Hello Everyone, catching up on the questions again. I know the topics are popular and I owe you one for next time.
I changed the format a bit for this time. I have the answers in more of a FAQ format with a little less verbage. I go through the question and try to distill out the major point. Hopefully this will be more efficient and informative, plus it allows for me to get to more issues more quickly. Let's see how it goes. Next entry will be a topic.
Do you need to remove Hydros? I am assuming your RE made the tubal surgery an option; some people can get pregnant with hydros in place. I make it an option with most of my patients. Of course you need to discuss this with your doctor, he knows your case better than I. It’s too early to tell about the Essure.
Is a high estrogen bad for implantation? I have not seen this to be the case. It is very true in mice, but mice are very different.
Why would someone who is 33 have 2 kids then 4 miscarriages in 15 months? If your workup is negative, we don’t know. It is important to have a hysterogram. I have had women with 4 miscarriages go on to have more than one child.
Is the estrogen prime good for low responders? It is no worse than anything else. If other stimulations have failed, give it a try.
If you make a lot of eggs does that mean you have PCO? It does not. It could mean you just make a lot of eggs. We see this all of the time.
If you are discouraged because you failed you fresh DE cycles, should you bother with your frozen? Believe it or not, we have some women who did not get pregnant with their fresh de embryos and have not returned for their frozen. Now there may be many reasons for this. If you would like to be pregnant, get up the nerve for the frozen cycle.
If you do not ovulate with clomid, should you add metformin? Consider the other option of very low dose injections. Metformin an option, but it may take months to get results, and in many cases ovulation dose not occur even with metformin.
Will acupuncture help? We don’t know, but I have many women doing it. In fact, in our office we provide acupuncture services, and the patients are very happy we do. We also provide Yoga and Mind body and psychological services. It’s all under the NYU Fertility Center Wellness Program.
FSH on day 2: should you wait for a lower number? Not sure. We prefer if our patients start with a number less than 13.4.
Can coasting have a negative effect on egg quality. Absolutely. Probably less so if the coasting is 1-2 days, but longer coasting is at times very bad for egg quality.
Can someone be prone to chromosomal miscarriages? Yes, there are some women who have a high proportion of chromosomally abnormal embryos.
Septum and PCO, which to fix first? Yes there are women with a septum who have had normal fertility and pregnancies, although I would be hesitant to leave a septum in because of the potential problems. It’s between you and your doctor. PCO is always fixable.
Is obesity a problem? No hard data, probably leads lower IVF rates. It’ more of a problem for pregnancy because of harm to the fetus. 11 eggs is ok, a few more may be better, ask your doctor about increasing your dose.
Should infertile women have a laparoscopy? Very few of my patients get a laparoscopy. If the only thing your insurance will cover is laparoscopy, then it’s a more reasonable approach. However, if there is no pain, no cysts and open tubes, the odds of a laparoscopy helping anything are low. Yes there are some women who everyone thought were fine who were found to have bad endo, but these cases are rare and usually there is a sign of the problem pre op.
Low sperm morphology: Usually not a factor. Some exceptions exist.
PCOS-like. I am happy that your doctor put it that way. Too many women are labeled with PCOS.
Temperature charting was good for the cave people. Please use a predictor kit.
What are the chances of conceiving with Clomid at age 40? Probably around 3-5 % per try.
Sperm clumping is probably not a problem. If anything, it should be solved with iui.
Stay with Clomid? Getting pregnant with clomid, but 2 miscarraiges. If you are getting pregnant, there is more of a reason to stick with it. I don’t think the clomid is causing the miscarriages, so getting pregnant with the injections amy be no different. See what your doctor thinks.
BPA leaching from cans an interfering with implantation? I wouldn’t worry about it.
Can a 34 yo with a poor response to the drugs become pregnant with IVF? Yes. At your age you only need a few eggs. Now more eggs would be better, but the odds are still very good with few eggs.
How to deal with antisperm antibodies? IUI or IVF.
Polar bodies are different than pronuclei. They both contain chromosomes. The polar bodies are the cells garbage. The pronuclei stay inside the egg and fuse the day after the fertilization. They come together to become the complete genetic material.
Is going for more than 9 eggs at 34 greedy. No , if your doctor thinks adding more drug will safely get you a few more eggs, that’s not so bad.
Is a lining of 16 mm too thick? It is if there is a reason it is thick. That is to say, if there are polyps making it thick, that’s not so good. If the lining is perfectly normal, and it’s thick, that’s ok.
Nuclear transfer and cytoplasmic transfer are not allowed in the USA. Just like many things in medicine, some preliminary results looked ok, but no one ever proved any benefit.
Does thyroid disease, like Hashimoto’s, cause miscarriages? This has been debated for the last 20 years, and there is no good evidence that it does. We are trying to do yet another study to look at the problem.
Does age matter for frozen embryos? No it’s the age you were when they were frozen, not the age you are now.
How come I became pregnant easily at age 23 and am having trouble now that I am 39? This is not uncommon, 16 years is a long time. A lot can happen.
Can you have regular cycle and not ovulate? I don’t think so. Ask what your progesterone levels are, even if they are over 3, you are probably ovulating. If you are not, well then it’s time for induction of ovulation.
Will DHEA help? It might, and if you are making a very low number of eggs, it may be worth a shot. I have had mixed results.
If you have frozen embryos, should you use them or jump into a fresh cycle? It is easier to use the frozens, but if you want the higher pregnancy rate, do the IVF again. If you only have 1-2 frozens, it may be better to do another fresh because not all embryos survive the thaw well.
Can a chromosomally abnormal embryo look beautiful? Absolutely, we see this every day.
What is the optimal TSH level? It depends who you talk to. The endocrinologists are going crazy trying to get everyone’s under 2. There is no real conclusive science showing this is important. Probably ½ the population has a TSH over 2, and ½ the population can’t be abnormal.
Can antidepressants interfere with FSH levels? Probably not.
Will assisted hatching reduce miscarriage? No it will not.
Can you have too much progesterone? No.
Does everyone with endometriosis need IVF? No. It depends on the status of your tubes. If the endo is causing scar tissue around the tubes and ovaries, than yes, IVF may be the best option.
Is a 12 cell embryo on day 3 a bad thing? The embryologists seem to think so. You cannot say you have a serious egg problem after 1 cycle.
Are fragments removed? They are typically removed f you are having hatching because the same little tool used to hatch can be used to suck out some fragments (unless you are having laser hatching). However, no one has ever showed that fragment removal makes a difference. Same goes for assisted hatching.
How do you define poor egg quality? I would say embryos that look less good than average. Embryos that are fragmented more than 20% are poor, even 20% is not great. Slow embryos are poor. However if you just did one cycle, you cannot be given the label until another cycle is performed.
What’s better, a frozen cycle with estrogen, or a natural frozen cycle? They are about the same. I find that sometimes the natural cycle gets a little confusing with the timing, and a small number of people ovulate earlier than expected, so if you do a medicated cycle, less is left to chance. However a natural cycle FET is a very acceptable practice.
See next time. Please read disclaimer 5/17/06. Dr. Licciardi