Buy it now on Amazon.com... and support HowToMakeaFamily.com! That's right, if you visit Amazon.com via this ad, a portion of every purchase you make during that visit will go to HTMAF.

Advertise on HTMAF!

Mark Perloe on Fertility Issues, Page 2

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.

{Please refrain from sending detailed lab results, as specific translation of such results without additional examination is of minimal benefit.}

• Antibiotics & Age Factor

I may have spoken with you before about a year and a half ago, about ttc after 40. We have an eight month old baby boy now who is awesome. My question is: I am taking doxycycline (for lymes and Erlichia) for one month. Will this drug interfere or be a problem if my wife and I are ttc again? She is 42. She is very nervous about it, very concerned about using any drugs. Thanks for any help you can provide.

I don't think that tetracycline should interfere with sperm production or quality. In order to get a better idea of fertility potential, please consider a clomiphene challenge test. This test measures an FSH and estradiol level on cycle day 3 and repeats the FSH test on day 10 after taking 100mg of clomiphene (two tablets) daily for cycle day 5-9. If the level of FSH is over 10, and estradiol is over 65 fertility may be reduced and if conception occurs, the risk of miscarriage is increased. See www.ivf.com/ovarianreserve.html

• Absent Sperm in Ejaculate

My husband and I recently went to a fertility clinic. I checked out fine. My husband and I have been together for 10 years. He was told when he was in his twenties that he could not have children. I then researched and found out about then-new technology that has been taking place. He was referred to a Urologist who did a biopsy on both of his testicles and he found 85% in one and 53% in the other. The doctor also did an ultrasound to make sure there wasn't a blockage and there wasn't. They didn't really explain to us why, if he makes sperm, why doesn't it come out? Is there an alternative to IVF? Is there some kind of hormone or vitamins or steriods he could take to make his sperm come out or increase it?

The likelihood that anything other than IVF would work is quite low. The problem is likely either an absent portion of the male reproductive tract, such as the vas deferens that carries the sperm or the epipidymis where the sperm mature, or a blockage due to infection. The former condition can be associated with an abnormal cystic fibrosis gene. So prior to attempting pregnancy, I would be certain that you carry a normal CF gene. Surgery is rarely helpful to fix the latter condition. Vitamins, steroids, other medications, or surgery are not likely to be of benefit.

• Clomiphene for PCOS

My ob/gyn believes I have some level of PCO (as do I: acne, long and irregular cycles, elevated LH, irregular as a teen). I took clomid on cycle day two through six this cycle, but am now on day 61 and know that I haven't ovulated yet -- BBT chart reflects this, as well as no ovulation symptoms. My last cycle was 71 days long.

Here's my question:
My doctor insists that she not give me Provera to bring on my period (so that we can increase to 100 mg of clomid). She says that we are trying to balance things out and that I need to wait for the menses to come on their own, rather than introducing any more hormones which may upset the balance we are trying to achieve. Is this a valid point? From what I have read there is no benefit in waiting it out. Is Provera that "upsetting"? I want to trust my OB, but I don't want to waste unneeded time.

I would not treat you with clomiphene in the first place, so using a higher dose after Provera is not something I would do with my patients as first line therapy. It sounds like you have anovulation and signs of androgen excess. These findings are sufficient to consider a trial of metformin, diet and exercise.

My patients with PCOS begin metformin 500mg XR with gradually increasing doses up to 850mg twice daily. Metformin can upset the stomach or result in diarrhea, so a low glycemic carbohydrate diet, adequate water intake and taking the medication with a full glass of water at the end of a meal may reduce side effects. Patients monitor BBT charts (see www.tcoyf.com and if no ovulation is seen by three months, a low dose of clomiphene may be initiated. Women who do not ovulate on up to five (5) pills per day, may ovulate on as little as one half (1/2) tablet daily. Metformin may be associated with a higher pregnancy rate, lower miscarriage rate and reduced risk of gestational diabetes during pregnancy. So, I consider an ultrasound to make certain that the uterine lining is not excessively thick, requiring a biopsy to rule out precancerous changes. An insulin glucose tolerance test can help me rule out diabetes and take a more educated guess at the dose of metformin you ultimately will require. See www.ivf.com/pcostreat.html

• Getting Around Severe Oligospermia

I have read with interest your comments on severe oligospermia as I was initially characterised with the idiopathic case. Here in the UK, the standard procedure seems to be to go straight to ICSI for couples with our case (my wife is fertile but my sperm counts have ranged from <0.5m to 0.6m per ml at best). We have unfortunately been unsuccessful with ICSI using two fresh oocytes, then with two frozen. We are just about to try the last two remaining frozen oocytes and are contemplating assisted hatching. However, I believe that I should try and improve my spematogenesis as my wife's ObGyn (who facilitated the ICSI) agrees after evaluating my varicocele that it is possibly a grade II. The referring urologist never picked up on the varicocele, but in 1999 referred straight to ICSI. I am concerned that there are no robust, controlled studies confirming that a varicocele embolization will help severe oligospermic cases (Does the Madgar study focus on severe OS?).

On to my queries:
Question 1: Is there an intermediate target that my sperm count should reach in order to utilise an ART method that avoids medication of the female.

Question 2: Is there a simple IUI possible without need for superovulation? Sperm suspension?

Question 3: Is hormone replacement therapy a possibility in my case?: My blood test shows FSH levels of 10.3 mIU/ml and a Estradiol of 43.9 pg/ml and testosterone level of 3.6 ng/ml . Are these indications of testicular failure? NB: LH at 3.8 mIU/ml, DHEA-S at 3.4 ug/ml and hTSH at 2.18 IU/ml. T4 and T3 levels are at 9.5 ug/dl and 1.5ng/ml. I have no history of mumps, undescended testes but have smallish testes (3cm left, 3.5 cm right) no drug or alcohol use but a mild smoker. Slightly overweight (South Asian, medium build, 5ft 8 and 180 lbs), and am therefore not sure whether my weight and sedentary lifestyle is the factor but mild gynecomastia may be a possibility.

Question 4: I have read a lot of literature about the benefits of supplements. I have started to take Fertility Blend for men but am also considering taking Proxeed. Will I be simply duplicating things unecessarily? Is there evidence of successful in vivo fertilisation using such supplements?

Re: q1+2 -- Consider varicocele repair. I am not certain if you mean two cycles of IVF or actually two eggs? If the latter, I just don't understand. You would need over 20 million motile sperm in the ejaculate for a reasonable chance of success without female therapy. Your numbers are far from reasonable for consideration of IUI. And, prior to IUI, a test of sperm DNA fragmentation should be considered (see www.scsadiagnostics.com.) A chromosomal analysis and Y chromosomal microdeletion test is recommended to determine if a genetic factor is involved. Either a missing or damaged chromosome could be evident on the chromosomal analysis, while the microdeletion tests looks for a specific segment of Y chromosome DNA that may bring about the problem you are noting here. The higher levels of estrogen along with slightly elevated FSH level make me suspicious that a chromosomal abnormality may be present.

Re: q3 -- The level of estradiol is a bit high. The use of an aromatase inhibitor such as letrozole may be helpful to reduce that level. An improvement may be seen.

Re: q4 -- There is no evidence to support that vitamin or nutritional support therapy would be effective in restoring fertility in males with serious semen abnormalities. If IVF did not work, I would not expect that you would benefit from Proxeed or Fertility Blend.

{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.}

Reproduction of material from any How to Make a Family pages without written permission is strictly prohibited
Copyright 2002 How to Make a Family
How to Make a Family, P.O. Box 35289, Houston, TX 77235-5289
Telephone 413.702.9620 | Fax 413.702.9620
E-mail admin@howtomakeafamily.com | How to Make a Family Privacy Policy