by Fred Licciardi MD
Monica asked about DES exposure. Most women who were exposed to DES do not have any problems with their uterus or cervix, but a very small percentage of exposed women do. You definitely need a HSG and may need to be followed by a high risk OB if the cervix or uterus is abnormal. The older fertility doctors have a little more experience, as DES was mostly phased out by the early 70’s.
Sophia asked about what to do next after 6 failed ICSI attempts. You need to be in the best clinic available to you. You could consider travelling for a second opinion.
Mandy asked about Clomid vs Metformin. In general, I use more Clomid than Metformin. If you do not ovulate, but do on Metformin, and got pregnant easily, great, sounds good, use it again. If it took you a while consider Clomid. Doctors differ on when to stop Metformin during pregnancy, and it may depend on the severity of your case of PCO. I do not think you caused the miscarriage by changing the Metformin dose.
Laura asked if ICSI is safe. We will not know the specifics for decades. So far it looks relatively safe. You need to speak to your doctor and carefully read the consent forms.
Sperm of 20 million and 20% motility: repeat the test. You have all of the options available to you. IVF may be your best shot if the sperm counts remain consistent.
Veronica asked about ICSI in a natural cycle. You can do whatever you want, but a natural cycle, while it may be successful, has a very low pregnancy rate. Your lining is fine. If your last protocol gave you your best results, yes do the same again.
M asked about IVF for a low sperm count after vas reversal. I think the microflare is a good protocol. It’s hard to say if I think it’s best for you. It seems you did pretty well with your last, but without seeing the whole cycle I can’t say for sure. To go from cancelled to 12 eggs is quite good. Ask your doctor about keeping the same protocol but going a little longer before your hCG.
Emily asked about being on Metformin for 8 months. What’s the crime in putting you on clomid? You can take both. Most doctors do not follow insulin levels in their Metformin patients. Sounds like time is just passing buy.
MK: Yes, FSH levels drawn on day 23 are not useful. Your later progesterone levels look fine.
Sandy asked about PCO and miscarriage. For every doctor who says there is a connection, there is another who says the opposite. If you ovulate regularly on your treatment and you easily conceived, there is no reason to believe it can’t happen quickly again. If it took you a long time to get pregnant, you can consider getting more aggressive this time.
Kristina asked about mildly elevated THS levels, otherwise known as subclinical hypothyroidism. Your doctor is probably right, your levels are not a problem. However there are tons of endocrinologists who disagree, and would treat you with thyroid medication. In the past I did not give medication to people like you, however I got so much flack from the endocrinologists I just gave in and started treating. You can see an endocrinologist for a second opinion.
Mr and Mrs Oldham have a sperm count of 6.5 million. If your count remains in this range, IVF is by far the way to go. You can explore other options, but your highest odds will be with IVF and ICSI.
Arpee: Thank you, a search function on the blog is a great idea. I will give it a shot.
Megan has had 3 miscarriages. She has 6 frozen embryos, but had become pregnant on her own. She doesn’t know if she will have a lower chance of miscarriage if she does the frozens or tries naturally. Theoretically, in a frozen cycle you are putting more than one in, so if one embryo is abnormal, maybe one of the other ones are ok, lowering your odds of miscarraige. This effect is probably minimal but may hold true. In general I don’t like PGD, but you may want to at least consider this for your remaining embryos to lower your odds of miscarriage. No matter how you become pregnant, unless there is something else in your history, your odds of having a baby in your next pregnancy are 70% (unless you are in your 40's, then your odds are a little lower).
Chris was told to take 6 months of lupron for her adenomyosis. Get another opinion. It depends on the severity of your case. I would give 6 months of lupron only in the most extreme cases. 6 months is a lot of time to lose.
Trixie has a 10 day luteal phase. This is probably too short. A little progesterone may do. Ask your doctor.
Rose has a high estrogen on day 3, but has been taking estrogen. I don’t know if you need estrogen, but if you do, try repeating your bloods on day 4 and maybe 5. You may be able to start your cycle even though it’s later than day 3. You may have estrogen in your system left over giving you this high reading.
Someone with Klinefelters has never had a semen analysis. Yes, you need this test. If there is no sperm, find a good reproductive urologist and consider the biopsy. Ask about doing the biopsy and IVF at the same time. Many times there is a minute amount of sperm, enough for icsi, but not enough to freeze.
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