Fertility: General Questions and Answers
SEEING A SPECIALIST
Q: I am wondering if it is possible to conceive with PCOS, thyroid disease, and Factor 5 blood disorder in a fairly reasonable time. We have been trying for a year and have now been referred to a specialist. I have two other children but have never had to see a specialist. I don't think I can handle the ups and downs of infertility much longer - what can a specialist do that my regular doctor can't?
Specialists in infertility have more technology available to treat problems specifically. It would be in your best interest to at least have a consultation and see what is available to you.
Q: I've been treated for PCOS since 1999 and have gotten to a point where I have regular periods and my hair growth has clammed down. I have a hard time with my weight and body acne. My worst fear is that I can never have children. My doctors feel that I am too young to worry about having children at this point. I take metformin as prescribed by my doctor. How do I know if I am ovulating? Is there any sure way to know if I am able to conceive?
There are a number of ways to tell if you are ovulating: 1. You can use the ovulation predictor kits from the drug store, 2. Your doctor can monitor you with blood work and/or ultrasounds, 3. You can check your blood for progesterone 1 week after you think you ovulated or 4. You can check you basal body temperatures to see if there is a sustained rise.
SMOKING AND CONCEPTION
Q: Would quitting smoking help me conceive? I am extremely healthy aside from the smoking. I eat a healthy diet, exercise 4x per week, however I just can't seem to give up smoking. I have been ttc for about a year and a half now, and am wondering if the smoking might be causing the problems. I am 32 years old.
While smoking itself is probably not the only reason for not conceiving it is associated with decreased pregnancy rates. It is always a good idea to quit smoking if you can.
CHEMICAL PREGNANCY OR MISCARRIAGE
Q: What is the difference between a chemical pregnancy and a miscarriage?
A chemical pregnancy loss is associated with a positive blood pregnancy test but no pregnancy seen on ultrasound. A chemical pregnancy loss occurs prior to 6 weeks from the onset of the last menstrual period. A miscarriage is the loss of a clinically recognized pregnancy, visible on ultrasound. Miscarriages usually occur after 5 weeks form the onset of the last menstrual period.
Q: I have 2 small polyps in my uterus, which were seen on a saline hysterosonogram. Could these polyps be the reason why I cannot conceive? There are no other diagnosed causes for my infertility at this time.
Polyps within the uterine cavity can act like IUDs and prevent implantation. It would be a good idea to have them removed.
Q: I have heard of women with high FSH levels taking wheat grass to decrease the FSH level. Have you seen any positive responses to this? I am 39 years old and my FSH level is 19. I would like to get my FSH level below 10 so that I will be a good candidate for IVF, and have heard some women have used this to get the level low enough for IVF.
An elevated FSH level is a sign of decreased number of eggs within the ovary. Thus the elevated FSH is not the problem but rather the result of the problem of decreased numbers of eggs in the ovary. It therefore does not help to decrease the FSH levels because this will not make more eggs. Women are born with all the eggs they are ever going to have and do not make more eggs throughout their lifetime. You may want to talk with your doctor about the option of donor egg.
DEPRESSION AND OVULATION PROBLEMS
Q: I suffer from clinical depression, and my doctor believes it is due to a serotonin and/or norepinephrine imbalance. I have been married for almost 2 years now, and my husband and I have decided to start trying to have a family. The only problem is that I don't have regular periods. I might have one every 3 months or so. My OBGYN has been doing some testing to see what could be causing this, and he has discovered that I don't ovulate. Could my serotonin and/or norepinephrine imbalance effect my ovulation?
Yes, abnormalities in these compounds can affect ovulation, but can be overcome by medications that stimulate the ovaries to ovulate directly. You should talk with your doctor about options for ovulation induction including gonadotropin stimulation.
Alcohol & Smoking
Q: I recently saw an urologist and was diagnosed with a very low sperm count. I am 42 and have been a smoker for over 20 years, and consume 3-4 drinks on a regular basis. My wife is 34, she does not smoke or drink. How significant a factor is my smoking and alcohol use contributing to a low sperm count?
Both smoking and alcohol can play a role in fertility. What is too much depends on each individual. With a low sperm count (depending on absolute number), you doctor will most likely recommend complete abstinence for 3 months and then recheck your sperm count.
Q: Can vitamins affect your FSH reading? My last several readings have all been in the normal range, but this time it was 10.6. I have been taking Vitamin 12, 200 mg, Vitamin E, 400 mg, Zinc, 100, Folic, 400mg and a baby aspirin every day. Do you think that could elevate my reading? If not and my reserve is depleting, would my FSH reading go up gradually or just skyrocket?
Vitamins should not affect FSH levels. Your rising FSH concentrations reflect your ovarian reserve and can rise either gradually or quickly. The rise varies individual to individual.
Thin Uterine Lining
Q: I'm about to try my first Frozen Embryo Transfer (FET). My previous 2 donor egg cycles failed, we think due to a thin endometrial lining. My RE would like to improve my lining to at least 7.5 mm prior to transfer. The only difference in medication for this protocol is that I am on estrogen patches, in addition to estrace, and lupron. I am 47 years old and have read about many women who have been successful with donor egg cycles. Do you have any suggestions on how to thicken up my lining in a short period of time in hopes that this FET is successful?
Viagra can increase the thickness in the lining of the uterus quickly, sometimes within 48 hours. You should talk with your doctor about trying this.
Q: My husband and I conceived our daughter through IVF with ICSI one year ago. His semen analysis shows 0% morphology, which was why we went straight to IVF. What are the possible causes for abnormal morphology? We would love to have another child without resorting to IVF and have heard about men using Pycnogenol and Mako Bark to improve morphology. Is there any merit to this?
Often there is no apparent reason for the presence of abnormal sperm. Anti-oxidant therapy (as you mentioned) has been shown to improve sperm counts and DNA fragmentation in some men. Whether this treatment could improve the sperm quality enough for spontaneous conception is not known until the sperm is evaluated before and after treatment.
In Vitro Fertilization
Q: My husband and I have been trying to conceive for two years and I have PCOS and endometriosis. We went through one cycle of IVF and it was not successful. What are the chances that future cycles of IVF may work considering the first one failed?
The more embryos that are exposed to the lining of your uterus, the higher the probability that one will implant. More cycles of IVF gives your uterus more exposure to more embryos. The probability of pregnancy with each cycle depends on the center performing the IVF. The cumulative pregnancy rate, in women under the age of 40, is 50% the first cycle and 80% after 2-3 cycles in some centers. With a history of endometriosis, you should consider a second cycle as it gives you the highest probability of parenting.
Q: How is the normal morphology scale converted to the Kruger (strict) morphology scale?
You can't convert it. They are different scales and use different standards for evaluation. Normal values for strict Kruger criteria are 4% in some labs and 14% in others. Normal values for WHO criteria are 50%.
Probability of Pregnancy
Q: If Kruger morphology is 1%, 2%, or 3% what is the probability of getting my wife pregnant via an IUI procedure?
The probability is very low. Your best option for all of the above is IVF with ICSI.
Questions have been answered by Carolyn B. Coulam M.D., a board certified Reproductive Endocrinologist practicing in Chicago, Illinois.
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