Back to More Fertility Questions
There will be 1-2 more for the blastocyst, but I will answer a few questions first.
Sorry, some of these questions were asked a while ago and my responses may be a little late if immediate action was necessary. I will still answer many of them hoping the answers will help others. If I skip your question, it does not mean it’s a bad one, it just means I cannot comment, or I just don’t have anything additional that will help.
There are a number of women who have tough stories about failing many IVF cycles and being faced with the donor egg decision. I always feel I want to recognize the problem by commenting, but my responses have been similar. Usually, it’s just up to you. The boring answer is get tot the best clinic possible and weigh your options. If I see anyone who I think is getting pushed to donor egg too soon I’ll comment.
Jennifer was discouraged because on clomid she found it difficult to time her intercourse because the cervical mucus remained thicker.
You should use a different method of checking for ovulation, namely the ovulation predictor kits. Clomid does make the mucus thicker, but not in some and partially in others. You can get pregnant if the mucus is thicker, but it depends how thick. This is another reason to consider insemination in order to remove the mucus from the equation.
Muriah had septum surgery but the HSG post op showed some septum remained. Why?
This is more common when the septum is very large. With a large septum, there is quite a bit of cutting. Of course we don’t want to cut too much, so at the top it may look like a dramatic improvement, but in reality, a little more should have been cut away. It is also possible that the doctor saw that there was a little left, but felt he had cut enough, but did not. It is also possible that as the uterus healed, it scarred a little at the top, making it look like the septum remained, when in fact it was cut properly but did not heal well. In any event, when I have a patient with a large septum, I do say that a second procedure may be necessary, although it has not been necessary in years.
It is also possible that there is a little left, but it’s not clinically significant. This is very common. I sometimes see a bit left and I say it’s not enough to worry about.
Jamie has spotting being treated with progesterone.
Just make sure your uterus is normal. Make sure you have a thorough ultrasound and HSG, and maybe a sonohysterogram, to be sure there are no polyps or fibroids. Some women need a biopsy. Otherwise, some women spot for unknown reasons and progesterone, sometimes with estrogen, fixes the problem.
Ruby’s husband has anti-sperm antibodies. I do not think this means anything.
KSNYC makes a few follicles but only makes 2 eggs Why? We do not know. If you had only done 1 cycle, we could say it’s just one of those things, try again. But after 4 cycles with varying protocols, and consistent results, well, that’s how you behave. I would say that at age 34, you should not give up yet.
Ronni is 40, makes nice eggs and embryos, has severe male factor, and is being told to do DE after 3 failed cycles. She is being told it’s an “egg issue”.
It’s up to you. Of course your problem is an egg issue, but you eggs can still give you a chance. I am going to guess that your odds are 15-25% with your eggs. You may want to consider traveling farther for a better clinic.
Amanda was on clomid, and injections are being suggested but is worried about multiples/hyperstimulation. Yes minimal stimulation is the way to go. We use anywhere from 37.5 -75 units.
Katrina’s husband has zero morphology. There is not much that can improve morphology. Spotting may or may not be a problem. See the post above.
Flycat is Catholic and does not want IVF or IUI. My suggestion is for you to speak to your priest/pastor. You never know, they may be more permissive and sympathetic than you think.
Helen has a bleeding cervix. You are right, cautery or freezing may scar the cervix. Get another opinion.
Lazarus is 41 and has failed a few cycles. Her doctor does not want to use the estrogen pirme. I say why not? It may or may not help, you just need to see.
Mina is 33 and was told she is in premature ovarian failure. You need to repeat the FSH and estrogen levels every 6 months, and least for a while. Sometimes things get better. However odds are the numbers are accurate and your doctor is correct.
Tracylayne’s husband has a translocation and 6 sperm. It seems that your advice is accurate. We do not know with certainty about odds of pregnancy and miscarriage.
Rehab nurse is considering reversing her tubal ligation. You are right in that you need to get to the right doctor, but it is hard to know who that person is. Some states have insurance companies that cover the procedure so doctors there have more experience because they do more. It’s the balance between reversing the tubes and just doing IVF. Some women prefer the IVF because they can still have contraception after the baby is born. The operation may cost more than one IVF cycle, however it may take more than one IVF cycle to get pregnant.
Chris has severe endometriosis. She has done 2 retrievals , makes a good egg number and has nice embryos. She has also done frozens.
Make sure you don’t have a hydrosalpinx (blocked swollen tube). Assuming you do not, it may just be a matter of trying again. Your history does sound like there are many positives that can work in your favor.
Karen has triplets and the new fertility clinic is criticizing her for wanting another baby. Go elsewhere, their attitude is not appropriate.
Heather wants to know if she should do back to back iuis. It probably is not necessary, providing the timing of the one iui is proper. If there is a question about the timing, use the 2.
The Kinsleys had a nice fresh cycle that failed and are worried that their frozen cycle will fail too.
There is not much to worry about. If they thought the embryos were good enough to freeze, they are probably more than good enough. This is one of the main reasons we freeze, if the fresh fails, you have the backup. It can work.
Curley wants to know if poor sperm can cause embryo quality issues. This is tough one. Usually not. However, I have seen a few cases along the way. The big problem is how to find out. If you make 20 eggs, you can feel better about splitting the eggs and using 2 sperm sources. If you have make 4 mature eggs, the experiment may not give you the answers you need. Most of my patients will try a few IVF cycles first, and then be forced to make a decision. May do not opt for the husband/donor split.
Sorry, some of these questions were asked a while ago and my responses may be a little late if immediate action was necessary. I will still answer many of them hoping the answers will help others. If I skip your question, it does not mean it’s a bad one, it just means I cannot comment, or I just don’t have anything additional that will help.
There are a number of women who have tough stories about failing many IVF cycles and being faced with the donor egg decision. I always feel I want to recognize the problem by commenting, but my responses have been similar. Usually, it’s just up to you. The boring answer is get tot the best clinic possible and weigh your options. If I see anyone who I think is getting pushed to donor egg too soon I’ll comment.
Jennifer was discouraged because on clomid she found it difficult to time her intercourse because the cervical mucus remained thicker.
You should use a different method of checking for ovulation, namely the ovulation predictor kits. Clomid does make the mucus thicker, but not in some and partially in others. You can get pregnant if the mucus is thicker, but it depends how thick. This is another reason to consider insemination in order to remove the mucus from the equation.
Muriah had septum surgery but the HSG post op showed some septum remained. Why?
This is more common when the septum is very large. With a large septum, there is quite a bit of cutting. Of course we don’t want to cut too much, so at the top it may look like a dramatic improvement, but in reality, a little more should have been cut away. It is also possible that the doctor saw that there was a little left, but felt he had cut enough, but did not. It is also possible that as the uterus healed, it scarred a little at the top, making it look like the septum remained, when in fact it was cut properly but did not heal well. In any event, when I have a patient with a large septum, I do say that a second procedure may be necessary, although it has not been necessary in years.
It is also possible that there is a little left, but it’s not clinically significant. This is very common. I sometimes see a bit left and I say it’s not enough to worry about.
Jamie has spotting being treated with progesterone.
Just make sure your uterus is normal. Make sure you have a thorough ultrasound and HSG, and maybe a sonohysterogram, to be sure there are no polyps or fibroids. Some women need a biopsy. Otherwise, some women spot for unknown reasons and progesterone, sometimes with estrogen, fixes the problem.
Ruby’s husband has anti-sperm antibodies. I do not think this means anything.
KSNYC makes a few follicles but only makes 2 eggs Why? We do not know. If you had only done 1 cycle, we could say it’s just one of those things, try again. But after 4 cycles with varying protocols, and consistent results, well, that’s how you behave. I would say that at age 34, you should not give up yet.
Ronni is 40, makes nice eggs and embryos, has severe male factor, and is being told to do DE after 3 failed cycles. She is being told it’s an “egg issue”.
It’s up to you. Of course your problem is an egg issue, but you eggs can still give you a chance. I am going to guess that your odds are 15-25% with your eggs. You may want to consider traveling farther for a better clinic.
Amanda was on clomid, and injections are being suggested but is worried about multiples/hyperstimulation. Yes minimal stimulation is the way to go. We use anywhere from 37.5 -75 units.
Katrina’s husband has zero morphology. There is not much that can improve morphology. Spotting may or may not be a problem. See the post above.
Flycat is Catholic and does not want IVF or IUI. My suggestion is for you to speak to your priest/pastor. You never know, they may be more permissive and sympathetic than you think.
Helen has a bleeding cervix. You are right, cautery or freezing may scar the cervix. Get another opinion.
Lazarus is 41 and has failed a few cycles. Her doctor does not want to use the estrogen pirme. I say why not? It may or may not help, you just need to see.
Mina is 33 and was told she is in premature ovarian failure. You need to repeat the FSH and estrogen levels every 6 months, and least for a while. Sometimes things get better. However odds are the numbers are accurate and your doctor is correct.
Tracylayne’s husband has a translocation and 6 sperm. It seems that your advice is accurate. We do not know with certainty about odds of pregnancy and miscarriage.
Rehab nurse is considering reversing her tubal ligation. You are right in that you need to get to the right doctor, but it is hard to know who that person is. Some states have insurance companies that cover the procedure so doctors there have more experience because they do more. It’s the balance between reversing the tubes and just doing IVF. Some women prefer the IVF because they can still have contraception after the baby is born. The operation may cost more than one IVF cycle, however it may take more than one IVF cycle to get pregnant.
Chris has severe endometriosis. She has done 2 retrievals , makes a good egg number and has nice embryos. She has also done frozens.
Make sure you don’t have a hydrosalpinx (blocked swollen tube). Assuming you do not, it may just be a matter of trying again. Your history does sound like there are many positives that can work in your favor.
Karen has triplets and the new fertility clinic is criticizing her for wanting another baby. Go elsewhere, their attitude is not appropriate.
Heather wants to know if she should do back to back iuis. It probably is not necessary, providing the timing of the one iui is proper. If there is a question about the timing, use the 2.
The Kinsleys had a nice fresh cycle that failed and are worried that their frozen cycle will fail too.
There is not much to worry about. If they thought the embryos were good enough to freeze, they are probably more than good enough. This is one of the main reasons we freeze, if the fresh fails, you have the backup. It can work.
Curley wants to know if poor sperm can cause embryo quality issues. This is tough one. Usually not. However, I have seen a few cases along the way. The big problem is how to find out. If you make 20 eggs, you can feel better about splitting the eggs and using 2 sperm sources. If you have make 4 mature eggs, the experiment may not give you the answers you need. Most of my patients will try a few IVF cycles first, and then be forced to make a decision. May do not opt for the husband/donor split.
posted by Dr. Licciardi at 6:29 PM
32 Comments:
Thanks for taking time to do this blog. I have just finished my 3rd failed Fresh IVF. I am 36 with poor ovarian reserve (CCT - 3day FSH 7, 10day FSH 16) and Husband is 29 with "severe antisperm antibodies (95% bound) poor count, motility and progresive velocity.
The first IVF, microdose lupron with menopur and bravelle produced 8 eggs, 4 mature only one fertilized (ICSI/AH) 1 day late = BFN. IVF 2 was a lupron cycle with bravelle and menpour, we got 18 eggs, 9 mature and only 2 fertilized (ICSI/AH), 1 8cell(a) and 1 6cell(b) =BFN. IVF # 3 was antagonist protocol with menopur and bravelle resulting in 14 eggs, 7 mature and 4 fertilized (ICSI/AH), 2 10 cell (1a and 1b), 1 8cell (a) and 1 5 cell (c) = BFN.
My RE keeps saying it's my husbands sperm and that we should be considering donor sperm (at least a split cycle) but from everything I've read antisperm antibodies should not be a problem with ICSI. Is it just my age and egg quality or is it both and we should move on to donor? The embryologist felt that there were usable sperm.
Any advice is appreciated. I go to a very reputable and successful clinic near Phila but am considering a second opinion but I would have to travel b/c the other clinics in Phila area are not any better (by SART ratings).
Jennifer C.
My husband had a semen analysis done a year ago for something unrelated to fertility, and his morphology was 4% on the strict krueger method. A year later, he had another semen analysis done, this time for infertility diagnosis, and it said his morphology was 0% normal.
My RE doesn't seem concerned about this at all, and doesn't even seem to believe that morphology is an issue when trying to conceive. RE has us doing IUI. Is this the route to go? I've heard conflicting reports that with 0% normal morphology one should go right to IVF.
Thank you.
Hello Again!!
I've been TTC for 4+yrs and have had 5 m/c's. I just started seeing an RE 1/2008 after my 5th m/c with my GYN. My GYN gave me false hope that my m/c's were caused by my Endometriosis that was removed during a lap/hysteroscopic procedure 7/2007.
The RE did an RPL, found FVL & MTHFR, both heterozygous. After many failed C's (not even 1 BFP) stimulating O with Follistim/Femara Combo's and getting 1-2 follies, my AF pain began to worsen and my bleeding became heavier w/excessive clotting. The low dose protocol (37.5iu's or CD 9&10 75iu's), have helped my lining tremedously, but are not helping to induce O any sooner than CD19/20. Last month my RE suggested we do another lap/hysterscopic procedure w/D&C. I just went in for my pre-opt today and I was told that I'll have 4 incisions. My last lap, I only had 1 incision. Can you tell me what benefit the RE might have from a lap using 4 incisions? How soon after the lap can we proceed with an IUI C? My lap is scheduled for 2/23/09.
Thank you for this blog. The information you provide has really helped. I'm hoping you could comment on my situation:
I am 28, have scaring in my left tube from a previous ectopic, and in my most recent laproscopy, the doctor said my right tube was completely scarred shut. The doctor said he cut off the "hand" of my tube. I also have PCOS. The doctor told me to call him when we were thinking about IVF.
A few questions:
1. Is it worth it to continue trying with clomid or femera until our turn for IVF comes in six months?
2. What are my chances for IVF working at 28, assuming there are no other issues than stated above?
3. A clinic we are considering travelling to posts rates of 60% pregnancy rate for under 35s. Is that possible? Our local clinic posts 40%, which is supposed to be about average for Canada.
Thank you for reading my questions! :)
Hello,
Long time reader first time poster. I became pregnant in Sept 08 with IVF and donor eggs from my younger sister. I became pregnant with twins (after 5 day xfer of 2 blasts) I am 25 going on 26, my husband is 25 and sister is 23. I recently was forced to deliver the twins @ 22 weeks gestation due to severe HELLP syndrome, they did not make it. We however miss our boys dearly but we are also looking to do a FET end of this year. My question is..we have 7 embryos frozen using the same donor and male partner...what are my chances of developing HELLP again if any?
Thank you,
Courtney
I had HELLP too. It is very hard. Go to
http://www.preeclampsia.org/
for tons of info.
Hi Dr. L, tahnks again for your blog, it's very helpful.
I am 31 in IVF #3 currently. IVF #1, regular Lupron protocol, 9 eggs, 6 mature, 4 fertilized, 1 transfered BFN. #2, Antagon protocol, 6 eggs 5 mature, 4 fert, 2 transfered, BFP ended in m/c at 6 weeks. Diagnosis: poor egg quality and low ovarian reserve
NOW: New clinic w/ doc that specializes in further testing and m/c. Protocol: BCP, 10 units of lupron for several days, 125mg cetrotide, adding in 750 IU Follistim, plus 1 vial menopur EOD. As of day 4, I had very few mesaurable follies w/ e2 levels of 20. After 8 days of stims, only 4 mesaurable follies total- multiple smaller ones. I asked my doc to up my menopur b/c when my last doc did that, my follies grew and my e2 levels jumpped. She did not want to do that.
I feel like i'm over suppressed, should not have been on BCP, should not hve had lupron and should have started the cetrotide after i started the FSH.
What do you think? Any advice is appreciated. Thanks much!
-Kate
I am 30 with grade III endometriosis. I had laparascopy in 9/08. HSG normal, husband with severe male factor, motility 8%. 1st IVF in 1/09 lupron long protocol w/ gonal-f. E2 went to 4000 on cycle day 11, coasted for 3 days, used ovidrel trigger. About 7-8 follicles seen, only 1 egg retreived. Day 3 transfer of a slightly fragmented 7 cell, BFN. Why do you think there was only one egg. What can be done to improve this?
Oh I was so sad to see you didn't address my question. But I am still going to keep on reading and looking for pearls that can help with my next step/decision making
DAVS/ADD in TX
Can you post a pic of a u/s follicle check with the use of FSH? My tech is not allowed to turn the screen or tell me what she sees. I get a call later in the afternoon to tell me the results so I never get to see what's going on. thanks, Lisa
Thank you very much for responding to my question. I think you're selflessly providing a wonderful service to couples who are likely facing some of their most difficult challenges. Thank you again! ~Ronni
Thanks for taking the time to do this blog and answer questions!
And you were right...b2b IUI's was not necessary as I am now finally pregnant!! It took 4 IUI cycles and 2 years but we are now finally pregnant!
Good luck to everyone!
This is a great blog. I have learned so much already just reading through!
I had a tubal reversal in 2004 and had onlt one tube that was repaired. I got pregnant but miscarried very early repeatedly. HAd 2 HSG's that showed a wide open tube, and then one in 2006 that showed a proximal occlusion suddenly. WE figured it was over for us. To our great surprise we got pregnant 2 months later (confirmed by beta at 60)and miscarried right away. Got pregnant again a few months later (HCG 126 when tested) and miscarried almost right away again.
Two RE's have now told me they believe my tube is blocked and all these pregancies are "in the tube". a total of 6 ectopics and none hve caused major problems and resolved themselves? Seems odd to me. If mt tube is blocked , hos did I get pregnant?
So do you think that tube is open? Would you recommend anything like a laparoscopy? No endometriosis was seen when I had my reversal.
I am just confused I guess.
Do you perform assisted hatching? Curious as to what one of the best REs/IVF clinics in the world does or if believes AH is worthwhile or even makes a difference.
Thanks!
Hi Dr. Licciardi-
I have a quick question for you: What is the advantage to adding more LH (Menopur) in a cycle? My first IVF cycle, I was on pure FSH (Bravelle) and did not produce many good quality eggs. I did much better the second IVF with Menopur added. Your thoughts??
Just wonder if you have a view on how critical the timing of egg collection is - do you think it is important to find a clinic that does this seven days a week?
Thank you so much for your generosity in keeping up this blog and answering all our questions with such care.
My question is this. We have gone through two fresh cycles of IVF (the first left none to freeze, the second, one gorgeous blast). Our second cycle was successful and we now have a one year old son. We're very fortunate.
With both of my cycles I had what my RE called VERY difficult retrievals. Though I produced 19-22 follicles, only 10-13 were retrieved because they just would not budge. Have you ever encountered this? We are preparing for our third IVF cycle for a second child and I thought I would try to find out anything I can about difficult retrievals.
Also, do you think it's worth doing an FET with just one frozen blast? I worry that we would get to transfer day and it would not survive the thaw. Also, with our second IVF, we transferred four day three embryos and had a singleton so I wonder if just one blast is enough to get me pregnant.
Thanks for your time and thoughtful replies to everyone.
Hi.
I have one question regarding progesterone intake after having IVF.
I have read the answers you have given before on the subject (as to why during an IVF you may have a lower progesterone production), and my question was how long you should take it. I have just been through an IVF procedure and I am now waiting to take a blood sample to check wether it succeded or not. I am taking progesterone, and I would like to know how long I should keep on taking it (if by next week they see that I am pregnant). I know someone who did the same and was told to take it during the first 3 months of pregnancy. The place I am doing it just mention the first 14 days (the ones until you take the referred blood sample).... What is the recomemded time?
Thank you
I had an imperforate hymen and as a result had to have a procedure done (forgot the term) when I was 16 to correct this. I know that "condition" is linked to endometriosis, which I also have. Last year I had my first laparoscopic procedure which showed I had it in quite a few places. I did Lupron therapy from May-September last year. (That was rough!) Typically, how long does it take before the endo. comes back? My most major symptom was pain during sex and spotting. I haven't had either one since. I know there's no cure, but I just am curious how much longer I may have before it comes back? (My tubes have not been affected.)
I also have a mild case of pcos and take 500mg Metformin daily. I have seen a difference with it.
And lastly, I have had my cervix cauterized (silver nitrate) due to bleeding. This was done 3 years ago, and have not heard any doctor say anything about it looking abnormal. Is scarring visible? Will this cause any potential problems?
Thank you very much for all that you do!
Hi there Dr, thank you so much for replying to my comment. But I did get pregnant and with twins!My first RE had my FSH results mixed with someone elses or so it seems. When she told me I had no option and that I will never be pregnant my world just collapsed. But thankfully I didnt give up and went to a different RE. I did my first IVF, and here I am, pregnant with twins. Just saw their tiny HBs 2 days ago. Mistakes do and can happen. I just think its sad for Dr's to give up that easily on patients and not try to find a solution.
Thanks again for the wonderful blog!
I refer to your comment regarding being pushed into donor egg too soon.
I am 29, PCOS, AMH = 2.7, FSH (Day 3) = 8.0. 4 Failed cycles, 1 m/c. My RE says it may be a genetic issue and/or egg quality issue due to PCOS. He is suggesting DE, which we are prepared to try. Have you seen any cases of PCOS patients going for DE as young as 29? Your thoughts please.
Dr. L - your blog is outstanding! Thank you so much for taking the time to explain everything and answer questions. Having a better understanding of our bodies and what is happening during this stressful time is so valuable!!
I have 1 blocked tube, high day 3 E2(in the high 50 to high 70 range), and a diagnosis of low ovarian reserve. I'm 40, DH is 38, he has great numbers all around. After 3 IUIs, I did my first IVF in October. Antagon protocol, BCP, 450 follistim ,150 Menopur, Cetrotide, 9 days of stims, 9 follicles between 14 and 18mm, 5 eggs retrieved, 5 fertilized naturally, 3 transfered, BFN. They said the eggs were "VERY poor quality" and the 3-day embryos were poor quality (2 of them) and moderate quality (1 of them). I guess my hubby's sperm upgraded one of them!! There was a high level of fragmentation on the worst 2, and a pretty decent amount of fragmentation on the moderate one. All 3 were 8 cells.
I'm now in my second IVF, with a slightly modified antagon protocol (estrogen instead of BCP, 300 of follistim instead of 450, and ganirilex instead of cetrotide). After 6 days, I seem to be progressing about the same with follicle growth, we have 9 follicles in the running so far. I'm also trying acupunture, a different doc and a few other minor adjustments. My doc said he's not a fan of the microflare protocol and that I actually reacted pretty well the first time, so he felt minor tweaks to the antagon protocol would be a better option for me. Anything else I should look into if this round doesn't work? (I always like to think about the next steps just in case!)
Also, can you discuss your thoughts on the procedures: embryo defragmentation, and co-culture to improve embryo quality? I have found it hard to get much information on this, and am wondering if it's worth traveling to a place that does these (my current place doesn't).
And finally, what are your thoughts about cytoplasmic transfer? I know it is banned in the US now, but do you think it has promise in the future? I'm interested in your opinions about the science as well as the ethical considerations.
Thanks!!
Hi Dr.! I know this sounds like a broken record but thank you so much for doing this blog - it's really very good of you and we need more doctors like you!
I have a quick question for you and hope you will answer it. I'm 26and I've been TTC for 6 months and I know it's not much but I got impatient and had some blood tests done. My doctor told me I had slightly high levels of Prolactin and the first step she's doing is giving me something to lower the Prolactin. However, I've been charting for 6 months and my cycle though somewhat irregular, always result in ovulation and a timely period. Do you really think Prolactin is my problem? Isn't it a problem only when it prevents you from ovulating? My levels are only a couple of units higher than normal. Thanks!
Please could you do an update on your morphology entry from 2006? In particular, it is interesting that you would recommend IUI for poor morphology rather than going straight to ICSI IVF.
Also, is there any more updated information on treatments (including supplements and diets or lifestyle changes) that improve morphology?
I have seen other bloggers ask similar questions, but I am still seeking additional information on morphology rates.
My wife and I (we are both 32) have a healthy boy at home who turned 2 a few days ago. He was the result of our first pregnancy and we conceived in the 2nd or 3rd month after we started trying.
We have been actively trying to have a 2nd child since he was around 10 months and have yet to have any luck. Although we were perhaps being impatient (her OBGYN told us to wait until April), once we hit one year of trying (a couple of months ago) we went to see a fertility specialist who is rated the top doctor in his field in our state. My wife's tests all came back with positive results. My sperm analysis showed a higher than average count and motility rate, but I had a a 0% morphology. This was perplexing, as we have a healthy 2 year old at home, and if anything, I have been living a healthier lifestyle in the past 2 years than I had before we conceived our first child. To me, the doctor did not seem overly concerned and suggested we go ahead with clomid and injectable treatments. We did one round of this and had no luck. Although the doctor said there was no way we would have gotten pregnant in that round anyway, due to one egg being overly large and the other being under developed, my wife still believes my morphology is the reason for our troubles.
She is not placing me per se, but at the same time, we were given such an underwhelming explanation of morphology that she believes this one test to be absolutely factual when it comes to my sperm and she also feels that morphology cannot be improved. It is in her nature to be pessimistic in matters like this - she never thought we'd get pregnant the first time either. She says she is not stressed, but her actions clearly show otherwise. She continually believes the worst possible scenario will happen.
From what I have heard and read, it seems that judging morphology is less important than motility or count and it is highly subjective in nature. One doctor may deem the sperm to be zero percent and another doctor may not be as strict and fine some sperm that are normal. Surely the fact that I fertilized her eggs a mere 2 years and 9 months ago, should show that I have viable sperm, correct? If you can shed any light on the absoluteness of the results from one sperm analysis, the liklihood it can improve, the liklihood the original test was not correct, what things I may need to do to increase morphology if necessary, if that is in fact my problem, whether a 2nd opinion is merited, etc., it would be much appreciated - and probably help my marriage.
I just discovered this blog, thank you for doing it.
I've never seen these questions addressed before -
Have you ever heard of Clomid causing a rash? I had a bad, itchy rash all over my body for 2 weeks after taking it (50 mg) for 1 month but I want to try it again.
How much is it reasonable to expect drugs like Clomid and Femara (I've read your concerns about this; my RE has me on my second cycle of it now) to reduce cycle length. I am still at 35-42 days with these drugs, and it seems like too long, but maybe I am just impatient (32 years old, 2 m/c last year and normal workups afterwards).
- Kathleen
Hi Doc,
I am so glad that I found this blogsite today as this afternoon seems to be a doomsday to me.
The doctor showed no respect and passionate when telling me the result of our test. My husband semen analysis is OK. But the doctor said bluntly that my FSH (which is 21.6 on the 4th day) is so high that even if I am 20 years old today, I will never be able to have any babies.
Aside that the USG on the 4th day show 5 follicle which he said the follicles should be 12-13.
So may I know if any chance that I can have the possibility to have baby from my own egg? or do I need a DE? I am 39 years old and living in GA.
thanks a lot...
regards, frida
Hi,
This blog is so helpful. Thank you for doing it. This is going to be a long one...I'll try to keep it as concise as possible. I am 34 years old and have had two miscarriages in the past year. Husband had normal semen analysis.
I went off the pill 2 years ago, and after a year still had not had a single period. First I was diagnosed with hypothalmic ammhenorhea, but I thought it was a suspicious diagnosis since I didn't have any of the indicators (I'm normal weight, not overly stressed, etc). Another doctor said I had PCOS, though I don't have any elevated hormone levels, hair growth, insulin resistance, etc. Just annovulation and nothing else wrong -- though I did get a little more acne and gained about 7 pounds after I went off the pill. So they put me on metformin and I ovulated within 2 months! And then I got pregnant the second time I ovulated, which I was astounded by. Saw the heartbeat at 7 weeks, everything was fine, morning sickness and everything. Stayed on the metformin. But at my 12 week appt no heartbeat. After the D&C they told me the chromosomes were normal. I continued on metformin and they added a folgard pill once a day. Then I had a second miscarriage a few months later, this time at 5 weeks.
After this I got very upset and decided to go to an RE. She did a bunch of tests. They found I was compound heterozygous for mthfr: positive for one copy of the C677T mutation and one copy of the A1298C Mutation. Also I am positive for one copy of the 4G allele in the PAI-1 gene.
Based on this, she sent me to a hemotologist and they think I need to be on a low dose of heparin in my next pregnancy, and I should take baby aspirin until then.
In the meantime, my RE has suggested trying clomid and going off the metformin, since I don't have IR. Not sure why it helps me ovulate, but figured it couldn't hurt to try a few cycles of clomid since I really was getting sick from the metformin (gastrointestinal). She has also upped me to 2 folgard pills a day (I've been on prenatals also but that's been true for the past 2 years)
I did my first cycle of clomid last month, and she said everything was great -- nice lining, big follicle, etc. We did an HCG shot and one round of IUI since she said my cervical fluid was a little scant. We figured this would be a home run. Unfortunately, though I did ovulate I did not get pregnant.
I feel extremely stressed since I'm turning 35 soon, and I have developed a suspicion of doctors since I was told when I was 32 (when I started trying to get pregnant) that everythign would be fine by so many of these doctors. It seems like I just keep getting new diagnoses, and sometimes doctors contradict each other. I'm not sure what to do, and I"m feeling really discouraged.
I guess my main question is if the clomid doesn't work in the next 2 cycles, should I just go back on the metformin and see what happens? Or do I need to consider IVF? Is there any reason why clomid might be better in sustaining a pregnancy than ovulating on the metformin? And why would metformin work if I am not IR?
Every woman has right to dream of having a baby. Tubal reversal allows a woman the ability to conceive naturally without any harm. Although tubal ligation is considered a permanent method of birth control
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Dr L,
My husband's sperm analysis last year was very low count (6 million) with slightly high pH. We have been working hard to get his count up and have been very successful (now 131 million) with vitamins and acupuncture, however his pH keeps rising. It is now at 8.7, everything else is normal. Is there anything we can do, naturally or medically, to correct this? We are currently doing IUI treatments and his post-wash counts are 19 million.
all woman especially the new maried are dreaming a good and healthy baby,but its depend to the couple,having fertility kits is helpful.
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