Archive for January, 2010
Ovulation Timing Questions
If your cycles are 55 days, are you ovulating? Most likely, probably around day 41. However, it is possible that you are not, so you must confirm through your doctor.
What if your cycles are 28-31 days but a progesterone test proves ovulation day 11? Very unusual, but it does not mean you are infertile. Check for ovulation a little earlier using the LH kit to see when it starts and to see if this is a consitant issue.
Is there a problem with 70 day cycles? Yes. You can try to track ovulation but when do you start to do so? If your cycles are always 70, check a progesterone day 60. If it shows ovulation at least you have that. It’s just harder to time things with such a long cycle, and you really don’t have many ovulations per year. If you want to get pregnant, get some help.
Miscarriage Questions
If you are having miscarriages on clomid, will IVF up your odds of going to term? Different doctors will give you different opinions. The IVF option will sit differently with different patients. We aren’t sure if IVF will reduce your miscarriage risk. So the answer is probably no, your odds will be the same with or without clomid. However there may me a play to try IVF with PGD. This option you really need to talk about with your doctor.
Does having an early miscarriage predict further pregnancy loss? Usually not. The odds are still excellent for having a baby in the next pregnancy if you had had only 1 miscarriage, or even 2-3 for that matter.
Will you ever conceive again after trying 3 iuis that resulted in one ectopic and 2 miscarriages? And suppose one of the tubes was removed? If the remaining tube is open, your odds would be excellent of conceiving again. But don’t wait too long before getting help.
Is there a relationship between a long follicular phase and miscarriages? Most likely no.
IVF Questions
Is it better to transfer a fair quality embryo on day 2 or let it grow to day 3 or day 5? Does the uterus provide an advantage over the Petri dish? Unless the lab is really bad (these days there are few really bad labs), then it does not matter. Now that’s’ if there are only 1-2 embryos. If there are more, going to day 3 will help you select the better embryos for transfer. Lab differences are more of a factor when going from day 3 to day 5.
What if the sperm is normal and you are not fertilizing? Should you try donor egg? If you wish, but the problem is more likely related to the sperm. Of course, unless you try donor sperm or donor egg you would not know, but if you look at a 100 patients who are having your problem, almost always the sperm is the issue.
If you are a poor responder, will adding clomid to an IVF cycle give you more eggs? It is one of the options. I make it may last, I put Estrogen prime of microdose first, then maybe clomid. Clomid sometimes makes the uterine lining thinner.
Is there a weight limit for IVF? It depends on the program. The fact is, people are getting bigger and doctors are getting more used to dealing with the big problem. However, it may be important to meet with the anesthesiologist who would be taking care of you during your retrieval. More important than your weight is the configuration of your neck and throat. They want to be sure that if you have trouble breathing, they can get a tube down without a problem. And let’s not forget that your doctor may be less worried about the retrieval and more worried about you and your baby during and after the pregnancy. It has been clearly shown that obesity is bad for pregnant women and bad for babies to be in the short and long term.
If you’re a poor responder, will dexamethasone produce more eggs? This has not been shown to be the case.
Do frozen embryos make healthier babies than fresh? There was one article that somehow came to this conclusion. We do not think there is a difference.
What if a “dominant follicle” seems to be the problem? Dominant follicles come in a variety of forms. Some women are very poor responders and only make one follicle. I have heard this referred to as a dominant follicle. More commonly, a dominant follicle means that you have the potential to make many follicles, but for some reason, only one is big and the others remain small. There are strategies to try to reduce this phenomenon but they may or may not work. We believe that in a natural cycle, the dominant follicle may be selected before the period even comes, so by day 2 the body has already laid out its plan for that month, and stimulating the ovary with drugs may not be able to alter that plan, leaving you with a low number, or just one dominant follicle. So by using oral contraceptives or lupron to turn off the ovary system for a little while, we may be able to stop the dominant follicle pre-selection and give more than one follicle a chance at becoming dominant. However, most of the time, the difference is not extreme
25 years old and not pregnant after an IVF cycle with nice embryos? In the end you will probably be fine. As I have said many times, get to the best program possible. Even at the best programs, these things happen.
What if you have a low AMH level (a sign of poor ovarian reserve) but have many resting antral follicles as seen by ultrasound and make many eggs during stimulation. In your case, the AMH is just dead wrong. As far as we know the AMH is not predictive poor egg/embryo quality, just egg numbers. AMH is promising as a way to measure reserve, but there are a few problems, most of us are not comfortable yet using if for a definitive diagnostic tool. In many cases it does give us correct information, but we need to fine tune the testing and result interpretation.
Interesting question. If a clinic is more aggressive in bring patients to IVF early without much other treatment, will their IVF success rates be higher than clinics that get some people pregnant first with clomid or FSH? Will doing IVF on fertile people make a clinic look better? I would say in a few case yes, this makes sense. In fact overall, since IVF seems to work well enough for most people, more people are doing IVF after shorter intervals of clomid or FSH. However it depends on the IVF success rate differences between the 2 clinics. If there is a small difference, I would point to the selection. If there is a big difference, IVF quality is a big part of the discrepancy.
How do you know if the clinic does a good job with blastocyst culture? Try asking what percentage of transfers are blastocyst for your age group, then ask the delivery rates for blast vs. day 3. Of course check their SART statistics. If they have very good pregnancy rates but do much blast, that may be fine. However also check on the number of embryos they put back. If they have good rates with a higher number of embryos returned and a higher number of triplets, that’s not so good. One of the goals of blastocyst culture is to take advantage of the natural selection process so that by day 5 the best embryos will stand out. If we can see which ones are better, we can put fewer in and reduce the odds of multiples, while maintaining higher pregnancy rates.
IUI Questions
When should you do the iui after the trigger shot? Ovulation will take place 36-38 hours after the shot. There is not a specific time that has been shown to be better. The sperm may be available to fertilize for at least 2 days. The egg is good for about 1 day. So it is reasonable to have the iui performed 24 hours after the trigger.
What if it seems on FSH you are ready too early? Even though you may be ready on the early side, the egg or eggs are probably not affected. However, if it is early there is less harm in waiting an extra day or 2 to give the hcg. I have not heard this to be more effective than just giving the hcg at the usual follicle size, independent of the cycle day.
Should you see an RE or should you let your general OBGYN handle the clomid? It depends on your threshold. If it’s really that more convenient and less expensive, and you are not in a super rush, a few months with your generalist is fine. Otherwise, get to the RE.
Donor Egg Questions
One of my most difficult questions. What if you are doing donor egg with a proven donor and your embryo quality is not great, even when splitting the eggs ½ donor sperm, ½ partner sperm? Clearly all avenues have been explored. If you have not already, and wish to continue, consider another opinion. Now I have seen proven donors give disappointing results in subsequent cycles. It is true that a young donor is more likely to make a baby with embryos that don’t look as good, so maybe the proven donor made fair embryos last time and made a baby. We have been surprised when there are pregnancies from poorly looking donor embryos, but thankfully we see it now and then.
Tubal/Uterine Questions
What about a second surgery for a septum, may it be necessary? Occasionally, more likely with a larger septum. Sometimes at surgery the cavity looks fully repaired but an HSG 2 months later shows there is still a good piece remaining. In this case maybe the upper septum scars together making it appear it was never cut. Or maybe it was never cut, which could be for 2 reasons. Maybe the doctor cut and cut and cut and was really pleased and observed there was a little piece left but felt almost it was gone, and that it was ok to leave a little. He may have wanted to avoid cutting too much, which would increase his chances of perforation. And many women do just fine with a small piece left, as long as it is not too big. But leaving a small percentage may still be leaving a substantial amount. To cut more and reduce the odds of perforation, the doctor can use an ultrasound during the surgery to watch the uterus and the septum, to help cut most of the septum but not perforate.
Another reason for finding some septum after the surgery is that there may be times when the pressure of the fluid used to distend the uterus during hysteroscopy pushes the and remaining septum up towards the muscle layer, making the inside of the cavity look smooth and normal. Yet, once the pressure is relieved by removing the fluid, a bit of the septum bulges back down into the cavity of the uterus. This is theoretical on my part, but I am guessing it does happen this way.
If you have proximal occlusion and your tube is opened, will it stay open? If it was really blocked and you have a procedure to have it opened the odds are about 70% that it will stay open.
Thanks for reading and please read the disclaimer from 5/17/06.
Dr. Licciardi
Posted on January 31, 2010 | Filed under Infertility News | Permalink
Can OTC Cold Medicines Affect Fertility?Fertili-Talk blogHowever, although most OTC cold medicines don’t affect fertility, many of them can be harmful to a developing fetus. So, if you are trying to get pregnant, …
Posted on January 31, 2010 | Filed under Fertility News | Permalink
Trying to Conceive When You are Clinically OverweightFertili-Talk blogIt is important to note that you should not diet strenuously during pregnancy or while breast feeding. Besides affecting fertility, being clinically …
Posted on January 31, 2010 | Filed under Fertility News | Permalink
SHANGHAI Jiao Tong University’s School of Medicine has identified one gene involved with sperm development that could lead to new male infertility treatments and new approaches to male contraception.
Posted on January 31, 2010 | Filed under Fertility News | Permalink
The gift of birth: Woman acts as surrogate for friend who battled cancerDaily CameraThe odds aren’t bad, but the doctors at Conceptions Reproductive Associates of Colorado, a fertility center in Lafayette and Littleton, …
Posted on January 31, 2010 | Filed under Fertility News | Permalink
Viola Lennon, co-Founder of La Leche League International and co-author of The Womanly Art of Breastfeeding, passed away last week. Quite the pioneer, to say the least, the death of Lennon marks the end of an era.
Lennon credited her mother with having the strongest influence on her breastfeeding mindset. She stated, “My mother portrayed breastfeeding as an enjoyable experience that brings you close to your baby.” And that she did…10 babies!
And we should take to heart another thought from Lennon: “Breastfeeding…led me to self-discovery and to a greater appreciation of the full humanity of the babies who were entrusted to me. Each woman needs to trust her own instincts, her own feelings, and her own sense of what will work for her with each baby. Women in the 1950s had forgotten the wisdom of previous generations in relation to breastfeeding. Mothers who tried to breastfeed on their own were almost always destined to fail. The neighbors sent their children to watch me breastfeed because they knew the children would not see it anywhere else!”
May her memory be a blessing.Co-Founder of La Leche League, Viola Lennon, Dead At 87 originally appeared on About.com Breastfeeding on Saturday, January 30th, 2010 at 14:05:52.Permalink Comment Email this
Posted on January 31, 2010 | Filed under Fertility News | Permalink
Merck Receives European Approval For ELONVA corifollitropin Alfa Injection …Medical News Today press release… the largest double-blind fertility agent trial in IVF performed to date. In the Engage trial, the ongoing pregnancy rate, the primary endpoint, …and more
Posted on January 31, 2010 | Filed under Fertility News | Permalink
Globe and MailMaternal mortality: Why it’s a crisisGlobe and MailShe was expected to prove her fertility, so she became pregnant almost immediately after her marriage. Because she had been poor all her life, …and more
Posted on January 30, 2010 | Filed under Fertility News | Permalink
Autoimmune Infertility Can Affect Either GenderFertili-Talk blogEven if you or your partner is found to have an autoimmune disease, it doesn’t mean that you cannot have a normal pregnancy with proper treatment.
Posted on January 30, 2010 | Filed under Fertility News | Permalink
Fertility link to stillborn tragediesDaily TelegraphOne per cent of pregnancies following fertility treatment end in stillbirth, compared to an overall rate of 0.7 per cent, according to figures from the …Overcoming the tragedy of miscarriageDaily Telegraphall 2 news articles
Posted on January 30, 2010 | Filed under Fertility News | Permalink
Fattening DTC Trend, California Start-Up Offers Prenatal Genetic Tests for 100 …GenomeWeb Daily News blog… medical director of the Fertility Centers of New England, was quoted as saying. One of our goals is to make this like the home pregnancy test, Counsyl …Inexpensive Gene Tests for Parents-to-BeNew York Times blogall 12 news articles
Posted on January 30, 2010 | Filed under Fertility News | Permalink
Natural Family PlanningCape May County Herald… of fertility signs Naturally Safe No health risks to women or harm to the environment Naturally Effective Both to plan or postpone pregnancy Natural …Many opt for natural family planningEden Prairie Newsall 2 news articles
Posted on January 30, 2010 | Filed under Fertility News | Permalink
Being pregnant makes following the growth of your baby that much more exciting. It’s also not bad to try and track your own “growth” via photos. If you haven’t been taking pictures of your ever growing abdomen, you should start now – it’s never too late. My kids love looking at pictures from when they were on the inside. The younger girls even make up stories to tell me what they were thinking. Like if it’s a picture of me at a party, Clara will say, “Mommy, I heard the music and said, ‘You’re too loud mommy! Then I kicked a lot.’”
Related:
Newly Pregnant Daily Pregnancy Advice Morning Sickness
Photo c C. AlleyHow You and Your Baby Grow originally appeared on About.com Pregnancy Childbirth on Saturday, January 30th, 2010 at 09:58:30.Permalink Comment Email this
Posted on January 30, 2010 | Filed under Fertility News | Permalink
Posted on January 30, 2010 | Filed under Womens Health News | Permalink
Family-planning aid could run until age 55DesMoinesRegister.comUnder the existing state program that helps pay for services such as pregnancy prevention, child-bearing age is defined as ages 13 to 44. …and more
Posted on January 30, 2010 | Filed under Fertility News | Permalink
While you may think that bleeding gums and pregnancy gingivitis are just part and parcel of pregnancy, we’ve been learning a lot about how our oral health plays a part in a healthy pregnancy. Recently in the news a stillbirth was linked to a woman’s oral care.
So what does this mean if you’re already pregnant or trying to get pregnant?
Continue to get your regular dental check ups – every 6 months.
Report bleeding gums to your dentist and your midwifeOB.
If you have cavities, get them treated.
Brush regularly with a fluoride tooth paste and floss daily.
Don’t share food and utensils, it passes bacteria.
Chew Xylitol gum.
Change your tooth brush every three months, and after illness like the flu.
Gum Disease and Pregnancy originally appeared on About.com Pregnancy Childbirth on Saturday, January 30th, 2010 at 07:48:39.Permalink Comment Email this
Posted on January 30, 2010 | Filed under Fertility News | Permalink
Families have the right to chooseManila BulletinUnplanned Fertility. Despite a steady rise in the level of contraceptive use, unplanned pregnancies are common. Overall, one in three births in the …
Posted on January 30, 2010 | Filed under Fertility News | Permalink
Merck Co., Inc., which operates outside the U.S. and Canada as MSD, announced the European Commission EC approval of ELONVA corifollitropin alfa injection. ELONVA is indicated for controlled ovarian stimulation COS in combination with a GnRH antagonist for the development of multiple follicles in women participating in an assisted reproductive technology ART program…
Posted on January 30, 2010 | Filed under Fertility News | Permalink
Doctor pans family-planning tweakDesMoinesRegister.comUnder the existing state program that helps pay for services such as pregnancy prevention, child-bearing age is defined as ages 13 to 44. An Iowa fertility …and more
Posted on January 30, 2010 | Filed under Fertility News | Permalink
CUTS: NHS fertility funding blowThe StarIt is fertilised in a laboratory before being transferred back to the woman who, it is hoped, will become pregnant. Each treatment costs 2900 and studies …and more
Posted on January 30, 2010 | Filed under Fertility News | Permalink
CUTS: NHS fertility funding blowSheffield TelegraphIt is fertilised in a laboratory before being transferred back to the woman who, it is hoped, will become pregnant. Each treatment costs 2900 and studies …
Posted on January 30, 2010 | Filed under Fertility News | Permalink
New York Daily NewsWomen Lose Almost 90 of Eggs by 30KPSP Local 2Jacobson now has three children, but admits she and many women she knows have struggled with fertility issues. “The longer you wait, the harder it is, …University study reveals why woman over 30 have less chances of pregnancyBarcelona ReporterFertility: 90 of eggs gone by age 30!WHAS 11.com subscriptionall 6 news articles
Posted on January 30, 2010 | Filed under Fertility News | Permalink
Heartburn or acidity during pregnancy is very common, and while it can happen any time during pregnancy, it is most common during the third trimester.
Many women complain of this problem during pregnancy and many women suffer from heartburn for the first time in their lives when they get pregnant. The situation will resolve itself after the baby is born and the reasons for this are as follows:
This is due to the fact that the baby is so big and takes up such a lot of space in the abdominal cavity at this time that the stomach is rather constricted causing the bile to rise.
The other reason why this happens is that during this time the levels of the progesterone hormone are high in the body. This causes the valve separating the stomach from the food pipe to relax and hence the contents of the stomach tend to flow back up from the stomach and give that disagreeable burning sensation that seems to spread out all over the chest area.
The progesterone hormone also causes the process of digestion itself to slow down, which can also cause heartburn and various other problems such as constipation etc during pregnancy.
Posted on January 30, 2010 | Filed under Pregnancy | Permalink
Do you know that you don’t have to be overweight to have too much body fat? You can weigh in at what you think is your ideal range and normal body size, but still be considered obese and thus, at risk for future heart problems. This phenomenon of “normal weight obesity” is the focus of a report by the Mayo Clinic, whose authors estimate that as many as 30 million Americans fall into this category. An informative feature story about this appeared in the Wall Street Journal’s HeartBeat Column this week.
Apparently, what’s most critical in evaluating whether you’re really fit or just acceptable is not your BMI score, the traditional measure for obesity, but how much body fat you’re carrying around. If you don’t have access to a gym that has equipment for measuring your body composition, a simple way to estimate if you are really fit is to measure your waist or use a metric called the waist-to-hip ratio (are you an apple or pear?). Many research studies have proven that fat stored around the middle (a particular problem for post-menopausal women) doubles the risk of death from stroke, cancer and cardiovascular disease. Why? Dr. Joann Manson, a Harvard endocrinologist explained in an NPR interview that “abdominal fat cells tend to be more active in producing hormones and chemical messengers that cause inflammation throughout the body.”
So, if you’re on a weight loss diet, be sure to include exercise, particularly weight training, to ensure that you’re building lean muscle as you lose weight. And don’t think you’re sitting pretty just because you’ve reached your ideal weight. If your percentage of body fat is still high, you’re not fit, you’re just at a (barely) acceptable level.
Posted on January 30, 2010 | Filed under Menopause News | Permalink
What’s new in the business scenePoughkeepsie Journal… factor infertility, anovulation, polycystic ovarian syndrome, endometriosis, tubal factor infertility, diminished ovarian reserve, recurrent pregnancy …and more
Posted on January 29, 2010 | Filed under Fertility News | Permalink
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