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Infertility Questions and Answers: Almost Caught Up

Posted Apr 28 2009 1:41pm
Anonymous asked about really trying to nail down the best progesterone for her IVF attempts. She failed one fresh cycle and 2 frozen cycles. She tried the injections and cream and Crinone. Her latest problem is she bled on Crinone, and had a thin lining in the luteal phase, and now is scheduled for a biopsy on Crinone.
Why? Crinone may be a good drug for some, but in your case it does not work. Why do a biopsy when you already know this drug gives you problems? I have never done an ultrasound in the luteal phase to check the lining. Maybe your doctor is on to something, but for most of us it’s all about the lining before your progesterone(ie we check in the follicular phase). Your problem highlights the reality that progesterone in oil, as difficult as it is, gives consistent results. If vaginal progesterone is your only option, and Crinone does not work out, you can consider old fashioned progesterone suppositories.

Anonymous asked about not getting her period after lupron.
This commonly happens. You odds of pregnancy will be based on your clinic’s success rates. Remember it’s the age you were when the embryos were frozen, not your age now.

Wannabmomma has PCO and has tried 5 clomid cycles with intercourse, no luck yet. She is 26 yo.
It is almost time to move to the injections. Most of us make your limit 6 cycles, fewer if you have regular cycles on your own. But, you are only 26, so you could consider a couple more with insemination. I really think this can be up to you.

Big Childwish has a significant miscarriage problem. She has had 4 consecutive miscarriages at about 7 weeks, all with a sac but no fetal pole. All of her testing is normal. She tried the blood thinner.
I am assuming you had a hysterogram, if not you need it. I am not sure if you have had a d and c with any of the pregnancies? This would tell you about the chromosomes of the fetus, possible giving you more information about the causes of your problems. Otherwise it may depend on your age. If you are younger, your chance of a baby in your next pregnany is still over 50%. If you are older, your odds are much lower.

Katie has PCO, did an IVF cycle with 7 eggs, 5 fertilized and 2 embryos for transfer on day 3, one 4 cell and one 5 cell.
OK, there are some positive things here. I like the way your doctor was cautious stimulation, and you do make eggs and embryos. You can use the information to improve your next try. First a little more drug will be OK. You don’t need to make 30 eggs, but 15 may be better than 7. If you are at a clinic with a 26% pregnancy rate, but can travel to a clinic with a 49% pregnancy rate, I say travel. If your clinic treats 100 patients, 74 will not get pregnant. If the other clinic treats 100 patients, 51 will not get pregnant. That’s a big difference.

Alibee has a complicated history. She has a unicornuate uterus with a normal tube and 2 ovaries. She has a fairly large fibroid. She has done 5 FSH iui cycles and 1 fresh IVF cycle and 3 FETs, and maybe more more fresh IVFs?
It sounds like your fresh IVF cycles were excellent because you had so many frozen embryos. It’s hard to prognosticate your future after failing frozen cycles. They just do not work as well as the fresh. They are worth doing, but if they don’t work, it’s hard to say things are bad. Your last fresh IVF cycle yielded very nice embryos. So why no pregnancy? Can it be your uterus? Possibly. Most women with a unicornuate uterus are not infertile, but there are a few who have trouble implanting, we don’t know why. Is it just bad luck with IVF? Possibly, but why are you not getting pregnant on your own? This is going to be a case of trying again, if you wish. Should you consider a carrier? It should be a consideration, but of course even that is not a guarantee.

Emily has unexplained infertility and has started clomid. Her first try did not work. She asked about some recent press concerning a terrible article about clomid not working for unexplained infertility.
That will be another blog, but they are wrong. There have been many many studies showing clomid does work. Just remember the odds, which are 8% per try in women with regular cycles. So you are on the right track, I hope it works out.

Jen seems to be hanging in there with her endometriosis progression and pain. Keep us posted.

Anonymous is concerned because her first IVF cycle worked and her second did not. She is worried about the 8% morphology.
This is not the issue. Morphology will not lower IVF pregnancy rates. It’s common that success in the first cycle causes fear when the second cycle does not work. Stick with it. Even in the best clinics, odds are 50% for young women, meaning it’s a 50% failure rate.

Amelia’s husband has an inversion in chromosome 1, causing low sperm counts. She asked about IVF with PGD.
This all depends on what your needs are, and the advice of a counselor. Of course you need to ask about the problems associated with this inversion. Is it just a low sperm count, or are you at risk for a miscarriage or even an abnormal child? You also need to be informed about the costs and success and failure rates of doing the IVF with PGD. In addition, you need to ask about the error rate of your PGD procedure.

Singh did 2 IVF cycles. The first resulted in 10 eggs, but 8 fertilized with more than 1 sperm (polyspermy). Her second cycle she did ICSI and did not have polyspermy. She is wondering if the polyspermy means her overall egg quality is bad, leading to a failure in her second IVF cycle.
We do not know if your problem is egg related, or related to a lab issue. Since you say you had nice embryos in your second cycle, your eggs are probably fine.

EMLU has severe endometriosis. Had Twins with her first IVF cycle, but has since had 2 fresh cycles, and then a frozen cycle revealed fluid in the uterus so the cycle was cancelled. She still has fluid in her uterus and a biopsy revealed endometritis.
Fluid in the uterus is a very difficult problem. I have a few patients with this and it’s tough. In your case you may want to a have a hysterogram (after the endometritis is cured) to be sure you do not have a hydrosalpinx, as this is the most common cause for fluid. You have another possible cause: endometriosis. Some women with advanced endometriosis also have adenomyosis (endometriosis of the uteris) and this can cause fluid. Definitely get treatment for your endometritis. However, most cases on biopsy are not really endometritis, it depends how quick your pathologists are to make the diagnosis. Some overdo it.

Anonymous has unexplained infertility and failed 6 months of clomid.
I would say that’s enough clomid, and you should consider FSH iui or IVF.

I agree with Christine

Beth asked about clomid for raising sperm counts.
It depends why the sperm counts are low. If his FSH is present but low, clomid may help, but that’s a really rare cause for low sperm counts. If his hormones are normal, clomid probably will not help. In fact some doctors think clomid lowers sperm counts by raising men’s estrogen levels. In any event, it’s ok to try some of these things, but don’t waste time waiting for results. Move on with your plan of action in the meantime.

Anonymous had a low progesterone and was put on clomid. So far so good. Then her luteal phase was only 10 days on clomid, and now she thinks she has not ovulated on clomid.
OK, see if you can get office monitoring on the clomid. Ask about getting an hCG shot once your follicle has reached 18-20 mm. This should straighten everything out. If monitoring shows that your cycle is not behaving properly, switch from clomid.

Anonymous is 27, but only got 3 eggs at her IVF cycle. Her doctor was overly cautious with the dose of drug.
OK, so now you know, you need more drug. It sounds like you had at least one nice embryo, so with more eggs you will get more nice embryos and have a much better chance of pregnant. I am optimistic.

Anonymous had infertility, tried clomid, and got pregnant with FSH iui. She miscarried twins at 6 weeks. She is a carrier for factor V.
It sounds like you are doing all of the right things. You just have to wait for the results of all of your tests. I hope it works out.

Mrs C was told she needed IVF because her husband had 1% morphology.
He was wrong, she was right. She got pregnant on her own.

Pam is 40, and failed 2 fresh donor cycles, with 2 good donors and nice embryos. She failed the frozen cycle and has 3 frozens left.
This could be bad luck or fair medical care. I can’t tell. You want to be sure you have had a hysterosalpingogram after your myomectomy. Make sure your doctor reads the films. After that it’s too hard to say form the blog what’s going on with you. Check the delivery rates form your clinic for DE. Most good centers are at least 50-60%.

I can’t comment on one article showing success with a strange therapy in a small number of patients. Let’s give it more time.

MiraclesdDHappen: 26 yo, trying for 7 years, 6 failed clomid.
We are all sorry to hear your still are not pregnant, but it’s time to move on. It’s either FSH iui or IVF. It can happen, it’s just going to take more work.

See you next time, and please read disclaimer 5/17/06/.

Dr. Licciardi
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