Q&A Sessions:

	-	Most Recent
	-	Age and Fertility
	-	Egg/Embryo Donation
	-	Follicle-stimulating Hormone (FSH)
	-	In Vitro Fertilization (IVF)
	-	Male Infertility
	-	Other Fertility Issues
	-	Polycystic Ovary Syndrome (PCOS)
	-	Tubal/Vasectomy Reversal
	-	Unidentified Infertility

Lissa asks:
What is the success rate of your tubal reanastomsis? Do most insurances cover this procedure? If not, what is the cost of it?

Scott Edwards, MD responds:
The success rate of tubal reanastamosis (tubal ligation reversal) will depend on many factors such as patient age and how much of the fallopian tube was undamaged by the tubal ligation. Pregnancy rates can be as high as 70 percent after reversal.

Some insurance plans cover this procedure but you would have to check with your own carrier to determine whether or not it would be covered. At the time of consultation, a financial counselor would be able to give an estimate of the cost.

Naailah asks:
I'm a 27 year-old black female and I'm about to under go in vitro fertilization (IVF). I was told by someone that has been though this process that black and Asian women do not have a good success with IVF. Is this true?

I'm healthy. The only problem was blocked tubes and now one is reopened, but I still want to do IVF. But every black women I talk to said it never worked. Some are on cycle three or four.

Please can you shed some light on this because I'm lost. I did have an STD. That's why both tubes were closed but after surgery one is open and looks normal. I was told to try but I am looking to just do IVF.

Scott Edwards, MD responds:
It is controversial whether race affects the success rates of IVF. While some studies have reported lower success rates in black patients, other studies have not. Much more important factors than race in determining chance of success are age and cause of infertility. As a 27 year-old with tubal factor, your chances of success with IVF are excellent! Do not be discouraged and rest assured there are many black women who have had babies through IVF.

Beth asks:
Four days ago I had an in vitro fertilization (IVF) embryo transfer and last night I believe I had an uterine contraction. Does this mean that 100 percent the transfer will not take, or is there still a chance it might be a success?

Maureen Kelly, MD responds:
A uterine contraction, perceived or not, does not mean the embryos will be expelled and there is no chance of conception. In fact, uterine contractions are quite common after embryo transfer, although many times they are not felt. Also, if the ovaries were stimulated, they can create sensations indistinguishable from cramping. I wish you the best.

Lin asks:
My husband and I have been trying to conceive for almost a year, however, we haven't been successful. I work in a print shop that does offset printing and am exposed to chemicals. Could this be a factor?

Scott Edwards, MD responds:
It is very unlikely that the chemicals are a cause of your inability to get pregnant. To help determine your fertility, a specialist would want to know if you are ovulating every month, if your uterus and fallopian tubes are healthy, and if your husband has a normal sperm count.

I would recommend that you visit a fertility expert to begin this evaluation. In the mean time, you could find out what types of chemicals are present in your workplace and bring this information to your visit. Best wishes.

If you would like to schedule an appointment with a Penn Fertility Care specialist, please call 800-789-PENN (7366). You can also request an appointment online.

Kathy asks:
I just had my first in vitro fertilization (IVF) cycle cancelled as I only had three follicles at 3 mm on left ovary and one 16 mm on right ovary. Will these 3 mm follicles release an egg on their own and is there a chance we can naturally fall pregnant when the egg is released?

We were diagnosed with secondary infertility, and have had two miscarriages this year. How long does it take for the follicles to mature to release the egg? Do you think we should still be having intercourse while I wait for my next cycle to begin?

Suleena Kansal Kalra, MD, MSCE responds:
I am sorry to hear that your cycle was cancelled – that can be very disappointing for a couple. The upside is that, even when a cycle is cancelled, it can give us valuable information regarding how to treat you in the future. Hopefully, that will be the case for you.

I would say that it is absolutely fine for you to attempt to become pregnant on your own while awaiting your next cycle. It is most likely that your 16 mm follicle will develop into a mature egg. It is less likely that the 3 mm follicles will become mature eggs as follicles generally grow 2 mm/day and do not reach maturity until 20 mm.

Jamie asks:
I am a 22 year-old female and I have been trying to conceive for about five years. I got my period the first time at 14 years old. I had it twice and didn't get it back until I was 16 years old. Ever since I was 16, my period has been "murder" for me. The pain is so bad I want to die and I always find myself in the ER.

I don't have health insurance so seeing a doctor is not an option right now. No doctor seems to care enough to run the proper tests on me to figure out what is wrong. Right now I feel alone and lost. I don't know what else to do. I have tried everything I can think of. My period has gotten so bad that it's always seven days long. But this last time it lasted four days very light and two weeks later I got it very heavy. I was going through tampons and pads like crazy. It lasted 13 days and very heavy the whole time.

The pain has gotten so bad I don't know what else to do. My doctor put me on birth control to regulate my period because it's never ever been regular and that didn't work. They also put me on naproxen for inflammation and that doesn't work, so I am lost. If you have any information that can help me please let me know what my next steps should be.

Clarisa Gracia, MD, MSCE responds:
Painful periods, or dysmenorrhea, are not uncommon in adolescents. Usually, birth control pills and anti-inflammatory medications such as those that you have tried are the first step and can dramatically decrease the pain. Sometimes you must try the pill for a while (three months) for it to regulate your cycles and improve pain. You can even take the pill continuously (skipping the pill-free week) to try to suppress your periods.

Other medications, such as depo-provera, can also suppress your periods. One cause of painful periods is endometriosis. In order to diagnose this condition, a minor surgery called a laparoscopy is required.

Depending on your other symptoms such as bowel or urinary symptoms, your pain could be related to other problems as well. I would recommend following up with another gynecologist for another opinion.

If you would like to schedule an appointment with a Penn Fertility Care specialist, please call 800-789-PENN (7366). You can also request an appointment online.

Michelle asks:
I am 32 and I am going through infertility testing. My FSH was normal last month 5.5, but my estrogen level was elevated 93. This cycle my estrogen was 46 normal but FSH was 26. I have read literature that states one's elevated FSH is an indication of poor chances of getting pregnant is that true?

Kurt Barnhart MD, MSCE responds:
An elevated follicle-stimulating hormone (FSH) level is associated with having a more difficult time getting pregnant. Your level is elevated. You should get a full consultation with reproductive specialist to go over your options. You are still young, so there are options.

If you would like to schedule an appointment with a Penn Fertility Care specialist, please call 800-789-PENN (7366). You can also request an appointment online.

Puddycat asks:
Could it be my husband has infertility problems and not me after all? I have had two miscarriages on my own that ended around 5-6 weeks. We were sent to a fertility clinic and found out that both of my tubes were blocked. We went on to do four in vitro fertilizations (IVF) and had one miscarriage that ended at six weeks, they said my egg quality is low.

So we went on to use donor eggs and lost that pregnancy at six weeks too. They did a karotype test on me and my husband and everything came back normal. So we decided to get a surrogate mother, she used her own eggs to become pregnant. She did get pregnant but it ended in a blighted ovum at nine weeks.

I was wondering your opinion. The surrogate is young and has two healthy children. Could this be my husband or just a fluke thing that happened? We don't know which way to go now. We have also had his sperm checked about two years ago and that was fine too.

Clarisa Gracia, MD, MSCE responds:
From your description above, it does not sound like this is a problem with your huband's sperm. A woman's age and FSH levels play a role in conceiving as well. Ask your physician how your FSH levels have been. I agree that it sounds like an egg quality problem.

It may be that donor egg is your best bet, but of course I don't have all of your medical information to give you adequate advise on this. If you are still uncertain, you may want to consider getting a second opinion after another physician reviews your records. Best wishes to you.

If you would like to schedule an appointment with a Penn Fertility Care specialist, please call 800-789-PENN (7366). You can also request an appointment online.