More Answers to Great Infertility Questions
Here’s a little vignette first.
I have a patient who was told after a hysterogram (HSG) and laparoscopy that her tubes were blocked. So she did an IVF cycle, didn’t get pregnant and came to me.
She was not told what type of blockage. I asked for her op notes and saw that her problem was that her tubes looked normal, but were blocked near the uterus (proximal tubal occlusion).
I told her that there is a way, using another hysterogram, that the tubes could be potentially opened using a wire. She went for the test and one tube did not require fixing, it was open, and the other needed the wire and was successfully opened. So her first HSG was wrong, both tubes were not blocked, and her laparoscopy, the so called gold standard, was wrong. See blog from 10/05/06, Blocked Tubes: 2 Cases of Proximal Tubal Occlusion.
None of this is uncommon. When I have a patient with proximal occlusion I send them for the recanulization hsg (the wire), and in many cases the original blocked tubes were nothing more than spasm, and the next hsg is perfectly normal. Laparoscopy isn’t always good for showing if the tubes are open. Sometimes it’s just hard to get the dye to go out the tubes at laparoscopy. If I am convinced that there is blockage at laparoscopy, I can pass the wire at that time. If this woman had her tube properly opened at laparoscopy, she maybe could have avoided IVF and seeing me.
Are low grade, slow blastocysts chromosomally abnormal? There may be a slight difference; better looking blasts may have better chromosomes than a blast that does not look as good. If there is a difference, it’s too small to make a decision related to transfer. In other words, if you best embryo is a slow blast, you should not be afraid to take it. Odds are if it sticks, it will be normal.
I made 7 eggs, why did the clinic immediately exclude me from a day 5 blastocyst transfer? Every clinic has its own criteria. Yours sounds a little strict, but check their SART stats. If their rates are good take their advice and follow their plan.
What about getting your period early in an IVF cycle? Probably if you were pregnant your period would have not come, even though you got it early. If you are taking suppositories, I would ask your doctor about taking progesterone injections for the next cycle. Sometimes I add estrogen. In general estrogen is not necessary after transfer, but in cases of early bleeding it may help.
What if there is no ovulation with clomid? If you don’t respond to clomid, you can’t keep trying forever. The injections sound intimidating, but most people get it done. If you do injections, it is very important that your doctor start you on a low dose and monitor you carefully.
What if you were planning to go to IVF if this IUI didn't work, but you got pregnant and miscarried? Logic would say it makes sense to do 1 to 3 more IUIs, after all you proved the tubes work, fertilization can take place and implantation can happen. However, most people, but not all, stick to the original plan and go to IVF out of frustration. Plus, usually a miscarriage results in extra lost time, and this gets people to want to get to IVF.
If you are older (I’m 49, so most of you are young to me), do your eggs need ICSI? Is the shell of the egg harder and less penetrable? This is my ARGHHHHH of the day. Simply, the answer is no.
At a young age, can anorexia or exercise induced amenorrhea mess up your eggs later in life? It actually is a very interesting question; however I have not seen any studies supporting this. There is probably no effect.
Could a woman with unexplained infertility donate her eggs? This is a tough one but probably not. Only because the recipients are taking a big financial and emotional gamble on the quality of your eggs. If you have unexplained infertility then have a successful IVF and wanted to donate later, that would be great for a recipient.
What if you are young and all the tests are normal. Your day 3 FSH is normal but you estradiol on day 3 is 20. Low is usually ok. Repeat it if you want piece of mind.
Donor egg or donor sperm? If you are young and the sperm counts are very low, and the embryos don’t look good, of course it could be the eggs or sperm. It really could go either way. Which brings us to a common dilemma. Getting inseminated with donor sperm is quicker, easier and tremendously less expensive that donor egg. So for that reason, if it’s not perfectly clear where the problem lies, and you have accepted the idea of donor egg, it is reasonable to consider a few courses of donor sperm insemination. Couples do seem more reluctant to do the donor sperm than they are for donor egg.
Major League questions about blastocyst. Are cryo’d blasts as sturdy as day 3 embryos? The answer is yes. A day 5 3BB is better than a day 6 4AA, unless the day 64AA was a day 5 3BB or better. It the trick with frozens in the freeze or thaw? Most of the skill is in the freeze, not the thaw.
Sorry, I do not now how to get pregnancy rates from Canada.
Update on 0ne-embryo transfer? Yes, in the past 1-2 years, every clinic has performed more and more one embryo transfers. So ask about their latest stats. I strongly suspect that the pregnancy rates for one embryo are lower in a frozen cycle. One way to up your odds in a frozen cycle would be to thaw a few (if you have them) and transfer the best one.
What if the sperm count is 145 million, with 40% motility and 2% normal morphology? Most REs would tell you that’s normal, but you need to ask yours.
If money is not an issue and you are faced with the choice between iui and IVF, and you want to do IVF, IVF is your best option. The success rate with FSH iui when all the testing is normal depends on your age. At age 37 it’s about 15%. Could be as high as 20%. IVF will be about twice that.
Should you go to surrogate if you are 43, have failed 6 fresh and 2 frozens, your lining is 5-6 mm and have 4 frozen embryos remaining. It’s a lot to consider, but surrogacy is an option. I am sorry but I can’t make more of a recommendation without seeing everything.
Can Lupron’s effects linger after your stop taking it? Anything is possible. However I have not had a patient with that problem.
With fairly good sperm should you spend the money on 2 iui’s or save for IVF? IVF is more cost effective than FSH iui. FSH iui is cheaper but much less effective. IVF is usually 2-3 times more effective than iui. There was a recent study showing going to IVF gets a baby with less time and money compared to FSH iui and IVF later if necessary.
Post coital test? Very few RE’s do this test anymore. It is just not accurate. Even if the test is abnormal, iui bypasses the cervix so antibodies in the cervical mucus (if such a thing matters) do not come into play.
Is IVF the answer if there have been 3 miscarriages and sperm with DNA fragmentation? I can’t be too negative about DNA fragmentation because it’s a little early to really know. However there is no good evidence yet to show those test are predictive of infertility or miscarriage. If your doctor feels differently, ask him or her to show you the studies.
Can very poor sperm lead to biochemical pregnancies and miscarriage? Yes but it’s not common. We all know that ICSI is used for very low sperm counts, and leads to good embryos and excellent pregnancy rates. However occasionally we see very low sperm counts and very poor embryo quality. In these cases, some women want to repeat IVF and expose a few of their eggs to donor sperm to see if there will be an improvement in the embryo quality. In some cases the difference is dramatic, and some couples will change over to donor sperm. If you are getting pregnant on your own without IVF and are having biochemical pregnancies, I’m not so sure it’s the DNA fragmentation.
Is IVF a treatment for 3 miscarriages? There are studies showing IVF without PGD is not very helpful for the treatment of miscarriages. There are some limited studies showing PGD may reduce the odds of miscarriage, but the data is not overwhelming.
What if you have had 3 biochemical pregnancies in a row? It’s hard to put much faith in the platelets, antibody, and autoimmune issues. Early on there is no placenta to speak of. There are no significant blood vessels to clot off. I must be sensitive to those of you who have had early losses and biochemicals, and then normal pregnancies after treatment for autoimmune/clotting factors. Maybe these things helped, but it can be possible that after a number of early losses, it was time for normal pregnancy.
What if you are 36 with all tests normal and 4 months of trying with good timing? Your odds of getting pregnant on your own in the next 4 months are still very good. Clomid or FSH iui are options, but giving it at least a total of 6 months on your own is a good idea.
How’s it going with the Priming protocol? If seems to work as well as other protocols in producing eggs. However the pregnancy rates are a little lower, so far. This is explained by the fact that we save the priming protocol for the worst responders, many of who have been cancelled using other protocols. So even if it’s a good protocol, we may not be seeing it because we are giving it to the patients who have low rates to begin with. So my bottom line is it’s worth trying as alternative, but it’s not a magic potion.
I am sorry I am not aware of co-culture with green monkey cells. Such a process would not be allowed in the US.
I have a patient who was told after a hysterogram (HSG) and laparoscopy that her tubes were blocked. So she did an IVF cycle, didn’t get pregnant and came to me.
She was not told what type of blockage. I asked for her op notes and saw that her problem was that her tubes looked normal, but were blocked near the uterus (proximal tubal occlusion).
I told her that there is a way, using another hysterogram, that the tubes could be potentially opened using a wire. She went for the test and one tube did not require fixing, it was open, and the other needed the wire and was successfully opened. So her first HSG was wrong, both tubes were not blocked, and her laparoscopy, the so called gold standard, was wrong. See blog from 10/05/06, Blocked Tubes: 2 Cases of Proximal Tubal Occlusion.
None of this is uncommon. When I have a patient with proximal occlusion I send them for the recanulization hsg (the wire), and in many cases the original blocked tubes were nothing more than spasm, and the next hsg is perfectly normal. Laparoscopy isn’t always good for showing if the tubes are open. Sometimes it’s just hard to get the dye to go out the tubes at laparoscopy. If I am convinced that there is blockage at laparoscopy, I can pass the wire at that time. If this woman had her tube properly opened at laparoscopy, she maybe could have avoided IVF and seeing me.
Are low grade, slow blastocysts chromosomally abnormal? There may be a slight difference; better looking blasts may have better chromosomes than a blast that does not look as good. If there is a difference, it’s too small to make a decision related to transfer. In other words, if you best embryo is a slow blast, you should not be afraid to take it. Odds are if it sticks, it will be normal.
I made 7 eggs, why did the clinic immediately exclude me from a day 5 blastocyst transfer? Every clinic has its own criteria. Yours sounds a little strict, but check their SART stats. If their rates are good take their advice and follow their plan.
What about getting your period early in an IVF cycle? Probably if you were pregnant your period would have not come, even though you got it early. If you are taking suppositories, I would ask your doctor about taking progesterone injections for the next cycle. Sometimes I add estrogen. In general estrogen is not necessary after transfer, but in cases of early bleeding it may help.
What if there is no ovulation with clomid? If you don’t respond to clomid, you can’t keep trying forever. The injections sound intimidating, but most people get it done. If you do injections, it is very important that your doctor start you on a low dose and monitor you carefully.
What if you were planning to go to IVF if this IUI didn't work, but you got pregnant and miscarried? Logic would say it makes sense to do 1 to 3 more IUIs, after all you proved the tubes work, fertilization can take place and implantation can happen. However, most people, but not all, stick to the original plan and go to IVF out of frustration. Plus, usually a miscarriage results in extra lost time, and this gets people to want to get to IVF.
If you are older (I’m 49, so most of you are young to me), do your eggs need ICSI? Is the shell of the egg harder and less penetrable? This is my ARGHHHHH of the day. Simply, the answer is no.
At a young age, can anorexia or exercise induced amenorrhea mess up your eggs later in life? It actually is a very interesting question; however I have not seen any studies supporting this. There is probably no effect.
Could a woman with unexplained infertility donate her eggs? This is a tough one but probably not. Only because the recipients are taking a big financial and emotional gamble on the quality of your eggs. If you have unexplained infertility then have a successful IVF and wanted to donate later, that would be great for a recipient.
What if you are young and all the tests are normal. Your day 3 FSH is normal but you estradiol on day 3 is 20. Low is usually ok. Repeat it if you want piece of mind.
Donor egg or donor sperm? If you are young and the sperm counts are very low, and the embryos don’t look good, of course it could be the eggs or sperm. It really could go either way. Which brings us to a common dilemma. Getting inseminated with donor sperm is quicker, easier and tremendously less expensive that donor egg. So for that reason, if it’s not perfectly clear where the problem lies, and you have accepted the idea of donor egg, it is reasonable to consider a few courses of donor sperm insemination. Couples do seem more reluctant to do the donor sperm than they are for donor egg.
Major League questions about blastocyst. Are cryo’d blasts as sturdy as day 3 embryos? The answer is yes. A day 5 3BB is better than a day 6 4AA, unless the day 64AA was a day 5 3BB or better. It the trick with frozens in the freeze or thaw? Most of the skill is in the freeze, not the thaw.
Sorry, I do not now how to get pregnancy rates from Canada.
Update on 0ne-embryo transfer? Yes, in the past 1-2 years, every clinic has performed more and more one embryo transfers. So ask about their latest stats. I strongly suspect that the pregnancy rates for one embryo are lower in a frozen cycle. One way to up your odds in a frozen cycle would be to thaw a few (if you have them) and transfer the best one.
What if the sperm count is 145 million, with 40% motility and 2% normal morphology? Most REs would tell you that’s normal, but you need to ask yours.
If money is not an issue and you are faced with the choice between iui and IVF, and you want to do IVF, IVF is your best option. The success rate with FSH iui when all the testing is normal depends on your age. At age 37 it’s about 15%. Could be as high as 20%. IVF will be about twice that.
Should you go to surrogate if you are 43, have failed 6 fresh and 2 frozens, your lining is 5-6 mm and have 4 frozen embryos remaining. It’s a lot to consider, but surrogacy is an option. I am sorry but I can’t make more of a recommendation without seeing everything.
Can Lupron’s effects linger after your stop taking it? Anything is possible. However I have not had a patient with that problem.
With fairly good sperm should you spend the money on 2 iui’s or save for IVF? IVF is more cost effective than FSH iui. FSH iui is cheaper but much less effective. IVF is usually 2-3 times more effective than iui. There was a recent study showing going to IVF gets a baby with less time and money compared to FSH iui and IVF later if necessary.
Post coital test? Very few RE’s do this test anymore. It is just not accurate. Even if the test is abnormal, iui bypasses the cervix so antibodies in the cervical mucus (if such a thing matters) do not come into play.
Is IVF the answer if there have been 3 miscarriages and sperm with DNA fragmentation? I can’t be too negative about DNA fragmentation because it’s a little early to really know. However there is no good evidence yet to show those test are predictive of infertility or miscarriage. If your doctor feels differently, ask him or her to show you the studies.
Can very poor sperm lead to biochemical pregnancies and miscarriage? Yes but it’s not common. We all know that ICSI is used for very low sperm counts, and leads to good embryos and excellent pregnancy rates. However occasionally we see very low sperm counts and very poor embryo quality. In these cases, some women want to repeat IVF and expose a few of their eggs to donor sperm to see if there will be an improvement in the embryo quality. In some cases the difference is dramatic, and some couples will change over to donor sperm. If you are getting pregnant on your own without IVF and are having biochemical pregnancies, I’m not so sure it’s the DNA fragmentation.
Is IVF a treatment for 3 miscarriages? There are studies showing IVF without PGD is not very helpful for the treatment of miscarriages. There are some limited studies showing PGD may reduce the odds of miscarriage, but the data is not overwhelming.
What if you have had 3 biochemical pregnancies in a row? It’s hard to put much faith in the platelets, antibody, and autoimmune issues. Early on there is no placenta to speak of. There are no significant blood vessels to clot off. I must be sensitive to those of you who have had early losses and biochemicals, and then normal pregnancies after treatment for autoimmune/clotting factors. Maybe these things helped, but it can be possible that after a number of early losses, it was time for normal pregnancy.
What if you are 36 with all tests normal and 4 months of trying with good timing? Your odds of getting pregnant on your own in the next 4 months are still very good. Clomid or FSH iui are options, but giving it at least a total of 6 months on your own is a good idea.
How’s it going with the Priming protocol? If seems to work as well as other protocols in producing eggs. However the pregnancy rates are a little lower, so far. This is explained by the fact that we save the priming protocol for the worst responders, many of who have been cancelled using other protocols. So even if it’s a good protocol, we may not be seeing it because we are giving it to the patients who have low rates to begin with. So my bottom line is it’s worth trying as alternative, but it’s not a magic potion.
I am sorry I am not aware of co-culture with green monkey cells. Such a process would not be allowed in the US.
Thanks for reading and don't forget to see the disclaimer 5/17/06
Dr. Licciardi
posted by Dr. Licciardi at 8:07 AM
28 Comments:
Thank you for your blog! Very informative!
Dear Dr. Licciardi -
First, I wanted to thank you so much for maintaining this informative blog. It is such a relief to see things spelled out carefully and accurately by a professional. Truly, thank you.
I'd like to comment on something you wrote in a prior post (Dec 06, 2007 - admittedly I was looking through your blog to find entries on PCOS):
"There are 2 types of women who do not ovulate: those that are starving themselves, and those who are eating a bit more that they should"
I would just like to clarify that not all anovulatory women without hypothalamic amenorrhea eat too much. I have PCOS. It is severe in the sense that I have never ovulated, and I have ammenorhea, extremely oily skin, and some facial hirsutism. My GTT came back normal, although if you ask me, I'm prone to hypoglycemia. I have always been a normal weight (5'4", 110-120lb). My estrogen levels are fine, so there is no hypothalamus issue in this. I eat a very careful and healthy diet. I exercise regularly. I don't eat anything processed. I can't remember the last time I had soda. I have never eaten too much of anything. Yet, here I am, with PCOS and significant infertility.
I should note that I did make lifestyle adjustments after the PCOS diagnosis - increased exercise, completely cut out grain-sources of carbohydrates and added meat into my diet to get more protein and fewer carbs (I was formerly a vegetarian). My acne went down and my energy shot through the roof, but no luck with the fertility problems. My LH is still very high, I did not respond to clomid, and I am in the midst of a rather disappointing follistim IUI cycle.
Any nutritional advice for lean women with PCOS? It is hard for us to sort through the "lose weight / eat less / exercise more" advice given to overweight women with PCOS.
Looking forward to reading through the rest of your blog! Thanks again
I'm wondering if you would have some answers for me... In the Netherlands, they are not very far with things around miscarriages.
I have had 6 miscarriages between 6 and 10 weeks. Sometimes there is a heartbeat but it stops, sometimes there is no heartbeat. Mostly there the embryo isn't big enough, it's always 2-10 days behind.
The miscarriages never come itselfs, I always need a curettage. The HCG-levels are high enough. Progesteron they don't test in the Netherlands, at least not in my hospital.
I had a lot of bloodtests and they can't find anything to explain the miscarriages. I used bloodthinners, which didn't help me.
After every miscarriage, my body needs 3 months to get lost of the HCG and get a normal cycles and ovulation again. The past 3 years I have been pregnant every 6 months. I'm 33 years old.
I'm getting really desperate... Do you have any ideas, anything I could do, any test I could recommend my doctors, any medicin I could use to try? Just looking for new ideas, because in the Netherlands they say: we can't do anything for you anymore, just keep on trying and there always is a chance that you will have an effective pregnancy....
Dr. Liccairdi,
You are always so helpful. I have a child from a previous marriage, we had no conception issues. Re-married at 38 and have gotten pg 3 times in 2 yrs naturally, but all 3 were m/c, 1 biochemical pg, 1 Trisomy 21 missed m/c in the 14th week, and 1 Trisomy 22 missed m/c in the 10th week, I had d&e's with fetal testing. I have done 2 IVF's, I made 15-18 eggs each, 9 embryo's going into day 4 transferred 4 embryos on Day 4 (for both IVF's); none made it to blast, both IVF's BFN, nothing to freeze. RE said my embryo's were slow but all embryos were at least 6 cell on day 3; lining a perfect 10 for every medicated cycle/and natural IUI cycle. I over stimulated both IVF's and all inject IUI cycles (E2 over 7000 for IVF's/over 3500 for IUI's). My FSH is 5.1/AFC 15-20; I have no immunity issues, no endo, no issues, just AMA. DH has 2% morphology, 30 million count, 70% motility, 24% DNA damage, and bilateral varicocele's that were repaired. We won't consider another IVF due to stress, money, physical toll, etc. Since our ART cycles have all failed (12 of them in all); and we have been pg 3 times naturally but lost to trisomy is it just a matter of hitting the right egg? Or is this a sperm issue? I am almost 41 (so I know what you are going to say ;) its my age? Is it a good sign that I keep getting pg naturally and can we have any hope that we might hit a good egg? Or if the m/c are my DH's sperm then are we hopeless to ever conceive a normal?
Question for you. My last IVF protocol, I did the Lupron flare protocol, and produced approximately 15 follicles. On the day of my trigger shot, the Dr's office called me and said my estrogen was 4,000, so instead of doing the 10,000 unit HCG shot, to do a 5,000 ovidrel shot. On the day of retrieval, only 1 egg was recovered, and the rest were immature. My RE told me he thinks it was due to the change in HCG meds that led to the follicles not being mature.
What happened here? Is the clinic liable at all? Feeling totally frustrated as I just spent thousands, responded well to the protocol, and had a disaster on retrieval day.
Thanks.
Thank you so much for this blog! It is very informative and is great for me to bring up issues for discussion with my doctor.
I have a question about exercise. I was advised to completely stop all aerobic exercise when trying to conceive, but was told that I could lift weights. I did stop exercising for 3 months, but resumed aerobic exercise (moderate, no more than 30 minutes 5x/week) for my mental health. I conceived this month and have now been advised to avoid all physical exertion, including lifting weights. I have no history of miscarriage. I did give birth to stillborn twins because of a cord accident. Is it really necessary for me to be completely sedentary during the first trimester? I am a very active person and am having a hard time with such a strict prohibition.
Dr. Licciardi,
Thanks for your blog. It's very helpful!
So my hubby and I have been doing infertility testing for a year. I had a miscarriage at about 7 weeks about 2.5 years ago and have been unable to get pregnant since. I did a 6 month study through the national institute of health where they gave me either a placebo or low-dose aspirin and a fertility monitor, all with no success of pregnancy.
My hubby's done 3 semenalyses, (which have proved to be normal. . . he had an abnormal count of about 30% on one, but the rest were fine and the counts were fine), we both did the antisperm/antibody test which turned out normal, he did the hamster test and got 100% penetration, an ultrasound which proved to be normal, as well as blood tests for both of us that have proved to be normal.
My cycle varies between 25-33 days, but always falls within that window, just varying lengths within that window. I recently did an HSG test and it showed no blockages.
Our next step in the process is a post coital test, a blood draw at a certain point in the cycle, and a sample of my uterine lining to see if it's thick enough at that point in the cycle to be viable for a baby.
My dr. said that at that point, if everything's normal, we can proceed with IUI. However, he did say that we should consider doing a laparoscopy to check for possible endometriosis. He said that even though my HSG test was normal that if I had endometriosis it could possibly flare up and die down. I've always experienced mild cramps for 1-2 days on my cycle but isn't that normal? He said cramps could be indicative of endometriosis. I have no problems with doing a laparoscopy if it weren't for the cost. . . $2500. I'm just wondering if with everything else positive if mild cramps being my only symptom are enough to warrant the cost of checking it out, or if it's something that won't affect my fertility too much.
Thanks for taking the time to read my questions!
Dr. Licciardi,
Thank you so much for this blog.
Background---
trying for our second child (my third) for over a year and a half. I am 37, my husband is 45. We were going to start FSH IUI in June, however I acheived a pregnancy without it. The pregnancy was lost at 8w3d. Pathology report indicated Trisomy 9. Doctor said we should do FSH IUI this next cycle. We can not afford to do IVF--we are 100% OOP. My H counts were 30% motility and only 1% morph. The doctor also said Trisomy 9 could be due to my age and it can happen again. Are we crazy to even attempt this IUI?? Do we have an increased chance of success being we have already gotten pregnant twice with one healthy child?
Dear Dr. Licciardi,
I like your blog, very informative!
Thanks for sharing!
I searched the previous blogs and learned a lot! I did not find anything specific to my situation, so here goes.
I am 37. I had 2 small polyps removed via hysteroscopy in February 2009 because I had intermittent bleeding and had been trying to concieve with no luck. At that time, I was told I had a thin uterine lining with some thickening around the area of the polyps which was in the cervix.
Since that time, I have been charting my temps and keeping a journal with details about my cycle like cervical mucus etc. I also use an opk.
My bleeding immediatley normalized in one cycle after my polyp removal, but my cycle is now very long, 42 days, which I know is still considered in the normal range, but my follicular phase is way too long.
I am ovulating according to the opk (and the temperature rise on my charts) on DAY 31, for 3 months now. My luteal phase is 11 days, which I think is ok, but could be longer.
The cycle is very consistent, but I have not tried to concieve as of late because I understand that eggs that late in the follicular phase could lead to misscarriage or birth defects. Is this accurate, could you qualify?
My question is, what steps should I take IF ANY, to shorten the follicular phase, ovulate earlier, and lengthen the luteal phase a bit more. Any insight is welcome.
I am not on any treatments currently, I am appropriate weight, do yoga 3 times a week, visit an accupuncturist 1 x month and take a special herb formula to support the reproductive organs. I have not had any bloodwork as of yet. If you think certain values would be helpful, please do tell and I will request those.
Thanks so much.
Hello Dr. Licciardi
I just stumbled upon your blog and Im so excited about this. My tubes are blocked due to scar tissue from surgeries relating to Crohns Diease. WE have done two cycles of IVF two great quality embryos each try. First try failed, second try we did assisted hatching and icsy. One stuck and we miscarried. WE are attempting round three with a frozen cycle. Do you recommend putting in 3-4 embryos or stick with two? WEre desperate!
Dr. Licciardi ,
One simple question, then a complicated one. First, how are polyps diagnosed? I am concerned I may have them but I had an “internal” ultrasound and everything looked okay. Would that have spotted any polyps if I had them?
And second: Do you know anything about Androgel, a topical testosterone supplement? My husband suffers from low testosterone and has been on Androgel since he was 16 or so. I read that this medicine can cause sterility. He has an appointment with his endo doctor in a few weeks, but I’m anxious to know what our odds are of conceiving. We have been TTC for 7 ½ months (but only on 5th cycle due to my long cycles after BCP) I’ve found mixed information about whether the counts can be brought back up with fertility drugs (HCG or clomid) but it was not from a reliable source—such as yourself.
I hope you can offer up some information on this subject. Thanks SO very much for writing this blog! You are a wonderful doctor and I only wish I lived in NYC so you could be my doctor!
Have you ever transferred a seven-day blast? What are the odds with a blast frozen that late? Do you think it's likely to survive the thaw?
Thank you for taking the time to answer questions - I am so grateful for your continued generosity and insight.
My situation - I am ovulating and menstruating regularly, all tests (estradiol, FSH) have come back great (same as I was 2 yrs ago, when we had our first successful IVF/ICSI; I am normally fertile, husband has severe infertility).
My problem - the RE is hesitant to go forward with another cycle because my 14-mo-old is still nursing 1-2x a day for a few minutes. (I don't pump, so I consider this as minimal breast stimulation.)
According to Dr Thomas Hale (author of Medication and Mother's Milk), fertility meds largely are hormones that a mother already produces and/or are too big to pass into milk and/or are poorly bioavailable orally (http://neonatal.ttuhsc.edu/discus/messages/53/256.html?1243503239). Plus, I have low milk production, so let's say for now that the meds won't affect the baby.
Why else is breastfeeding contraindicated during ART? Prolactin is elevated during nursing, but considering how little the baby nurses and given that I'm reguarly ovulating, doesn't that mean its antifertility effects are minimal?
I understand that the odds of success can be generally low, and to reduce it by a few more percentage points is foolish, but I am heartbroken about weaning and can't find any concrete evidence that minimal breastfeeding of a toddler has a clinically significant effect on fertility.
(PS. I have a biology PhD and have been scouring the fertility literature. If you have any references, please let me know.)
Thanks very much for your consideration.
What a wonderful blog...thank you for sharing. My husband and I have been struggling to conceive for over 2 years now, with medical issues.
I used OPKs this cycle, and had 7 days of positive tests. My dr said (over the phone) this means I have PCOS. I am 26 had blood teststhat all came back normal, and I have no other PCOS symptoms. She says the only option is Clomid, but that I will not need to be monitored at all. Is 7 positives really such a big deal?
Dr. Licciardi,
Thank you for your blog. I have diminished ovarian reserve and just did IVF#1 with the microdose lupron flare. It didn't work. I was intrigued by your comments in your 1/8/07 post about the Antagon protocol and your comments in this post about the Priming protocol? Would it be possible for you to write more about these protocols and/or other options for poor responders in a future blog? I'm 38 w/ FSH between 11 (1.5 years ago) and 8 (3 mos ago) and AMH (?) of 0.3. In this cycle, we got 5 follicles, but only one egg. Thank you!
I just wanted to add to my post--I am 27 and my husband is also 27. We knew it may take a while and although we are ready now, we ULTIMATELY hope to have our first baby before we are 30.
I am 33, my husband is 35. He had chemo and chest radiation for nhl 6 years ago. We have been trying to conceive for the past 12 months. He has had several SA's over the past 6 years, not normal at first, but now considered normal. Does this explain everything? Could his sperm still be a problem even though his SA is "normal"? Are there further tests we could have done? I am in the process of my testing. Thank you. -tarah
you're an ass.
I am glad I found this blog, it is very informative. Here is our story. I am 31 and dh is 34. We started ttc over a year ago at the same time I started having spotting a few days before my periods something that has never happened before and has been present for the last 16 cycles since. After 5 months trying (7 cycles since my cycle length is only 22-24 days) we started testing. It was discovered dh had very low sperm count and volume. No reason could be found for the problem and we did our first ivf+icsi cycle in April. They got 9 eggs from me but only 6 were mature (I think they triggered me too early). Out of the 6, 4 fertilized, but by day 2, 2 of the 4 were not doing well (one was dying, other was dividing abnormally). They put in the other 2 (a 2 and 4 cell). I got pregnant with one baby. Had great betas and good heartbeat at 6w5d. At our next u/s 2 weeks later there was no heartbeat. I had a d&c I week later and the testing came back as 46xx. I changed clinics and we started on another ivf+icsi cycle. The protocal was basically the same (antagonist) except repronex wasn't used and gonal-f dose was increased from 225 to 375. I had 10 follicles going into ER and they got 6 eggs however one of the eggs was empty and another was degenerated. They icsi the remaining 4. 2 out of the 4 embryos died on day 2 and they put a 6 cell (min frags) and 7 cell (no frags) in on day 3. I am right now in the two week wait. I did notice though on the paper someone wrote that the sperm morphology was very poor. On dh's 2 previous SA morphology was 75-90%(this was 7-8 months ago and he has been on vitamins for almost a year). I am just wondering how his morphology can go from excellent to extremely poor in a period of months also why is my egg quantity and quality so bad when I just turned 31? My FSH 5 months ago came back at 9, but estrogen was borderline high (I don't know the number but guessing between 75-100)
Hello Dr. Licciardi,
I have stumbled upon your blog and was wondering if you have any experiences with a Reciprocal Trans-Location Carrier??? Chromosome 5 and 8 are rearranged in me. This is very rare I think .2% of the population have it. I have been told that IVF is the only way to really have a healthy child. I've had 3 miscarriages so far and I'm only 26. Is there a chance of staying pregnant with this diagnosis? Naturally or through IVF?
Dr. Licciardi, thank you for starting this blog, it's great to get to read about the doctor's perspective. I'm learning so much!
I'm 27y/o and my husband and I have never gone off birth control. I assume we're both fertile. However, I've just found out I'm a carrier for Hemophilia A (severe). I'm sure you already know this gives me a 50/50 chance of a son with full-on hemophilia.
My husband and I would like to go straight to IVF with PGD, to screen out both affected male and carrier female embryos. I've seen you mention elsewhere on the blog that you don't care much for PGD, but does that apply to cases like mine? Would you recommend it and consider it effective in screening out specific genetic disorders?
I'm also very curious about how the labs keep the embryos and the samples matched up. I'm in Portland, OR and the PGD lab is in Detroit, MI. How are they going to know for sure that the results from the lab match up to the embryos they're going to transfer or freeze? I'd hate to "discard" a healthy one, or transfer an affected one.
Many thanks!
Thank you for this blog! The best collection of information I've seen! I'm wondering if you have any thoughts on my current issue....
I am 33. I have 2 children that I conceived naturally and easily in 2004/2006. I have had 2 c-sections.
We decided to try for a 3rd (and last) baby, & we have been trying for a year and a half with no success. I have just started seeing a fertility specialist. My main concern is that since my cycles resumed after my last child, my cervical mucus at the time of ovulation is very dark brown. Not just streaked--it literally looks like chocolate syrup. All of my hormone profiles have looked great. I do have a submural/submucosal fibroid that the specialist has recommended I have removed. At first he thought this may be the cause of the yucky CM. However, when he performed an HSG on day 7 of my cycle(which was unremarkable other than the fibroid), he had some difficulty passing the catheter. When he did get it passed, lots of this "chocolate syrup" goop came out. He said that it seems that I have some degree of cervial stenosis, and am retaining menstrual products. He dilated my cervix; and repeated the dilation 2 weeks later. He seemed to think this would take care of this issue; at least temporarily.
I haven't been able to find much information on this topic at all. It seems to me that this MUST be related to my current infertility. As it seems there would be no way for sperm to get through this yucky CM, right? While I am still open to having a myoectomy for my fibroid (I also have had issues with heavy flow/painful periods); I don't want to have it, only to find out that this cervical issue is still a problem. What can you tell me about cervical stenosis. What would cause it to develop? (I have never had a d&c, cone biopsy, or any other procedure on my cervix! And my c-sections were planned b/c of breech presentation.) Does cervical stenosis typically cause infertility? Is this an over-comeable problem? Would IUI be an option if these cervical dilations do not work? Could IUI be sucessful if I am still having the yucky chocolate syrup CM?
Thanks for any help!
Thank you so much for such a wonderful and helpful blog. I have a question re male morphology. On the two sperm analysis that my husband got, they both ready that he had 0% morphology because the sperm were missing the acrosome. We finally got pregnant after IVF with ICSI. I am currently pregnant and couldn't be happier. Going forward, we would like to get pregnant natuarally again in the future. I have one daughter that is 2 years old that was concieved naturally after only 2 months of trying. Baby #2 was the IVF/ICSI baby. What could have happened to the sperm in a 1.5 years to make them have no acrosome? I have also heard this is not an easy problem to remedy. Can sperm change in a year following lifestyle changes or taking vitamens? The only thing he did differently is keep a blackberry cell phone in his pocket. Any advice or are we stuck doing IVF/ICSI for #3.
My husband & I have 2 childen concieved naturally/quickly. The youngest is 2 years old. We have recently had a sperm analysis done and have been told he has a good count (54 mil), good morphology, but 38% motility; with only 19% fast forward motility.
Could this just be an issue on this sample since he has fathered 2 children so recently? Is there a good chance it will be fine when we repeat in a few months? What could have changed?
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Dear Dr. Licciardi,
Thank you for your informative blog. I have learned so much!
My question is: I am 35. I had a Cone biopsy in '01 for cervical cancer. I went in for an HSG 2 weeks ago. The radiologist had to manually dilate my cervix open in order to fit the catheter in. Apparently, my cervix had scarred almost shut. (The first dilator or catheter they used was a French 4 something) They were able to perform the HSG and my tubes and uterus are clear. My OBGYN said that my cervix should remain open "for a while." She would like us to continue to try to conceive for the next 2 months, and then if we are not successful move to clomid. My concern is that my cervix will quickly scar shut again. My cycles are irregular and I am wondering if I should be dilated each cycle. Should I go to see a Reproductive Endocrinologist now because they have greater expertise with such issues? My husband's Semen analysis results were very good. I have been unable to find much information on cervical stenosis, which is what I assume I have.
thank you for your time!
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