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Last Answer Session, For Now.

Posted Apr 28 2009 1:41pm
I have been collecting information on the thin endometrium and will write about it next time. So far, I have not come across anything earth-shattering, but I will let you know what I found and what I think.

Here we go with the list of questions.

Christine: It does not sound like progesterone was indicated for your natural pregnancy. In addition, many doctors do not think progesterone is necessary for a medicated iui cycle. It looks like your levels now are great.

Dear Helene, I cannot comment much more without seeing everything. Trying again is the key, and I hope you do better, you probably will.

Maggie, Unexplained infertility is confusing, so much so we doctors are confused about it.
Your doctor sounds right about your lining, it is thin, and he may not be able to do anything about it, and it may not matter much anyway. Your odds may still be very good.

Jenna, there is a lot of literature showing progesterone is not necessary for FSH/ LH iui. I may use progesterone if there is good indication, otherwise usually I do not. Usually, a bad pregnancy makes a low progesterone, not the other way around.

Lori, The infection rate after iui depends or the risk profile of the patients. In my practice, the rate is less than 1/1000. It also depends on what you mean by infection. True infections after iui are very severe and require IV antibiotics.
Your odds depend on your age. 20% is for women under 35, and it goes down to 5% for all women in their 40’s.

NYC, A low estrogen on day 2-3 is want you want. Levels through the rest of the cycle can really vary from person to person, so as long as there is some, you should be ok.

Hope, you need a Hysterogram (the x-ray), not a Sono Hsyterogram. A hysterogram is much better for diagnosing tubal problems.

13 million sperm? Use it, you never know. I don’t know why there is a difference. You should check the counts again, they will probably be higher.
Colchicine can lower sperm counts, but the change will vary from man to man. You need to ask a urologist.

Mrs H, Do not under any circumstances remove any testicles. I understand the frustration in not knowing why things don’t work out. Maybe you now have “unexplained infertility”. If you are not getting pregnant on Metformin, you need to talk to your doctor about other medications.

Underweight? Probably not a problem, as long as you are normally regularly ovulating,

43 yo, failed IVF with one embryo. It all depends on you. If you want to do another cycle with a 5% pregnancy rate, it’s your option. Most doctors would let you, but not encourage you.

Husband with cancer. If his sperm count is now zero, you really need to rethink this plan. First, you need to recheck your day 3 bloods, I bet they are more normal than your last set. You have 2 vials. Why waste ½ of the sperm on iui? Your odds with the iui (if your bloods are more normal) will be 20-30%. You need to consider IVF. With IVF, less than a vial can be used. The embryologist can chip away at the ice crystal removing some sperm , but leaving most of the vial intact. Therefore you can get many IVF tries from 1 vial. Now, if you don’t want IVF, or can’t do IVF, they you are left with iui. If your husband is producing some sperm now, then iui does make more sense.

Bad donor eggs. Hard to say. Maybe the eggs were good but just didn’t fertilize, and you were left with one that squeaked by. It’s also possible you had a donor who made poor eggs, however is more commonly seen when fertilization takes place and the embryo development is poor. Whatever the cause here, your uterus probably had nothing to do with the bad outcome.

Implantation hormones? There are no reliable tests for this yet, that I am aware of.

Blue: Blastocyst transfer: another blog. We like to see embryos at least 5 cells, 6 is better, on day 3. 8 cells are probably a little better however if the grading is good, 6-7 cell embryos should be good enough. Sometimes it depends on the time of day. If the transfer is early or late, the cell number can be different.

Adenomyosis: I’ll put it on the list.

Napro: no comment.

Della. Most of us go through 3 FSH iuis before IVF. But everyone has different circumstances, so you will have to decide. I don’t think a couple of extra iui cycles will hurt anything. I have had women get pregnant on their 4th try.

Mwiegers: of course you should try again. There are a ton of positives here. You make eggs, and will fertilize more, and make it to blast, and get frozens. It’s almost all good. The next protocol probably does not matter much. If you had hyperstimulation issues, your doctor needs to lower your dose.

Gestational Surrogacy: OK with me.

Shelli: yes bad luck with age mixed in. If you get pregnant again, odds are you will have the baby. You may not, but the stats are in your favor.

Pegs. It’s hard for me to comment on a cyst I have not seen. 4 cm is on the bigger side, sorry I can’t tell you more.

Desperate: I am very sorry to hear about your loss. I am sure it’s hard not to feel guilty. Bad things just happen. Don’t be afraid, you have to stay strong. Go when the time is right. None of the odds change. You didn’t hurt or help you chances going ahead.

Pam, Forgetting about the morphology, it seems like you have done everything short of IVF and need to consider IVF as your next step.

Iron and miscarriage: usually not.

Clomid day 14. It depends. If you don’t ovulate then you can take clomid day 5, 15, 25 or any other day, provided you didn’t start your cycle yet. Some doctors want you to get your period, or bring on a period before clomid. This may depend on how long it has been since your last period.

Infection and Infertility: I really want to comment, but I can’t. Therefore: no comment. If you see me in my office I will have a lot to say about this.

Anna: Yes your story is strange, but I have seen this. There is no explanation. Hopefully this is your last strange cycle.

Thanks again, and read disclaimer 5/17/06.

Dr. Licciardi
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