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Some Additional Answers to Infertility Questions

Posted Apr 28 2009 1:41pm
Eventually I will get to the blastocyst topic. For now suffice it to say that some programs are better than others at blastocyst, so it may not be your eggs. Don’t feel cheated because you never had a laparoscopy. A good doctor can usually determine which patients need a lap. Most of my patients do not need that surgery. Some patients request a laparoscopy, and that’s ok too.

Dear Matty,
Very sorry to hear your story. You doctor should not want you to do IVF with PGD, he should go over the options and let you decide. PGD may help, but it’s not all it’s cracked up to be. You are lucky to be making so many eggs at age 40. Your highest odds for pregnancy will come from IVF, but other methods can work. IVF usually has a 2-3 times higher pregnancy rate than FSH iui. If you want to do more natural iui, than that’s what you should do, at least for now.

12 mature eggs form 21 follicles is a little low, but this happens. If they were immature I would agree with going longer, but since they were mature, you did not receive hCG too early. Who knows, maybe you got it late. Ask you doctor what the pregnancy rates are with one frozen blast. It’s probably 10% or less.

Mrs. H,
You need to take the advice of your urologist, or get a second opinion form another urologist.

Most of us give steroids after retrieval to reduce the level of inflammation in the uterus. The practice goes back to very small study done more than 20 years ago. We are not really sure if it does anything. If they prescribed Medrol, that’s a corticosteroid.

The sperm seems fine. You need to check the stats for clamed iui, FSH iui, and IVF, then decide. I have a blog on those stats.

Dear Empty Baby Room,
You need another opinion. It sounds like there are too many unanswered questions about your diagnosis and treatment.

Ducks Mom,
Metformin may bring you to regular cycles. It doesn’t always, but in you case it sounds like you are improving. Infections: you really need to ask your doctor. If he feels there is not issue, that’s good enough for me. Sometimes a shifted uterus is indicative of scar tissue, but usually it means absolutely nothing.

Sorry about your ectopics. It really sounds like bad luck. Clearly you are at increased for another ectopic, unless your tubes have been removed. If not, you could consider tubal removal as an option. Odds are your next pregnancy will be in the uterus, even if you keep your tubes.

Your problem is unique because you don’t have the option of trying on your own every month. Women, who say, fail IVF and want to try to get lucky on their own, sometimes get pregnant. You can not have the luxury of all those free tries, you are dependent on the office procedure Therefore if your odds are lower than other women’s, based on your FSH level, you still need to try inseminations. Not forever, but maybe more than you have so far. IVF and iui are a little different in that it’s hard to screw up an iui cycle, so you should be ok where you are.

We can’t promise you will get pregnant, but almost all women with your story have success. You have many factors in your favor. There are women reading this who wish they were in your shoes because of our age and response.

Sorry I don’t think there is anything to endometrial activation.

You need a second opinion. I find it unusual that you would have 8 fresh embryos for transfer and need to thaw the frozens in the same month. Unless you pushed them to do so. I see the results were somewhat helpful, it just seems like a lot of embryos to go through in one cycle.

LA Dude,
I do not think PGD is helping you, I think its hurting your chances. Now I need to say that I am not familiar with the proceedings of your specific clinic. Maybe they have great live birth rates with PGD, but they would be an exception. PGD is a profit center. If they can show you that even though PGD is more expensive, it’s worth it because it increases live birth rates, then I have no complaints.

Dear Eno-a-Go-Go,
Unfortunately your story is not uncommon. Your problems are being made worse by the doctor’s fighting. First the sperm is probably fine, and you will see this in the next semen analysis.
Now about you. I agree that is strange that your doctor put you on clomid with a 4 cm endometrioma. The problem is not that it made enod worse, it probably had no effect on your cyst at all. It’s more that if there is a big cyst, many times there is more endo elsewhere, and tubal scar tissue, therefore the clomid will not help you get pregnant. However, I saw someone last week who got pregnant on her own with a cyst just like yours.
If he did a hysterogram and the tubes were open, clomid is acceptable, but not the norm.
If most of the cyst is not removed, it has a higher chance of growing back. I remove the cysts completely. However, rarely, we come across a cyst that just does not want to come out, and we drain it. If you want to go straight to IVF, than that’s what you should do. It’s a very reasonable next step.

More next time,

Dr. Licciardi

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