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Answering Some Infertility Questions

Posted Jan 07 2011 1:46pm
Hello Again to Everyone.

I hope the holidays treated you as well as possible.

Today I will go through some past comments and answer some of the frequently asked questions that I have not yet answered on my previous blogs. I will enter one more cervical stenosis blog later. I realize that topic is very narrow; only applying to a small percentage of you. Like some of my other entries,the topic is not common but the information vital to some and very lacking on the web.

Hyperstimulation: I have not yet addressed this topic and will do so in the very near future. In many, but not all cases, hyperstimulation can be avoided or at least reduced in severity. I'll discuss how.

Should you hatch your embryos? Don't get hung up on this one. We really don't know the details about the benefits of hatching. At NYU we hatch in selected cases, and we have a "sense" that we are doing the right thing. If a clinic has good pregnancy rates, take their advice on hatching. They may never do it, they may always do it, both are acceptable in today's fertility world.

The pros and cons of septum surgery: also to be addressed. I have written a bit about septums and septum surgery, but I will add another post later. I recently have had the privilege to perform surgery on some women with large septums.

42, high FSH and no response to the IVF fertility drugs. Should you try again? If you need to try again, go ahead. Worst case scenario is that you are where you are now. Your odds of success are very low and you may lose money, and the unemotional answer is that you should consider stopping. So first get informed, including getting a second opinion, then you can decide and proceed as you wish.

Could a low vitamin B level increase the FSH level? I have not read anything supporting that, but increase your B levels and repeat the FSH.

PCO and low sperm morphology. If one doctor recommended clomid, and you agree, the approach is reasonable. Going straight to IVF is not crazy, but less commonly the first step.

Clomid for the treatment of unexplained pregnancy loss. Clomid may be prescribed for women with pregnancy loss, usually to increase the progesterone levels. If you are taking progesterone, clomid may not be needed. I am not aware that clomid will increase the viability of an egg or embryo. It may give you more than one egg, which may help in one of the eggs is abnormal. However, in general, clomid is not on the list of treatments for recurrent pregnancy loss. As you know there is not much on that list anyway. I don't think it will hurt.

Fluid in the uterus at the time of transfer. This usually can be detected prior to transfer.

An estradiol level of 7,000 on the day of hcg is very high. I'll talk more about this in my hyperstimulation bog. Starting on a lower dose of medicine is the fundamental issue.

What if you have one blocked tube, became pregnant with IVF and now want to try for a second child? Should try on your own first? If that was your only known problem, talk to your doctor. Waiting at least for a few months may be ok.

7 years of trying and your only workup consists of an hsg? Yes, get your partner checked and get to a fertility doctor.

Odds with injectables at 34. It's about 15-20%. Twins? If you are anovulatory, get on a very low dose. This should produce 1 egg. Check with the ultrasound, if there is more than one follicle, you would have the option to cancel the cycle. One egg can not be guaranteed every time.

Spotting and PCOS? Get an endometrial biopsy if you have not already had one. And a hsg and maybe a sonohysterogram to rule out a polpy. If that's all ok, then discuss progesterone or alternative treatments with your doctor.

A good sonohysterogram should pick up a septum.

Do women increase their odds of pregnancy after a HSG? I have not seen that frequently. I do so many, that occasionally someone gets pregnant afterwards, but I don't think the test was the solution.

To my "twice as nice" patient (double cervix etc who happens to be very nice too) thanks for writing and keep me posted. Dr. Licciardi

The best test to diagnose fibroids is the ultrasound. If your ultrasound is normal, you do not have fibroid.

Will egg freezing work with an FSH of 15? This is not good. For more details, refer to the egg freezing blogs.

Are embryos that are transferred on day 5 better than the embryos that were frozen on day 6? Yes they are, but it was still worth freezing. Obviously you make a good "batch". Give them a chance, at least one of them may do just fine.

How telling is the antral follicle count? It's a guide but not the final say. I have seen 6 resting follicles turn into 15 eggs, and 4 turn into 1. You can't ignore your count, but don't make any important decisions based on the antral follicle count only. Age, FSH, and possibly AMH are more important. Many people feel you can measure the antral follicle count anytime in the cycle.

Does the fertilization rate, or number of polyspermy embryos, or number slow growing embryos have any impact on your chance of pregnancy if in the end you have a couple of nice embryos to transfer? Maybe. At the most recent meeting of the American Society of Reproductive Medicine, there was one report showing a higher pregnancy rate when the fertilization rate was very high. However my overall feeling is that if you can get to a couple very nice embryos, the quality of the remaining unused eggs and embryos is not that indicative of success.

29 years old, an estradiol level on the hcg of 2993, 6 eggs, one embryo for transfer. The main issue here is the disconnect between your age/estradiol level and your egg number. I have seen a few women from other centers who come to me with a similar history. When I repeat their stimulation, they get many more eggs. I don't know if it was something we did better at NYU, or the first cycle was just a fluke.

If you have follicles on ultrasound, at least one of which is 16 mm or greater, and take an hcg shot, you will almost always ovulate. An progesterone level of 7 confirms ovulation.

What if you have only one vial of sperm remaining, is there something you can do to conserve your resource? You can thaw and refreeze, talk to your doctor about the pros and cons. At NYU, our embryologists sometimes scrape some of the frozen specimine to get just enough sperm for the case, leaving most of it unthawed. ICSI would be required. Ask you doctor about that too.

What if your only sign of PCO is a blood test? I wouldn't worry too much about it. If you are getting regular cycles an abnormal blood test should not impact your fertility. If the test is indicative of other medical issues make sure you get that checked out. You will have to ask your doctor for the details.

What if the first cycle of clomid did not work? If you are OK with the concept of clomid for your situation, it's ok to try a few cycles. Now the plan should never be written in stone, so if you are getting nervous about another cycle it's ok to change course. But I would not worry that it will never work based on a failed first try; stick with it a little longer.

That's it for now, I'll write again soon. Thanks for reading and please read disclaimer 5.17.06.

Dr. Licciardi
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