Back to School, Back to Questions
Hello Everyone! I hope you had a nice summer.
I’m going to start the fall off with answering some very interesting and important questions. Then I have the next few blogs already mapped out. Here we go.
PCOs. Can you have PCOS if you have regular cycles and no symptoms, just ovaries that have many follicles? No, you need to have one other symptom: irregular infrequent periods or androgen excess, the later being demonstrated by increased facial/body hair, acne, or more rare symptoms. I frequently see women who have healthy ovaries on ultrasound, meaning they look good because they have many follicles, probably enough to fit the criteria for PCOS. But without the other symptoms, these women are just lucky.
Uterine Abnormalities. If your uterus is bicornuate or dydelphic, a singleton is highly preferred over multiples. Sometimes the best way to achieve this is by having IVF and a single embryo transfer.
FSH. If you were told you have a high level, you must repeat the test. Odds are that the results will be similar; however that is not always the case. I’ve seen many women who were dismissed from other practices for having high FSH levels only to have better results on repeat: some became pregnant.
Amenorrhea. If your ovulation stopped due to weight loss, it may not return after weight gain. We don’t know why, but in some but not most cases, the changes in the brain that occur with weight loss become permanent. I am not sure about the term Ovarian Insensitivity, I would get another opinion.
Endometriosis. Most doctors today do not do a laparoscopy on women who just started trying and have no evidence of endometriosis. Evidence means very painful periods and or visible cysts of endometriosis on the ovaries seen on ultrasound. If the hysterogram is normal, i.e. the tubes are open, and the history and findings do not point to endometriosis, the odds of finding significant endometriosis on laparoscopy are very low. This does not mean you can’t have the laparoscopy if you wish, but in most cases it is recommended only as an option.
Ectopic Pregnancy. If during IVF, embryos are placed in the uterus, how is it possible to have an ectopic pregnancy in the tube? Unfortunately this does happen, probably because the embryos float into the tube sometime after the transfer. The uterus is a muscle and this muscle does undergo slight but regular contractions. It’s possible that the embryo gets squeezed up into the uterus. There are fewer ectopic after IVF these days, for a few reasons. One big one is that we put in fewer embryos these days. Fewer means there are lower odds of one ending up in the tube. Another is that many women who need IVF because of big blocked tubes (hydrosalpinx) have these tubes removed prior to IVF. A hydrosalpinx is a swollen tube damaged from infection, very severe endometriosis or previous surgery. The interior of these blocked tubes becomes damaged, making ectopics more likely.
Cervical Mucus. Most infertility doctors are not concerned with cervical mucus. We all understand that women who have no treatment or minimal treatment get pregnant on their own. Some women who get their mucus in some way adjusted get pregnant, but the rate of pregnancy may not be higher than baseline.
Thyroid. So far there is no good evidence showing a relationship between thyroid abnormlaites and embryo quality. Certainly, the thyroid should be close to normal while attempting and during pregnancy. It is very difficult to get accurate TSH level during IVF stimulation because during and IVF cycle, the estrogen levels become higher than normal, and this interferes with accurate assessment of TSH.
Embryo Quality. Are poorly growing embryos more likely to be genetically abnormal? The answer is yes, but not by much. This means that the way an embryo looks is not tightly related to chromosomal normality. A poor looking embryo is a little more likely to be genetically abnormal, but you can’t count on it. So if your best embryos are slow growing, we transfer them.
Early Pregnancy Failure. Women with pregnancy losses should have a karyotype, which is the blood test done on both partners to check for possible chromosomal abnormalities. Another necessary test is the hysterogram which will test for uterine abnormalities.
Should women with repeated loss keep trying on their own, do fertility drugs and iui, or move to IVF, possible with PGD? This one of the most difficult questions in our field. I tend to feel that if you are getting pregnant easily on your own, keep trying on your own. However, there is a place for IVF with PCG depending on your situation and age. Certainly finances come into play.
Cervical Stenosis. Usually improves after a vaginal birth because the cervix stretches so much. If the baby is born via c-section, the cervix may not have opened enough to make an improvement. Sometimes even in women without stenosis, healing post c-section can greatly increase the angle between the cervix and the uterus. This is not really stenosis, but this acute angle can make it very difficult to get a catheter, say for iui or embryo transfer, from the cervix into the uterus.
Anti-sperm antibodies. Most fertility doctors these days do not see a relationship between anti-sperm antibodies and infertility. If these antibodies are a factor, most of the time the antibodies that are the biggest problem are those that are in the cervical mucus. The antibodies in the mucus grab the sperm trying to swim through. Therefore, avoiding the cervical mucus via iui can do the trick. You do not need to take fertility drugs if it is felt your only problem is antibodies; an iui without the drugs may suffice.
Uterine lining. All experienced fertility doctors have many women who have become pregnant with “thin” linings. No one knows what the cutoff should be. One problem is that the studies are not done correctly. For instance, let’s say an IVF program analyzes their pregnancy rates according to the thickness of the uterine lining. What happens is the different thicknesses become grouped. They may look at pregnancy rates for women with linings greater than 10mm, 7-10 mm and less than 7 (this is just one example: some may do >9, 6-9 and <6, or any other way they wish). The problem with this is less than seven includes women with 4s and 5’s. So to say less than seven is a cutoff may not be accurate because the pregnancy rate at 7 may be just fine, but it will be lower in women with 4’s and 5’s, but they are all grouped together. The reason the studies are not set up as the pregnancy rates for 6 mm and 7 mm and 8 mm etc. is that the overall number of women in each study is small, so number of women in each group becomes too small to calculate a difference.
Why is my lining thinner today than yesterday? This is very common. The most likely reason is that the lining was measured in a different location on each day. When we scan, we quickly look for the thickest part and write it down. Most fertility doctors are not really interested in progression from day to day. If we glance at it and it looks ok without even measuring it, we quickly find a spot, any spot, and get a measurement. Another reason for differences is that you may have a different person measuring on different days. Different people may measure differently; the measurement should be close, but not exactly the same.
Another possibility is that the lining grows and shrinks a little from day to day. I’ve noticed, usually in cases where the lining is thick, that linings change from day to day. The lining does usually grow thicker as the cycle progresses. Sometimes there is a quick growth such that by day 7 it’s nice and thick and stays at about that level through the next week or so. Sometimes the lining is thin on day 10, but after 2-3 more days it has a late improvement and looks great.
AMH. How can your FSH level be normal and you AMH be very low? Because we don’t know yet what normal and abnormal levels of AMH are. The values also vary considerably from lab to lab. I have not yet started doing AMH levels for this reason. I have seen levels of 0.16 along with FSH levels of 7 in young women. In some labs, over 1 is good, I others lower levels are normal. More time is necessary to work this one out.
Ovulation Induction. You can get pregnant in an iui cycle if the follicle is 16 mm. It’s a little on the small side, but in most cases it’s big enough. One reason we wait on a 16 mm follicle is that there may be others that are even smaller. In those cases, we much prefer to wait.
IVF Failure. Are there some women who will just never get pregnant? Unfortunately the answer is yes. But we have no idea in advance who these women are, unless there is an obvious reason for their infertility. There probably a few men or women who have a hidden untestable genetic problem that prevents pregnancy. Some women just can’t catch a break. They have problems that seem correctable with surgery or IVF, but they don’t get pregnant, or they have miscarriages. It’s a terrible cast, one of many that life sets us into.
IUI Clomid at 41? Cross my heart, we have a woman in our practice that got pregnant and had a baby at age 47 on clomid, after every other treatment under the sun. That being said, taking clomid in your 40’s may not be the best thing. Even with iui, the odds are less than 5%, and every month you are not pregnant, you are one month older.
Blastocyst Transfer. Would embryos that stop growing from day 3 to day 5 have been better off getting transferred on day 3? It depends on the experience of the IVF clinic. At NYU we are very experienced and successful with day 5 (also called blastocyst) transfer. I feel very confident that the lab is as good as the uterus from days 3-5. Very rarely I have a patient who I prefer to transfer on day 3. This is happens when the embryos look close to perfect on day 3 but terrible on day 5, a very rare occurrence. Many IVF programs are not as experienced or successful with culturing to day 5, and in these cases, a day 3 transfer may be better.
Agonist vs Antoginist. (Lupron vs Cetritide or Ganirelix). I use some but not much lupron anymore. One reason has to do with patient convenience; lupron is just one more shot people have to take. Cetritide and Ganirleix are given by injection, but only a few doses are necessary. Plus lupron can cause an ovarian cyst to grow interfering with the timing of the cycle start. In some cases, especially in older women, I believe that lupron can suppress the number of developing eggs. But the lupron protocol is still one that I go to at times.
Low estradiol on day 3? Hard to explain why the level is so low if you are having normal ovulation. If indeed you are having normal ovulation and respond with normal estrogen levels to fertility drugs, the low level on day 3 may not be a problem.
7 miscarriages. Very sorry to hear of your problem. I assume you both had karyotype testing. You may want to consider IVF with PGD. I understand that there may be financial barriers to that service and doing IVF/PGS does not guarantee pregnancy much less a successful pregnancy.
2 Miscarriages after IVF with good egg number and nice embryos. Talk to your doctor, it sounds to me like things can happen in the positive for you.
Thanks for reading and don’t forget to read the disclaimer 5/17/06.
Dr. Licciardi
I’m going to start the fall off with answering some very interesting and important questions. Then I have the next few blogs already mapped out. Here we go.
PCOs. Can you have PCOS if you have regular cycles and no symptoms, just ovaries that have many follicles? No, you need to have one other symptom: irregular infrequent periods or androgen excess, the later being demonstrated by increased facial/body hair, acne, or more rare symptoms. I frequently see women who have healthy ovaries on ultrasound, meaning they look good because they have many follicles, probably enough to fit the criteria for PCOS. But without the other symptoms, these women are just lucky.
Uterine Abnormalities. If your uterus is bicornuate or dydelphic, a singleton is highly preferred over multiples. Sometimes the best way to achieve this is by having IVF and a single embryo transfer.
FSH. If you were told you have a high level, you must repeat the test. Odds are that the results will be similar; however that is not always the case. I’ve seen many women who were dismissed from other practices for having high FSH levels only to have better results on repeat: some became pregnant.
Amenorrhea. If your ovulation stopped due to weight loss, it may not return after weight gain. We don’t know why, but in some but not most cases, the changes in the brain that occur with weight loss become permanent. I am not sure about the term Ovarian Insensitivity, I would get another opinion.
Endometriosis. Most doctors today do not do a laparoscopy on women who just started trying and have no evidence of endometriosis. Evidence means very painful periods and or visible cysts of endometriosis on the ovaries seen on ultrasound. If the hysterogram is normal, i.e. the tubes are open, and the history and findings do not point to endometriosis, the odds of finding significant endometriosis on laparoscopy are very low. This does not mean you can’t have the laparoscopy if you wish, but in most cases it is recommended only as an option.
Ectopic Pregnancy. If during IVF, embryos are placed in the uterus, how is it possible to have an ectopic pregnancy in the tube? Unfortunately this does happen, probably because the embryos float into the tube sometime after the transfer. The uterus is a muscle and this muscle does undergo slight but regular contractions. It’s possible that the embryo gets squeezed up into the uterus. There are fewer ectopic after IVF these days, for a few reasons. One big one is that we put in fewer embryos these days. Fewer means there are lower odds of one ending up in the tube. Another is that many women who need IVF because of big blocked tubes (hydrosalpinx) have these tubes removed prior to IVF. A hydrosalpinx is a swollen tube damaged from infection, very severe endometriosis or previous surgery. The interior of these blocked tubes becomes damaged, making ectopics more likely.
Cervical Mucus. Most infertility doctors are not concerned with cervical mucus. We all understand that women who have no treatment or minimal treatment get pregnant on their own. Some women who get their mucus in some way adjusted get pregnant, but the rate of pregnancy may not be higher than baseline.
Thyroid. So far there is no good evidence showing a relationship between thyroid abnormlaites and embryo quality. Certainly, the thyroid should be close to normal while attempting and during pregnancy. It is very difficult to get accurate TSH level during IVF stimulation because during and IVF cycle, the estrogen levels become higher than normal, and this interferes with accurate assessment of TSH.
Embryo Quality. Are poorly growing embryos more likely to be genetically abnormal? The answer is yes, but not by much. This means that the way an embryo looks is not tightly related to chromosomal normality. A poor looking embryo is a little more likely to be genetically abnormal, but you can’t count on it. So if your best embryos are slow growing, we transfer them.
Early Pregnancy Failure. Women with pregnancy losses should have a karyotype, which is the blood test done on both partners to check for possible chromosomal abnormalities. Another necessary test is the hysterogram which will test for uterine abnormalities.
Should women with repeated loss keep trying on their own, do fertility drugs and iui, or move to IVF, possible with PGD? This one of the most difficult questions in our field. I tend to feel that if you are getting pregnant easily on your own, keep trying on your own. However, there is a place for IVF with PCG depending on your situation and age. Certainly finances come into play.
Cervical Stenosis. Usually improves after a vaginal birth because the cervix stretches so much. If the baby is born via c-section, the cervix may not have opened enough to make an improvement. Sometimes even in women without stenosis, healing post c-section can greatly increase the angle between the cervix and the uterus. This is not really stenosis, but this acute angle can make it very difficult to get a catheter, say for iui or embryo transfer, from the cervix into the uterus.
Anti-sperm antibodies. Most fertility doctors these days do not see a relationship between anti-sperm antibodies and infertility. If these antibodies are a factor, most of the time the antibodies that are the biggest problem are those that are in the cervical mucus. The antibodies in the mucus grab the sperm trying to swim through. Therefore, avoiding the cervical mucus via iui can do the trick. You do not need to take fertility drugs if it is felt your only problem is antibodies; an iui without the drugs may suffice.
Uterine lining. All experienced fertility doctors have many women who have become pregnant with “thin” linings. No one knows what the cutoff should be. One problem is that the studies are not done correctly. For instance, let’s say an IVF program analyzes their pregnancy rates according to the thickness of the uterine lining. What happens is the different thicknesses become grouped. They may look at pregnancy rates for women with linings greater than 10mm, 7-10 mm and less than 7 (this is just one example: some may do >9, 6-9 and <6, or any other way they wish). The problem with this is less than seven includes women with 4s and 5’s. So to say less than seven is a cutoff may not be accurate because the pregnancy rate at 7 may be just fine, but it will be lower in women with 4’s and 5’s, but they are all grouped together. The reason the studies are not set up as the pregnancy rates for 6 mm and 7 mm and 8 mm etc. is that the overall number of women in each study is small, so number of women in each group becomes too small to calculate a difference.
Why is my lining thinner today than yesterday? This is very common. The most likely reason is that the lining was measured in a different location on each day. When we scan, we quickly look for the thickest part and write it down. Most fertility doctors are not really interested in progression from day to day. If we glance at it and it looks ok without even measuring it, we quickly find a spot, any spot, and get a measurement. Another reason for differences is that you may have a different person measuring on different days. Different people may measure differently; the measurement should be close, but not exactly the same.
Another possibility is that the lining grows and shrinks a little from day to day. I’ve noticed, usually in cases where the lining is thick, that linings change from day to day. The lining does usually grow thicker as the cycle progresses. Sometimes there is a quick growth such that by day 7 it’s nice and thick and stays at about that level through the next week or so. Sometimes the lining is thin on day 10, but after 2-3 more days it has a late improvement and looks great.
AMH. How can your FSH level be normal and you AMH be very low? Because we don’t know yet what normal and abnormal levels of AMH are. The values also vary considerably from lab to lab. I have not yet started doing AMH levels for this reason. I have seen levels of 0.16 along with FSH levels of 7 in young women. In some labs, over 1 is good, I others lower levels are normal. More time is necessary to work this one out.
Ovulation Induction. You can get pregnant in an iui cycle if the follicle is 16 mm. It’s a little on the small side, but in most cases it’s big enough. One reason we wait on a 16 mm follicle is that there may be others that are even smaller. In those cases, we much prefer to wait.
IVF Failure. Are there some women who will just never get pregnant? Unfortunately the answer is yes. But we have no idea in advance who these women are, unless there is an obvious reason for their infertility. There probably a few men or women who have a hidden untestable genetic problem that prevents pregnancy. Some women just can’t catch a break. They have problems that seem correctable with surgery or IVF, but they don’t get pregnant, or they have miscarriages. It’s a terrible cast, one of many that life sets us into.
IUI Clomid at 41? Cross my heart, we have a woman in our practice that got pregnant and had a baby at age 47 on clomid, after every other treatment under the sun. That being said, taking clomid in your 40’s may not be the best thing. Even with iui, the odds are less than 5%, and every month you are not pregnant, you are one month older.
Blastocyst Transfer. Would embryos that stop growing from day 3 to day 5 have been better off getting transferred on day 3? It depends on the experience of the IVF clinic. At NYU we are very experienced and successful with day 5 (also called blastocyst) transfer. I feel very confident that the lab is as good as the uterus from days 3-5. Very rarely I have a patient who I prefer to transfer on day 3. This is happens when the embryos look close to perfect on day 3 but terrible on day 5, a very rare occurrence. Many IVF programs are not as experienced or successful with culturing to day 5, and in these cases, a day 3 transfer may be better.
Agonist vs Antoginist. (Lupron vs Cetritide or Ganirelix). I use some but not much lupron anymore. One reason has to do with patient convenience; lupron is just one more shot people have to take. Cetritide and Ganirleix are given by injection, but only a few doses are necessary. Plus lupron can cause an ovarian cyst to grow interfering with the timing of the cycle start. In some cases, especially in older women, I believe that lupron can suppress the number of developing eggs. But the lupron protocol is still one that I go to at times.
Low estradiol on day 3? Hard to explain why the level is so low if you are having normal ovulation. If indeed you are having normal ovulation and respond with normal estrogen levels to fertility drugs, the low level on day 3 may not be a problem.
7 miscarriages. Very sorry to hear of your problem. I assume you both had karyotype testing. You may want to consider IVF with PGD. I understand that there may be financial barriers to that service and doing IVF/PGS does not guarantee pregnancy much less a successful pregnancy.
2 Miscarriages after IVF with good egg number and nice embryos. Talk to your doctor, it sounds to me like things can happen in the positive for you.
Thanks for reading and don’t forget to read the disclaimer 5/17/06.
Dr. Licciardi
posted by Dr. Licciardi at 9:49 PM
22 Comments:
What about a low estrogen level on the day of your follicle check? My RE does an ultrasound and e2 level check usually the day before my IUI. Twice I've had great looking ultrasounds with two 20ish mm follicles but my e2 level comes back at around 100. Shouldn't it be around 400? Could this be why we aren't getting pregnant? My doctor doesn't seem too concerned but if it isn't important why do they keep checking it?
Dear Dr. Licciardi,
thanks for your blog, I am discovering a fantastic source of honest and clear information. One remark if I may: any chance you can include a search function in your blog or introduce on the right side menu a thematic classification? I am reading your blog today for the first time and reading it in a chronological order is not the most effective... I have to go through google to try to do a thematic search on your blog (ie for me, PCOS issues or good sperm numbers for an IUI...)
Thanks anyway!
There is a lot of medical help for those who have such a problem.It is good that there are avenues of discussion so that one and all come to know to avail this help.
Thank you for your blog Dr. Licciardi, there is so much wonderful information available here for couples. I have read all of your articles and I was just curious if you could post a more detailed blog about low morphology. I understand you dont think it is a problem when there are good supporting factors and in our case we have great supporting factors. High Count, High Motility but 3% normal morphology. Someone else asked if there was anything you can do to actually increase your morphology and your answer was that there isn't really a problem. But like so many other women, there has to be something we can do to make the little boys normal? IF its not a problem when everything else checks out why cant we get pg? Are there any ideas on what actually causes low morphology? There are just a lot of questions, and Im sure Im not the only one who has these kind of questions about low morphology. Thanks. :)
To Anonymous at 1:24 p.m.:
You can search the blog by typing in your search term up at the top left corner (it has a B next to it).
I use it quite often.
Thanks anonymous 1.24pm: I did indeed find the search box...after quite some time reading all the entries chronologically. Dumb me :)
Some "general" questions:
- PCO+femara (or clomid)+Ovidrel+IUI: when do you know if it necessary to add some sort of progesterone support in the second part of the cycle? Any particular test, results that should trigger that decision?
- Why do doctors prescribe IUI instead of timed intercourse for very good count (240M/ml), normal motility (51%) and low morphology (2% in our case)? I understand sperm wash and IUI doesn't improve the normal morphology percentage anyway? Is it just a "why not?" approach?
- how dangerous are clomid side effects on vision: I know you don't like femara because of the risk of someone taking it while being pregnant, in my case clomid worked perfectly fine but I had some light visual problems (weird effect on lights at night). Doc said no way, pressure on your optical nerve, you switch to letrozole (which works very well I must say: no side effect, one big follicle instead of 3 with clomid). Should I have insisted on staying on clomid? What would you have done? Stick to clomid? switch to Injections? (I am a "simple" case for the moment "thin PCO 30yo" ovulating with treatment so I wouldn't have liked to go straight to injections)
- can you ovulate too early with an ovidrel shot for your 24h/36h post ov. shot IUI to work? Got the shot at 8am, felt cramps all day like I was ovulating, got the IUI at noon the next day but had had no sign of ovulation in the previous 12h. Did we miss it? Is it a pattern: some women ovulate in 12h so I should talk to my doc about getting an IUI after 12h rather than 30?
Thanks if you can answer any of the questions above in one of your future entries. If not, thanks for your awsome blog anyway!
Anais
Dear Dr. Licciardi,
I am wondering if you can share your insights with me.
I have a very unusual situation and no diagnosis.
Our original diagnosis was severe male factor, and our very first IVF/ICSI cycle 4 years ago was a success and we had a baby boy.
Last year we decided to get back to the game and try to have for a sibling. My husband sperm improved a little bit, so we tried clomid IUI 3 times with no success. Then we moved to IVF. My uterus/ tubes are normal, i ovulate on my own,my AFC is 12, but my FSH started to be elevated 8.5 and i am 35.5 yr old.
We tried to start IVF 3 times, but all were canceled on the day of the baseline due to high progesterone. On the first one, I was on nasal suprefact, but it didn't supress me and my hormones were rising among with a small cyst. On the second one, we had a natural start and was canceled again due high progesterone. The 3rd time i was on birth control pill (Marvelon) to reduce my progesterone, but it happened again. On the baseline I had high progesterone, 2 cysts so it was canceled.
Now my dr want me to start again with natural start, and we are going to go ahead with the cycle regardless of progesterone. My Dr said my eggs will be retreived / fertilized and then freeze them all. A couple of months later we are going to transfer them. I do not understand how can that help? If they can not figure out how to reduce my progesterone before , how will they reduce it after IVF? Also I though frozen embrios have a lower success rate then fresh. So why would help freezing the mebrios? Moreover what is wrong with me? We have no diagnosis, and my Dr said I am a very unique strange case. I am totally confused.
please tell me your opinion
Dr. L -- thank you so much for your answers. I asked about cervical stenosis, hoping that after a vaginal birth it would be less of an issue. :)
It took 5 years of infertility to get to the point of two failed hysterosalpingograms which failed because they couldn't get the catheter through my cervix. Was given a recommendation to "have this done in theatre, under anaesthetic." And then the laparoscopy in which the tubes did not fill or spill but the Dr. had to punch through significant cervical scarring. And a normal spontaneous pregnancy within two months of that.
This has left my partner and I on the older side, and I have fear of secondary infertility. We'd love a younger sibling for our son!
Thank you again for all of the information you make available.
I have a question about stress.
I'm 26 and my husband is 28, they ran all the standard tests (ultrasound, semen analysis, HSG, bloodwork) and everything came back normal. I'm of normal posture (5'9" and 135 lbs).
We've been trying to get pregnant for a year now and my gynaecologist prescribed Clomid to increase the number of follicles. Last month on 50 mg, I still only had 1 so this month I was told to take 100. However, the medication really affects me and I end up feeling awfully depressed and angry and agitated for an entire week. On top of that, I have a fulltime job and am also taking a fulltime courseload in the last semester of my undergrad studies and applying for grad school.
I'm now starting to worry that stress is a factor, since people are constantly telling me it is. I don't see a way to reduce it though and am now wondering if it is even a good idea to take Clomid - taking it turns me into an evil angry person and adds a tonne of stress to my life.
I end up stressing over feeling stress in the first place, so I'm wondering if there is any evidence that stress really does affect chances to get pregnant? I am referring to the stresses listed above, not a major personal crisis or what have you.
Thanking in advance for your reply.
Kind regards,
I just had my tubes removed. After months of increasing pain around my ovaries, with repeated "normal" ultrasounds showing good blood flow to my OVARIES, I had a laparoscopy since we knew I had some adhesions and lots of endometriosis in the past. Everything was a mess. The tubes "disintegrated" when she tried to free the adhesions, and she found that most of the tissue in the tubes was actually necrotic. So anyway, I am now 100% dependent on IVF. Right now, we can't afford a cycle.
During the surgery, it was found that my ovaries have gone retroperitoneal.
She told me many women do successfully undergo IVF with ovaries that are completely retroperitoneal.
I guess I'm just wondering what your experience has been?
There is so much wonderful information available here. I really appreciate the time you're taking to put up this tutorial. I have a question though, when you sew on fabric, you need to lock in your stitches at the beginning and end of your row by reversing. I don't see this on the cards I've seen with sewing on them. Good Links. Thank you so much!! So many good ideas for my next pregnancy. I had a hard time finding great stuff so thought I would share what has taken me my pregnancy to find.
infertility
Dr Licciardi,
Could you please wrire an article on the "unstuck" type of Asherman's Syndrome.I had a normal looking HSG yet I have had very light periods(last 1 day) since I had a suction D&C 2 years ago.Thanks!
Hi Dr. Licciardi,
I look very forward every month to read your blog, and wanted to let you know how much I appreciate your good job on this blog. I am a resected septate uteri, who has never got pregnant at 30 years old (almost 31). It has been 6 long months since resection and 2 unsuccessful IUIs. Do you think that SU causes infertility? My Dr said he corrected endometriosis stage III during my laparoscopy/hyst, but he said I should be good to go since he cleaned my endometrium a lot. We have no other infertility issues, and I am wondering, if we should keep trying with IUI. What would you recommend? Thank you so much.
Thanks for sharing the idea there would be some apprehensions from segment but i am up for it.
Dear Dr. Licciardi,
Thank you for your helpful blog.
As a marriage counsellor working with couples who are traumatised by infertility, I have found it very useful, as the jungle of medical jargon can be very overwhelming.
I will recommend it to others.
Dear Dr. Licciardi:
Am unsure how to get a question to you so I'm commenting here. Thanks in advance!
Just had endo cells on my pap; had endo biopsy (dr. says doesn't think cancer); thickness was 11 25 days post 1st day LMP. This seems pretty good to me.
Also, had a 21-day FSH that was 4.4 (scale, normal, 4.4-9). Last year, day 3 FSH was 11.05; day 28 FSH (measured by accident early) was 7.0.
I had a teensy bit of spotting about 18-19 days post LMP this past cycle for 1st time. HCG was 3, which OB attired to "noise."
Have never had estrogen measured, but if I have an 11-ml thickness and pretty good cervical fluid, should it be OK?
Are 21-day FSH readings of any use at all?
Just a bit of background; 3 miscarr. age 46-48, naturally-occurring preen., karotype on heartbeat pregnancy inconclusive. I'm 51. I'd really like to get have children and am trying to assess chances.
Do you believe in CGH; is it diff. from preimplantation genetic diagnosis?
What stimulation protocols do you believe work best in older women?
Thanks!
Thank you for all of the useful information on your blog. I have been told that I have polycystic ovaries and a high ovarian volume, but all blood work has been fine. It seems that my RE wants to move forward with Clomid and IUI, but I would like to correct the issue, not just focus on the pregnancy. Was is the treatment for polycystic ovaries for someone that does not have PCOS? I have read a lot about diet and insulin resistance, but do not know if that applies to me. Thank you again!
You mentioned that it is very rare to have spectacular embryos on day 3 and slow growing / not good embryos on day 5 but that's what happened to us. I'm 32 and my husband and I have been trying for 2 years. I had two IVF cycles at a top clinic with good day 5 transfer rates and this happened for both cycles. The only problem we had was a slight male factor - 35% motility and 1+/2 forward progression. After the failed IVF cycles we had testing done for sperm fragmentation (DFI) and it was high - 29%. My husband had surgery for varicocele removal and the DFI improved to 9% and the motility to over 50%. We're starting IUIs now to see if that was the issue and perhaps would do another IVF if that doesn't work. Do you think the day 3-5 growth of the embryos is genetic with the eggs somehow, the DFI or something else? We did two day 5 transfers and had two morulas transferred both times, yet on day 3 we had 9/9 of what my doctor termed to be spectacular looking embryos. any thoughts?
Thanks so much for your blog. My question is about RH antibodies. If I am RH negative, and I had an abortion years ago without a RHOGAN shot, is it possible that I have developed antibodies and could they be the cause of unexplained secondary infertility (and/or repeated very early miscarriages)? Thank you
I just wanted to comment to the patients with re-current early pregnancy loss. I am so sorry you have had to go through this. I had 2 early miscarriages before turning to donor embryos, had another early miscarriage, then went on to have our miracle baby! It can happen for you, keep trying, and don't rule out the possibilities of using donor embryos, eggs, sperm.
Great post. Its interesting to learn so much about all of those various causes of infertility. When I was having trouble becoming pregnant I used a eBook I found over at www.theinfertilitymiracle.com , it was a little wishy washy, but overall it helped out, and made conception possible. might want to check it out.
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