THE DOCTOR IS IN

How do I know it’s time to visit an Endocrinologist vs. a high-risk obgyn? What’s the difference?

Good question, a reproductive endocrinologist is a trained OB-GYN, with three years subspecialty training in reproductive endocrinology and infertility with the goal of helping a woman get pregnant and stay pregnant until the first trimester is nearly complete then the woman is sent to either an OB-GYN or a high risk OB. It is important if a woman has multiple medical problems to have a preconception counseling appointment with the high risk doctor, ideally before getting pregnant to discuss medications, risks, benefits and how to optimize the condition preconception.

How long is the IVF process?

The IVF process requires completion of the evaluation including determining if hormone levels are normal, the uterine cavity is normal, semen analysis is normal, if applicable, as well as blood tests for virologies required by the FDA (HIV, Hepatitis B and C, syphilis, and HTLV). The process may include days on the oral contraceptive pills, varying from 10-21 days and then initiation of injectable medications for approximately 9-12 days, then an ovulation trigger called the hCG injection, 36 hours later, the eggs are obtained and then fertilized with subsequent 3-5days until the embryos are placed into the uterus. So, the entire process once all the evaluation is complete may take between 24-45 days.

Would I immediately try IVF before other infertility treatments (artificial insemination, clomed etc)?

This decision is based on your age, a blood test called FSH on the third day of your period, an ultrasound looking at your antral follicle count, if your tubes are open versus closed and the quality of the semen analysis, if applicable. If a woman has blocked fallopian tubes with no evidence of swelling or fluid in the tubes, IVF would be recommended. If the FSH is elevated or antral follicle count is low, then some physicians would encourage the woman to proceed to IVF.

I have had multiple miscarriages over the past year. I just found out I have a problem with my protein c. I will need to take heprin shots if I do become pregnant again. But this has me worrying about so many other health problems I may face for myself and any future children.

It is unlikely that protein C problems are causally associated with miscarriages. It may be associated with later pregnancy loss or pregnancy induced complications such as high blood pressure, premature separation of the placenta, or poor fetal development and growth, but in my opinion there is currently no convincing evidence that it causes recurrent pregnancy loss. Indeed, heparin may be needed to address the protein C problem but this is not likely to improve your chance of viable ongoing pregnancy. I suggest that you contact a reproductive specialist to discuss this in greater detail.

What are some foods that can help follicles reach 20 mm? I am undergoing IVF treatment and is being delayed because my follicles are not at 18mm. What can help get them their?

Unfortunately, there are no foods or supplements that have been proven to help follicles grow. The ideal goal of follicular stimulation is to have at least two follicles reach 18 mm with half of the remaining follicles being over 15 mm on the day of triggering ovulation with the human chorionic gonadotropin (hCG). The protocol used for ovarian stimulation is all important and it is wrong for any doctor to assume that “one size fits all approach” will work for all women. Yes indeed 70% of women will respond to a standard “recipe type” stimulation protocol but 30% of women, especially those who have diminished ovarian reserve (often older women with elevated day three FSH levels) and also women who are very high responders to fertility drugs (often women with irregular periods as in polycystic ovarian syndrome-PCOS or very young women) will not readily yield an optimum number of good quality eggs to such an approach.

My husband and I have been trying to have a baby for about six months. We're both in our mid-20s. We've been using the ovulation predictor sticks, as well as charting my temperature. About two days after the ovulation predictor's positive result, my temperature jumps about .4-.5. However, it only stays that way a few days before dropping back down and remains low through the next week or so until I get my period. The thermometer's directions say my temperature should stay elevated for 11-14 days until my period. Is this always the case or could there be a problem? Thank you.

The fact that you have not been able to conceive after trying for six months is, I am sure, somewhat disconcerting. However, as a general rule, we recommend that a couple try for one year before embarking on fertility investigations. So unless you have definite menstrual irregularities, or symptoms/signs of clinical problems, I would wait a few more months before panicking.

I'm 26 and i had already 2 miscarry, i really suffer from it lossing my hope to concieve again. my husband and i has the same blood type, type A is there a connection or conflick having the same blood type?

I would not be despondent over having had two miscarriages. About 25% of pregnancies will inevitably miscarry and a woman who has had one or two miscarriages has no greater chance than 25% of having another. Your blood group has nothing to do with the issue. The time to start getting concerned is if you have three or more miscarriages in a row. In such a case expert medical advice would be needed.

I am 39 years old and was diagnosed with FSH of 15 after having 2 misscarraiges. Is there anything I can do if we get preganate again to carry to term, since I know it's my FSH causing the miscarriage?

I am afraid that an FSH of 15, as measured two to three days following the onset of normal menstruation, is a sign that you likely have diminished ovarian reserve (fewer available eggs in your ovaries). This does not mean that you will not be able to conceive on your own or with specialized medical assistance but it does suggest that this will be more difficult since you may be running out of time. Since time is of the essence and the chance of conceiving on your own is no better than 6-10% per month, I strongly recommend that you visit a reproductive specialist who administers ovulation induction agents in the hope of increasing the number of available eggs. Moreover, with time possibly running out, you should probably go straight to in vitro fertilization (IVF). If a decision is made to first try a short course of ovarian stimulation with fertility drugs with or without artificial insemination using washed and enhanced sperm, I certainly would not wait more than six months before proceeding to IVF.