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Q & A Sessions: Unidentified Infertility
Our experienced Penn Fertility Care physicians answered
your questions about unidentified infertility.
craftyroe2
asks:
We have been trying to conceive with the
help of fertility specialists with no luck.
I had all the tests done including a laparscopy
and everything came back normal except they
couldn't get dye through my tubes during
the lap or the HSG but my doctor said my
tubes are clear. My husband was never tested
expect for the post-coital testing but his
dentist said it looks like he has thrush.
Can this cause the unexplained infertility?
Christos
Coutifaris, MD, PhD responds:
To my knowledge, thrush does not cause infertility
unless it is a reflection of some systemic
disease that may affect reproductive function.
I would recommend a formal semen analysis
and not rely solely on the post coital test.
Also, given that on two occasions (laparoscopy
and HSG) the tubes failed to fill, I suspect
that the main problem is proximal tubal
occlusion. Treatment can involve cannulation
under X-ray guidance (with moderate success)
or in vitro fertilization. We wish you the
best. |
Yvonne
asks:
My boyfriend and I have been trying for a baby for over a year without any success. I am so worried that I will not be able to conceive. I am 34 years old. What do you think I should do.
Response:
If you've experienced the following events, it may be time for you to schedule an appointment with an infertility specialist:
- If you are under 35 and have been unable to conceive after a year of trying to get pregnant.
- If you are over 35 and have been unable to conceive after 6 months of trying to get pregnant.
- When you've lost two or more pregnancies to miscarriage.
- When other infertility treatments have not been successful.
If you do not have regular menstrual cycles, or if you have had prior gynecological problems including endometriosis, pelvic surgery, tubal pregnancy or infections, you should seek assistance sooner. If you would like to see a Penn Fertility Care physician, please call 1-800-789-PENN (7366) or you can request an appointment online. |
Trini asks:
I'm 26 years old and have been on birth control
pills for a few years now to help regulate
my cycle. I now want to have children.
My mother had the problem of irregular
cycles but never took birth control pills;
instead she was given clomid. Should
I be taking that? I know that the problem
is with me and not my boyfriend because
he has a three year-old son.
Kurt Barnhart, MD, MSCE responds:
Irregular cycles may be a sign of a hormone imbalance that prevents you form ovulating (releasing and egg) each month. Birth control pills help regulate your cycles, but do nothing to fix the underlying issue. Clomid may work for you, but you should only take it after a full evaluation by an expert.
When you want to start a family, you may consider this. Remember as long as you are on birth control pills, you are preventing yourself from getting pregnant. |
Angie asks:
I had an unexplained miscarriage in August 2005 and an ectopic in October 2005 that was treated with two cycles of methotrexate. I am currently on 100 mg clomid and awaiting intrauterine insemination. I have no other problems except my reproductive endocrinologist wants to avoid another ectopic.
Is this really necessary or can I try again on my own? Also, what are the chances of having twins or more? I do have endometriosis but that was treated surgically last month to prepare pelvis for pregnancy.
Kurt Barnhart MD, MSCE responds:
I am sorry to hear about your miscarriage and ectopic pregnancy. The clomid you are taking is a way to help you conceive sooner than if you were trying on your own. It will not really increase or decrease your chance of having another ectopic pregnancy - that risk is about 15 percent either way. If you want to take your time, there is nothing wrong with trying on your own.
If you want to increase your chances of getting pregnant sooner, clomid is one way to go. The chances of twins are about 10 - 15 percent with clomid. If you want to be more aggressive, you may want to get a test called an HSG to look at your tubes to give you a better idea if they are normal. Often a second opinion will give you some other ideas, and a perspective on your specific issues. |
Amy asks:
My boyfriend and I are planning on having children.
We have not used any type of birth control in four years and are still
having problems with conceiving. I was wondering if there is anything
that you could suggest? I currently have no health insurance at this
time and am not working so I have the time right now for anything your
facility could suggest.
Clarisa
Gracia, MD responds:
I definitely recommend that you get evaluated by a fertility doctor once
you have insurance. Basic fertility testing includes: checking to see if
you are ovulating (releasing an egg) every month, checking your husband's
sperm count, and finding out if your tubes are open by doing a test called
an HSG.
If you cannot seek care from a physician
currently, I would at least track your
menstrual cycles and try the over-the-counter
ovulation predictor kits to determine if
you are actually ovulating. This can help
you time intercourse as well. I would also
suggest that your husband have a semen
analysis done, which is a relatively easy,
inexpensive test to assess his fertility.
Since I do not know anything about your
age or medical history at this point, it
is very difficult to make any more specific
recommendations. If you are over the age
of 35, I would not wait too long before
seeking care. As one ages it becomes more
difficult to become pregnant!
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. |
Kath asks:
I am looking into trying fertility treatments again. I have
had three natural pregnancies. One I lost at 17 weeks due to Turners
Syndrome and the other two did not form embryos only the sac.
My ob/gyn
said I can get pregnant but can't sustain for some reason. My thryoid
was
tested and was perfect. My progesterone levels were good in this last
pregnancy.
I tried fertility treatments one year
ago for four months. I did two
cycles of clomid and one IUI. The doctors
at the time said my hormones
are not in sync.
Should I try fertility again even though
I have been able to get
pregnant? Is IVF the way I should go? Penn
Fertilty has been
recommeded to me since I don't want to
go back to the old group.
Kurt
Barnhart, MD, MSCE responds:
You describe some difficult problems. I am sure this has been a very
frustrating and upsetting time. Among other things, miscarriages can be
caused by a hormonal imbalance. Even if all the hormones are normal, it
is possible that fertility treatments can help decrease the time it takes
a person to become pregnant, and even possibly decrease the chance of a
future miscarriage by "picking a better egg." That is the idea
behind
IVF.
If you would like to be seen by a Penn
Fertility Care specialist, we would start
with a complete review of what has happened,
and then discuss what option(s) you may
have. For further information
or to consult with a Penn fertility
specialist, please call 1-800-789-PENN
or request
an appointment online. |
Lorraine asks:
I have not had a period for almost a year. I've been to many doctors.
The last one has not found anything in ultrasound, blood tests, etc,
no reason noticeable. He wants to do an HSG, biopsy, and another test
with saline. I'm confused. I don't know what to do with these tests
or what they will find (if anything). We've never had a pregnancy and
have been trying for 12 years; no miscarriages.
Samantha
Butts, MD responds:
There are many causes of "amenorrhea" which is the medical term
for lack of menses. Since you say that you've had multiple tests done I
would hope that some of the most common hormonal causes of amenorrhea have
been ruled out (such as menopausal states and other common hormonal abnormalities).
Any tests that are performed should be taken into context dependent upon
your age, general medical health, and any medications you take, etc as
these can have significant impact on your ability to have normal periods.
If you have been trying to conceive for
12 years without success certainly an HSG
would be helpful in determining a cause
of infertility. Perhaps once all the necessary
data is collected and interpreted as a
whole, your physician can give a comprehensive
impression of what is causing the symptoms
you have. |
Shannon asks:
My husband and I are trying unsuccessfully to conceive our second child. My son was conceived the first month we started trying, my periods are regular, we are both healthy with no past health issues, and we are following the ovulation charts as to the best days to conceive. I am not sure what to do next, it has been about 6 months, I just assumed it would be as easy the second time as it was the first time. Do you have any advice?
Kurt Barnhart, MD, MSCE responds:
I am sorry to hear about your difficulties. What you are describing is secondary infertility. It is common. If you are less then 35 years you may choose to give it bit more time (up to a year).
If you are more than 35, I would recommend getting an evaluation by a fertility specialist, like the ones at Penn Fertility Care, to see if there are any problems that maybe corrected. Often no problem is found and that is called unexplained infertility. However, there are treatments that can help you shorten the time it takes to have your second child. |
Knewton asks:
I have an eight year-old daughter. I lost a baby in Feb 2006. I was four months pregnant. My husband and I have been trying since then with no success. I have been taking a women's fertility blend pill and it seems they are not working. Is there something wrong with me, or is there something extra that we can do to start up the process? Also I am only 26 years old.
Samantha Butts, MD MSCE responds:
Without knowing what your evaluation has been up to this point this is a difficult question to answer. I would need to know, for instance, whether or not you had a specific evaluation to see why you had a miscarriage so far a long.
If there is something specific that caused a miscarriage in the second trimester it should be looked into and knowledge of this could make an impact on your odds of having a normal pregnancy. I would express your concerns to your gynecologist and consider being evaluated by an infertility specialist, especially if you are on fertility medications. |
Laura asks:
I had an abortion three years ago but now I have met a man of my dreams and have been tring to get pregnant for 13 months with no success. I'm not sure if it's me or my man. He experiences premature ejaculation of 3 minutes or less sometimes. He also has back problems and one of his testicles is smaller than the other.
On the other hand my periods have become irregular lasting only one and half days sometime four days and so on. If it is my man is there any non-prescription drugs to help him? Or could it be me? I'm so depressed; I want to be a mom.
Kurt Barnhart, MD, MSCE responds:
I am sorry to hear that you are having difficulty getting pregnant. It is likely not due to your abortion (unless it was complicated by infection or the need for a re-operation). Given that you and your partner both have symptoms that potentially can affect your ability to get pregnant; I would suggest that you both get a complete evaluation.
One does not want to make any assumptions that one factor is the culprit, when there can be more than one. You should see a fertility specialist, and at least your partner should get a semen analysis. Much of what happens after that depends on what is found on the tests.
Good luck to you; do not take any short cuts. |
Stephanie asks:
I was diagnosed 10 years ago with unexplained infertility. My husband and I have had every test that can be done and everything came back normal. I was also told about 12 years ago that my cervix is tilted. I have one child for whom conception took five years, and infertility drugs did not work (just luck). We have been trying again for about six years with no luck. Could the tilted cervix be my problem?
Kurt Barnhart, MD, MSCE responds:
I am sorry that you have had such difficulty. I do not think a tilted cervix or uterus is the cause of your problem. There is a diagnosis of unexplained infertility in which all tests are indeed normal.
However, I would suggest that you get a full "re" evaluation from a reproductive endocrinologist, like those at Penn Fertility Care. Some of the tests have become more accurate, and sometimes something is uncovered when you have the test repeated. Even if the tests are normal, or abnormal, I am confident that we can come up with a treatment plan to help you. |
Kayla asks:
I have been trying to have a baby for five years and have had no luck. What can I do to increase my chances of getting pregnant?
Kurt Barnhart, MD, MSCE responds:
There can be many reasons you are having difficulty getting pregnant. You should have a full evaluation by a reproductive endocrinologist, who will evaluate your hormones, the patency of your tubes, and your partner's semen analysis. When you have had a full evaluation, a more detailed assessment can be made to help you start a family. Good luck. |
Colleen
asks:
I am 29 years old with unexplained infertility
and my IUI's with clomid have failed. I
want to avoid twins (i.e. I want to have
only one kid.) Would you do a single embryo
transfer? (I understand success rate will
drop). How many single embryo transfers
have you done in the past; and what have
the success rates been?
Steven
Sondheimer, MD responds:
I think single embryo transfer can be an
appropriate choice for you to make. We hopefully
would be able to cryopreserve (freeze) embryos
and limit your risk of twins. Given your
age and diagnosis this is an acceptable
decision on your part. Penn Fertility Care
does offer single embryo transfers dependent
upon a patient's diagnosis. |
Tina asks:
Over the past year I have been through numerous
intrauterine inseminations (IUI's) using
both Chlomid and GonalF with no postive
results. My doctor wants to proceed to IVF,
so we are taking a break for a few months.
So far, the diagnosis is "unexplained;"
everything is normal. Should I be getting
a second opinion from another practice?
Is there anything Penn can do that another
doctor could have missed?
Kurt
Barnhart, MD responds:
I am sorry that your initial treatments
have not resulted in success for you. Sometime
the diagnosis is "unexplained"
and it is time to move to a more aggressive
treatment like in vitro fertilization (IVF).
Much depends on your individual circumstances.
Often a second option will allow a fresh
look at your case and find something that
was overlooked. Of equal importance is that
if you do make the decision to go to IVF
you choose a program with outstanding success
rates.
We would be happy to review you case with
you and discuss the need for IVF. If you
would like to schedule an appointment with
a Penn Fertility Care specialist, please
call 1-800-789-PENN (7366) or schedule
an appointment online. |
Lisa asks:
I have been under the care of a reproductive
endocrinologist for two years now. I have
gone from unmedicated home insemination
to injectable medications and intrauterine
insemination (IUI). I had a miscarriage
on the first injectable cycle. I will be
forty this month and though my "blood
work" is all at "very good levels"
I'm at a crossroad. What I'm doing isn't
working. So, would changing
doctors really change the outcome or should
I just move into the acceptance?
Kurt
Barnhart, MD responds:
I am sorry to hear that your treatment has
not met with your satisfaction. Based on
the information you gave me, I would be
far more aggressive in treatment.
Getting a new or second opinion allows
some perspective regarding you entire situation.
I think it is always a good idea to get
such help. Good luck — we would be happy
to provide a second opinion. If you would
like to schedule an appointment with a Penn
Fertility Care specialist, please call 800-789-PENN
(7366) or schedule
an appointment online. |
Alea asks:
I am 27 years old and my husband is 33 years
old. I have been diagnosed with unexplained
infertility, and have been through four
intrauterine inseminations and two in vitro
fertilizations, which resulted in two miscarriages.
I have changed doctors and the new doctor
has completed some tests that were not done
previously, and we are going in for a consult
for a laporoscopy.
I have been told by doctors that I don't
have endometrosis, but I do have painful
periods. Is this usually a surgery that
is recommended? Will I have a chance of
conceiving naturally after the laporoscopy?
Steven
Sondheimer, MD responds:
There is not one best plan. Undergoing a
laparoscopy as both a diagnostic and therapeutic
procedure seems like an appropriate step.
Since you are young and no cause of infertility
has been found there is a good chance you
might conceive spontaneously over the years.
I know you have been through a very difficult
journey but I would encourage you and your
husband to try to remain strong and continue
to enjoy an intimate relationship (i.e.
continue to have an active sexual life in
spite of all this terrible stress). |
Astanis asks:
I am 29 and my husband is 35. My husband and I have been trying to conceive for
about a year with no luck. His semen is something like 20mm or more so we
were told he was fine. I had an HSG and everything was clear and normal.
I've never missed a period and ovulate on about day 19 every month. What
is the next step?
Steven
Sondheimer, MD responds:
I often meet with couples where all of the infertility evaluation is normal and
still pregnancy is not occurring. If possible, the two of you should meet with
an infertility specialist, a gynecologist with special training and certification
in reproductive endocrinology and infertility would be optimal.
You and your doctor can review all
of the evaluation and history and
determine a plan. Conception may
occur with little or no medical intervention,
you are relatively young and your
evaluation has been normal so far.
If conception continues not to occur
I usually recommend stimulation and
monitoring of follicular growth and
ovulation along with regular intercourse
as well as timed insemination with
a concentrate of your husband's semen,
this is called intrauterine insemination.
I wish you the best. |
Renee asks:
I am 29 years old and my husband and I have been trying to conceive for three
years. I've been thru two cycles of in vitro fertilization with no success
and before that five cycles of artificial insemination.
I do not have an embryo problem
and my husband does not seem to have
a problem either with the tests/analysis's
that he's had done recently. Is there
any chance that the reason for me
not having any success with becoming
pregnant could be from past surgeries
causing scar tissue? For example,
a leap cone biopsy?
Would this be something that I should
have a closer look at rather than
going thru with another cycle of
in vitro and would this be something
that could be easily corrected?
Richard
Tureck, MD responds:
I suspect that you have had a hysterosalpingogram prior to your procedures. If
not, that would be the next course of action. |
Jordan1 asks:
I am a 30 year-old female and my partner is a 33 year-old male. I had a UAE performed
a year ago and one healthy child by previous relationship. My husband and
have been trying for the past 10 years to conceive a baby. We've had 11 miscarriages
in the last 10 years all naturally conceived children.
We have taken a karotype blood test
and performed several test on the
fetus to ensure the chromosomes are
normal. My last miscarriage was at
19 weeks and 3 days, an emergency
D&E was performed. My water broke
on my job, I was rushed to the hospital
and discovered my membranes ruptured,
so there was no way to save the baby.
I haven't been diagnosed with any
medical term to diagnosis my condition.
I was told it maybe a structure problem
due to scarring of the uterus from
the multiple D&Cs. What condition
does it appear I may have since I
haven't been able to carry a pregnancy
full term? Since, I've just miscarried,
when should I be seen by a specialist
to perform a hysteroscopy?
Kurt
Barnhart, MD responds:
I am sorry to hear about your difficulties and your recent miscarriage. You should
let at least one full menstrual cycle pass from your miscarriage before having
your uterus evaluated. I think seeing a specialist is a good idea, as your entire
case should be reviewed. I would need to see you and review your health history
to diagnose your condition.
Sometimes new eyes can find something
that has been overlooked or was not
apparent. We would be happy to take
care of you at Penn Fertility Care.
If you would like to schedule a consultation,
please call 1-800-789-PENN (7366)
or schedule
an appointment online. |
Mimi asks:
I am currently 32 and I conceived once two years before I started seeing a fertility
specialist and lost the pregnancy within the first few weeks. With no luck
after two years of trying we decided to see a fertility specialist and she
sent us through a laprocrostopy (blocked tube and husband's sperm is good)
and two cycles of IUI. On the second try it worked but I lost it within the
second week.
Is there a reason that this keeps
happening and so far apart? Also
we are interested in trying with
help again since it has been almost
seven months (and no luck on our
own) since we last tried. Could you
make a suggestion on what we should
do next? Should I go back to the
same doctor or try someone new?
Christos
Coutifaris, MD, PhD responds:
Even though losing a pregnancy is very upsetting, it is a fairly common event.
Usually, an evaluation is not started until after three miscarriages have occurred.
Obviously, such an approach seems unsatisfactory to patients and certainly it
can be extremely upsetting.
It would be appropriate, after two
miscarriages to proceed with a limited
evaluation, which includes, primarily,
a few blood tests. Any board-certified
reproductive endocrinologist should
be able to guide you through such
an evaluation and recommend further
treatment.
We, at Penn Fertility
Care, would be happy to see you,
if you choose to seek another opinion.
Feel free to give us a call at 1-800-789-PENN
(7366). You can also request
an appointment online. |
Ron asks:
I have been seeing a fertility doctor for one and a half years and I feel like
they are more interested in my money than my problem. Until now they have
not told me whether or not I would be able to have children, or what my problem
is. I am also diabetic, and I don't know if that is or isn't my problem.
Would
you be able to tell after several tests
whether or not someone could have children,
or what their problem may be? I am
considering changing doctors.
Richard
Tureck, MD responds:
Overall, it is important for a fertility specialist to keep an open line of communication
with their patients to explain a diagnosis, even if the diagnosis is "unexplained
infertility."
10-15 percent of infertility cases have
a diagnosis of "unexplained infertility."
If you are not satisfied or question
the information your physician has
given you, I suggest you contact Penn
Fertility Care to make a consultation
appointment. If you bring your records
to the consultation, one of our specialists
can review them and will guide you
on their suggested coarse of treatment. |
Suzanne asks:
I am ovulating, and have a 28 - 29 day cycle (I ovulate on day 13 or 14). In
the last year, however, my periods have become much lighter and now last
only about three days. Could this indicate a problem? My husband and I have
been trying to conceive for about 4 months, and I have had one early miscarriage.
Also,
I am charting my BBT, and while I do
have a biphasic curve (coverline usually
around 97.2), during my luteal phase,
my tempertures go up and down and then
up again (in a range from 97.6- 98.1).
Is that an indication of inadequate
progesterone? I am 37 and my husband
is 43.
Christos
Coutifaris, MD, PhD responds:
What you are describing, does not really
indicate a major problem. However,
given that you are 37, I would recommend
trying for another couple of months
and then, if not successful, you
and your husband should see a specialist.
You may even want to consider checking
a sperm count now in order to insure
that there are no male factor problems.
Also, if there anything in your history
related to a pelvic infection, there
may be a tubal problem that needs
to be evaluated and addressed.
|
Robin asks:
My husband (33) and I (32) have been trying to conceive for a year. A few weeks
ago, I went for a consult with my ob/gyn who said my charts look perfect,
sent my husband for a semen analysis — everything looked fine with
that. The doctor sent me for an HSG which was all clear.
Now my doctor's recommending a post-coital.
I've read differing opinions about
the effectiveness of this test, as
far as how telling it really is,
but I'm going ahead with it. What
is your opinion on the effectiveness
of this test (based on it being perfectly
timed)? And if this test reveals
a problem with my cervical fluid,
what could it be and what options
are there to overcome the problem?
Christos
Coutifaris, MD, PhD responds:
The post-coital test is a test that is being used less and less nowdays. However,
if the mucus is excellent and in the face of a normal semen analysis, a very
poor test (less than 5 motile sperm per high power field) may be significant.
For example, if acidity of the mucus is too high (low pH) the sperm die. If a
mucus abnormality is found, intrauterine inseminations may be the way to overcome
the problem.
This is the short answer. It gets
more complicated if you consider
that intrauterine inseminations without
superovulation with hormones has
a fairly limited success and even
with ovarian stimulation, the success
is 11% per cycle or 34% over four
cycles.
These are the only reliable
statistics published in a paper by
Guzick and co-workers in the New
England Journal of Medicine several
years ago. Quotes of higher pregnancy
rates with these treatments have
not been confirmed. If you would
like to dicuss your options, please
contact us by calling
1-800-789-PENN (7366). You can also
request
an appointment online. |
kab830 asks:
My husband and I have been trying to conceive for two years. I had two children
before I met him. We have one child together. I was on birth contol after
having my last child. It will be two years next month that we have been having
unprotected sex. Can you help?
Christos
Coutifaris, MD, PhD responds:
By definition, you have what we call
secondary infertility (having been
successful before, but now being
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. We would
be happy to see you and your husband
to review the evaluation and possible
treatments. |
Elizabeth asks:
My husband and I are 37. We have not been able to conceive after one year of
trying. I've had ovulation at least once on my own (doc's early cycle blood
test), but when when my doctor tried clomiphene citrate (two cycles) I've
not ovulated. Why would I ovulate on my own, but not with additional help
of the clomiphene citrate? My husband's semen analysis just came in: good
count and good motility but 80 percent abnormal morphology. Does that give
us poor odds in terms of his sperm, too?
Steven
Sondheimer, MD responds:
You have a good question and justified concern. I would want additional information
before deciding on the next best approach to fertility. Do you normally have
regular periods, and is each period similar in flow and duration? I am trying
to determine if you occasionally ovulate rather than regularly ovulate.
Hormonal tests including evaluation
for ovarian aging will be important.
With this information your doctor
can help you to decide between gonadotropin
stimulation or returning to one or
two more attempts with clomiphene
citrate. |
Jess asks:
My husband and I are 27 years old and both healthy. Unfortunately I am currently
experiencing my second miscarriage in less than a year. I am distraught thinking
that something could be very wrong with either one of us. Is it too soon
to see a fertility specialist? I was told by my Ob/Gyn to wait until three
miscarriages but I do not want to continue to go through this emotional roller
coaster if something is wrong with me.
Clarisa
Gracia, MD responds:
Miscarriages are very common and the chances that you will have a normal baby
in the future are high. However, it is not unreasonable to seek evaluation after
at least two miscarriages.
We would be happy to help you. If
you have further questions or would
like to schedule an appointment with
a Penn Fertility Care specialist,
please contact 800-789-PENN (7366)
or request
an appointment online. |
Jenna asks:
Over the past year I had gone through three failed in vitro fertilizations. In
the beginning my doctors did not know the cause, but now they are suspecting "poor
egg quality."
I started this whole infertility procedure
while I was in my 20's. I am now 30 years
old and do not have the faintest clue as
to why I would have this condition. I rarely
drink alcohol or caffeine and I have never
used drugs, smoked, or ever been diagnosed
with a sexually transmitted disease.
I have been through just about every
test there is and still I turn up
short of answers. Both my mother
and sister and other relatives have
all conceived and had full term pregnancies
with no problem. Did I do something?
Is there anything I can do? Kurt
Barnhart, MD responds:
You are in a very difficult situation. If you do have decreased ovarian reserve
(poor egg quality), it is by no fault of your own. To date, our field does not
know why women have this problem. Currently, we are actively researching that
question. However, you are young to have this condition.
Before you are labeled with a condition
you may or may not have, it is worth
a second opinion. Young women with
decreased ovarian reserve have achieved
pregnancy in our practice. It is
possible that a modified protocol
may work for you as well. If that
is not a possibility, it may be worth
hearing from an objective third party.
I would be happy to work with you. |
Valerie asks:
My husband and I have been married for 20 years and have been
unable to have a baby. We have never used any protection. Is there a blood test
to see if our blood types may be incompatible?
Richard
Tureck, MD responds:
There are many tests (including some blood tests) that can be performed to evaluate
the state of your fertility. Both you and your husband should be evaluated by
a fertility specialist to determine the cause of your inability to conceive.
Factors in both a male and/or female can be causing a problem. Our program would
be happy to help you.
If you would like to schedule an
appointment with a Penn Fertility
Care specialist, please contact 1-800-789-PENN
(7366) or request
an appointment online. |
TND asks:
My husband and myself have been trying to get pregnant for over a year. We have
been together and basically been have having unprotected sex for about four
years. I was pregnant almost four years ago, but miscarried at six weeks.
We have been calculating ovulation and using the test strips. Could you let
me know what the next step would be. Does it sound like we have a fertility
problem? Thank you
Answer provided by Penn Fertility
Care:
It is recommended that women under age 35 who have been unable to conceive after
a year of trying to get pregnant or women age 35 and over who have been unable
to conceive after six months of trying to get pregnant, see a fertility specialist
for a fertility evaluation to help determine the cause of infertility. In addition
the male partner needs to be evaluated as well since approximately 40 percent
of fertility issues stem from the male. We would be happy to meet with you for
a fertility consultation.
|
Spintex asks:
I have been trying to conceive after a cesarean section that I had in 2004, all
without any luck. My periods are really becoming scanty. My doctor advised
that I undergo a D & C to have my womb washed so that my period can flow
normally and also so that I can conceive. Is this appropriate?
Clarisa
Gracia, MD, MSCE responds:
If your periods are regular, but light - I would first recommend doing an evaluation
of the inside of your uterus and tubes with a hysterosalpingogram.
Also, you may need to have your husband's sperm checked and make sure that you
are ovulating every month. |
Nancy asks:
My husband and I have been trying to conceive for a little over six months now
with no luck. My cycles are irregular, which could be the problem. Have we
been trying long enough to speak with a fertility specialist as we are not
pregnant yet?
Christos
Coutifaris, MD, PhD responds:
If you've experienced the following events, it is recommended that you schedule
an appointment with a fertility specialist:
- If you are under age 35 and have
been unable to conceive after a
year of trying to get pregnant.
- If you are over age 35 and have
been unable to conceive after six
months of trying to get pregnant.
- When you've lost two or more
pregnancies to miscarriage.
- When other infertility treatments
have not been successful.
If you do not have regular menstrual
cycles, or if you have had prior
gynecological problems including
endometriosis, pelvic surgery, tubal
pregnancy or infections, you should
seek assistance sooner.
If you would like to see a Penn
Fertility Care physician, please
call 800-789-PENN (7366) or you
can request
an appointment online. |
Daryl asks:
My husband and I are not using contraceptives, but I still cannot get pregnant.
Should I consult a doctor to help me get pregnant?
Clarisa
Gracia, MD, MSCE responds:
Your situation depends on your
age and how long you have been trying
to get pregnant. Usually it is recommended
that women less than 35 years of age
see a physician for evaluation after
one year of unprotected intercourse.
If you are older than 35 or have irregular
periods, you should see a physician
sooner (after 6 months). |
Mel in PA asks:
I am 35 years old and my husband is 33. We are both in good health. Our son was
born in May 2002 at exactly 40 weeks. In Oct 2003, I miscarried at about
9.5 weeks, then again April 2004 at 7.5 weeks. All three pregnancies were
planned "first try"
conceptions. After nearly a year with no
success, we consulted a fertility specialist
(the only one in the area).
All of the testing was normal; chromosomal
analysis, hysterosalpingogram, laparoscopy/chromopertubation,
and blood work. I tracked Basal Body
Temperature (BBT) from August 2004
to June 2006. All showed an increase
near day 14. Lh predictors showed
a surge just prior, except when on
clomid (both 50 mg and 100 mg showed
no surge, no temperature increase,
and no follicles over 10 mm.
Sperm count showed normal during
two intrauterine insemination (IUI)
(FinalMotCt 24.7 M/mL and 32.5 M/mL).
I have even tried 2.5 mg Femera on
days 3 through 7 with 2 mL Noveral
on day 11. No one seems to be able
to explain why we lost our two angels
and why we're not yet pregnant. In
vitro fertilization (IVF) is too
expensive and not covered by insurance.
Are there any options? Any tests
that were missed? Thank you for you
time.
Clarisa
Gracia, MD, MSCE responds:
It sounds like you have had most of the appropriate testing. By "blood work" I'm
not exactly sure what you mean. If you have not been tested with a day three
follicle stimulating hormone (FSH) and for antiphospholipid antibodies, those
would be useful. |
Claire asks:
I am 37 years old and have been trying to get pregnant for the last three years.
I have gone through all tests (which are normal) and letrozole and clomid
cycles, but have been unsuccessful. My doctor has done all of the tests,
and he feels that this is unexplained infertility. He can't understand if
we have any problems. However, now he has suggested me for injectables or
in vitro fertilization (IVF). I am very scared of injectables
— is there any other solution?
Samantha
Butts, MD MSCE responds:
Many patients with unexplained infertility are able to conceive with clomid,
but it does not work for everyone. While clomidis a safe medication, the odds
of pregnancy when using it are lower than for injectables or IVF. The odds of
getting pregnant successfully with clomid (or with any treatment) decline with
age, and the fact that you are now 37 makes other treatments, such as injectables
or IVF, more likely to be effective for you than clomid. |
Confused asks:
My husband and I are in our early to mid-30's and have been trying to get pregnant
for 18 months with no success. I have had several blood tests all came back
normal, an abdominal ultrasound proved ovulation (as well as over-the-counter
tests), and even having intercourse knowing the ovulation pattern. We're
still not pregnant. My husband has also had blood work and mutiple semen
analyses again — all normal. If everything is normal then why aren't
we pregnant?
Richard
Tureck, MD responds:
There are multiple reasons for not achieving a pregnancy. It may be worthwhile
to inquire about a hysterosalpingogram (x-ray of uterus and fallopian tubes)
or further fertility testing. We would be happy to meet with you, review your
history, and provide you with a second opinion. |
kab830 asks:
My husband and I have been trying to get pregnant for two years now. I had two
children before I met him; we have one child together. After my last child
I was on birth control. I was on it for one and a half years. I have been
off the pill for two years now. I was reffered to an infertility specialist
by my ob/gyn. He did some test and could not find anything wrong. The infertility
specialist said everything looked great for both my husband and I but still
no baby.
Last month we had intercourse every
other day. We thought that way we
would not miss my fertile day. That
did not work either, I have had a
27-29 day cycle. Last month it was
27 days. Before trying to get pregnant
I always had a 28 day cycle. Would
you please see what you can do to
help us!
Steven
Sondheimer, MD responds:
Of course, you should ask this same question to the infertility specialist you
saw as well as your own gynecologist. Unexplained infertility is actually a common
finding and diagnosis. There are treatments for unexplained infertility. The
most common treatment is to give medication such as oral clomid or injectable
gonadotropins along with ultrasound monitoring.
The eggs are released after you
are given an injection of a medication
such as HCG. Then specially prepared
washed sperm from your husband can
be inseminated directly in your uterus.
This is called intrauterine insemination
(IUI) of washed sperm. This is different
from in vitro fertilization since
your eggs are allowed to release
on their own and not be directly
removed from you.
In vitro fertilization
(IVF) also can be used to treat unexplained
infertility and is even more successful
than a single cycle of intrauterine
insemination. IVF requires more medication
and includes a small operation to
remove the eggs from your ovary with
a needle guided by ultrasound. You
might also get pregnant without treatment
at all. Good luck! |
Maria asks:
I had two tubal pregnancies and had both tubes removed. I tried IVF five times
all under the age of 32, the first IVF at age 26, All having an egg quality
issue. No mature eggs to no fertilization and yielding very few eggs with
the max amount of stimulation drugs being used.
I've been to three different
clinics and nobody can give me a reason
as to my egg quality issue since all
test come back normal. Do you have
any information or suggestions for
me. I am 35 years old and would like
to have a family ASAP!
Christos
Coutifaris, MD, PhD responds:
It is difficult to give an accurate answer without having all the information.
However, it is surprizing that you have been told that there is an egg problem
given that you had conceived spontaneously at least twice (unfortunately both
times the embryos implanted in the fallopian tubes). If you would like, we will
be happy to review the complete information with you and give you an opinion.
|
Frans1s asks:
I am a 31-year-old female. I have been suffering from infertility and lack of
menstrual cycle. I was first told that I needed to gain weight and cut back
on working out (I was a tri-athlete). I obeyed and cut back on activity and
gained about 15 lbs — still no cycle.
I did fertility shots and hyperstimmed
(hyperstimulated). I did get my cycle
after the hyperstim, but have not
gotten my period for three months.
I have now been given progesterone
to induce the cycle.
I have been told based on blood
work that my estrogen levels and
follicle stimulating hormone (FSH)
levels are fine, but my progesterone
is low. Why is my body not normalizing,
and will I be able to get pregnant?
Steven
Sondheimer, MD responds:
Yours is a common question and challenge. Here you work so hard to be in good
shape, but your reproductive system seems to be adversely affected. Almost always
this problem eventually reverses itself with time, weight gain, decreased exercise
and good calorie and nutritional intake. The problem is that predicting when
the system will start to work again is not accurate. If you get your period after
you take the progestin, I have a feeling you are going in the right direction
— keep up the weight gain and decreased activity.
Your system might now be able to
respond to an oral medication, such
as clomiphene citrate, which is less
likely to cause hyperstimulation.
Or, with close monitoring, you might
be able to be stimulated with a gonadotropin
at a dose and duration at which you
do not hyperstimulate.
Also, take heart — in my experience,
after the baby is born, though very
busy, you will be easily able to
stay in good physical shape. Keep
up the calories. |
kab830 asks:
I was wondering if you can help me out.
I usually have a 28 day cycle, sometimes
29 day. This month I had a 33 day.
Do you know why this happened? I
never had a cycle like this. I'm
trying to concieve, but not having
any luck. I do have 3 children.
I have seen a specialist and they
told me my husband and I were both
fine. I do understand that stress
can affect fertility. Do you have
suggestions on what I could do to
release stress? I think stress plays
a big part on why I am not concieving.
Please email me when you have my
answer. Thanks!
Steven
Sondheimer, MD responds:
I know you feel stress may be a big
cause of your not getting pregnant.
In my experience and our research,
not getting pregnant is very stressful
but probably does not cause infertility.
If stress is keeping you from having
intercourse it may be playing a role.
Your delay in menses can be due to
many causes.
We would be glad to see you in the
office to explore this in more detail.
Often an occasional delay in ovulation
leading to a delayed period can be
due to stress or other life event.
However there are also many other causes
and seeing a physician is a good idea. |
Jacqueline
asks:
I am 40 years old and I have been trying to get pregnant but have not had any
luck. I went to a doctor in Puerto Rico and he did some tests and said that there
was nothing wrong with me. He put me in treatment for one year, but no luck.
I would like to know what treatment I can pursue so I may become pregnant.
Clarisa
Gracia, MD, MSCE responds:
It is difficult to answer that question without knowing exactly what tests and
treatments you have had already. Your age does make it difficult to become pregnant.
I recommend that you get a copy of you records from Puerto Rico and see an infertility
specialist here in the United States. Check into your insurance to see
what, if any, treatment is covered.
You
may take medication to increase the
number of eggs released and have
your husband's sperm placed in the
uterus, or we may recommend that
you undergo in vitro fertilization
(IVF). |
Paula asks:
I had a child in 2000, he was almost a premature baby but labor was stopped with
magnesium sulfate. He had to be born via c-section. Now we have been trying
to conceive for two years and still no baby. Could my problems with the first
have anything to do with my infertility now?
Richard
Tureck, MD responds:
There are many reasons as to why couples experience infertility. Age may be a
factor, a low sperm count, blocked fallopian tubes, endometriosis, defects in
ovulation, etc. Your doctor should investigate the potential causes of your infertility
since you have been trying to conceive for two years. If you have not been to
a fertility specialist (a reproductive endocrinologist), I suggest you make an
appointment to see one since you have been trying for longer than a year.
It is recommended that women under
age 35 see a fertiilty specialist
after a year of trying to conceive.
Women age 35 and above should see
a fertility specialist after trying
to conceive for six months. I wish
you the best. If you would like to
have a consultation with one of our
fertility specialists, please call
1-800-789-PENN (7366). |
Angelle asks:
My husband and I have been diagnosed as
"unexplained infertility" after
2 1/2 years of trying (I am 26, he's 27).
I had been on birth control pills for six
years prior. I have had laparaoscopy surgery
(no endometriosis, no problems), I ovulate
regularly, I've had numerous blood tests,
my tubes have been checked.
My husband
had a varicocelectomy and has a great
count now. We have seen a fertility
specialist in our area once. I am
on day two of my third round of Clomid.
Everything is going great health-wise,
except for the fact that I'm not
getting pregnant. How does my future
look - what should I do next?
Kurt
Barnhart, MD, MSCE responds:
It sounds as if you have had good treatment so far. Having unexplained infertility
is frustrating. We all would like to know what may be preventing you from getting
pregnant. However, the good news is that you do have a good chance of eventually
conceiving.
It may be time to be more aggressive
with the treatments you are undertaking.
It is best to talk to a specialist
about all of your options. You should
consider ovulation induction or even
in vitro fertilization. We wish you
luck and would be happy to talk to
you about this further.
|
BTG asks:
I am 29 years old and have had two miscarriages in the past seven
months (8/03 and 12/03). I recently had a ton of blood work taken (FSH,
LH, genetic chromosome analysis, etc) to test all levels - they came back either
negative or normal which is what we all had hoped for.
My doctor feels I just
have had two cases of bad luck back
to back. Is this possible? Or do
I need to see a specialist in your
office? These blood tests were done
at no particular time in my cycle.
Could the results change at different
times of the month? Thank you.
Kurt
Barnhart, MD, MSCE responds:
I am pleased to hear that your blood work up to date is normal. That is of course
good news. It is not too early to see a fertility specialist. A specialist may
be able to determine a cause of your misfortune. It is also possible that everything
else is fine, and that may give you a greater piece of mind.
It is hard for me to see if you
have had a complete work up without
seeing the details, but myself or
another Penn Fertility Care specialist
would be happy to review the results
with you and determine your next
steps. Feel free to contact us at
1-800-789-PENN (7366). |
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