|
|
 
 
|
Mark Perloe on Fertility Issues, Page 9{Read more of Dr. Perloe's responses: Page 1 / Page 2 / Page 3 / Page 4 / Page 5 / Page 6 / Page 7 / Page 8}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.}
Many years ago, I conceived and delivered 3 healthy children. I then had one miscarriage.
I wish to have another child, and have not been able to conceive in 15 years. I also had a pelvic
inflammatory disease, which may be the problem. Is there treatment for PID or correction for any damage it may have caused?
Either age related infertility of tubal problems may be the cause of your infertility. I would start by checking ovarian reserve. This involves testing the FSH and estradiol level on day three of your cycle followed by clomiphene tablets, (2) from day five through day 9. Then retest the FSH. If elevated, this indicates diminished fertility related to your age and may indicate that donor eggs may be needed. If the ovarian reserve testing is normal, a semen analysis and HSG (hysterosalpingogram) would be the next step. If the tubes are open, you would likely be treated with ovulation induction and intrauterine insemination. If there is tubal damage, I would suggest you consider invitro fertilization. Please read www.ivf.com/ovarianreserve.html
What are some possible causes for low sperm motility?
What are your thoughts in general on the combined use of an OTC ovulation predictor test and clomiphene therapy?
I feel it is very important to utilize the urinary LH predictors when using clomiphene. On clomiphene, two things need to happen. First, you must grow a follicle; second, an LH surge must occur to trigger release of the egg. Often clomiphene will result in growth of follicles, but they will fail to release. By starting the urine LH kit on or about the fifth day after finishing clomiphene, you can detect the surge. But if no surge is seen by the end of the kit, about six days later, I would recommend an ultrasound. If mature follicles are noted, an hCG shot can trigger release of the egg and often pregnancy results. This is more appropriate than the approach many MD's adopt to simply increase the dose the next month. The result is often enlarged ovaries, thin endometrium and thick cervical mucus. One caveat though, if the test is positive too early, it may indicate a false surge or an inappropriate response to clomiphene with high LH levels. The result of this would be low chance of pregnancy and therefore I would recommend injectable therapy. Please read www.ivf.com/clom.html for more info.
Can emotional stress on the part of the woman be the cause of an egg that either won't fertilize or won't implant? YUP. How to measure it I don't know. One study looking at recurrent loss showed improved fertility after stress reduction training. Another shows stress associated with increased uterine muscle tone. A third shows changes in types of white cells in peripheral blood due to stress and this too may interfere. If nothing else, stress can interfere with your relationship and make it more difficult to comply with your physician's recommendations.
{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 |
