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Mark Perloe on Fertility Issues, Page 3

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.}

• Endometriosis & Multiple Partners

My family thinks my endometriosis and ovarian cysts are related to a very short period in my life when I was promiscuous. This is quite an upsetting position for them to take. Particularly because that period was over ten years ago and for a very short time, and I have been happily married for seven years. I have a completely new life and can hardly remember this very short period of my life at all, apart from when they mention it. Furthermore, I did not contract any STDs at this time. Would you reassure me that promiscuity has nothing to do with causing endometriosis and ovarian cysts? I need to be absolutely sure in my own mind. This judgemental reaction has been the most upsetting part of my experience with endometriosis and ovarian cysts.

There is no evidence to suggest that endometriosis and functional ovarian cysts are related to sexual activity. We are not really certain why endometriosis develops, but it appears to be related to changes in the immune system which may can be inherited from one of your parents. Studies have found that those with a first degree relative with endometriosis have a 4 times greater risk of developing endometriosis. I would advise your relatives to check the facts before they pass judgement on your prior behavior.

• Worries About TTC Again

I am 30 years old. I had an ectopic pregnancy two years ago, my husband and I had tried to conceive for two years prior. After the ectopic we went to a fertility clinic and after one attempt of IVF have conceived and delivered our first son. We are very happy, but not really sure what is going to happen next.

After an HSG, it appears I have one functioning tube. My husband and I are considering attempting artificial insemination, but worry about another ectopic pregnancy. My question is, how do they detect ectopic pregnancies early enough that you can take a pill to terminate the pregnancy (as opposed to surgery)? Also, can you give me some guidance how to decide whether to attempt artificial insemination or do IVF again...we had such good luck and are great candidates for IVF, which is why we did IVF to start, but artificial insemination would be easier.

If you did not conceive after two years of attempting pregnancy the first time, I would advise you to have IVF this time again. The risk of ectopic is about 25%. Early blood hCG monitoring along with a progesterone over 15-20 will rule out ectopic pregnancy. If the progesterone remains low and the hCG levels do not rise normally, you may have another ectopic. If this is suspected and your physician confirms the absence of a normal uterine pregnancy, then an injection of methotrexate can help you avoid surgery in up to 85% of cases.

• Poorly Monitored Clomiphene Therapy

I am 41 yrs old, have three births under my belt, [with] one miscarriage one year ago. I have had the dye test and everything was normal. My husband's sperm count was normal. The doctor prescribed Clomid. I am on my fifth month of taking Clomid and have not been able to get pregnant. I am experiencing a lot of strange pains in my ovaries. My doctor basically has prescribed the medication and has me go in on Day 21 of my cycle for a progesterone level test & a pregnancy test.

Five days ago, the progesterone level was at 15 and my hCG was positive. Four days later they repeated the hCG test and told me it was negative. The ovulation kits/sticks are inaccurate -- one month they indicated ovulation twice in the month. I read your article [regarding] some "doctors' hands-off approach." I believe this is the case with me. What do you suggest? My husband and I are on a emotional rollercoaster with this "clomid." The last time the doctor saw me was five months ago when he prescribed the clomid.

First off, if you do not conceive by three months, clomiphene is not likely to work. The pain you are experience may be due to ovarian enlargement as a complication of unmonitored clomiphene therapy. I would advise that you speak with a fellowship-trained reproductive endocrinologist to determine an appropriate course of action.

• Unicornuate Uterus:
  Is it common?

I recently had an exploratory laparoscopy and hysteroscopy and was diagnosed with a unicornuate uterus. I have one left tube that is blocked, a non-communicating horn and both ovaries. Have you had other patients with this anomaly? I have been pregnant once (in 1999) but miscarried at 11 wks (a missed abortion with a D&C.) We have been trying to conceive for two years now. My husband and I will be looking into IVF treatment. I am looking for a clinic that has had experience with this before.

This condition is not all that unusual. If the remaining smaller abnormal uterine half is filled with blood or is connected, some suggest removing this half. I am not convinced the there is sufficient data in the literature to support this sort of treatment. I would be concerned about the risk of prematurity associated with multiple births and would try to limit the transfer to one blastocyst if possible, rather than multiple embryos on day three. There is a slightly higher risk of miscarriage and early delivery due to early cervical dilation. This can be avoided by a procedure called cervical cerclage where a stitch is placed in the cervix to keep it closed until delivery. This is best performed by a perinatologist, a fellowship-trained high-risk obstetrician.

{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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