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More Fertility Questions Answered

Posted Apr 28 2009 1:41pm
Courtney has a problem with Clomid and Femara because they make the lining of her uterus very thin. Should she switch? Yes indeed. It’s time for the injections; hopefully you will see a difference.

Anonymous asked about recurrent aneuploidy and miscarriage, PGD and donor egg. Check my blog on PGD. The answer is going to have to come from within, and you understand your obstacles. Even though I am not big on PGD, there are some cases where it should be considered. It may depend on how many miscarriages you have had, your FSH levels and your response to the medications.

Amina has severe anemia and an abnormal uterus and is considering pregnancy. The sickle/thal combo can be very dangerous during pregnancy. You need to sit down with a high risk doctor before you conceive. It’s hard to say what your uterine diagnosis is. If there is a big difference in the sizes of your uteri, it is more likely to be a unicornuate with a rudimentary horn, but this is just a guess. You need an MRI to get all of the facts. And you need the right person (maybe more than one) to read the films.

Jenn is having success taking long term Femara for endometriosis. Your story is giving me and patients important information. Thank you.

Amy M has a short luteal phase and is worried her doctor is not treating it correctly. She is getting Clomid, but not progesterone. I am not worried about your progesterone level of 11. I would concentrate on the length of the luteal phase on Clomid. If you get a 13-14 day luteal phase, you are probably ok. However, I also don’t see a problem with taking progesterone. I don’t know if raising the dose of Clomid will increase the progesterone level.
Sarah 23 asked if the endometrium can be too thick. I have not had problems with a very thick endometrium, providing there are not polyps or hyperplasia. These are things that can make the lining look thicker and could interfere with implantation.

Penny asked about potential problems associated with poor blood flow to the uterus. I don’t do this test; I have not seen any good literature supporting its use.

Jen has an IVF baby, but 3 nice IVF cycle have failed since. She is 35. It sounds to me like the last cycle was fine. It’s hard without seeing all of your records. You need to keep trying. You may not be able to due to finances or other reasons, but if your only barrier is emotional, you must try again. I suspect you are ready to do so, but want to do everything you can in your power to bet it right. Again, I don’t know everything about you, but I have to remain optimistic. It worked once; you make many eggs and get good embryos. Ask about repeating your hysterogram.

Anonymous has bilateral hydrosalpinx and a male factor. If there is some live moving sperm, IVF can work for you. If there are no sperm, you are right, no sense in having your tubes removed. The easiest question is the one about your doctor who is not giving you any information: just get another. There are many doctors out there who can’t wait to see you.

Anonymous asked about Femara. I am sorry but I don’t use it. I just get worried about that one person who takes it while pregnant. If your FSH is high, you know what the deal is. If you want to try it, it will not hurt you, or change you FSH levels. Clomid is not really bad for high FSHers, it is just not very effective, even in young women with normal FSH levels, although of course we use it regularly.

Jill is an excellent responder who has not yet become pregnant. Her doctor is adding metformin. I think this is fine. I did more of the same in the past, but less do lately. I have just started giving less fertility drug instead. I see you will be on less drug and this too should help. I have personal thoughts about long lupron in women with PCO. I think it prolongs the cycle. A no lupron cycle may be 1-2 days shorter, and this may be good for a woman whose estrogen skyrockets. This is just an opinion at this point. Ask your doctor.

Catherine is 40, and has trouble with her health care providers. They aren’t letting her do IVF. Yes you can get pregnant with 4 months of unmonitored Clomid at age 40, but come on let’s get real. Time is the problem. Your odds will be less than 5%, and your odds with FSH iui will be about 10% and your odds with IVF will be higher, although that depends on the success of your IVF clinic.

Thanks for reading and please read disclaimer 5/17/06.

Dr. Licciardi
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