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Mark Perloe on Fertility Issues, Page 1
Dr. Mark Perloe is an innovator in the use of Internet communication for educating patients via his groundbreaking site, IVF.com. Perloe is director of reproductive endocrinology, infertility and in vitro fertilization at Atlanta Medical Center and Medical Director at Georgia Reproductive Specialists, and is noted for the individualized and in-depth attention he gives to his patients in their efforts to conceive. Send your question to Subscribe to The Blueprint to be notified of his responses {Please refrain from sending detailed lab results, as specific translation of such results without additional examination is of minimal benefit.}
I have read that taking Clomid increases your chance of having twins. Does the amount, the dosage, or the duration of taking this influence your chances? It would seem logical that since the higher doses are usually associated with more follicles, and eggs are more likely to be normal in younger women, the younger you are and the higher dose you receive would appear to put you at a greater risk of multiples. But this has not been proven. Another consideration is the reason you are receiving clomiphene, and the duration of your infertility. If you have PCOS with many follicles the risk of multiples may be higher. To avoid the needless risk, I prefer active monitoring of clomiphene therapy and would rather administer hCG to trigger ovulation of mature follicles than increase the dose during the next cycle. This approach seems to work quite well to allow women to take the lowest dose possible. Please read www.ivf.com/clom.html to learn more about clomiphene therapy.
I was wondering if you could experience pregnancy symptoms 2 days after having sex? Like morning sickness?
I have a question about whether or not I have luteal phase defect (lpd). Each month I start spotting pretty heavily about 4-5 days before my period starts. I had severe endometriosis years ago and had surgery to clear that up before I got pregnant the first time. Do my symptoms sound like luteal phase defect and are there tests I can do to find out for certain? What are the usual treatments? There is no such thing as luteal phase defect. There is low progesterone as a result of poor or inadequate follicular development. In either case, it really doesn't matter as the treatment for endometriosis-related infertility and LPD (if you believe it exists) are the same: ovulation induction and IUI (intrauterine insemination). You would really not need the IUI for LPD, but most studies show that treating endometriosis rarely has any fertility-heightening benefit. So, I would start either with clomiphene and IUI or injectable gonadotropins (such as GonalF or Bravelle) and IUI. If there is significant scarring from endometriosis, then IVF (in vitro fertilization) is a better option.
I had a tubal ligation in the past and now wish to conceive. Is it possible to reverse a tubal ligation and then get pregnant? Yes, but it is quite expensive. In most centers the total cost approaches between $10-15,000. Success rates can be as high as 85% if you are young and the sperm is great. If there is a sperm problem, then IVF is a much better option. Certain sterilization procedures are harder to repair. I can only determine if surgical repair is appropriate after reviewing the operative report. IVF with shared risk is a better option, in that the fees are only slightly higher, the success is about 85% and if you don't have a baby, you get back most of what you have paid our clinic.
{Read more of Dr. Perloe's responses:
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{Disclaimer: Every effort is made to present accurate and reliable information, but this column is intended to provide general information, not direct psychological or medical advice to the person posing the question. Use of such information is voluntary and should only be undertaken after independent review of its accuracy, completeness, efficacy and appropriateness to your specific situation. If medical or psychological advice is needed, seek the services of a competent, licensed professional.} |
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