen sperm. During that time I was on Clomid 50mg (x3 cycles. 2 ici's, 1 iui).
I've had a hsg, b/w, u/s, etc which all came back "great", "fine", "excellent" all of those wonderful words. However, during my testing cycle with the RE I had an u/s that showed a "collapsed" follie with fluid on the day of a +opk and some smaller ones. My doctor ruled out PCOS but said I have PCO.
This cycle, I was given gonal f dosed at 75. I had an u/s today on cd 8 which showed only one dominant follicle measuring 10mm on my right side and some smaller ones. I was told to continue at 75 and return on cd 11. I must admit I was really disappointed in only one dominant follie. I expected more, ironically fearing I would end up with too many have the cycle cancelled. My question is if I only produced 1 dominant follie on injectables do you think this means that I wasn't producing any without meds or even on the clomid? I'm just trying to make sense of all of this. Thanks.
Lisa
what do you think about the protocol involving doing a biopsy the month before an IVF in order to promote a healthier lining?
Hi Doctor L- thanks for the blog. I am almost 31 and have gone thru 2 rounds of IVF. #1 in June was the regular Lupron protocol. 9 eggs retrieved, 6 mature, 4 fertilized, only 1 made it to 3 day transfer, 7 cell, negative outcome.
Diagnosis: Poor eggs and low ovarian reserve
IVF #2 in September: Antagon protocol. 6 eggs retrieved, 5 mature, 4 fertilized, transfered 3 on day 3- 2 perfect 8 cells and 1 small 5 cell. Result: positive
Good rising betas, u/s showed sac w/ a yolk sac at 5w3d.
u/s yesterday (6 days past u/s #1) showed no growth- miscarriage.
My RE has no explanation for my poor eggs and seems hesitant to do further testing. I go to a very reputable clinic in Chicago. Perhaps they are not equipped for further testing.
I know of an RE in the area that specializes in testing as well as recurrent miscarriage. In my opinion, there has to be a reason for my bad eggs. Do you think it's wise to get a 2nd opinion and possibly switch clinics? My RE said next cycle (January) we'll do a microdose Lupron Flare protocol. Is that a good protocol for me?
Any advice is appreciated. thanks!
~Kate
Thank you for your blog---I've gotten some really good information here. I, too, have a question though.
My husband has severe MFI. He(42)has had two dismal SAs, last one showed a volume 1.8ml, conc. of 0.2mi/ml, 1% morph, 22% mot. We are obviously planning for IVF/ICSI with our RE in the Spring. (I'm 31and all my tests have been good).
His urologist called me yesterday and said he could check for some blockages or retrograde ejaculation, but didn't believe he would find anything. He also said we could try empiric Clomid, but that it wasn't likely to help as his FSH was normal and testosterone was only mildly low. Chromosomal tests have all been normal.
I would like your opinion, but it is mine that there is nothing that could raise his sperm counts high enough to help us and we should just proceed to ICSI and forget the additional uro testing, as no abnormalities have been found thus far.
This has been my REs opinion as well, but of course he stands to gain considerably from that approach so I just wanted to be sure we are on the right track.
Thank you.
Hi Doc -
I just need a shot of perspective. I am 40, FSH ranges between 10 and 14 - mostly 11-12 in the last 2 years we've been TTC. Early this year I tried IVF twice and both cycles were converted to IUI. Both cycles were MDL protocol with no BCP's prior to the cycle. Both times I had low antral follicle count (2-4) but had 8 follicles develop in the first week of stims. In each case, by 7-8 days into the stims, two follicles had gotten to maturity necessitating converstion of the cycles. I had no confidence in the clinic, so switched to a very good clinic in SF, CA.
At that clinic, I had one IVF cycle in August on estrogen priming. The doctor didn't do an antral follicle count - said it wasn't relevant since we were throwing the kitchen sink at it by using an aggressive protocol. I had 8 or 9 follicles develop with 10 eggs retrieved, 7 mature, 5 fert, after pgd, 2 normals. Embryos were not great quality. The cycle failed.
A few weeks ago, I had an AFC which was 3 or 4 and a test for AMH which came in at 0.35 which I understand is embarrassingly low and would suggest packing it in on my eggs. These are my questions:
Is 10 eggs a poor result?
If it isn't, then how this outcome jib with the low AMH/high FSH/low AFC - are these pieces of data consistent or at odds?
I'm trying to decide whether to take one more hack at it with another cycle and can't tell if my fertility just dropped off the cliff in the last month or if it might be worth another try.
Thanks!!
Hi. I know you are not a big fan of PGD but I wondered if you thought it might be apppropriate in my case. I am 34 and have been TTC since April 07. I had a chem pg in July 07 and started ART in Feb 08. In August 08 I did FSH IUI and miscarried twins at 6wks. Had lap in Sept and I had mild to moderate endo, 90% of which was removed. Tried again this past month and now have a beta of 108 and a progesterone level of 4, and my doctor tells me this is not viable. I am being monitored for an ectopic. When I start up again, is IVF with PGD a reasonable next step? (I also want to do testing for recurrent pregnancy loss). I don't care about the money for the PGD, I just don't want any more miscarriages! But I don't want to do PGD if it could damage embryos and not improve my chance of success.
Hi, I'm Kacy. If you would be willing to answer another question I have one. I have been reading your blog but have never left a comment until now. I am almost 27, I have never had regular menses and the most regular I have ever been is on the birth control pill. Even then I only have about 8 menses a year. Since we were trying to get pregnant I stopped the pill and my periods stopped completely. This was about a year ago. My doctor put me on progesterone and clomid. We tried that for four cycles and I tested for LH levels and nothing was ever detected. I changed doctors and she put me on metformin. Can you speak to the advantages or disadvantages of metformin? And how long should I try that until we go to the next step? My husband hasn't gone yet but he is scheduled for a semen analysis.
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Thank you for sharing all of your wisdom with everyone. I did IVF#1 at 27 yrs old, retrieved 5 eggs, 4 fertilized w/ICSI, 3 transferred, pg with twins, lost one at 7ish weeks and now have a healthy son. IVF#2 and #3 (at age 30 and 31) both yielded about 8 eggs, 5 fertilized w/ICSI, transferred 4 and 3, both negative. IVF#4 (32 y.o.) we got 12 eggs, 100% fertilization w/ICSI, transferred 3 blasts on d5 and got pg with twins. M/C at 6w6d. DH has varicocele that was repaired in 02, but still has low count and low morph. Should we try IUI or do you think that would be a waste of money? We are trying IVF again in January and I know I should be positive because we've had 50% success rate out of the 4 we've done, but I'm having such a hard time. Any suggestions? Thank you again.
Kahla
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Thank you for your blog. I am 36 years old with PCOS. I also had a hot nodule on my thyroid that was treated with radioactive iodine in August. However, my mother just found out she has the BRCA1 breast cancer gene (she had two breast cancers - one at age 31 and the second at age 43). My RE thinks Clomid will be the way to go when I'm ready which is after my endo gives the go ahead that my thryoid is ok (probably looking at February timeframe). My Mom's oncologist is concerned with me taking Clomid because of a possible link to breast cancer. (I have not been tested for the gene yet.) What is your opinion? Is there another alternative?
Hi Doctor, thank you for your great blog!
We have been trying for 6 years, I'm 36.
History:
a)1st miscarriage March 05 - 11wks, baby was always 2 weeks behind and no heart beat. D&C.
b)1st Lap and hysteroscopy Oct 05 Revealed 2 large Fibroids on top of my uterus pushing the tubes away.
c)1st Laparotomy Apr 06, fibroids removed, right tube possibly damaged.
d) 2nd miscarriage Oct 06, 9wks , baby was two weeks behind, never had a heartbeat. D&C.
e) 2nd Laparoscopy May 07, one Adenomyome removed inside uterus.
f) 3rd miscarriage Aug 07. No D&C
g) New clinic, HSG revealed scar tissue inside uterus, right tube blocked and 1 adenomyome. All bloods normal, chromosomes and genetics tested, normal.
h) 2nd Laparomtomy and hysteroscopy Aug 08, scar tissue, 1 x fibroid, 1 x adenomyome and 1 x polyp removed.
g) 2nd Hsg revealed right tube still blocked and scar tissue still present.
I ovulate every month and my cycles are normal.
Now my questions:
1) I'm going in for another hysteroscopy on Tue to remove the scar tissue. If this does not work is surrogacy and adoption my only options?
2) Is miscarriage a guarantee should I fall pregnant?
3) if pregnancy is achieved and I get past the 1st trimester, do I run the risk of a 2nd or 3rd term loss or even still birth or ruptured uterus?
4) Would yo recommend more procedures to try and remove the scar tissue until it is gone?
Thank you so much for your time and dedication to all our questions, it is so refreshing to have someone qualified to answer all our questions.
hi. thanks for this blog. i have a question. i just found out that i have a unicornuate uterus. my doctor said that my left tube was open and clear and that i would be able to conceive on my own but it may take a little longer. what are your thoughts on a UU?
Thank you for your time and energy with this site. I'll be brief. I'm 38. My husband and I did IVF/ICSI in August, when I was 37. I have an FSH level of 4 and walked around for a month with a gut full of swollen follicles, nearly hyperstimulated. I made 33 eggs. We transferred one fresh embryo, but it did not result in a pregnancy. We did, however, freeze 12 embryos. Three of them are of Aplus quality, the rest are sort of medium quality.
Now, here is my question: For a number of reasons, we need to wait until December 09 to transfer our frozen embryos. I will be 39 then. Will it make a difference to wait?
Your feedback is greatly appreciated...
Hi doctor, this is my second post, I'm the 30 year old who went off birth control (Ortho-tricyclen) last May after being on it for 11 years. I had my saline infused sonography today, and everything looked normal (uterine cavity, ovaries, fallopian tubes). I'm going in for a follow-up and next steps in two weeks. Also, since I last posted, I've gained 5 or so pounds, and reduced my physical activity. If you have any advice or thoughts on my situation, I'd appreciate it.
This blog is such a helpful tool to so many of us. Thank you.
I'd like your advice on my current situation:
TTC 2 years (not one positive pregnancy test)
ME: 33
Clockwork Normal Cycles (27-28 day, with ovulation on either CD13 or 14). Had complete hormone b/w and all results normal. Had HSG - again normal.
HUSBAND: 45
Abnormal SA
Count: 209mil
0% A
15% B
4% C
81% D
Morphology very poor.
We have our first meeting with RE in two weeks. Can you tell me if you would reccommend IUI or IVF/ICSI? My gut says to put all my chips in and go with ICF/ICSI given I'm pretty sure my egg quality is good and the fact that he has almost no motile sperm.
I'd love to hear your thoughts.
Thanks again.
I'm amazed by yr dedication to answering the questions posted here, i wish my doctor would do even half (or just 1/4) of what u are doing.
I am on second fresh ivf and am on lucrin 10 units for the past 15 days(lupron), and have just been told that i have to extend the jabs for another 11 days before i can start on puregon.
some nagging questions i have which i have asked but did not get a response from my doctor, and i hope you can help.
1) is there a fixed level that my estradiol level shd be to be considered suppressed?
2) there was no baseline test before starting on lucrin, nor will there be another test before starting puregon, so how do they know that i will be sufficiently suppressed then?
3) how do they come out with 11 days of extension? why not 7 days or 14 days...why 11? it looks pretty random to me. perhaps you can shed some light?
4) does a longer lurcin protocol affect the lining of the womb and will that affect the chances of successful implantation?
5) one other totally unrelated qn - does having fibromyaglia worsen the side effects of lucrin..personally i feel that that my bones hurt a lot more - but i was told that i am imagining it...and does having FM reduce the success of IVF?
Would be really pleased if you can help alleviate some of my worries. thanks so very much in advance.
Hello, I am (just turned) 38 years old. My husband (32 years old) and I have been trying since 5/06. We had all of our testing done in 4/07 - including an HSG - by the same facility I am going to now. We know that my husband has problems trying when I am ovulating - so timing is an issue - and that his motility and morphology are not the best (1/07 Vol 1.5, total count=71,motility=53%,morphology=normal 5%). Due to unhappiness with the doctor we were using, we didn't try any treatments and just tried naturally. Then in June of this year we tried a different doctor's clinic and Clomid/IUI. I had one good egg at 24mm and a smaller one at 10mm. DH's morphology, motility, and count at the IUI were considered perfect - no problems. The IUI didn't work. Then my cycle went crazy even though I've had perfect 24 day cycles for over 2 years (not getting it, getting it too soon) and I wasn't impressed with how the doctor ignored it. I went back to the original clinic, but switched doctors in the office. So in August the new doctor suggested we redo the HSG and have monthly FSH/E2 tests. My FSH and Estradiol tests are now up and down every month (7/08 FSH=33.7, E2=46.5, 3 follicles; 8/08 FSH=7.28, E2=110, 6 follicles). He wants to try natural IUIs (since I didn't respond well to Clomid), but after the repeated HSG. I am obvioulsy worried that my ovarian reserve is diminishing and my insurance doesn't cover IVF or very much for that matter. Would it be wrong for me to insist on not having the HSG repeated - since the first one showed nothing and I haven't had any pain or changes since, but rather save my money for a different protocol? Other than repeating the semen analysis and my FSH, E2, U/S tests - is there another test that should be done for someone who has experienced NO pelvic pain or problems other than the obvious less than stellar FSH/E2 results? Am I wasting my time and money with a natural IUI? I like this doctor, but am embarrassed that we can't just spend as much money as needed to pay for all of the testing and IUI/IVF attempts. Your blog provides so much information, I was hoping you could lean me in a more positive direction. Thank you!
Hi there, I'm 40 years old and single, I did 10 AI with one donor when I was 38 with no success, since then I have done 5 IVF cycles with 2 different donors. I got pregnant twice during the first cycle. The first cycle was long protocol and then the next 3 cycles were short protocol with only 1 viable embryo transferred each cycle. The 5th cycle we went back to long protocol and got three embryos, I had one unsuccessful transfer then I've just completed the second unsuccessful transfer with the final two embryos. There has been talk about egg donors, but I really want to know if there is still a chance for me to use my own eggs?
Does anyone know how PGD works in conjunction with MicroSort (www.microsort.com)?
Hi Dr,
I just went for a clomid IUI cycle, and semen analysis showed 2%morphology, 92% head piece defects and 6% mid piece defects. Motile sperm was 18.86mill in 250ml. Does this mean that only 2% of 18.86 mil sperm is "normal"?? Grateful for your views.
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