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

Ccshanie asks:
What is it called when a woman has long cycles 35 days or more and her body is beginning the process of developing a follicle without actually releasing an egg, thereby showing two peaks on your ovulation predictor? How would this condition be treated?

Response:
It is very possible that you may not be releasing an egg every month. Sometimes when that happens, your hormones my fool the ovulation predictor kit to turn positive when you really did not release an egg. There are a number of reasons you may not release an egg every month. The treatment depends on the specific reason. It is best to get a complete evaluation from a specialist.

Jennifer asks:
I have a healthy son who is three. My husband and I are trying to have another but I have had three miscarriages in the past two years. I was about 10 weeks when I found out the first baby died inside at six weeks, the other two I was around four weeks and six weeks. I've had a lot of tests and everything came back normal, even the test taken on the baby for the first miscarriage came back fine. I don't know what to do. I can get pregnant but have trouble keeping.

Response:
Unfortunately, I don't know if all the appropriate tests were taken, not which test taken on the baby which was normal. These would be important in evaluating your situation. Besides blood tests (including chromosomes on you and your husband), were any evaluations of your uterine cavity performed?

Scoop asks:
Can a 43 year-old healthy woman with three c-sections and tubes cut have a chance of getting pregnant again? What are her options?

Response:
It depends on your hormonal status. You should obtain a blood hormonal evaluation on day 3 of your cycle for FSH and estradiol levels.

Fooha asks:
If I dont ovulate, does that mean I don't have eggs? How will I get pregnant if I see a fertility doctor?

Response:
There are many reasons why a woman may not ovulate. It usually does not mean that there are no eggs in her ovaries. A specialist can order a few tests which can usually uncover the reason. Once the reason is determined, there are many different approaches to help the patient ovulate. This evaluation and treatment is best done under the care of a Board Certified reproductive endocrinology and infertility specialist.

Deb asks:
I had three miscarriages before having a successful pregnancy and healthy child. Progesterone suppositories were what I used and give credit for this success. I used progesterone again when trying for my second and had yet another miscarriage. A D&C showed no chromosomal abnormalities (I'm now 38 years old). What else could it be? I have had every test imaginable, all showing no sign of trouble.

Response:
I am sorry to hear about your losses and your frustration. There are many reasons for a miscarriage. I would suggest you get someone (as a second opinion) to go over all of the tests you have had. There may be some issues that have not been looked at (decreased ovarian reserve, polyps, are two that come to mind).

This is a very frustrating issue. Good luck. We would be happy to help you, if we can. If you would like to schedule an appointment with a Penn Fertility Care specialist, please call 1-800-789-PENN (7366) or visit pennhealth.com to schedule an appointment online.

Kama asks:
I have two children: 9 and 7 years old. I had Mirena coil for four or five years. Since I removed it I have been trying to become pregnant for a year, but with no success. I am ovulating every month and have regular periods. Why I can not get pregnant?

Response:
The prior use of the Mirena IUS is not the cause of you not getting pregnant. You and your husband are now older and this may be playing a role. The two of you should ask your doctor about an infertility evaluation.

Red asks:
Can you get pregant without your tubes? Doctors removed my tubes about 13 years ago but my periods have been regular until now. I haven't had one this month and so I am just wondering.

Response:
If both your tubes have been removed, it is like having a tubal ligation and you should not be able to get pregnant. However, there are always strange things that can happen (like only part of your tube was removed), so you should do a pregnancy test to find out. It is possible to get pregnant with the help of in vitro fertilization (IVF).

NYCgirl asks:
Am I overmedicating to do PGD after two miscarriages? Should we wait to see if we have a third before we try? My first miscarriage was a trisome 20, the other trisome 21. Both my husband and I have had every test and everything is normal.

Response
I do not think PGD is a good test to lower the risk of miscarriage unless you are looking for a specific abnormality. I do not think you have experienced something that can be specifically evaluated with PGD. I would not suggest it to you. It is just adding complexity (and cost).

Leigh asks:
I had a culture done and it came back positive for ureaplasma, which is a bacterial infection. They suggested 10 days of antibiotics. I have been trying to concieve for four years and had two IVF's which both resulted in miscarriages. Do you think that this bacteria infection had anything to do with not being able to concieve or the miscarriages? Why do doctors not check for this routinely?

Response:
Data is conflicting. Many investigators have concluded that ureaplasma is not associated with primary infertility and that although doxycycline eradicates the infection, doxycycline was of no benefit in the treatment of primary infertility of unknown cause. Other data have shown that this organism may bind to sperm, hampering motility.

Anonymous asks:
I am trying to have a baby but was told my testosterone was too high, I have not been on any birth control in over a year. Is there anything I can do to lower it? Also can infertility help with conceiving a specific sex?

Kurt Barnhart, MD, MSCE responds:
You should have a formal evaluation by a fertility specialist for your difficulty in getting pregnant and your elevated testosterone. They very well may be related. There are options to help you, but first it must be determined why the testosterone is elevated. Then treatment can be tailored to your needs.

There is no "full proof" way of helping select one sex over another (even though some claim they can do it). We would be happy to meet with you, simply call 1-800-789-PENN (7366) for an appointment.

Corrin asks:
We have been trying to have a child for eight months with no success so I went to my gynecologist. I asked her if an overly acidic environment might be the problem. 30 years ago, after trying to conceive for two years, my Mom was told that an acidic environment was her problem and was told to douche with a baking soda mixture before sex. She got pregnant that month.

I asked my doctor if that could be my problem and she said that douching is only to try for a certain sexed child and would not aid me in getting pregnant. Is that right? Why did it work for my mother repeatedly with three children? Also, my ob/gyn she is taking blood and doing another test to determine if I am ovulating. Are there other tests she should be doing prior to putting me on ovulation inducing drugs?

Richard Tureck, MD responds:
Sperm do not like an acid environment. Sometimes, the cervical mucus is acidic and can kill sperm. This is found by performing a post-coital test following intercourse. Bicarbonate can remedy this, however, you should seek the guidance of a fertility specialist to determine your condition. We would be happy to help. You can reach us at 800-789-PENN (7366).

Allison asks:
Is Penn doing any research on cytoplasmic transfer? Do you feel this is going to be a useful and available ART procedure in the future for women with poor egg quality or high FSH?

Christos Coutifaris, MD, PhD responds:
Cytoplasmic transfer has been banned by the FDA for about one year now until animal data about its safety are collected. Although, theoretically, it may be of some use for some patients, the potential risks at this time outweigh the benefits. We do not recommend this procedure for any patients (in addition to it being against the law).

Cassi asks:
My husband and I have been trying to have a baby for two years. We are going to a fertility specialist, and in January I did a laparoscopy to make sure my tubes were open. Both of our tests have come back perfect.

Five months later, I am still not pregnant, and my usual (for the last 10 years) 27 day cycle changed to a 21 day cycle. I got a second opinion and am now on clomid. Is there any explanation for the changed cycle? Will Clomid help? Is stress a factor (for me or for him)?

Richard Tureck, MD responds:
The fact that you have not achieved a pregnancy is probably not related to the surgery. You may wish to take your basal body temperature to get an idea of the length of the luteal phase (2nd half) of the cycle. If there is a short luteal phase, clomid may correct that. I wish you the best.

Jraizen asks:
I am interested in using a gestational surrogate as recourse to an unexplained second trimester RPL. Could you share with us the number of patients you have treated using their own eggs and sperm with a gestational surrogate, and the success rate of those transfers in the last three years? Thank you.

Christos Coutifaris, MD, PhD responds:
For the past several years we have been doing one to two such patients per year. Generally speaking, success depends on the age of the patients. I cannot recall of a failure, except that some couples required more than one attempt to achieve the pregnancy.

Jessica asks:
Do you do blastocyst (day five) transfers; or do you do only day three transfers? What percentage of your transfers are day five vs. day three? I have read that blastocyst transfers can cause more monozygotic twins and also could cause more birth defects (since embryo is outside longer). Is this true in your experience?

I am 30 and have regular ovulation; and very good values of E2, FSH, LH, etc. and have mild endometriosis. If I do in vitro fertilization at your center; and assuming that I have a few (four to five) good qaulity embryos would you recommend day five transfer for me or day three transfer?

Steven Sondheimer, MD responds:
Given your age, the information you provided, and our experience I would recommend day three transfer of two fertilized eggs. This would give you a good chance of success. If desired, we would attempt to cryopreserve (freeze) other fertilized eggs for the future.

Always asks:
I am a 35 year-old mother of one and I am having problems
conceiving. I was in a severe car accident at the age of 12 and had wall contusions through out my abdomen. When having my daughter in 1991 she was delivered at 32 weeks because I was diagnosed with a complete placenta abruption. I later tried to have another child in 1998 and I had a miscarriage at 18 weeks of another placenta abruption and toxemia.

I would like to know is it possible for me to conceive another child and do think that this maybe another underlying cause of why I have not been able to conceive in the past two years? Are there any suggestions that you may have to help me with my situation?

Sam Parry, MD responds:
I cannot comment regarding your ability to conceive since I don't have all of your medical history. However, intra-abdominal adhesions are not associated with placental abruptions and typically do not recur. However, hypertensive disorders of pregnancy (which might cause placental abruptions) may recur. I suggest that you talk to a high risk pregnancy specialist (a maternal fetal medicine specialist) for a preconception consultation.

Rene asks:
After a round of Follistim/Clomid, my ultrasound showed six follicles (two 18mm, two 15mm, a 13, and a 9mm). The reproductive endocrinologist canceled the cycle and did not give me the hCG trigger. My estrogen level was 1100. How likely is it that someone in my situation will ovulate on her own? I have never had an annovulatory cycle and do not need fertility medications to ovulate.

Kurt Barnhart, MD, MSCE responds:
You likely will eventually release some of your eggs, but by not taking the trigger. You are avoiding potential hyperstimulation and conceiving with multiple births. You should have your menses within two to three weeks. Best of luck to you.

Sue asks:
I have one child from a previous marriage and my new husband and I are trying to have another. We are both 41 and have no trouble conceiving. I have had two missed abortions where the fetuses died in utero at six or seven weeks. I am again six weeks pregnant and had an ultrasound which showed a heartbeat. What are the chances that I will miscarry again? Are there any reasons besides age playing into it?

Harish Sehdev, MD responds:
Now that a fetal heart beat was seen, your risk for miscarriage is about 5 percent (down from 35 percent). When you get to 10-12 weeks gestation, the risk will drop to 2 percent, and then to 1 percent at 16 weeks.

Yes, maternal age does play a role, as with increasing maternal age, there is an increased risk for fetal chromosomal abnormalities. Other factors can play a role, namely underlying medical conditions such as thyroid disease, hypertension, and diabetes.

You should see a genetic counselor to review screening and testing options so that you and your husband can proceed as you see best for yourselves. Also, we know that moms of advanced maternal age are at at increased risk for complications later in pregnancy, and your doctor will follow you more closely than with your previous pregnancy (assuming that you have no other medical concerns).

Curious asks:
I have just had a regular period and am having pregnancy symptoms. I have been on the pill four years strong and missed one pill two weeks prior of my period. Is it possible that I may be pregnant?

Sharon Byun, MD responds:
It is always possible to get pregnant while taking the birth control pill, but not likely. With perfect use (no missed pills taken at the same time every day) the failure rate is about 1 percent. With typical use (i.e. forgetting to take an occasional pill on time), the failure rate can be as high as 8 percent.

The easiest way to determine whether or not you are pregnant is to take a home urine pregnancy test. Home tests are highly accurate at detecting pregnancy and can become positive even before you are late for your period. If you are having pregnancy symptoms, I would recommend that you take a home urine pregnancy test and if you are still concerned contact your ob/gyn.

Naailah asks:
I've been trying to find out if I'm infertile or not lately and I been having a hard time to get to talk to a physician about it. I need to know if it's true that some STDs can cause women to become infertile? And if so, is the infertility reversable or not?

The question is related to the STD called gonorrhea. I had it years ago but at that time I didn't know I did or for how long, and I think that I may have became in infertile. I had up to date paps they came back clean but that's as far as it goes because I don't have insurance and I'm dealing with the free clinic. But I want to see a real doctor for answers and to be seen for a low cost but I don't know where to look. Do you have any suggestions?

Clarisa Gracia, MD, MSCE responds:
Certain STD's such as gonorrhea and chlamydia can cause infertility by causing scar tissue to form inside and around the fallopian tubes. You should have a test called an HSG to evaluate whether your tubes are open. This can be done through any gynecologists office. It is possible that some clinics perform this test as well for a reduced rate. I would call a university clinic in your area to look into this.

Jennifer asks:
I took one month of clomid to become pregnant last year and I gave birth in June of 2006 and am breastfeeding solely. I want to become pregnant again as soon as possible. Can I achieve that while breastfeeding and would I be able to take any fertility drugs? and if not- what should I do to become pregnant?

Samantha Butts, MD, MSCE responds:
It is possible to conceive while breastfeeding but is usually more difficult in the first few months of breastfeeding and especially if you are not supplementing with formula. The need for clomid again or any fertility medication should be made once you have reconsulted with the physician who initially prescribed it to you.

Sara asks:
I had ectopic pregnancy surgery two weeks ago. How long does it really take to become normal again? What should I do to become pregnant after surgery?

Harish Sehdev, MD responds:
Recovery from surgery can be variable, and it is also affected by whether the surgery was done laparoscopically or by a laparotomy.

For now, talk to your doctor about when you can resume intercourse. I would recommend continuing your prenatal vitamins and if your physician agrees base on your condition, wait until you have one to two menstrual cycles before attempting to get pregnant again.

Because you have had an ectopic pregnancy, you are at risk for a subsequent ectopic. Therefore, upon your next pregnancy, you should have an ultrasound at six to seven weeks gestation (sooner if you should have any pain or bleeding). I hope this is helpful.

MaryD asks:
I am 39 (40 in two months) and my husband is 46 (with two girls from a previous marriage: 22 and 16). We have had five intrauterine inseminations (IUI's) clomid and injectibles, and one IVF. I am currently on birth control pills but will start stimulation on soon.

What is the optimal cell size and grade for transfer? Last time I transferred two embryos. One was four and one five (with minimal fragmentation). However, I don't know the grade of those embryos. Can you help?

Samantha Butts, MD, MSCE responds:
This is a difficult question to answer fully without all of the clinical facts such as: the reasons for your infertility and the dose of drugs that were used to treat you. A general principle with respect to embryo transfer is to put back a reasonable amount of embryos that increases the odds or pregnancy and controls the odds of multiple birth. We aim to put back the best quality embryos whenever possible. The number to transfer that is recommended by professional guidelines goes up with age because age plays a major role in egg and embryo quality.

It is possible that the number of embryos you had put back was a function of your stimulation which may or may not be able to be adjusted or it could be a result of appropriate medication doses and that was the best result that could be generated for you that cycle. I would recommend discussing your cycle at length with the physician who is treating you and asking him/her these questions directly.

Dikesha asks:
I'm trying to conceive. I was on Deprovera, and was diagnosed with pelvic inflammatory disease (PID) twice. Now I'm taking Clomid and it's not working. Any advice?

Samantha Butts, MD, MSCE responds:
Given your history you should definitely have a complete evaluation by an infertility specialist. Your history of PID two times could have damaged your fallopian tubes making it difficult for the egg you produce each month to be fertilized by sperm.

Also, it can take your body many months to start to ovulate normally after having been on Depo Provera and this can add to your difficulty getting pregnant. With the proper evaluation, an infertility specialist should be able to tell you whether these or other factors are making it difficult for you to conceive.

Love27 asks:
At the age of 19 I had one ovary removed due to a STD and was told I would never be able to have children. Now, at the age of 27, I have tried several times and no luck. Is it possible I can still have a child with one ovary?

Samantha Butts, MD, MSCE responds:
It is definitely possible to get pregnant with one ovary. If you had an infection in the past, though, it could have damaged your fallopian tube which is where an egg is deposited after ovulation and where it gets fertilized by sperm. Damage to a fallopian tube from a pelvic infection can cause it to be blocked preventing the sperm from being able to reach the egg and making it more difficult for you to conceive.

Whether or not your fallopian tube has been damaged can be determined by specific studies and this should be arranged through your gynecologist or an infertility specialist. An evaluation will determine your course of therapy to become pregnant.

Jill asks:
I have now had three miscarriages in the past year. I am 40 years old. The miscarriages were all at about eight weeks and the last one had a heart beat at seven weeks. I have no health issues that usually cause miscarriages and have a child from a previous marriage.

I have heard about the mother's immune system sometimes attacking the fetus. Could this be happening? Is there anything to do to stop it? My blood type is O and my husband's is A. Could that have something to do with it?

Harish Sehdev, MD responds:
I would meet with a perinatologist, a physician who specializes in the care of high-risk pregnancies, as the physician would check for the presence of a Lupus anticoagulant (does not mean that you have Lupus) and an anticardiolipin antibody.

Also, a perinatologist would review your history and evaluate if other tests should be done such as screeing for medical conditions such as diabetes or thyroid disease.

Jilly asks:
I had a miscarriage about two and a half months ago. It was my first pregnancy. I still have not had a period. Is this normal!? I was told two years ago that I was going through pre-mature menopause but my current doctor did not believe this and then I ended up pregnant. Anything you can advise would be so helpful.

Sharon Byun, MD, responds:
I would need more information to answer this question properly. For example: your age, other medical problems, menstrual history, current medications, sexual activity since the miscarriage, etc. You can start by taking a pregnancy test, but you should really follow-up with your ob/gyn for an office appointment.

Cheri asks:
I recently had an ectopic pregnancy that was treated with metholtrexate. Three weeks after that shot my hormone levels were down to zero. After two trips to the emergency room for abdominal pain, I found out I had a torsed tube. By the time I had the surgery, the entire tube was dead, and therefore removed.

I was able to keep the ovary though. What kind of effect does that have on my fertility? I was told that the other tube would do the job of both tubes but that is a bit hard to believe.

Harish Sehdev, MD, MSCE responds:
Yes, while it may be hard to believe, one tube is still good, assuming that it is okay. Fertility and chance for pregnancy is really not affected. The main concern is that you are at risk for another ectopic pregnancy. Therefore, when you do become pregnant, you should let your doctor know so that your Beta hCG levels can be followed and an ultrasound done when appropriate.

MG asks:
I have been trying to conceive for the past year and a half. For the past 15 months I have been experiencing bleeding mid-way through my cycle. This was lasting about four or five days and was light pink in color. I had a laparoscopy and D&C in May and a very minimal amount of endometriosis was found. The doctor also scraped a bit around the uterus, but found nothing significant.

Following the surgery I stopped bleeding mid-cycle for three months, however, it has returned again. For my last two cycles I have been bleeding mid-cycle but it has only been lasting about 24 hours. Can you tell me what you think it could be?

Samantha Butts, MD responds:
Abnormal bleeding such as you describe can have a number of sources ranging from hormonal abnormalities to causes having to do with changes in the tissues of the reproductive tract particularly the uterus and the cervix.

One reassuring piece of information is that it sounds like you recently had a D&C (at the same time as the laparoscopy) to sample tissue from the inside of your uterus recently. The purpose of such a procedure is to make sure that no abnormal cells are lining the inside of your uterus causing you to bleed abnormally.

It was not clear to me from the description whether or not a hysteroscopy was performed at the same time. A hysteroscopy involves the use of a tiny diagnostic camera to look inside your uterus for abnormalities such as fibroids or polyps which might also cause bleeding. If these things were not ruled out, you might have temporary relief of bleeding after the D&C but a return since a more invovled procedure is invovled in removing either a polyp or a fibroid from inside your uterus.

Certain hormonal abnormalities such as thyroid hormone abnormalities can cause abnormal bleeding and these require only a blood test to diagnose. In addition, multiple medical conditions as well as medication and herbal remedies can cause abnormal bleeding. While endometriosis has been associated in some instances with pre-menstrual spotting, it does not have a real relationship to bleeding in the middle of the cycle.

I would recommend thoroughly reviewing with your physician your medical history and medications that could be related to the bleeding you describe. If the inside of your uterus has not been formally evaluated a course to pursue. Make sure that your pap smears are up-to-date and normal. Any laboratory testing for hormonal abnormalities as I mentioned above may also be necessary.

Deb asks:
My sister-in-law has had three miscarriages. Doctors have since learned that her uterus is not functioning properly. I would love to be a gestational surrogate for them. I have delivered three children and was able to conceive on the first try with each of them. I will turn 37 early next year.

The concerns that I have are my age, the medications I would have to take, and the likelihood of twins via in vitro. Can you have just one egg implanted or does that drastically decrease the chance of success? Does my age factor in at all? And finally, what are the average side effects of the drugs?

Clarisa Gracia, MD responds:
I am assuming that you would like to be a surrogate only (carry the baby) and use your sister's egg and her husband's sperm. In that case, your age does not impact success (her age and quality of egg is important).

The medications that you would have to take include leuprolide acetate injections daily, oral estrogen, and progesterone injections and progesterone pills. These medications can give you a variety of mild side effects including mood changes, bloating, dry skin and may increase you risk of developing blood clots (similar to the risks of the birth control pill).

You can definitely have just one embryo placed in your uterus, but it does decrease the pregnancy success. If your sister is less than 35 years old, we would normally recommend placing two embyros. There is up to a 50 percent likelihood of twins.

If you would like further information or to consult with a Penn fertility specialist, please call 1-800-789-PENN or request an appointment online.

Dee asks:
If your tubes are tied, will it show positive for being fertile
on the oviscope and/or ovi sticks?

Steven Sondheimer, MD responds:
Yes, the fertility tests will likely still be positive. When a women has her "tubes tied" this type of sterilization interrupts the tube which connects the ovary to the womb. Therefore the sperm and the egg cannot reach each other and pregnancy is prevented.

Fertility tests determine if an egg is about to be released. Sterilization does not interfere with the release of the egg so these tests will likely be positive even if the tubes are tied.

Donna asks:
I am almost 29 and been trying to conceive for the past eight months. I have very painful periods and on several occasions I vomit for 12 hours. However, last month my pains were so bad, that I'm thinking something was seriously wrong. I went to the hospital's emergency ward. They performed an appendectomy and was told that I also had endometriosis.

The surgeon wouldn't go into the severity of the endometriosis but I was told to see my gynecologist. My ob/gyn wants me to go on Lupron for about three months. I have some reservations about going on this drug. I thought maybe a laparoscopy to determine the extent of the disease would be the first step. What do you recommend?

Samantha Butts, MD MSCE responds:
Endometriosis can have a significant negative impact on your quality of life due to severe pain with your periods. In addition, it is also associated with infertility. How much of an impact endometriosis has on your fertility varies from person to person. We generally perform laparoscopies to fully diagnose the condition and to treat it surgically, usually with lasers to vaporize the areas of endometriosis.

If you are trying to conceive, three months of lupron will effectively prevent you from ovulating and you will not be able to get pregnant. If your first priority is getting pregnant, I would avoid Lupron. If your pain is severe, surgery can help with symptoms and would give you and your physician an opportunity to learn if there are any other abnormalities in the anatomy of your pelvis that would make it difficult for you to conceive.

Stephanie asks:
I have not have a period for about four months. I want to know if this is normal? My doctor doesn't seem to mind too much saying that they won't do any testing until it's been about a year. Well, I'd like to have children sometime soon. I am 24 but if something is wrong I'd like to know now. Any suggestions? Is this healthy and normal or could there be a major problem?

Sharon Byun, MD responds:
There are many reasons why a woman may not have her period for a prolonged duration. Of course, the possibility of pregnancy should be excluded first. A common cause of missed periods in the absence of pregnancy can be anovulatory cycles where a woman does not ovulate regularly. She can also have abnormal thyroid function or increased secretion of a hormone called prolactin that can be associated with a milky discharge from the nipples.

Missed periods can also be associated with stress, eating disorders, strenuous exercise, premature ovarian failure, or anatomic abnormalities. In any case, the fact that you have not had a period for 4 months warrants medical evaluation. You should see your doctor for an appointment as soon as possible.

GEB asks:
I have been told that my hormone levels and ovaries are normal although I can never carry a pregnancy due to my uterus not being strong enough. We are therefore keen on gestational surrogacy, but I am aware that STD tests are usually required and my husband acquired genital herpes (typeII) about six years ago. Will this prevent us entering into a surrogacy arrangement?

Kurt Barnhart, MD, MSCE responds:
The FDA mandates that all persons involved in the use of a surrogate get screened for viral infections like hepatitis and HIV.  You should work closely with your fertility care provider to make sure all of you are in compliance with the regulations. This is very important and you should only be treated by a clinic that is familiar with these regulations. However, past exposure to herpes will have no affect on the process and will not preclude you from proceeding.

Roxy asks:
Does a women with irregular periods ovulate?

Sharon Byun, MD responds:
A woman with irregular periods can ovulate but less predictably. For example, a woman with a regular 28-day menstrual cycle tends to ovulate on/around day 14 of her cycle, i.e., 14 days before the first day of her next cycle. If a woman has 35 day cycles, she will likely ovulate on/around day 21 of her cycle, again, 14 days before the first day of her next cycle.

If periods occur irregularly, such as every 21-35 days, the exact date of ovulation can be a little more unpredictable because ovulation is going to tend to occur approximately 14 days before the first day of the next cycle. If a woman misses her cycle for several months at a time, she is likely not ovulating during that time period.

Anonymous asks:
I had an ectopic pregnancy located in my ovary. It was caught early enough and was given Methotrexate vs. laproscopy. We are trying to get pregnant again what are my chances of having a normal pregnancy? And what could be the cause of these types of pregnancies? Should I see a specialist?

Harish Sehdev, MD responds:
At this time there is no need to see a specialist. It reasonable to go ahead and attempt conception. Because you had a prior ectopic pregnancy, you are at increased risk for another ectopic. Therefore, you should let your doctor know when you become pregnant so the health care provider can monitor your progress.

Olivia asks:
I have had several first trimester losses; only one was determined to be a chromosomal problem. What are the chances that I have low progesterone early on? Is it true that you need to begin taking progesterone close to conception? Is this test routine?

Harish Sehdev, MD responds:
The data regarding the use of progesterone is not strong, and I usually do not prescribe progesterone. I would recommend that you discuss this with your doctor and possibly see a Maternal Fetal Medicine specialist for further evaluation.

Sandy asks:
I have been trying to get pregnant for two years. The last ultrasound I had done showed I have cysts on my ovaries, and three fibroids that have been giving me some trouble. I also know I have some endometriosis because I had my gall bladder removed three years ago.

My doctor wants me to go for another ultrasound, which will be my third in a matter of months. He said he isn't sure what is going on since only two fibroids showed on my first ultrasound. He said my next option is to have surgery or he will send me to an infertility specialist. I have a three year-old son. Would you recommend "exploratory surgery?"

Samantha Butts, MD MSCE responds:
Without knowing more of your history and other reasons for your infertility I could not make a strong recommendation for or against surgery. It seems that if ultrasounds are not adequately providing a picture of what is going on with your fibroids then other imaging tests should be considered to clarify the matter.

With respect to the endometriosis and cysts, MRI may be helpful in getting a better understanding of what is happening there as well. Most non-invasive tests should provide a reasonable picture that along with a doctor's clinical judgment can guide you one way or another.

As a general principal though, we typically operate for clinical indications, in other words, if you have severe symptoms from fibroids, endometriosis or cysts, that should be the reason to operate.

Peggy asks:
I have both blastocysts (the structure formed before implantation) and embryos frozen currently. Is it true that blastocysts have a higher survival rate after cryopreservation than embryos? Why, or why isn't this the case? Thank you for the information!

Kurt Barnhart, MD, MSCE responds:
There is no one answer to your questions. In some programs transfer of thawed blastocysts results in a very high pregnancy rate. In others it is very poor. The same can be said for cleavage stage embryos or embryos at the 2 pronuclear stage. Success rates are very individual to each program. At Penn Fertility Care, we have enjoyed a higher than 40 percent live birth rate with the use of frozen embryos, but we seldom use blastocysts.

Mcguiness asks:
I have had three abortions in the past, over 10 years ago. Two months ago we started trying get pregnant. I do have a normal 28 day cycle and am ovulating on the 14th day. Does my past have effects on me trying to get pregnant today?

Kurt Barnhart, MD, MSCE responds:
If your procedures were all without complication (heavy bleeding, infection, need for re-operation) there should be no effect on your future fertility. If you have doubts, you may consider a test called an HSG to look at your tubes and uterus.

Amrita responds:
I am a 30 year-old female. I have a history of having irregular periods and I want to know whether this condition hampers me in getting pregnant.

Harish Sehdev, MD responds:
Certainly, irregular periods can make getting pregnant more difficult. The cause for the irregular periods also needs to be determined, as that may play a much larger role in trying to conceive. I would suggest that you see you gynecologist to review your history, have an exam, and most likely have some blood tests performed.

AYA asks:
I had a suspected natural miscarriage this month. After two weeks I had a pregancy test and it showed a faint positive line. When can I try conceiving again?

Harish Sehdev, MD responds:
I would recommend continuing your prenatal vitamins and if your physician agrees base on your condition, wait until you have one to two menstrual cycles before attempting to get pregnant again. However, you should consult with your physician as I am not aware of any other medical problems, menstrual history, current medications, etc.

Parveen asks:
How does a doctor find out if a woman's fallopian tubes are blocked and how/why?

Sharon Byun, MD responds:
There are two different ways in which a doctor can evaluate whether or not a woman's fallopian tubes are blocked. This evaluation is usually performed as part of an evaluation for infertility. If the tubes are blocked, then fertilization of the egg by sperm cannot occur (fertilization occurs in the fallopian tube). If fertilization does occur, there is a higher risk of having a tubal (ectopic ) pregnancy.

The first test to evaluate for tubal blockage is called a hysterosalpingogram (HSG). This is a special x-ray test where the patient lies on an x-ray table and has dye injected into the uterus. A speculum is inserted into the vagina and the dye is injected through the cervix. An x-ray machine is then placed over the abdomen and pelvis and pictures are taken to see how the shape of the uterine cavity looks and also to see if the dye comes out of the tubes.

The second type of evaluation is a surgical procedure. Typically a laparoscopy is performed where a small incision is made at the umbilicus and the abdomen is filled with gas. A camera is then placed through this small incision to look into the abdomen and pelvis. A blue dye is injected into the cervix. The doctor can then directly visualize whether or not the blue dye comes out of the ends of the fallopian tubes.

Nita asks:
I had my second transvaginal pregnancy ultrasound today, and right after the ultrasound I went to the bathroom and noticed some blood, and at that time I though it was not important. However, six hours later (within this six hours I had not been to the bathroom), I noticed blood again on the pad (1cm x 5.5cm). Is this a sign the vagina is hurt or a sign of miscarriage? My last menstrual period was two months ago and I have never had bleeding/spotting after conception. Please advise what I should do.

Kurt Barnhart, MD, MSCE responds:
Bleeding is common early in pregnancy. Many women have bleeding and everything is fine. However, in some cases, bleeding can be the first sign of a complication, such as a miscarriage or ectopic pregnancy.

The best test is the ultrasound. If everything is ok, and they see the baby and its heart beat, then likely it is not big deal. Keep your scheduled appointments and call back to your doctor's office if the bleeding is heavy (like a period) or does not stop.

Jenn asks:
What are some possible explanations for secondary recurrent miscarriage, particularly those happening in the second trimester? I've had three consecutive miscarriages and had a uterine septum removed after the second.

Samantha Butts, MD MSCE responds:
Other than a uterine septum, some other causes include increasing age of the mother (which is associated with decreased quality of eggs), minor chromosomal abnormalities in either parent, or conditions that predispose the mother to blood clots forming within the early placenta. Consultation with an infertility specialist will allow you to be tested for each of these possibilities.

Wendyrfc asks:
My daughter is 16 and just been told she has a double uterus. Is this going to stop her from having children, and what is the treatment she will receive?

Kurt Barnhart, MD, MSCE responds:
I am sorry to hear about your daughter's diagnosis. A "double uterus" can be a few different things. If the doubling is due to a septum, that may be able to be fixed surgically. If it is truly a duplication of the uterus and cervix, reproductive potential depends on the size (and potential function) of the larger portion.

When your daughter is ready, she can be seen by a reproductive endocrinologist and/or a maternal fetal medicine specialist to get a better idea of her chances. This diagnosis does not preclude having a normal, happy baby.

Naailah26 asks:
I had a laparoscopy done five days ago. I had an adhesion removed and my tubes were re-opened, and a blue dye test was done and confirmed they are open. Is there anything else I can do to increase my chances of getting pregnant? I wish I could afford in vitro fertilization (IVF), but I cannot. When I go to group support, I hear everyone's stories, some with my problems who had good outcomes, and some who didn't.

They have wasted a lot of time with one problem, when another should have been dealt with. Without IVF, how can I increase my chances of getting pregnant while I'm still young? I'm 26 years old with no health problems other than the tubes and that was corrected.

Clarisa Gracia, MD, MSCE responds:
Opening the tubes can have success rates as low as 10 percent and as high as 60 percent, depending on how healthy your tubes look. You may want to get more information from you doctor about this. At this point, I would try to time intercourse for when you are ovulating, and wait for 6 months or so.

Margaret asks:
I have been trying to conceive a second child for over 14 months, and I am 32 years old. We had similar problems conceiving our first child, and were only successful after Clomid and intrauterine insemination (IUI). I am hesitant to use Clomid again because I am very fearful of twins. I love the idea of twins, and we would have happily welcomed twins when trying to conceive our first child; however, with a toddler at home, now it would be financial ruin for us to have twins at this point.

So, my question is: What are the real odds of having twins while on Clomid? I was on 50 mgs and usually produced three good follicles. Thanks!

Kurt Barnhart, MD, MSCE responds:
I am pleased that you were successful with the treatment for your first child. Clomid is a relatively mild fertility treatment. When used correctly, the chance of twins is about 20 percent. However, you really should have a full consultation with a fertility specialist to go over all of your options and see if anything has changed since the birth of your first child. Good luck to you.

SAKnox asks:
I am 38 years old and have been trying to conceive for two and a half years. We have seen a infertility specialist and he said I had a blocked right tube that needed to be repaired or removed and would have to undergo in vitro fertilization. I had back surgery and am bipolar; therefore, my weight is 242 lbs. He said he would not start any treatment until I lost 50 lbs. Should I seek a second opinion or is losing weight a major priority?

Kurt Barnhart, MD, MSCE responds:
Losing weight is a very important aspect to improve your health. Your doctor may or may not have mentioned to you that being overweight has implications regarding your risk of anesthesia for either your surgery or your in vitro fertilization. It would be a good idea to lose weight.

Sal asks:
I am 41 and my husband is 43 years old. We have a 10 year-old son and are trying for another sibling. We have been trying to conceive for the past three years. My HSG result shows that I have a posterior fundal fibroid 3.8 cm. and small bilaterial ovarian follicular cysts were found.

My gynecologist said the result should not prevent me from getting pregnant and ordered a semen analysis for my husband. He did this and the result is as follows: sperm count .62 >20ml. Motility for first hour 40%, 2-4 hours 20%, and 4-7 hours - none. Epithelial and bacteria were scant.

Please let me know if you think that we have a major infertility problem and give your suggestion. What's the next test?

Samantha Butts, MD responds:
I would certainly recommend that if you have been trying to conceive for three years that you be formally evaluated by an infertility specialist. It is good that your gynecologist has started the evaluation but an infertility specialist is best able to interpret those results, keeping in mind what is avaiable and most appropriate for you with respect to treatment options.

It's difficult for me to interpret your test results without seeing them in person and I think any decision to treate you should be made in the context of all your findings and medical history. If you would like to schedule an appointment with a Penn Fertility Care specialist, please contact 1-800-789-PENN (7366) or you can also request an appointment online.

Gemma asks:
How hard is it to conceive after having the Mirena coil (IUD) removed? Does it make any difference at all to fertility? My first child only took three months to conceive.

Steven Sondheimer, MD responds:
Intrauterine contraception (IUD) is a safe and effective form of contraception. There are two types of IUDs available in the USA, Mirena (hormone containing) and Paraguard (copper containing). Both have very good pregnancy rates after discontinuation.

The pregnancy rate is similar to that of couples discontinuing barrier methods, but while using the IUD the couples had forgettable and effective contraception. After stopping the Mirena your chances of getting pregnant return to normal within a month or two. It is not unusual for any couple to find that pregnancy occurs quicker or longer at different times in their reproductive life.

Sandi asks:
I am going to be 40 in a month and a half. I did the clomid challenge test. On day three, my FHS was 8.9, on day 10 it was 12.5. Two years ago they had taken it without the clomid challenge test and it was 11.8. Would injections help if we can not afford IVF?

Clarisa Gracia, MD responds:
The injections plus intrauterine insemination WILL increase the chances of pregnancy in your situation. Essentially they work by increasing the number of eggs released per month and by placing a high number of your husband's sperm in your uterus at the time that the eggs are released. Unfortunately because you have had what we consider a “high” fsh level your chances of getting pregnant are lower that a woman your age with normal fsh levels.

Even if you cannot afford IVF, I would recommend trying injectables/iui at least for three cycles. Eventually, if these treatments are not successful, you may want to consider donor egg. Please talk to your health care provider to determine an option that is best for you.

Sarah asks:
I have been trying to get pregnant for over a year. I have irregular periods and had an abortion two years ago. My boyfriend has had a hip replacement and had loads of x-rays when he was young from age 12-22. Could this have anything to do with not getting pregnant? I have been pregnant before. We are both healthy non-smokers and non-drinkers. My doctor makes me feel that I'm wasting his time.

Kurt Barnhart, MD, MSCE responds:
You ask a great question. It is possible (but unlikely) that the x-rays have an impact on the ability of your boyfriend to help you conceive. However, one should not make any assumptions and you both should be tested to see what, if anything, is the problem. Your boyfriend should have a semen analysis test performed by a fertility specialist.

Mickey asks:
I'm a pretty healthy 31 year-old male (as per fertility specialists) and my wife is about 43 years old. We tried to conceive for approximately one year before seeing a specialist.

My wife was diagnosed with a blocked right tube and she also had mitral valve repair about 10 years ago but other than that she had a normal evaluation by the specialist. Is there any reason why she and I could not have a child using her own eggs?

Steven Sondheimer, MD responds:
First, I would recommend that your wife speak with her cardiologist and also a maternal fetal medical specialist (high-risk obstetrician) about any dangers carrying a pregnancy might have for her given her valvular heart repair.

Based on your wife's age, I do not think IVF using her own eggs is likely to be successful. If blood tests show that she has normal ovarian reserve she might consider trying IVF but due to her age, there is a very great chance of failure and disappointment. If the cardiologist gives her the go-ahead then the two of you should decide if using a donor egg is right for you. Using a donor egg from a younger woman gives the best chance of a successful pregnancy outcome.

I cannot comment on the meaning of the blocked tube without knowing the entire findings from the hysterosalpingogram. A single blocked tube at the beginning of the tube, if the other tube is found to be patent may not be an abnormal finding. There is still hope that the two of you might have a spontaneous pregnancy with her eggs and your sperm. However the facts are that at age 43 there is a greater risk of infertility, miscarriage and having a pregnancy affected by Down's syndrome.

We would be happy to meet with you and discuss your options further. Penn Fertility Care does perform in vitro fertilization procedures and have an on-site donor egg program. If you would like to make an appointment, please call 1-800-789-PENN (7366) or schedule an appointment online.

Julie asks:
I am currently trying to decide what to do about my bilateral hydrosalpinx (a blocked, fluid-filled fallopian tube). I've just had a failed in vitro fertilization (IVF) attempt and I am about to have frozen embryos put back, if they thaw correctly. Assuming these do not take due to the hydrosalpinx (which I don't expect them to, but promised myself a couple of chances before I consider my tubes being removed or clipped), basically I could really do with knowing a professional opinion as to whether it is best to remove my tubes or is clipping them enough?

When I had my IVF attempt, my uterus was full of fluid with a very thin lining of 4.5. I do get a clear discharge when my tubes are particularly painful. Is clipping them enough, as it's a smaller procedure and less recovery time, or is my best chance to achieve a pregnancy removal of my tubes. I've tried to research whether anyone has ever achieved a successful pregnancy with hydros and I have not found a single success story, until they were removed or clipped. Is this the case or is it achievable?

Steven Sondheimer, MD responds:
The doctor performing the laparoscopic surgery to evaluate and treat the blocked fallopian tubes needs to make the decision on whether to occlude (obstruct) your tubes near the uterus or actually remove your tubes.

In general, in cases of hydrosalpinx, if the tubes can be removed easily with the laparoscopic approach that would be my first choice. The fluid from the hydrosalpinx may be interfering with implantation and this surgery will improve your chances of success with in vitro fertilization.

Katjia asks:
Is Bepanthol cream likely to affect the sperm quality because at the moment we are using it as a lubricant. It contains aqua, panthenol myristrate, cetyl alcohol, stearyl alcohol, propylene glycol, lanolin, potassium, cetyl phosphate, phenoxyethanol, and pantolactone.

Clarisa Gracia, MD responds:
I have not been able to find specific information about that cream and fertility. It is generally recommended to avoid lubricants if you are having issues with infertility. However, if necessary use the smallest amount possible. In addition, water and mineral oil are some of the least toxic lubricants.

BRetro asks:
I have a retroverted uterus and have heard that the typical missionary position may not be best for conception. What do you advise?

Steven Sondheimer, MD responds:
This is a common question. Most women observe that semen runs out of the vagina after intercourse, this is normal. The sperm have already reached the cervical mucus shortly after ejaculation. Probably even with a uterus tilted backward whether you are on top or bottom does not influence the chances of conception occurring.

Nonetheless just like the advise from your financial planner, diversification might be a good way to hedge your results, but only if it is fun.

Dry asks:
My husband and I have been trying to have a baby for four months and have been unsuccessful. We were using a lubricant and just learned that lubricants may be bad for conception. What should we use? Is water okay?

Steven Sondheimer, MD responds:
Saliva or water are safe to use as lubricants. I doubt if using a very small amount of a water soluble lubricant such as KY Jelly or astroglide will decrease your fertility.

Chrissy asks:
My husband and I have been trying to get pregnant for about seven months with no luck. I am now 36, he is 34 (no children). What is the best way to find a new doctor? I am not happy with my current ob/gyn and I don't know how to approach a new doctor with my frustrating issues. What are the first steps I need to take?

Clarisa Gracia, MD responds:
At this point, I would recommend that you look for a doctor who specializes in reproductive endocrinology and infertility. You should bring any records from your gynecologist if you have had testing done such as a semen analysis or hysterosalpingogram. The new doctor will take over from there with any evaluation, testing or treatment necessary.

If you would like to schedule an appointment with a Penn Fertility Care specialist, please contact 1-800-789-PENN (7366) or you can also request an appointment online.

Theresa asks:
My husband has a vasectomy from a previous marriage. I have endometriosis, ovarian cysts, and fibroid tumors. Insurance coverage is not available for us in this scenario, and our credit score does not allow for a loan.

Are there any programs for our situation, to assist with funding. I desperately want to have a child, and have been treated by a specialist for ten years. But, with my financial situation, I have no options for having any type of procedure.

Kurt Barnhart, MD, MSCE responds:
Unfortunately at this time, we do not have any special programs to aid in your financial situation, and I do not have any to which I can refer you. We occasionally have clinical trials evaluating potential new breakthrough medications for women trying to get pregnant. These trials do often cover all of the cost of treatment. Please check our web site on the research and clinical trials page for new announcements in the months to come. Good luck to you.

Ms. T asks:
Is it possible to become infertile after already conceiving two kids? I am 27 years of age and have not become pregnant in eight years and have not been on any kind of birth control.

Christos Coutifaris, MD, PhD responds:
There is a condition called secondary infertility which means that a person has had a successful pregnancy before, but now is unable to conceive. There are many causes for secondary infertility, affecting both the man and/or the woman. An evaluation is needed that includes a detailed medical history, usually a physical examination, determination of ovarian reserve (which is usually related to age) and other endocrine blood tests, ovulation, semen analysis, evaluation of the uterine cavity and the fallopian tubes.

It is recommended that you see a fertility specialist after one year of trying to conceive (if under age 35). We would be happy to see you and your partner to review the evaluation and possible treatments. If you would like to make an appointment, please call 1-800-789-PENN (7366) or request an appointment online.

Mrs. O asks:
I was woundering if infertility causes hair to grow on your chin? I used to take projestrone — could it be that? Or the infertility itself?

Richard Tureck, MD responds:
Sometimes excess male hormones can be a cause of not ovulating and can cause hair growth and infertility. I recommend that you have your hormone levels checked by your doctor.

ACL79 asks:
I am a 26 year-old female. I had a miscarriage in November 2004 at approximately seven weeks. In April 2005 I found out I was pregnant again, but started spotting two days after I found out. I went to my Ob/Gyn, had blood drawn. I bled for approximately eight days. I think I passed tissue, but my doctor still had me get my HCG and progesterone levels checked. My HCG went up, but my progesterone was low. She prescribed me 100mg prometrium once a day.

My doctor thinks I could still be pregnant. I'm due for an U/S at my appointment at eight weeks. Could I still be pregnant? My doctor said it is still possible to be pregnant after a woman passes some tissue. Is this possible? Can having a previous miscarriage make me more prone to having subsequent one?

Kurt Barnhart, MD, MSCE responds:
It is very important that you have a full evaluation including serial hCG (quantitative pregnancy tests) and an ultrasound to understand exactly what is going on. You should not wait until eight weeks to get the ultrasound. It is possible that this is a lingering miscarriage. Not to alarm you but it is also possible that the pregnancy could be in your tubes (ectopic pregnancy). If an ectopic pregnancy were to rupture, it can be life threatening.

Dianne asks:
I had a sonohysterogram done which found no abnormalities. This procedure was done on cycle day 10. I had taken clomid days four through eight. The doctor was able to visualize several small follicles on the right ovary and two large follicles on the left. She only measured one which was 10mm. Is this a normal size for this time in my cycle? Is it likely that I will ovulate this cycle? And with a follicle this size when would you recommend starting tests and intercourse?

Kurt Barnhart, MD, MSCE responds:
Most people who take clomid indeed ovulate. The follicles that are ready are likely the larger ones (not measured?). Those would give you the best idea of the timing. In the absence of knowing their size I can only guess.

Most women ovulate on clomid around the same time, or a few days later then they would in their regular cycle. Thus, if your cycle is 28 days, you would ovulate between day 14 -17. If your cycle is 30 days you likely will ovulate between 15 and 19. It is best to try to be together during those times. To give you more specific advice I would have to review your entire case.

Yuri asks:
I had to have a laparoscopy when I was 28 years old because my right tube was blocked. Two months after the procedure, I had an ectopic pregnancy. Then six months later I had a successful pregnancy. My daughter is now four years old. However, her dad and I split up and during that time, I was not sexually active. I just got married six months ago, (to someone else) and we are trying to get pregnant with no success.

Is it possible for my tube to be blocked again? Should I get an ultrasound to verify that my tubes are alright? Also, my husband had rheumatic fever when he was a child and a doctor told him early on that all the medication that he has been on, well, it is possible that he is sterile. What can we do?

Richard Tureck, MD responds:
I would suggest getting a semen analysis as a first step. Then you will know if his sperm are viable. Depending upon your husband's test results, there are various procedures that can be performed. As for your tubes, tubes can get blocked again but I suggest that you talk to your physician about your options.

MD asks:
I am 41 years old and have a 20 month-old child. My husband and I have been trying to conceive a second child for four months. Just before I got pregnant with my first child I had an HSG test; two cycles later I got pregnant. It could have been a coincidence but I've heard a lot of women say that they had a similar experience.

The results of that test were questionable as the doctor said there was damage and she needed to repair it but I did manage to conceive with no additional intervention. Should I consider having the HSG test again? Also, do water based lubricants impact fertility?

Kurt Barnhart, MD, MSCE responds:
There certainly is a suspicion that the HSG may be able to "clean" up the tubes and thus make someone more fertile. You are correct however, that it may be simply a coincidence. However, given your circumstances I would go a complete work up to see if there may be something else preventing you from conceiving. Tests should include a repeat HSG (to decide if there is or is not tubal damage), a day three follicle stimulating hormone FSH level, and semen analysis on your partner.

In addition, water based lubricants should not be a problem.

SSA asks:
I am 28 years old and had an abortion two years back. Now we've been actively trying to conceive for the last four months with no results. I am also tracking my ovulation. Last time I conceived just by the failure of contraception for a day so I am really worried that something has gone wrong with me. Please help. Will I ever get pregnant?

Steven Sondheimer, MD responds:
Many couples take six months to nine months and occasionally longer before achieving pregnancy. Since you were pregnant two years ago you are probably more likely than average to get pregnant again. The abortion from two years ago will not make getting pregnant more difficult. Share your concerns with your doctor. If you are not pregnant over the next few months your gynecologist might ask your partner for a semen analysis as the first step in a evaluating fertility.

Teresa asks:
I started the birth control pills for my three weeks before planning on starting the stimulation process. Two days after my uterine sounding I had an ultrasound and blood work to determine if I was ready to start medicines.

During this, they found a cyst on my ovary and I am wondering if the birth control pills could have caused this? I have never been on birth control pills and I have never had problems with cysts.

Luis Blasco, MD responds:
Birth control pills do not produce ovarian cysts. The actually aid in decreasing the incidence of cysts.

CT asks:
My wife and I have tried to conceive naturally for about three months. Her cycle has been irregular so timing has been an issue. She was also diagnosed and treated for cervical cancer six and a half years ago. We were wondering if we should meet with a fertility doctor to check my sperm and her conditions as a preliminary measure? We would like to have more than one child so we would like to be efficient in our trying/planning. Also, do insurance plans cover these types of visits/tests?

Richard Tureck, MD responds:
Your age can play a part in the level of treatment you would need. If you are in your twenties there is still a lot of time to conceive - depending on your condition, you may benefit simply from taking hormone medications. If you are in your thirties you may want to follow more aggress