Infertility FAQs
Hello Everyone, catching up on the questions again. I know the topics are popular and I owe you one for next time.
I changed the format a bit for this time. I have the answers in more of a FAQ format with a little less verbage. I go through the question and try to distill out the major point. Hopefully this will be more efficient and informative, plus it allows for me to get to more issues more quickly. Let's see how it goes. Next entry will be a topic.
Do you need to remove Hydros? I am assuming your RE made the tubal surgery an option; some people can get pregnant with hydros in place. I make it an option with most of my patients. Of course you need to discuss this with your doctor, he knows your case better than I. It’s too early to tell about the Essure.
Is a high estrogen bad for implantation? I have not seen this to be the case. It is very true in mice, but mice are very different.
Why would someone who is 33 have 2 kids then 4 miscarriages in 15 months? If your workup is negative, we don’t know. It is important to have a hysterogram. I have had women with 4 miscarriages go on to have more than one child.
Is the estrogen prime good for low responders? It is no worse than anything else. If other stimulations have failed, give it a try.
If you make a lot of eggs does that mean you have PCO? It does not. It could mean you just make a lot of eggs. We see this all of the time.
If you are discouraged because you failed you fresh DE cycles, should you bother with your frozen? Believe it or not, we have some women who did not get pregnant with their fresh de embryos and have not returned for their frozen. Now there may be many reasons for this. If you would like to be pregnant, get up the nerve for the frozen cycle.
If you do not ovulate with clomid, should you add metformin? Consider the other option of very low dose injections. Metformin an option, but it may take months to get results, and in many cases ovulation dose not occur even with metformin.
Will acupuncture help? We don’t know, but I have many women doing it. In fact, in our office we provide acupuncture services, and the patients are very happy we do. We also provide Yoga and Mind body and psychological services. It’s all under the NYU Fertility Center Wellness Program.
FSH on day 2: should you wait for a lower number? Not sure. We prefer if our patients start with a number less than 13.4.
Can coasting have a negative effect on egg quality. Absolutely. Probably less so if the coasting is 1-2 days, but longer coasting is at times very bad for egg quality.
Can someone be prone to chromosomal miscarriages? Yes, there are some women who have a high proportion of chromosomally abnormal embryos.
Septum and PCO, which to fix first? Yes there are women with a septum who have had normal fertility and pregnancies, although I would be hesitant to leave a septum in because of the potential problems. It’s between you and your doctor. PCO is always fixable.
Is obesity a problem? No hard data, probably leads lower IVF rates. It’ more of a problem for pregnancy because of harm to the fetus. 11 eggs is ok, a few more may be better, ask your doctor about increasing your dose.
Should infertile women have a laparoscopy? Very few of my patients get a laparoscopy. If the only thing your insurance will cover is laparoscopy, then it’s a more reasonable approach. However, if there is no pain, no cysts and open tubes, the odds of a laparoscopy helping anything are low. Yes there are some women who everyone thought were fine who were found to have bad endo, but these cases are rare and usually there is a sign of the problem pre op.
Low sperm morphology: Usually not a factor. Some exceptions exist.
PCOS-like. I am happy that your doctor put it that way. Too many women are labeled with PCOS.
Temperature charting was good for the cave people. Please use a predictor kit.
What are the chances of conceiving with Clomid at age 40? Probably around 3-5 % per try.
Sperm clumping is probably not a problem. If anything, it should be solved with iui.
Stay with Clomid? Getting pregnant with clomid, but 2 miscarraiges. If you are getting pregnant, there is more of a reason to stick with it. I don’t think the clomid is causing the miscarriages, so getting pregnant with the injections amy be no different. See what your doctor thinks.
BPA leaching from cans an interfering with implantation? I wouldn’t worry about it.
Can a 34 yo with a poor response to the drugs become pregnant with IVF? Yes. At your age you only need a few eggs. Now more eggs would be better, but the odds are still very good with few eggs.
How to deal with antisperm antibodies? IUI or IVF.
Polar bodies are different than pronuclei. They both contain chromosomes. The polar bodies are the cells garbage. The pronuclei stay inside the egg and fuse the day after the fertilization. They come together to become the complete genetic material.
Is going for more than 9 eggs at 34 greedy. No , if your doctor thinks adding more drug will safely get you a few more eggs, that’s not so bad.
Is a lining of 16 mm too thick? It is if there is a reason it is thick. That is to say, if there are polyps making it thick, that’s not so good. If the lining is perfectly normal, and it’s thick, that’s ok.
Nuclear transfer and cytoplasmic transfer are not allowed in the USA. Just like many things in medicine, some preliminary results looked ok, but no one ever proved any benefit.
Does thyroid disease, like Hashimoto’s, cause miscarriages? This has been debated for the last 20 years, and there is no good evidence that it does. We are trying to do yet another study to look at the problem.
Does age matter for frozen embryos? No it’s the age you were when they were frozen, not the age you are now.
How come I became pregnant easily at age 23 and am having trouble now that I am 39? This is not uncommon, 16 years is a long time. A lot can happen.
Can you have regular cycle and not ovulate? I don’t think so. Ask what your progesterone levels are, even if they are over 3, you are probably ovulating. If you are not, well then it’s time for induction of ovulation.
Will DHEA help? It might, and if you are making a very low number of eggs, it may be worth a shot. I have had mixed results.
If you have frozen embryos, should you use them or jump into a fresh cycle? It is easier to use the frozens, but if you want the higher pregnancy rate, do the IVF again. If you only have 1-2 frozens, it may be better to do another fresh because not all embryos survive the thaw well.
Can a chromosomally abnormal embryo look beautiful? Absolutely, we see this every day.
What is the optimal TSH level? It depends who you talk to. The endocrinologists are going crazy trying to get everyone’s under 2. There is no real conclusive science showing this is important. Probably ½ the population has a TSH over 2, and ½ the population can’t be abnormal.
Can antidepressants interfere with FSH levels? Probably not.
Will assisted hatching reduce miscarriage? No it will not.
Can you have too much progesterone? No.
Does everyone with endometriosis need IVF? No. It depends on the status of your tubes. If the endo is causing scar tissue around the tubes and ovaries, than yes, IVF may be the best option.
Is a 12 cell embryo on day 3 a bad thing? The embryologists seem to think so. You cannot say you have a serious egg problem after 1 cycle.
Are fragments removed? They are typically removed f you are having hatching because the same little tool used to hatch can be used to suck out some fragments (unless you are having laser hatching). However, no one has ever showed that fragment removal makes a difference. Same goes for assisted hatching.
How do you define poor egg quality? I would say embryos that look less good than average. Embryos that are fragmented more than 20% are poor, even 20% is not great. Slow embryos are poor. However if you just did one cycle, you cannot be given the label until another cycle is performed.
What’s better, a frozen cycle with estrogen, or a natural frozen cycle? They are about the same. I find that sometimes the natural cycle gets a little confusing with the timing, and a small number of people ovulate earlier than expected, so if you do a medicated cycle, less is left to chance. However a natural cycle FET is a very acceptable practice.
See next time. Please read disclaimer 5/17/06. Dr. Licciardi
I changed the format a bit for this time. I have the answers in more of a FAQ format with a little less verbage. I go through the question and try to distill out the major point. Hopefully this will be more efficient and informative, plus it allows for me to get to more issues more quickly. Let's see how it goes. Next entry will be a topic.
Do you need to remove Hydros? I am assuming your RE made the tubal surgery an option; some people can get pregnant with hydros in place. I make it an option with most of my patients. Of course you need to discuss this with your doctor, he knows your case better than I. It’s too early to tell about the Essure.
Is a high estrogen bad for implantation? I have not seen this to be the case. It is very true in mice, but mice are very different.
Why would someone who is 33 have 2 kids then 4 miscarriages in 15 months? If your workup is negative, we don’t know. It is important to have a hysterogram. I have had women with 4 miscarriages go on to have more than one child.
Is the estrogen prime good for low responders? It is no worse than anything else. If other stimulations have failed, give it a try.
If you make a lot of eggs does that mean you have PCO? It does not. It could mean you just make a lot of eggs. We see this all of the time.
If you are discouraged because you failed you fresh DE cycles, should you bother with your frozen? Believe it or not, we have some women who did not get pregnant with their fresh de embryos and have not returned for their frozen. Now there may be many reasons for this. If you would like to be pregnant, get up the nerve for the frozen cycle.
If you do not ovulate with clomid, should you add metformin? Consider the other option of very low dose injections. Metformin an option, but it may take months to get results, and in many cases ovulation dose not occur even with metformin.
Will acupuncture help? We don’t know, but I have many women doing it. In fact, in our office we provide acupuncture services, and the patients are very happy we do. We also provide Yoga and Mind body and psychological services. It’s all under the NYU Fertility Center Wellness Program.
FSH on day 2: should you wait for a lower number? Not sure. We prefer if our patients start with a number less than 13.4.
Can coasting have a negative effect on egg quality. Absolutely. Probably less so if the coasting is 1-2 days, but longer coasting is at times very bad for egg quality.
Can someone be prone to chromosomal miscarriages? Yes, there are some women who have a high proportion of chromosomally abnormal embryos.
Septum and PCO, which to fix first? Yes there are women with a septum who have had normal fertility and pregnancies, although I would be hesitant to leave a septum in because of the potential problems. It’s between you and your doctor. PCO is always fixable.
Is obesity a problem? No hard data, probably leads lower IVF rates. It’ more of a problem for pregnancy because of harm to the fetus. 11 eggs is ok, a few more may be better, ask your doctor about increasing your dose.
Should infertile women have a laparoscopy? Very few of my patients get a laparoscopy. If the only thing your insurance will cover is laparoscopy, then it’s a more reasonable approach. However, if there is no pain, no cysts and open tubes, the odds of a laparoscopy helping anything are low. Yes there are some women who everyone thought were fine who were found to have bad endo, but these cases are rare and usually there is a sign of the problem pre op.
Low sperm morphology: Usually not a factor. Some exceptions exist.
PCOS-like. I am happy that your doctor put it that way. Too many women are labeled with PCOS.
Temperature charting was good for the cave people. Please use a predictor kit.
What are the chances of conceiving with Clomid at age 40? Probably around 3-5 % per try.
Sperm clumping is probably not a problem. If anything, it should be solved with iui.
Stay with Clomid? Getting pregnant with clomid, but 2 miscarraiges. If you are getting pregnant, there is more of a reason to stick with it. I don’t think the clomid is causing the miscarriages, so getting pregnant with the injections amy be no different. See what your doctor thinks.
BPA leaching from cans an interfering with implantation? I wouldn’t worry about it.
Can a 34 yo with a poor response to the drugs become pregnant with IVF? Yes. At your age you only need a few eggs. Now more eggs would be better, but the odds are still very good with few eggs.
How to deal with antisperm antibodies? IUI or IVF.
Polar bodies are different than pronuclei. They both contain chromosomes. The polar bodies are the cells garbage. The pronuclei stay inside the egg and fuse the day after the fertilization. They come together to become the complete genetic material.
Is going for more than 9 eggs at 34 greedy. No , if your doctor thinks adding more drug will safely get you a few more eggs, that’s not so bad.
Is a lining of 16 mm too thick? It is if there is a reason it is thick. That is to say, if there are polyps making it thick, that’s not so good. If the lining is perfectly normal, and it’s thick, that’s ok.
Nuclear transfer and cytoplasmic transfer are not allowed in the USA. Just like many things in medicine, some preliminary results looked ok, but no one ever proved any benefit.
Does thyroid disease, like Hashimoto’s, cause miscarriages? This has been debated for the last 20 years, and there is no good evidence that it does. We are trying to do yet another study to look at the problem.
Does age matter for frozen embryos? No it’s the age you were when they were frozen, not the age you are now.
How come I became pregnant easily at age 23 and am having trouble now that I am 39? This is not uncommon, 16 years is a long time. A lot can happen.
Can you have regular cycle and not ovulate? I don’t think so. Ask what your progesterone levels are, even if they are over 3, you are probably ovulating. If you are not, well then it’s time for induction of ovulation.
Will DHEA help? It might, and if you are making a very low number of eggs, it may be worth a shot. I have had mixed results.
If you have frozen embryos, should you use them or jump into a fresh cycle? It is easier to use the frozens, but if you want the higher pregnancy rate, do the IVF again. If you only have 1-2 frozens, it may be better to do another fresh because not all embryos survive the thaw well.
Can a chromosomally abnormal embryo look beautiful? Absolutely, we see this every day.
What is the optimal TSH level? It depends who you talk to. The endocrinologists are going crazy trying to get everyone’s under 2. There is no real conclusive science showing this is important. Probably ½ the population has a TSH over 2, and ½ the population can’t be abnormal.
Can antidepressants interfere with FSH levels? Probably not.
Will assisted hatching reduce miscarriage? No it will not.
Can you have too much progesterone? No.
Does everyone with endometriosis need IVF? No. It depends on the status of your tubes. If the endo is causing scar tissue around the tubes and ovaries, than yes, IVF may be the best option.
Is a 12 cell embryo on day 3 a bad thing? The embryologists seem to think so. You cannot say you have a serious egg problem after 1 cycle.
Are fragments removed? They are typically removed f you are having hatching because the same little tool used to hatch can be used to suck out some fragments (unless you are having laser hatching). However, no one has ever showed that fragment removal makes a difference. Same goes for assisted hatching.
How do you define poor egg quality? I would say embryos that look less good than average. Embryos that are fragmented more than 20% are poor, even 20% is not great. Slow embryos are poor. However if you just did one cycle, you cannot be given the label until another cycle is performed.
What’s better, a frozen cycle with estrogen, or a natural frozen cycle? They are about the same. I find that sometimes the natural cycle gets a little confusing with the timing, and a small number of people ovulate earlier than expected, so if you do a medicated cycle, less is left to chance. However a natural cycle FET is a very acceptable practice.
See next time. Please read disclaimer 5/17/06. Dr. Licciardi
posted by Dr. Licciardi at 3:19 PM
49 Comments:
Thanks for the DHEA answer. I am using it now and seem to be having a bit more eggs each cycle.
I am considering DE. Given that I am 40, can it be safe to assume I will have much better luck with DE from my 26 year old cousin? I have been trying for 4 years now, with only one very early mc last month and a second trimester loss from PPROM lst year- they say that was a fluke and couldn't find anything wrong with the placenta or the baby autopsy. They did discover that I have a prothrombin factor 2 mutation and that may be why I had some bleeding during that pregnancy. Their only thought might be that the bleeding caused irritation to the membrane and caused my water to break. They are not worried about me carrying- but will give me lovanox next time. What do you think?
Thanks Dr. L - I appreciate the answers. I am going for my retrieval on Monday for IVF#3 - I did microdose lupron this time instead of long lupron. We are probably looking at 4-6 eggs so my response was not much better...also, my follicles are huge and I am hoping that they are not too mature - what is your position on follicle size and over-mature eggs?
Thanks again.
Thanks for your answer to my question about effects of coasting on embryo quality, Dr. L. I was coasted for 3 days which is longer than you think ideal, but am now 17 weeks pregnant with one of those embryos. I'm wondering whether you feel the negative effects of coasting relate just to pregnancy rates, or also to the subsequent health of the fetus/baby? Thanks again. Catherine
I am a 31yo female with 1 4-year-old conceived on the first month of attempting conception. We have tried for a second child for more than 3 years, with 2 early losses (both 4 weeks) and no reasons. Hormone levels (fsh, lh, e2, progesterone, etc) are all normal, tubes open, husband fine, cycles of normal length (28-30 days, ovulation around cd15/16), etc. Immune testing normal, blood clotting issues not present (I am heterozygous mthfr but homocysteine is normal), specialized ultrasound to assess blood flow to uterine lining looks excellent, etc. I do have Hashimoto's thyroiditis, but I've had it for 6 years and it is well-controlled.
My ongoing problem is that I have a fair amount of irregular spotting - both before and after ovulation. I had a hysteroscopy last summer with some polyps removed, but the spotting never stopped. I am nervous to pursue ivf because of all the abnormal spotting. To me, if I'm spotting on cd10/11/12 - not associated with ovulation - it seems like something is "off." I don't want to invest the money into ivf until I've done everything possible to address any abnormalities that might affect implantation.
My RE thinks the spotting is a "normal" abnormality. My ob/gyn feels badly that I'm dealing with that much spotting (it's super annoying at best) but isn't sure where to go since the polyp removal didn't fix matters. I was taking Zoloft, which I've read can cause abnormal uterine bleeding, but I've been off it for 8 weeks and the spotting persists. For what it's worth, the spotting is a new occurrence. I never had *any* spotting prior to having my son. It started about the time we'd been trying to conceive around a year.
I've done several cycles of Clomid; I often spot more on Clomid than not. I've tried progesterone, and it hasn't made a difference. I tried one cycle of injectables, and I honestly don't recall what happened there with the spotting, but if I'm doing injectables I'd rather just jump straight into ivf because of the potential for higher-order multiples.
Is there anything else I should investigate before pursuing ivf? I just can't stomach the thought of wasting thousands and thousands of dollars if there's something I should investigate beforehand. Insurance pays for testing - nothing for treatment.
And while I'm filling up your comment box with excessive questions, I'll ask if there's any relationship between low ferritin levels and infertility. I've had one family practice doc who said it can be a factor (suggested you need ferritin levels of above 40 to improve chances of implantation) but I've only read this as a letter to the Lancet in 1991 regarding ferritin levels related to hair loss.
Thank you!
Hello, I am glad to find this blog. It is a bit reassuring to see read all these info. I had afailed IUI and because one my fallopian tube may be blocked ("may" because results are unclear..the dye went to my veins), my doc suggested IVF. I do travel alot and I am wondering if taking the plane can alter the procedure. Basically, can you take the plane after and IUI or an IVF?
Thank you
oh by the way, I am 33/ My first estradiol and FSh were respectively 83/4.5. My second Estradiol and FSH, were 34/16!.
When the doc saw 16, he said I should go to IVF.
Hi Dr.!
My doctor says I have slightly higher levels of Prolactin and she has put me on Parlodel 2.5mg. I already ovulate and have more or less regular cycles.. do I really need to take this medicine before she gives me Clomid?
I'm 26, TTC for 1 year, 1 unexplained miscarriage, no other known issues.
Thanks!
Thank you so much for this wonderful blog!
I have MTHFR (two copies) and have had three losses. One Turners Syndrome baby lost at 20 weeks, a chemical pregnancy and a missed miscarriage at 7 weeks. We had a daughter with no complications prior to these. Do you believe these were all caused by the MTHFR? I am taking 4mg Folic Acid/day and a B12, is this enough? I am so afraid of another loss. Thank you so much!
Hello, I am 27 and was recently diagnosed with Late onset CAH. My cycles are sporadically irregular( 2-3 months regular, then 2-3 months no cycle). I have a 2 year old daughter conceived easily. My question is, should I start taking dex or some other steroid to try to conceive again? Will it increase my chances of getting pregnant? And are there any risks in taking these medications, before or during pregnacy? Thank you!
Thanks for doing this!
I am so confused though, our doctor told us that IVF would be our only option with low sperm morphology (0-1% normally shaped).
I've been trying to get pregnant with medical assistance for a year. DX "Unexplained", but did have an 8cm intramural fibroid removed in Dec08 after 3 failed rounds of FSH/IUI. My RE recommended 3 more rounds of FSH/IUI before IVF becomes only option. My stats are always great - 3-4 follicles between 16mm and 20mm, E2 typically between 1200and 1800, progesterone as high as 198, post-wash total available sperm 30 million with 95% motility. First post-myomectomy IUI was unsuccessful, still waiting for the results of this one. If it is unsuccessful, do we still have a good chance with FSH/IUI? We cannot afford IVF.
- Unexplained but hopeful
Can you do a topic on Unexplained Infertility?
I am curious for your advice on my situation. I am 29 and recently went through my first IVF cycle. After being put on a standard lupron protocal I responded so poorly and had to be cancelled. My doctor then put me on micro-dose lupron protocal and I responded much better. They were able to retrieve 10 eggs but out of them I only had 2 embryos of average quality. (8 cell/grade 2, 6 cell/grade 2). The cycle failed. My doctor told me that my chances of success were not going to be very high and that I should consider other options. I was very suprised to hear this as this was our first IVF cycle. Do you agree with him or should I give it another chance? If I should give it another chance is there a better protocal for women with poor ovarian reserve and poor embryo quality? Please help!
Also could you do a post on poor ovarian reserve?
Hi,
I am on my second Clomid cycle and one IUI cycle done with no results. I am on my second IUI now. I had an ectopic which ruptured and had one of my tubes removed. For the past couple of cycles through careful monitoring, only one of my ovaries always ovulates, the one that has the tube removed :( I need to know what my chances are. Is IVF the only option or is there some hope??
Dr. L. -
Thanks so much for answering my question about our little 12-celled embryo. We are trying one more time - going with antagonist protocol. I'm currently going to acupuncture, and taking royal jelly and coenzyme q10 to help with egg quality (though I was very pleased to see your comment that I should not have been told I have a "serious egg issue" after one cycle! My RE floats on the pessimism boat...) Have you had much success with the antagonist protocol? Will it help produce better eggs and embryos?
Your patience in answering everyone's questions is admirable...
Thanks so much in advance!
Dr. L,
Thank you for doing this blog, I regret I didn't find it a few years ago. I will try to be brief and get the the question!
TTC #2. After two years of infertility, had boy via IVF 1/08. My initial issue was high prolactin. Took parlodel for a bit, then 3 rounds of clomid, 3 IUI with gonadatropins, then 2 IVFs. I was off the parlodel by the first IVF. My RE said it probably wasn't necessary.(I've never gone back on it)
After nursing for 14months, period finally came back, and we are TTC #2. First cycle was 33 days, not 100% sure I ovulated, but think I did late..On 3rd cycle now, and have begun using a fertility monitor for the 2nd cycle. I tend to ovulate late, day 19 or 20, then have a short LP, 11 days, and ALWAYS brown spotting at 10 DPO.(had this when TTC#1 too, but no one was concerned then though I always have)
I feel like the short LP, spotting, late O, are all signs that I just ovulate poorly. During both my IVFs I remember the RE saying he was surprised at my egg quality for being so young (31). Meaning, my eggs seem a bit older.
Oh, recently had a physical and my TSH was 2.267.
My OB told me at my 6 wk postpartum that if I haven't conceived naturally after 6 months to head back to the RE. I am wondering if I should even wait that long? The short LP just really makes me think things aren't working correctly. Is that a clear reason to go straight to the RE? Any insight is appreciated!
Dr. L,
Thank you for doing this blog. I am DXed PCOS and got pregant last year in IUI but miscarried it later. When we started out our treatments late last year with Injections, we found that my LP is getting shorter. First cycle, my LP was just 10 days. Second cycle I got overstimmed with more than 5 follicles and IUI was not performed. I started bleeding on day 25 of that cycle and baseline U/S showed that follicles have become cysts now. Currently on BCPs and my RE has planned to have a HSG to look at my tubes and uterus before next cycle. My LP was just fine before. So does miscarriage has led to some new problems ?? My RE said we can try two more cycles of IUI before thinking about IVF. Any thoughts of this will be appreciated.
Thanks,
Shirley
Love the blog! Question: 38 years old, healthy, normal weight/bmi, FSH is 5 (highest was 5.1), all other hormone levels normal, very normal cycles and I do ovulate monthly. Just completed our first IVF w/ICSI for male factor, which failed. Retrieved 30 eggs, 24 mature, 16 fertilized and 3 were transferred on D3 (each were 6-7 cells with a little frag). RE says sperm not an issue; egg quality issue this round. Never suspected PCOS but wants to test based on my response and egg quality. Is it possible to have PCOS with no symptoms and normal labs? If no PCOS, what would cause high response and low egg quality?
Dr. L,
I am a 23 year old with a variation of PCOS (2:1 ratio of LH to FSH, mildly cystic ovaries). My husband's SA showed good counts(360 million total/ 80 million per cc) good motility (60%, 2+) but his morphology was 2% on the Kruger scale. We are on our fourth monitored cycle of Clomid (I was not ovulating on my own) and have not gotten pregnant. I am ovulating, but my progesterone has not been over 15. It's been 13.2 and 14.1 on the two successful times. We keep upping my dosage hoping for a better level. I am currently on 150 mg with two dominant follicles this cycle. My question is, why is my progesterone not higher on a medicated cycle when I am ovulating (according to u/s after the fact) and is that bad? Also, would the morphology issue be enough to push us to IVF? I have read a couple of your posts where you said morphology was not a major issue if the other SA factors were good, but I haven't heard this many other places. I did see a study the Mayo Clinic did on IUI success rates with low morphology- they said lower morphology did not affect the number of pregnancies in IUI, which leads me to agree with you. Thank you so much for your time!
- Jessica
Also, I should mention that Clomid has not affected my lining- it is at 12mm currently. This is our last cycle on it before heading to an RE, though. My OB/gyn is monitoring me per my request. All other levels are normal and my HSG was all clear.
Great Post
FERTILITY & CONCEPTION
Path to Pregnancy
Pregnancy is the result of a chain of events. Because of the intricate series of events required to accomplish a pregnancy. Every month the pituitary gland in a woman's brain sends a signal to her ovaries to prepare an egg for ovulation. The pituitary hormones — follicle-stimulating hormone (FSH) and luteinizing hormone (LH) — are involved in a delicate interaction with the ovaries to bring an egg to the point of ovulation. A large boost in LH carries a message to the ovarian follicle to release its egg (ovulate). The time of ovulation — is around day 14 of menstrual cycle — although ovulation varies among women with different lengths of menstrual cycles. The egg is then captured by the fallopian tube and is viable for about 24 hours after ovulation. For pregnancy to occur, a sperm must unite with the egg in the fallopian tube within this time. Sperm are viable for up to 72 hours and must be present in the fallopian tube at the same time as the egg for conception to occur. When sperm and egg meet in the fallopian tube fertilization occurs. The egg is covered by a protective shell called the zona pellucida. Many thousands of sperm attach to the outside of the zona pellucida but only one ultimately enters. If fertilized, the egg moves into the uterus 2 to 4 days later. The new cell is called an embryo. There it attaches to the uterine lining (endometrium) and begins a 9-month process of growth. The cells around the embryo secrete human chorionic gonadotropin (HCG) which help to keep up the production of oestrogen and progesterone from the ovary, which helps maintain pregnancy. While this may seem simple, in fact many things can happen to prevent pregnancy from occurring
About Infertility
Infertility is usually defined as not being able to get pregnant despite trying for one year. This is called Primary Infertility. A broader view of infertility includes not being able to carry a pregnancy to term, with recurrent miscarriages and inability to conceive after one or more successful pregnancies is called Secondary Infertility. In India it is estimated that approximately between 15-20% of all couples of fertile age suffer from infertility. This figure is on the increase because of increased urbanization and pollution, stress, a competitive work environment and a hectic and fast placed lifestyle. Infertility related problems could strike anyone rich or poor, educated or illiterate. It is a myth that infertility is always a "woman's problem." In fact study shows that
* 40% are related to the women
* 40% are related to the man
* 10% are due to couple problems
* 10% have unknown causes
In females, the causes could be irregular ovulation or egg production, hormonal imbalance, tubal block, problems in uterus like fibroids, adhesions, synechae congenital anomalies chocolate cyst of ovaries and unexplained. Common reasons in male are low motility of sperms with normal or low count, Varicococele congenital absence of Vas deferans, Testicular dysfunction and hormonal imbalance. Azoospermia Obstructive & Non-obstructive. Diagnosis and treatment at the clinic are based on the latest medical procedures, with close attention paid to individual requirements of the couple. Going by our track record, it is our dedicated care and years of experience has resulted is great success. Arpit Test Tube Baby Centre maintains constant interaction with well known IVF and Research Centres in India and Abroad.
Would you explain why you do not believe in the effects of female antisperm antibodies as you stated previously? My RE is recommending IVF with ICSI for that reason. Thank you in advance and thank you for your blog.
Hx: female: everything good except moderate endo removed Jan 09 during dx lap- no structural involvement and no real symptoms prior to surgery; high antisperm antibodies Dec 08 via blood analysis; previously short luteal phase lengthened when started taking Folamin
Hx: male: Dx low motility and morphology Feb 08 has improved to only mild motility issues now even normal once; sperm penetration assay normal; always high counts
Tx: IUI x 2 with femara prior to lap surgery for endo; now recommending IVF with ICSI due to female antisperm antibodies
We have been trying to conceive for almost two years. During that time, mild male issues have resolved themselves and I've had mild endo removed. Everything else has checked out fine. We are starting the process of moving into IUIs now that we've had no success following the removal of the endo. My question is that on at least two cycles, I've developed a feverless illness similar to flu symptoms at around 10 to 14 days post ovulation followed by a very unusual period: (1) 24 hours of chocolate liquid bleeding on first day and (2) a heavy period with no ovulation the following month. The flu symptoms disappear with the onset of full red flow. I always ovulate around day 14 or 15 and I'm a typical 28 day cycle except for these instances. There are few other times I have been concerned but nothing as dramatic as the cycles I described. Could this be early miscarriages or symptoms of implantation problems that have yet to be diagnosed? I have asked the RE but she is not concerned and is not interested in implantation failures as a area to explore it seems. She was also not concerned with my endo symptoms and was wrong so I'd like another opinion before dismissing this. I'm very afraid to move onto IVF following IUIs with these concerns.
Just found your blog....what a god sent! Here's my issue. I am 11dpiui and still testing negative. In most cases I know that is to early but I have a 25 day cycle! Does that change anything? I am supposed to see AF tomorrow!!! Shouldn't I be getting an earlier answer than most with a longer cycle???
i got my embryo transfer done with 3 embryos 7 days back and it was done on day three but i would like to know some early signs coz this is the most difficul time before i do blood test dome.is urine test recommended.
Thank you for doing this blog. Here's my story:
Irregular cycles after stopping birth control. A transvaginal ultrasound showed polycystic ovaries. I am thin (5'5" 116#) and show no other signs of PCOS. I got pregnant on my own and miscarried. After the miscarriage, I did two rounds of 50mg of Clomid and conceived my son. He is now 16 months.
We have been trying again since August. I am getting my period 6 to 9 days after a positive ovulation stick. February we did 50mg of clomid. March we did 100mg and my ultrasound on day 12 showed two large follicles (4cm and 3.2cm). I didn't get a positive ovulation test until day 16. On day 27, I got my period.
I ovulate on my own, but have short luteal phases. The clomid has not changed that the last two cycles. Ideas? Should we stay the course or try something different at this point?
Hi,
I have PCOS and have done 2 cycles of clomid and IUI. Both times my progesterone levels were high after ovulation -- 20 -- but i did not get pregnant. But my RE says I should take progesterone supplements following my next ovulation just in case...a) does this make sense and b)can it hurt? Her theory seems to be "it can't hurt so why not try it"
Thanks!
I was wondering what your take is on a testosterone level of 73 and DHEA of 286. My fasting insulin was 7 and my highest FSH was 12. I also have a fasting glucose of 101.
I was wondering what your take is on a testosterone level of 73 and DHEA of 286. My fasting insulin was 7 and my highest FSH was 12. I also have a fasting glucose of 101.
Thank you for your very informative blog. I am 41 1/2 and have been trying to conceive for 2 yrs now. I have had 2 miscarriages and a few cysts that have slowed the process down for me. Originally I stared off doing IUI's with clomid. I became pregnant exactly 2 yrs ago on this first attempt - then lost the baby. I failed the next round a few months later and then tried IVF using all the IVF protocol drugs (meipur + follistim), however I did not respond well. I think only 2-3 gd size follicles. Next we went back to clomid and added follistim. I got pregnant and then lost it at 7 wks. After this my RE indicated that I respond the best to clomid along with the injections and has kept me on it (I've done 2-3 more cycles). My FSH has ranged from 11 - 14.5 over the past 2 yrs - however my last reading was 16.7. I had just finished a month on agysten which I had taken to get rid of a cyst (birth control didn't work) and when my cycle came I hardly had much bleeding and my estrodiol was zero with FSH 16.7. Do you think this was due to the medicine I had been taken? What do you think my changes are at this point to conceive? My RE seems to be pushing me towards DE - but I really want to try for IVF first. Do you think it is fair for me to push further to try IVF? How could I possibly make it to a round of IVF? I've done welll with Clomid (once had 5 good follicles and another couple of times 4). Any advice you can provide would be much appreciated. Rgds, Caro
I am 25 years old and responded to clomid well. My RE is having us move on to IUI with a trigger. My husbands sperm count was 60 million with 61% motility and 3% strict morphology. My question is what is the cause of low morphology and does it play any kind of "major" role in success rates with IUI?
Hello, I am 28 and my husband is 27. We have just learned that our 1st IVF w/ICSI and assisted hatching was unsuccessful. We retrieved 10 eggs, transferred 2 grade A embryos and have 2 grade A embryos frozen. Our dx is male factor, low morphology and varicocele (had surgery, did not help), everything on my end comes back normal. My question is, do you think it is worth it to do genetic screening on my husband before we move ahead with a frozen transfer (he is an Ashkeni Jew, if that matters)? Could it have been an implantation issue?
Just wanted to add that we had 4 failed unmedicated IUIs before moving on to IVF. Thanks!
Hi Dr.
TTC for a year. Progesterone levels normal. Semen analysis normal. Ultrasound revealed tumor. benign. Had laproscopy amd hysteroscopy 3 weeks ago. Left tube blocked completely. Covered with endo. Fibroid on Ovary and one in uterus removed. Start first Clomid cycle next week. Then post-coital and ultrasound on ovaries. Is this the right course of treatment? Just scared and want second opinion.
Thanks,
Julia
Hi Dr. - A few questions, my DH at age 30 was diagnosed with a lsc - 3.8 million/ml average of two tests and low morphology (1% and 2%) according to strict WHO standards. His volume was also low (2.8mls). We saw a couple of drs are were referred to a fertility clinic. We had not started trying to conceive when we received this information. We decided to throw the bcp out and try for all we could, with charting, etc. and 6 months later I was pg. We now have a healthy son, age 16 months.
Looking to baby #2 and wondering....was our son a miracle child? Can a couple have normal fertility within these parameters??? Have you seen anything like this before??? Any advice would be helpful. Thank you!
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Hi Dr.
This is my first time reading your blog and I find your blog extremely helpful. Thank you so much.
I have a few questions. I am a 32 female who have been TTC for 2 years. I have gone through 2 cycles of IVF and both failed.Both times the result were the same, only 3 eggs were retrieved, 1 fertizlied. In addition, for both cycles, the doctor were going to stimulate me for longer days becuase the folicles are not mature enough, but I seem to broke through Lupron meaning that my progesterone level goes up so he had no choice but to trigger me earlier than he would like to. Have you seen such a case? What are the reasons that Lupron can't control my ovluation. The doctor seems to think I have egg quality issue. Could you advise on what I should do? Should I try IVF again? What are my chances of getting pregnant if I go for a 3rd try?
Thank you in advance for your help
Hi Dr.
Thank you for your answers.
I have a question. Progesterone is important in maintaining pregnancy. At my current clinic, after the embryo was tranferred, I was instructued to take 100MG of endometrin vaginal gel, and 1cc of progesterone in oil per day. They do not monitor my level of progesterone during the 2ww period to make sure my level is high enough to maintain the pregnancy. Is that critical? Does your clinic do that?
Are there any genetic tests I should have done since I and two of my sisters, also in their 20's, are infertile?
My Mother had no problems becoming pregnant, out of 4 pregnancies she had 4 healthy babies.
My Grandmother was an only child and had problems carrying to full term. Most of her 7 miscarriages were between 4 and 6 months. She tried treatment with cortisone resulting in a live birth, but the baby lived only 24 hours due to overdose of cortisone. For my mother they adjusted the dose.
Thank you
Great post.
great job doc. but guyz do you know what is Fertility kits. i found it last day when i was surfing the internet.
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Dr. Licciardi,
Thank you for your blog. I am a 32 year old woman with PCOS and am TTC #2. On day CD38 E2 was 51.8 and FSH was 3.1. U/S showed some activity on the right ovary at CD32. Would you call this cycle a bust?
Thank you for your time.
You are amazing for answering all these questions. I have 1,000 for you, but I think I will just keep reading and see if you eventually answer through others. Thanks again for blogging. It gives me a sense that I am not alone.
Thanks for the low morphology response, although after a recent Repronex course (treatment recommended by my physician due to my husband's low morph - otherwise good #s and motility, and lots of eggs on my side, I'm more confused than ever. I'd be thrilled to continue au naturale, but does low morphology mean that IUI or IVF is our only option?
"What are the chances of conceiving with Clomid at age 40? Probably around 3-5 % per try?"
This is horrifying. Please tell me there was more to that question than this or I might as well start crying and stop trying now.
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This post has been removed by a blog administrator.
I have just started IVF #3. Its an antogonist cycle using Follistim & Ganrilex. The BCPs for supression left me w/ a cyst, thick lining and an E2 of 150. I took Provera. The cyst went way down and after my period the lining was 3.9. But, my E2 remained high at 142. I started stims on the advice of my RE. In Jan, my FSH was 5.6 and E2 was 50. Now, in July, my FSH is 6.2and my E2 is still 142. The RE says its low ovarian reserve and not the cyst causing the high E2. Is it possible that the E2 can change that dramatically in a few months? What are my chances of success with such a high E2?
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