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Back to More Fertility Questions

Posted Apr 28 2009 1:41pm
There will be 1-2 more for the blastocyst, but I will answer a few questions first.

Sorry, some of these questions were asked a while ago and my responses may be a little late if immediate action was necessary. I will still answer many of them hoping the answers will help others. If I skip your question, it does not mean it’s a bad one, it just means I cannot comment, or I just don’t have anything additional that will help.

There are a number of women who have tough stories about failing many IVF cycles and being faced with the donor egg decision. I always feel I want to recognize the problem by commenting, but my responses have been similar. Usually, it’s just up to you. The boring answer is get tot the best clinic possible and weigh your options. If I see anyone who I think is getting pushed to donor egg too soon I’ll comment.

Jennifer was discouraged because on clomid she found it difficult to time her intercourse because the cervical mucus remained thicker.
You should use a different method of checking for ovulation, namely the ovulation predictor kits. Clomid does make the mucus thicker, but not in some and partially in others. You can get pregnant if the mucus is thicker, but it depends how thick. This is another reason to consider insemination in order to remove the mucus from the equation.

Muriah had septum surgery but the HSG post op showed some septum remained. Why?
This is more common when the septum is very large. With a large septum, there is quite a bit of cutting. Of course we don’t want to cut too much, so at the top it may look like a dramatic improvement, but in reality, a little more should have been cut away. It is also possible that the doctor saw that there was a little left, but felt he had cut enough, but did not. It is also possible that as the uterus healed, it scarred a little at the top, making it look like the septum remained, when in fact it was cut properly but did not heal well. In any event, when I have a patient with a large septum, I do say that a second procedure may be necessary, although it has not been necessary in years.
It is also possible that there is a little left, but it’s not clinically significant. This is very common. I sometimes see a bit left and I say it’s not enough to worry about.

Jamie has spotting being treated with progesterone.
Just make sure your uterus is normal. Make sure you have a thorough ultrasound and HSG, and maybe a sonohysterogram, to be sure there are no polyps or fibroids. Some women need a biopsy. Otherwise, some women spot for unknown reasons and progesterone, sometimes with estrogen, fixes the problem.

Ruby’s husband has anti-sperm antibodies. I do not think this means anything.

KSNYC makes a few follicles but only makes 2 eggs Why? We do not know. If you had only done 1 cycle, we could say it’s just one of those things, try again. But after 4 cycles with varying protocols, and consistent results, well, that’s how you behave. I would say that at age 34, you should not give up yet.

Ronni is 40, makes nice eggs and embryos, has severe male factor, and is being told to do DE after 3 failed cycles. She is being told it’s an “egg issue”.
It’s up to you. Of course your problem is an egg issue, but you eggs can still give you a chance. I am going to guess that your odds are 15-25% with your eggs. You may want to consider traveling farther for a better clinic.

Amanda was on clomid, and injections are being suggested but is worried about multiples/hyperstimulation. Yes minimal stimulation is the way to go. We use anywhere from 37.5 -75 units.

Katrina’s husband has zero morphology. There is not much that can improve morphology. Spotting may or may not be a problem. See the post above.

Flycat is Catholic and does not want IVF or IUI. My suggestion is for you to speak to your priest/pastor. You never know, they may be more permissive and sympathetic than you think.

Helen has a bleeding cervix. You are right, cautery or freezing may scar the cervix. Get another opinion.

Lazarus is 41 and has failed a few cycles. Her doctor does not want to use the estrogen pirme. I say why not? It may or may not help, you just need to see.

Mina is 33 and was told she is in premature ovarian failure. You need to repeat the FSH and estrogen levels every 6 months, and least for a while. Sometimes things get better. However odds are the numbers are accurate and your doctor is correct.

Tracylayne’s husband has a translocation and 6 sperm. It seems that your advice is accurate. We do not know with certainty about odds of pregnancy and miscarriage.

Rehab nurse is considering reversing her tubal ligation. You are right in that you need to get to the right doctor, but it is hard to know who that person is. Some states have insurance companies that cover the procedure so doctors there have more experience because they do more. It’s the balance between reversing the tubes and just doing IVF. Some women prefer the IVF because they can still have contraception after the baby is born. The operation may cost more than one IVF cycle, however it may take more than one IVF cycle to get pregnant.

Chris has severe endometriosis. She has done 2 retrievals , makes a good egg number and has nice embryos. She has also done frozens.
Make sure you don’t have a hydrosalpinx (blocked swollen tube). Assuming you do not, it may just be a matter of trying again. Your history does sound like there are many positives that can work in your favor.

Karen has triplets and the new fertility clinic is criticizing her for wanting another baby. Go elsewhere, their attitude is not appropriate.

Heather wants to know if she should do back to back iuis. It probably is not necessary, providing the timing of the one iui is proper. If there is a question about the timing, use the 2.

The Kinsleys had a nice fresh cycle that failed and are worried that their frozen cycle will fail too.
There is not much to worry about. If they thought the embryos were good enough to freeze, they are probably more than good enough. This is one of the main reasons we freeze, if the fresh fails, you have the backup. It can work.

Curley wants to know if poor sperm can cause embryo quality issues. This is tough one. Usually not. However, I have seen a few cases along the way. The big problem is how to find out. If you make 20 eggs, you can feel better about splitting the eggs and using 2 sperm sources. If you have make 4 mature eggs, the experiment may not give you the answers you need. Most of my patients will try a few IVF cycles first, and then be forced to make a decision. May do not opt for the husband/donor split.
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