Questions About Infertility Issues
Ovulation Timing Questions
If your cycles are 55 days, are you ovulating? Most likely, probably around day 41. However, it is possible that you are not, so you must confirm through your doctor.
What if your cycles are 28-31 days but a progesterone test proves ovulation day 11? Very unusual, but it does not mean you are infertile. Check for ovulation a little earlier using the LH kit to see when it starts and to see if this is a consitant issue.
Is there a problem with 70 day cycles? Yes. You can try to track ovulation but when do you start to do so? If your cycles are always 70, check a progesterone day 60. If it shows ovulation at least you have that. It’s just harder to time things with such a long cycle, and you really don’t have many ovulations per year. If you want to get pregnant, get some help.
Miscarriage Questions
If you are having miscarriages on clomid, will IVF up your odds of going to term? Different doctors will give you different opinions. The IVF option will sit differently with different patients. We aren’t sure if IVF will reduce your miscarriage risk. So the answer is probably no, your odds will be the same with or without clomid. However there may me a play to try IVF with PGD. This option you really need to talk about with your doctor.
Does having an early miscarriage predict further pregnancy loss? Usually not. The odds are still excellent for having a baby in the next pregnancy if you had had only 1 miscarriage, or even 2-3 for that matter.
Will you ever conceive again after trying 3 iuis that resulted in one ectopic and 2 miscarriages? And suppose one of the tubes was removed? If the remaining tube is open, your odds would be excellent of conceiving again. But don't wait too long before getting help.
Is there a relationship between a long follicular phase and miscarriages? Most likely no.
IVF Questions
Is it better to transfer a fair quality embryo on day 2 or let it grow to day 3 or day 5? Does the uterus provide an advantage over the Petri dish? Unless the lab is really bad (these days there are few really bad labs), then it does not matter. Now that’s’ if there are only 1-2 embryos. If there are more, going to day 3 will help you select the better embryos for transfer. Lab differences are more of a factor when going from day 3 to day 5.
What if the sperm is normal and you are not fertilizing? Should you try donor egg? If you wish, but the problem is more likely related to the sperm. Of course, unless you try donor sperm or donor egg you would not know, but if you look at a 100 patients who are having your problem, almost always the sperm is the issue.
If you are a poor responder, will adding clomid to an IVF cycle give you more eggs? It is one of the options. I make it may last, I put Estrogen prime of microdose first, then maybe clomid. Clomid sometimes makes the uterine lining thinner.
Is there a weight limit for IVF? It depends on the program. The fact is, people are getting bigger and doctors are getting more used to dealing with the big problem. However, it may be important to meet with the anesthesiologist who would be taking care of you during your retrieval. More important than your weight is the configuration of your neck and throat. They want to be sure that if you have trouble breathing, they can get a tube down without a problem. And let’s not forget that your doctor may be less worried about the retrieval and more worried about you and your baby during and after the pregnancy. It has been clearly shown that obesity is bad for pregnant women and bad for babies to be in the short and long term.
If you’re a poor responder, will dexamethasone produce more eggs? This has not been shown to be the case.
Do frozen embryos make healthier babies than fresh? There was one article that somehow came to this conclusion. We do not think there is a difference.
What if a “dominant follicle” seems to be the problem? Dominant follicles come in a variety of forms. Some women are very poor responders and only make one follicle. I have heard this referred to as a dominant follicle. More commonly, a dominant follicle means that you have the potential to make many follicles, but for some reason, only one is big and the others remain small. There are strategies to try to reduce this phenomenon but they may or may not work. We believe that in a natural cycle, the dominant follicle may be selected before the period even comes, so by day 2 the body has already laid out its plan for that month, and stimulating the ovary with drugs may not be able to alter that plan, leaving you with a low number, or just one dominant follicle. So by using oral contraceptives or lupron to turn off the ovary system for a little while, we may be able to stop the dominant follicle pre-selection and give more than one follicle a chance at becoming dominant. However, most of the time, the difference is not extreme
25 years old and not pregnant after an IVF cycle with nice embryos? In the end you will probably be fine. As I have said many times, get to the best program possible. Even at the best programs, these things happen.
What if you have a low AMH level (a sign of poor ovarian reserve) but have many resting antral follicles as seen by ultrasound and make many eggs during stimulation. In your case, the AMH is just dead wrong. As far as we know the AMH is not predictive poor egg/embryo quality, just egg numbers. AMH is promising as a way to measure reserve, but there are a few problems, most of us are not comfortable yet using if for a definitive diagnostic tool. In many cases it does give us correct information, but we need to fine tune the testing and result interpretation.
Interesting question. If a clinic is more aggressive in bring patients to IVF early without much other treatment, will their IVF success rates be higher than clinics that get some people pregnant first with clomid or FSH? Will doing IVF on fertile people make a clinic look better? I would say in a few case yes, this makes sense. In fact overall, since IVF seems to work well enough for most people, more people are doing IVF after shorter intervals of clomid or FSH. However it depends on the IVF success rate differences between the 2 clinics. If there is a small difference, I would point to the selection. If there is a big difference, IVF quality is a big part of the discrepancy.
How do you know if the clinic does a good job with blastocyst culture? Try asking what percentage of transfers are blastocyst for your age group, then ask the delivery rates for blast vs. day 3. Of course check their SART statistics. If they have very good pregnancy rates but do much blast, that may be fine. However also check on the number of embryos they put back. If they have good rates with a higher number of embryos returned and a higher number of triplets, that’s not so good. One of the goals of blastocyst culture is to take advantage of the natural selection process so that by day 5 the best embryos will stand out. If we can see which ones are better, we can put fewer in and reduce the odds of multiples, while maintaining higher pregnancy rates.
IUI Questions
When should you do the iui after the trigger shot? Ovulation will take place 36-38 hours after the shot. There is not a specific time that has been shown to be better. The sperm may be available to fertilize for at least 2 days. The egg is good for about 1 day. So it is reasonable to have the iui performed 24 hours after the trigger.
What if it seems on FSH you are ready too early? Even though you may be ready on the early side, the egg or eggs are probably not affected. However, if it is early there is less harm in waiting an extra day or 2 to give the hcg. I have not heard this to be more effective than just giving the hcg at the usual follicle size, independent of the cycle day.
Should you see an RE or should you let your general OBGYN handle the clomid? It depends on your threshold. If it’s really that more convenient and less expensive, and you are not in a super rush, a few months with your generalist is fine. Otherwise, get to the RE.
Donor Egg Questions
One of my most difficult questions. What if you are doing donor egg with a proven donor and your embryo quality is not great, even when splitting the eggs ½ donor sperm, ½ partner sperm? Clearly all avenues have been explored. If you have not already, and wish to continue, consider another opinion. Now I have seen proven donors give disappointing results in subsequent cycles. It is true that a young donor is more likely to make a baby with embryos that don’t look as good, so maybe the proven donor made fair embryos last time and made a baby. We have been surprised when there are pregnancies from poorly looking donor embryos, but thankfully we see it now and then.
Tubal/Uterine Questions
What about a second surgery for a septum, may it be necessary? Occasionally, more likely with a larger septum. Sometimes at surgery the cavity looks fully repaired but an HSG 2 months later shows there is still a good piece remaining. In this case maybe the upper septum scars together making it appear it was never cut. Or maybe it was never cut, which could be for 2 reasons. Maybe the doctor cut and cut and cut and was really pleased and observed there was a little piece left but felt almost it was gone, and that it was ok to leave a little. He may have wanted to avoid cutting too much, which would increase his chances of perforation. And many women do just fine with a small piece left, as long as it is not too big. But leaving a small percentage may still be leaving a substantial amount. To cut more and reduce the odds of perforation, the doctor can use an ultrasound during the surgery to watch the uterus and the septum, to help cut most of the septum but not perforate.
Another reason for finding some septum after the surgery is that there may be times when the pressure of the fluid used to distend the uterus during hysteroscopy pushes the and remaining septum up towards the muscle layer, making the inside of the cavity look smooth and normal. Yet, once the pressure is relieved by removing the fluid, a bit of the septum bulges back down into the cavity of the uterus. This is theoretical on my part, but I am guessing it does happen this way.
If you have proximal occlusion and your tube is opened, will it stay open? If it was really blocked and you have a procedure to have it opened the odds are about 70% that it will stay open.
Thanks for reading and please read the disclaimer from 5/17/06.
Dr. Licciardi
If your cycles are 55 days, are you ovulating? Most likely, probably around day 41. However, it is possible that you are not, so you must confirm through your doctor.
What if your cycles are 28-31 days but a progesterone test proves ovulation day 11? Very unusual, but it does not mean you are infertile. Check for ovulation a little earlier using the LH kit to see when it starts and to see if this is a consitant issue.
Is there a problem with 70 day cycles? Yes. You can try to track ovulation but when do you start to do so? If your cycles are always 70, check a progesterone day 60. If it shows ovulation at least you have that. It’s just harder to time things with such a long cycle, and you really don’t have many ovulations per year. If you want to get pregnant, get some help.
Miscarriage Questions
If you are having miscarriages on clomid, will IVF up your odds of going to term? Different doctors will give you different opinions. The IVF option will sit differently with different patients. We aren’t sure if IVF will reduce your miscarriage risk. So the answer is probably no, your odds will be the same with or without clomid. However there may me a play to try IVF with PGD. This option you really need to talk about with your doctor.
Does having an early miscarriage predict further pregnancy loss? Usually not. The odds are still excellent for having a baby in the next pregnancy if you had had only 1 miscarriage, or even 2-3 for that matter.
Will you ever conceive again after trying 3 iuis that resulted in one ectopic and 2 miscarriages? And suppose one of the tubes was removed? If the remaining tube is open, your odds would be excellent of conceiving again. But don't wait too long before getting help.
Is there a relationship between a long follicular phase and miscarriages? Most likely no.
IVF Questions
Is it better to transfer a fair quality embryo on day 2 or let it grow to day 3 or day 5? Does the uterus provide an advantage over the Petri dish? Unless the lab is really bad (these days there are few really bad labs), then it does not matter. Now that’s’ if there are only 1-2 embryos. If there are more, going to day 3 will help you select the better embryos for transfer. Lab differences are more of a factor when going from day 3 to day 5.
What if the sperm is normal and you are not fertilizing? Should you try donor egg? If you wish, but the problem is more likely related to the sperm. Of course, unless you try donor sperm or donor egg you would not know, but if you look at a 100 patients who are having your problem, almost always the sperm is the issue.
If you are a poor responder, will adding clomid to an IVF cycle give you more eggs? It is one of the options. I make it may last, I put Estrogen prime of microdose first, then maybe clomid. Clomid sometimes makes the uterine lining thinner.
Is there a weight limit for IVF? It depends on the program. The fact is, people are getting bigger and doctors are getting more used to dealing with the big problem. However, it may be important to meet with the anesthesiologist who would be taking care of you during your retrieval. More important than your weight is the configuration of your neck and throat. They want to be sure that if you have trouble breathing, they can get a tube down without a problem. And let’s not forget that your doctor may be less worried about the retrieval and more worried about you and your baby during and after the pregnancy. It has been clearly shown that obesity is bad for pregnant women and bad for babies to be in the short and long term.
If you’re a poor responder, will dexamethasone produce more eggs? This has not been shown to be the case.
Do frozen embryos make healthier babies than fresh? There was one article that somehow came to this conclusion. We do not think there is a difference.
What if a “dominant follicle” seems to be the problem? Dominant follicles come in a variety of forms. Some women are very poor responders and only make one follicle. I have heard this referred to as a dominant follicle. More commonly, a dominant follicle means that you have the potential to make many follicles, but for some reason, only one is big and the others remain small. There are strategies to try to reduce this phenomenon but they may or may not work. We believe that in a natural cycle, the dominant follicle may be selected before the period even comes, so by day 2 the body has already laid out its plan for that month, and stimulating the ovary with drugs may not be able to alter that plan, leaving you with a low number, or just one dominant follicle. So by using oral contraceptives or lupron to turn off the ovary system for a little while, we may be able to stop the dominant follicle pre-selection and give more than one follicle a chance at becoming dominant. However, most of the time, the difference is not extreme
25 years old and not pregnant after an IVF cycle with nice embryos? In the end you will probably be fine. As I have said many times, get to the best program possible. Even at the best programs, these things happen.
What if you have a low AMH level (a sign of poor ovarian reserve) but have many resting antral follicles as seen by ultrasound and make many eggs during stimulation. In your case, the AMH is just dead wrong. As far as we know the AMH is not predictive poor egg/embryo quality, just egg numbers. AMH is promising as a way to measure reserve, but there are a few problems, most of us are not comfortable yet using if for a definitive diagnostic tool. In many cases it does give us correct information, but we need to fine tune the testing and result interpretation.
Interesting question. If a clinic is more aggressive in bring patients to IVF early without much other treatment, will their IVF success rates be higher than clinics that get some people pregnant first with clomid or FSH? Will doing IVF on fertile people make a clinic look better? I would say in a few case yes, this makes sense. In fact overall, since IVF seems to work well enough for most people, more people are doing IVF after shorter intervals of clomid or FSH. However it depends on the IVF success rate differences between the 2 clinics. If there is a small difference, I would point to the selection. If there is a big difference, IVF quality is a big part of the discrepancy.
How do you know if the clinic does a good job with blastocyst culture? Try asking what percentage of transfers are blastocyst for your age group, then ask the delivery rates for blast vs. day 3. Of course check their SART statistics. If they have very good pregnancy rates but do much blast, that may be fine. However also check on the number of embryos they put back. If they have good rates with a higher number of embryos returned and a higher number of triplets, that’s not so good. One of the goals of blastocyst culture is to take advantage of the natural selection process so that by day 5 the best embryos will stand out. If we can see which ones are better, we can put fewer in and reduce the odds of multiples, while maintaining higher pregnancy rates.
IUI Questions
When should you do the iui after the trigger shot? Ovulation will take place 36-38 hours after the shot. There is not a specific time that has been shown to be better. The sperm may be available to fertilize for at least 2 days. The egg is good for about 1 day. So it is reasonable to have the iui performed 24 hours after the trigger.
What if it seems on FSH you are ready too early? Even though you may be ready on the early side, the egg or eggs are probably not affected. However, if it is early there is less harm in waiting an extra day or 2 to give the hcg. I have not heard this to be more effective than just giving the hcg at the usual follicle size, independent of the cycle day.
Should you see an RE or should you let your general OBGYN handle the clomid? It depends on your threshold. If it’s really that more convenient and less expensive, and you are not in a super rush, a few months with your generalist is fine. Otherwise, get to the RE.
Donor Egg Questions
One of my most difficult questions. What if you are doing donor egg with a proven donor and your embryo quality is not great, even when splitting the eggs ½ donor sperm, ½ partner sperm? Clearly all avenues have been explored. If you have not already, and wish to continue, consider another opinion. Now I have seen proven donors give disappointing results in subsequent cycles. It is true that a young donor is more likely to make a baby with embryos that don’t look as good, so maybe the proven donor made fair embryos last time and made a baby. We have been surprised when there are pregnancies from poorly looking donor embryos, but thankfully we see it now and then.
Tubal/Uterine Questions
What about a second surgery for a septum, may it be necessary? Occasionally, more likely with a larger septum. Sometimes at surgery the cavity looks fully repaired but an HSG 2 months later shows there is still a good piece remaining. In this case maybe the upper septum scars together making it appear it was never cut. Or maybe it was never cut, which could be for 2 reasons. Maybe the doctor cut and cut and cut and was really pleased and observed there was a little piece left but felt almost it was gone, and that it was ok to leave a little. He may have wanted to avoid cutting too much, which would increase his chances of perforation. And many women do just fine with a small piece left, as long as it is not too big. But leaving a small percentage may still be leaving a substantial amount. To cut more and reduce the odds of perforation, the doctor can use an ultrasound during the surgery to watch the uterus and the septum, to help cut most of the septum but not perforate.
Another reason for finding some septum after the surgery is that there may be times when the pressure of the fluid used to distend the uterus during hysteroscopy pushes the and remaining septum up towards the muscle layer, making the inside of the cavity look smooth and normal. Yet, once the pressure is relieved by removing the fluid, a bit of the septum bulges back down into the cavity of the uterus. This is theoretical on my part, but I am guessing it does happen this way.
If you have proximal occlusion and your tube is opened, will it stay open? If it was really blocked and you have a procedure to have it opened the odds are about 70% that it will stay open.
Thanks for reading and please read the disclaimer from 5/17/06.
Dr. Licciardi
posted by Dr. Licciardi at 4:43 PM
31 Comments:
I love the new format. Thank you for always taking time out to answer questions.
I'm almost 29yo with 2 children. Last one was a case of vasa previa with an emergency-c. I was told that I should only have one more and by 30. I had been trying for a year and they took my AMH level only to tell me that it came back <.1. My dr. said that would put me at a post-menopausal state...Is there anything else that could make this come back this way? I'm running out of time and can't seem to get pregnant. Thank you!
I recently came across your blog and have been reading along. I thought I would leave my first comment. I don't know what to say except that I have enjoyed reading. Nice blog. I will keep visiting this blog very often.
Alena
http://ovarianpain.net
This is a fantastic blog. Great work! I came across another blog you might be interested in, regarding Embryo Donation and Adoption:
http://embryodonationandadoption.blogspot.com/
Hi Dr L,
I've spent months trying to find the answer to my question. Maybe you can help. There is a lot of talk about a thin endometrium, but what about THICK? Can it be too thick?
Could a THICK endometrium contribute to implantation failure?
I am 31, normal weight, unexplained infertility, and have had 2 failed IVFs with beautiful embryos. We did a 5DT of 3 early blasts and a 3DT of 3perfect 8 cells.
I am a "perfect" responder. My E2 rises nicely...actually, quickly. (3000ish at trigger both IVFs after 8 days stims and 10/11 mature eggs). My lining is normal at baseline (3mm) but gets THICK. 14mm and 16mm at trigger. HSG, SHG and Hystro/Lap all clear. All hormones normal (FSH/LH/P4/E2) in a natural cycle, but get high with stimulation.
I have a few 2pn embryos frozen for a FET. Our plan was to better control my cycle (lower E2 and thinner lining) but after 2 doses of E2V my E2 went to 350 and after a 3rd dose my lining was 14mm. (Didn't bother to draw the E2, we cancelled).
My question(s) - could my sensitivity to E2 be contributing to my infertility? Is my lining getting too thick? Do you think the answer is to try this FET again on even a lower dose of E2V?
Hyperplasia does not seem to be my issue as my lining properly sheds. I just seem to be really responsive to estrogen. The only thing my RE can find "wrong" is that all of my hormones are "too high". My E2 gets high for COH/IUI and IVF. And, my P4 has been over 150 on injects (no suppementation) and over 300 for IVF (1/2 CC PIO).
Thanks for your insights.
- Kat
It is very useful information. I like it very much. It will be help a huge number of people, who have the interest in this field. Keeps it up great work!!!!!.
So glad I came across this blog!
I am 26 years old. I have PCOS and I have had 3 DNCs, recently had an HSG tubes were clear, and the day before Thanksgiving a Hysteroscopy to remove scar tissue from my uterus. She(OBGYN) ran all of my hormone levels and said that she cannot figure out why I still do not have cycles that she has literally checked everything. I have not had a cycle since July of 2008 and the only way to make me have a cycle is through birth control. We have tried different levels of Progesterone and Hormone Replacement Therapy, but the only thing working is birth control which obviously is an issue if you are wanting to have a baby.
My husband and I have been trying for 3 years. I have read about FSH injections. Do you think this could possiby work? Any suggestions are appreciated.
Thank you for you time,
Cassi
Thanks so much for all the helpful information you post here! I have a question. I'm 26 years old and was diagnosed with hypothalamic amenorrhea last summer after no cycles for a long time. I have since gained about 10 pounds, and thankfully, my cycles started coming back. However, they have been pretty long with short luteal phases. The past two cycles, I have ovulated on day 33 and 35, respectively. On the last cycle, I took progesterone suppositories to correct the LPD and ended up with terrible PMS and a 17 day LP. So this time I thought I would check and make sure I still needed the progesterone, so I got my p4 tested at 5 dpo. It came back as 4.8, which is definitely low, so I'm back on the suppositories.
Here's my question: My OB said that the low progesterone could be because I'm "not ovulating effectively." I don't understand what that means. Is that a possibility? Or is it related to the fact that I have such long follicular phases? If I'm not ovulating effectively, it seems like the progesterone suppositories aren't going to solve the issue. But what else can I do?
I have zero infertility coverage and we can't currently afford to see an RE at this point, so that's why I've stuck with my OB so far.
Thanks so much!
Charissa
I'm confused about Clomid vs injectables? Is one better than the other? I've read that injectable make better quality eggs, is this correct? Nicole
Hi,
I am The editor/writer with physician.com. I really liked your site and i am interested in building a relationship with your site. We want to spread public awareness. I hope you can help me out. Your site is a very useful resource.
Please email me back with your URl in subject line to take a step ahead and also to avoid spam.
Thank you,
Anna Huges
editorial.physician@gmail.com
www.physician.com
Thank you for your very informative blog.
I am soon 38, my husband 33, unexplained infertility, in treatment for 2 years (Belgium). We have done 5 ICSI cycles, all failed. Every time the stimulation seems to go very well, after 9-10 days I have a lot of follicles - the problem is that very few of the eggs are mature (only some 20-30%). I have to add that the pickup always takes place at the (theoretically) right moment: the biggest follicle over 18 mm, in the last cycles even over 20 mm, e2 around 4000. The maximum of embryos we have managed to obtain was 3, there has never been anything left to freeze.
Short history:
1. short protocol, PUREGON: 21 eggs retrieved, 8 mature, 4 embryos on day 5, all genetically abnormal (PGS done due to participation in a clinical study), no transfer
2. long protocol, SUPREFACT + MENOPUR: 14 eggs retrieved, 5 mature, 2 embryos to transfer on day 3 - ectopic pregnancy, Methotrexate
3. long protocol, SUPREFACT + MENOPUR: 18 eggs retrieved, 3 mature, 2 embryos to transfer on day 3
4. long protocol, SUPREFACT + MENOPUR: 14 eggs retrieved, 4 mature, 3 embryos to transfer on day 3
5. long protocol, SUPREFACT + PERGOVERIS: 26 eggs retrieved, 6 mature, 1 embryo to transfer on day 3
The doctors have already tried:
- replacing a urinary FSH+LH medication (Menopur) with a recombinant one (Pergoveris - not marketed in the US),
- upping the dose of hcG
- replacing a urinary hcG (Pregnyl) with a recombinant one (Ovidrel)
- IVM (20 follicles punctured, only 3 immature eggs found, none matured in the lab).
We are determined to try a couple of times more because the few embryos that we obtained were of good quality (morphologically).
I understand you have had similar cases in your practice as I have read in your blog that "sometimes no matter what we do, woman’s ovaries make more immature eggs than expected" . My question to you is: do these women eventually get pregnant? Does the large number of immature eggs point to some major disorder or is pregnancy still possible? Do you have any suggestions as to what we could try next?
We would greatly appreciate your reply. Thank you for your time.
Question--if diagnosed with cervical ureaplasma, what are implications for IVF? I am on antibiotics to cure this, but just wondering.
Thanks for the open discussion...it is hard to understand ones own body cycle and the ovulation process well enough.This will definitely help.
Thanks for taking the time to provide such an informative blog!
I'm recently married to man who had a vasectomy about 15yrs ago. I'm 33, he's 45. Is IVF with ICSC our only option? Also, what sort of workup would I need? I don't think I have any reproductive issues and have always had regular cycles, but I've never attempted a pregnancy before. He has a child from a previous marraige, but is there any risk in using testicular sperm 15 yrs after a vasectomy?
Thanks!!!
Dr. Licciardi:
Thank you for this great blog. I wonder if you can provide some insight on my case. I am 33 and was categorized uexplained infertility after a year of trying to get pregnant. My RE gave me the option of a laparoscopy, injectibles/IUI, or IVF. My husband and I opted for the lap because our RE feels that if there is endo and it is treated that injectibles/IVF can be more effective. Turns out I had stage 2 but pretty extensive and he was able to remove most but did not touch the endo on my tubes so as not to risk damage to them and only cauterized the endo on my ovaries. I did 1 cycle of injectibles/IUI and responded well, and almost had my cycled cancelled due to overstimulation, but we triggered early. Unfortuantely, I am not pregnant. He said we can try another 2-3 cycles of injectables/IUIs or go to IVF, which would have a better success rate. Unfortunately, due to the clinic schedule I cannot start IVF until April.
How long does one need to be on OCs prior to an IVF cycle? Wouldn't there be time for one more cycle in between? Would the endo on my tubes affect my ability to get pregnant without IVF? Is there any reason to pursue anything other than IVF at this point?
Thank you!
Hi,
I have a question about injectables versus clomid. I respond VERY strongly to clomid (6 large follies on 50 mg and 4 follies on 25 mg). Is there any reason to consider injectables if the clomid/iui fails? Is there any difference in implantation rates per follicle between the 2 regimens?
Thanks very much.
Hi Dr. Liccardi -
My question has to do with the "unexplained" diagnosis. All my blood tests have come back normal, as well as the HSG and SHG. My husband is normal as well for both types of sperm analysis. We've been unprotected for 4 years, gone through 3 clomid cycles, 2 injectibles/IUI, 2 fresh IVF and 1 FET. I have never had a positive pregnancy test in my life. Have you had any success with finding a dx for unexplianed patients? My doctor says he doesn't think there is anything wrong with my uterus, but what's left? The eggs are mature, they fertilize well, develop well in the petri dish, but just don't take in the uterus. Bad luck or is ther something else I should consider?
Thanks for any insights. I've just turned 35, most of the above treatments took place from 32-34yo.
Hi, I have a question for you, I got married in nov 2009, my wife had not convieved yet, and the problem is she had swear pain during her periods, after ultra-sound I came to know that my wife has polyp in Uterus of about 9mm.
My question is it dangerous? for her or it can cause Infertility or Miscarriage?
What are your thoughts on IVM?
I have another question about IUI timing. You had mentioned that sperm will live 2 days and so doing an insemination 24 hours following a trigger would be reasonable. Are you referring to fresh washed sperm? If so, does the timing change when using frozen? I heard that frozen sperm only last 24 hours, with the first 12 hours by far being the best. Would it then be more reasonable to try to time the IUI around the 36 hour mark?
Thanks for all that you do,
Tara
I love your blog..Its so informative. We have recently completed our 4th IVF...I produce 10-12 eggs, 18-24 follies every time. But they arnt mature or the follies are empty. On IVF #3 cycle I had 10 mature, 9 fertilize and one day 3, 9 that looked amazing..but on day 4 all but two died...And I didnt get pregnant. This last cycle I had 12 eggs. 6 mature, 3 fert and 3 (6 cells)trans on day 3. I had a chemical. Should I even try again? I just started taking DHEA, Royal Jelly, Wheat Grass and L- Argintine to help inprove my eggs. I am only 33 next month. The only thing that raised a red flag to me is my FSH went from 2.9 to 9.8 in two years...no smoking and healthy eating and a healthy weight..what should we do?
Hi Dr Licardi,
Thank you for your blog.
After a failed IVF/ICSI (half&half) cycle last October (1 D6 blast and 1 D6 morula; IVF), we opted for a medicated FET cycle. After taking estrogen patches for 7 days, I started progesterone pessaries for 4 days, twice daily, in addition to the estrogen patches. On the day of transfer my progesterone was low- 7 and was given 2 progesterone shots (I was told it should be 12). We transferred 2 G1 D3; ICSI embryos. I was instructed to take the progesterone pessaries 3/daily. 4 days later I had my levels checked again (E- fine, but my P was even lower- 5.7! I have been told to stop the pessaries and come in for the PIO shots once a day until my first HCG on Sunday (D10 DPO; embryo age). So, I will have 3 full days of PIO shots. Is this enough to help the embryos implant?
Also, shouldn`t my clinic have decided on the day of transfer, as my P level was low, to have me take shots instead of pessaries indefinitely?
Also, does IBD (ulcerative proctitis) affect ART, in that it is an auto-immune disease?
Many thanks,
Doctors don't know what causes infertility in about half the cases in men, but think many men's infertility problems may be rooted in their genes.
I have made my treatment decisions based on my extremely low AMH # (0.1). I will be injecting 450 IU of Bravelle and 150 IU of Menopur a day shortly, because my RE thinks that with my low AMH, we have to use very large doses of drug to see if I would respond. This is my first time trying the treatment and I don't take any other drugs during my normal life. You said in your blog that: "AMH is promising as a way to measure reserve, but there are a few problems, most of us are not comfortable yet using if for a definitive diagnostic tool." Should I try large dosage with my very first cycle based on my AMH #?
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My husband and I are both 32 y.o. I tested normal and his SA results were very low count/ morphology/motility so we were advised to go straight to IVF.
I overstimulated; the Dr. retrieved 31 eggs, 15 mature, and with ICSI, only 8 fertilized and all were frozen, while I recovered from horrible overstimulation. Thereafter, we did 2 separate FETs. Our embryos were frozen at the pronuclei stage. The first FET, we transferred after 3 days (4, 6, 8 cell and good quality); I had a biochemical pregnancy. The 2nd FET, they transferred after 2 days (2 2-cells). Both FETs were done with assisted hatching.
My question is- we have 3 frozen embryos left. Should we repeat assisted hatching, and which day do you think we should do the transfer after thaw so as to maximize our chances of implantation??
(As an aside, we really have lost faith in our doctor after he changed the transfer date at the last minute because the embyrologist was suddenly "busy" on the scheduled date, and he said to us that he would never advise hatching in our circumstances BUT hatching was done prior to both transfers!! We desperately tried to find another clinic to take our last frozen embryos to, but no one would take them, so we will transfer with the *bea* doctor and if it doesn't work, move on to another doctor).
Thank you so much. Lolo
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