The AFA Blog

Can You be a Poor Responder and Get Pregnant on Your Own?

by Fred Licciardi, M.D.

So a little story about a couple I saw recently. She was a poor responder with borderline FSH levels, normal tubes and a favorable age. He had low sperm counts. They had been through IVF. I suggested that he see a urologist because maybe there was something that could be done to improve his counts. She still ovulates every month, so by upping the odds on the sperm side, maybe they could get lucky and get pregnant on their own.

My statements were very surprising to them. They had been told that because of her “fertility status”, meaning her FSH was a little high, pregnancy could not occur naturally, so why bother with the sperm.

This may be close to accurate but it is not completely true. Unfortunately, many couples with significant fertility problems never get pregnant, but for some, the pregnancy rate per month is not zero. Even if it is ½ percent per month, after a year, a few women with normal tubes, borderline FSH levels and good sperm will get pregnant (age helps).

Can you count on it?  No, but if there is something fixable, you might as well explore the options.

This is also the reason that some doctors suggest a laparoscopy after many failed IVF cycles. Even if the odds of tubal disease are low, correcting a small problem may improve the odds of a spontaneous pregnancy down the road.

Immature eggs and infertility treatment

by Fred Licciardi, M.D.

Say you are undergoing IUI or IVF and your doctor has told you that you have a high percentage of immature eggs.

Remember, having a rate of 10-20% of immature eggs is normal.

However, having a high percentage of immature eggs can be a function of a few things. Firstly, maybe you received the hCG too early, and waiting 1-2 more days may have increased the percentage of mature eggs. Most people on average do not have an excess of immature eggs when receiving their hCG shot, once their biggest follicles reach about 18 mm. Some women however, need their biggest follicles to be 20 or 22 mm before most of their eggs are mature.

There is no way to know this in advance of the first cycle. But, if this is the case, changes should be made for subsequent cycles and you should discuss this with your doctor.

There are some women who, no matter how long we wait to give the hCG shot, will still have a large number of immature eggs. We can’t explain why this is so.  It is simply a case of dealing with what you have.

In general, we don’t want to wait too long before giving the hCG shot because eggs can become over-mature and this could show up later as poor quality embryos.

It's a Boy!

by Ken Mosesian

Congratulations to Rachel Zoe and husband Rodger Berman on the birth of their first child, Skyler Morrison. Zoe, a celebrity stylist, is the star of the Rachel Zoe Project. Last year, at the close of the season, she was discussing her desire to start a family with her physician. He told her that at her age it may be too late. She was clearly shocked.

Her response reminded me of the responses we had gotten from the hundreds of women that we have spoken with across the country about the reality of the biological clock. Well educated, professional women, who don't realize that fertility begins its first decline at age 27, and then takes a significant dip around age 35.

In a truly poignant scene, she spoke directly to the camera, saying that she had worked so hard and so long to make sure she had a thriving business, presumably to be able to provide for the child and to be able to take time off, only to find out that it may be too late.

Sometimes infertility can't be prevented, but there are many things that can be done to help one conceive. Awareness of how age factors in is absolutely key. Check out our Infertility Prevention Handbook for more information. 

And to Rachel and Rodger, our best wishes to you and your family. Here's to health, happiness, and joy for you all. 

 

 

 

 

 

The Clomid Death Sentence

by Fred Licciardi, M.D.

A few years ago I was visiting another hospital. When touring the OBGYN department, I ran across a very busy obstetrician in the middle of office hours. He was running form room to room and had a pile of charts in his hands. After her appointment, one of his patients cornered him in the waiting area and softly said, “by the way, I have not been able to get pregnant again.” Automatically, he pulled out his prescription pad scribbled a years supply of Clomid, saying, “Let me know if nothing happens in a year.” Seeing me at the last second, he said, “Actually, make it 6 months”

Needless to say I was not happy with either of his recommendations.
Giving a patient a prescription for 6 months of Clomid may be giving that woman’s fertility a death sentence.
If a woman is 39 and not getting pregnant, and she takes 6 months of Clomid, she will probably turn 40 before she starts her work-up. By the time she makes her appointment, sees the doctor, and gets her workup, it’s 6 months, maybe longer, and now it’s all too late.
It’s ok to use Clomid. I limit it to about 3 months, and there should be some workup first. I occasionally use 6 months of Clomid, but only in the case where the woman doesn’t ovulate without it. I skip Clomid in older women.

How late is late? You only know what you know

by Maria Portella

In the last month there has been some excellent articles in the UK press which really deserve to be shared. The links to the articles are below and the headline points are right on the money:

• The best age to have a baby is between 20 and 35
• Don't wait too long for a baby: Women are SIX times more likely to suffer from fertility problems when 35 than at 25
• Doctors have issued the stark warning to couples as more and more women pursue careers and leave parenthood until their late thirties.

Now, of course, not all women leave or wait JUST because of their careers. Many don't meet their other halves until in their thirties so what do you do - we all love the idea of you meet and are married and get pregnant within six months of meeting but even at age 30 plus it doesn't work like that - life isn't the fairytale for all of us and it can take 2 or 3 years before you are settled enough to get married and start to have kids by which point you are out of the optimum period.

 To me it highlights the massive challenge that comes with being a woman in the 21st century. They tell you to be financial independent and not to rely on men for financial security (well my dad certainly drummed that one into me and for good reason when he saw the amount of divorces around him and women left struggling to raise children with little money and relying on maintenance - he didn't want that to be me); but the flip side is you get an education and a career first in your twenties when historically and traditional women were having babies.

 You'll read commentaries about how women just want to 'have it all' but that is just nonsense [my opinion]. My dad died many years ago but I am sure that he no more wished for me to have to have struggled with infertility as he did not wish for me to struggle financially because I was financial dependent on a man and left divorced. And that is a man's perspective for his daughter! Not a feminist view.

 So what we need to do is make sure we educate women (and men) so that they can try and organise their lives (as best they can) to strive to achieve the two. It is harder for women possibly on this count than for men, I don't think we can argue against that. Women have more of a finite time-line to contend with than our male counterparts. But as women we have two options: to complain it isn't fair, and suffer the consequences; or do something and make sure we keep all young men and women better informed than we were by our predecessors.

 I know which one I am picking and I hope you will too - share and educate our young men and women on the challenges of fertility. Awareness is key.

 The Links:

http://www.dailymail.co.uk/health/article-1351237/Women-6-times-likely-suffer-fertility-problems-35-25.htmlhttp://www.telegraph.co.uk/health/healthnews/8287719

http://www.telegraph.co.uk/health/healthnews/8287719/Doctors-warn-couples-not-to-leave-it-too-late-to-have-a-baby.html?sms_ss=email&at_xt=4d4ade58d7be4928%2C0

http://www.guardian.co.uk/society/2010/dec/31/pregnancy-mothers-fertility-children