Ask Our Doctors – Archive
Our Medical Directors are outstanding physicians that you will find to be very personable and compassionate, who take care to ensure that you have the most cutting-edge fertility treatments at your disposal. This is your outlet to ask your questions to the doctors.
Hi I m on decapeptyl from day 21 of my previous cycle now for 12 days for long protocol of my 5th icsi cycle…Have not been on ocp but my periods delayed than usual…is it due to decapeptyl??Natural pregnancy seems v unlikely.
It s possible that you have an agonist-induced ovarian cyst. Have an US and blood estradiol to determine same.
Good luck!
Geoff Sher
Many thanks for your comments. what have done is IVF not an IUI, in my natural cycle too obtain my egg and the only medicament used was ganirelix once my follicule was 16mm and estradiol 100 in day 12, however the next two days estradiol was 47, progesterone 0.44 and lh 4, so i didnt ovulated but i think was the effect of ganirelix. i have normal cycles of 28 days and apparently not prematurely lh high levels. i had 3 more natural IVF in the last months: one cycle they got one natural egg (after ovitrelle and ganirelix in day 12 when estradiol 267_ result in one embryo and transfer but not pregnant), another cycle ovulated espontaneously after ovitrelle and ganirelix in day 14 when estradiol 330 and another cycle they administered ganirelix in day 9 and drop estradiol however lh was normal, I think they are doing something wrong.
Many thanks for answering all of our questions. It’s a huge relief to feel heard. Thank you. My question is: I am 37, female. I had a surgery to remove uterine polyps 6 months ago and that went fine. My HSG was normal. My FSH level is rather consistently around 12. I’m about to start my third natural cycle IUI with Ovidrel injected 36 hours before the procedure. All other hormone aspects come back normal, husband also normal numbers. I understand that the polyps likely interfered with getting pregnant for the past two years we’ve been trying. I have good follicle count relatively, between 8 to 12 on each ovary about. I have very normal periods, right on time each month. Is there some route we are not exploring or is there some kind of outside the box thinking I need to pursue? I know that my FSH level is not great. Is this hopeless? Thanks so much, in advance.
I do not believe that natural cycle IUI has any real benefit. In my opinion, IUI should be combined with ovarian stimulation.
It is hard for me to believe that more than three decades have flown by since I first introduced intrauterine insemination into the clinical arena (Journal of Fertility & Sterility, April, 1984). At that time and for more than 2 decades thereafter, I held the strong belief that IUI would provide a less expensive, safe and equally successful alternative to IVF in cases where the woman had at least one (1) patent Fallopian tube…. How wrong I was! In my defense however, let me say that in the 1980’s and 90’s the reported National IVF success rate was under 15% while y IVF success rates are now often 4 or even 5 times higher.
Today I believe that IUI is being over-used, is not nearly as beneficial as I once thought and that there are (often ignored) serious down-sides to its use. Here is one important example: Women who fail to ovulate or ovulate dysfunctionally, often respond to controlled ovarian stimulation (COS) by the releasing (ovulating) of several eggs at a time. Since unless IVF is used, it is not possible to control/regulate the number of embryos reaching the uterus, the risk of high-order multiple pregnancies (triplets or greater) is far greater with IUI. And, multiple pregnancies (especially triplets or greater) carry a very high maternal and neonatal risk.
Here are a few of the misperceptions about the use of IUI:
1)IUI is a “cost saver”. However, given the fact that IVF is at least 3-4 times more likely to be successful, when one looks at cost per baby (rather than cost per procedure) this turns out to be a fallacy. But cost also comes in the form of emotional currency and this needs to be measured in terms of the much lower chance of success with IUI.
2)”IUI is less invasive than IVF”… ….True! However aside from the surgical egg retrieval (which is a very safe procedure in the right hands/setting), IUI with gonadotropins requires largely the same drugs, preparation and monitoring as does IVF and the success rate is several fold lower than IVF.
3)The use of oral Clomiphene Citrate for IUI- COS provides the same success rates as does Gonadotropin-IUI. This is absolutely incorrect. In fact the IUI success rate with clomiphene is about 30% lower than when gonadotropins are used.
4)Natural cycle IUI has benefit: This is only true when frozen donor sperm is used for inseminations and in the isolated cases where there is non-immunologic cervical hostility to sperm. In all other cases, COS is needed to improve success.
5)IUI can be used in cases of Embryo Implantation Dysfunction: Given the complexity of treatment is in cases where a thin uterine lining, significant uterine anatomical disease or immunologic implantation dysfunction (IID) prevents a healthy pregnancy, it is my opinion that IVF is the preferred primary approach.
6)IUI can supplant or replace IVF in all cases where there is patency of at least 1 Fallopian tube. However, contrary to popular belief, there is no evidence that IUI improves pregnancy potential in cases of:
a.Moderate or severe male factor infertility
b.Endometriosis with patent Fallopian tubes. Since inseminating sperm does not overcome the main impediment to fertility, i.e., a “toxic” peritoneal factor that compromises sperm penetrating the egg envelopment).
c.Older women (over 40y) where the IUI pregnancy yield is only about 2% per treatment cycle.
Upon Honest Reflection:
Unfortunately, too many physicians who should (and alas often do) know better, still liberally recommend IUI preferentially in cases of moderate or severe male infertility, older infertile women or those with diminished ovarian reserve (DOR), cases of endometriosis or where there is clear evidence of an anatomical r immunologic implantation issue. Such women would be much better advised to go directly to IVF but find themselves attracted to what they erroneously consider to be a much lower cost alternative.
Then there is the fact that many infertile patients, erroneously believing that IUI is less risky that IVF, provides an equivalent chance of success, and comes at a much lower price tag, put undue pressure on their physicians to first try the former several times before resorting to the latter.
To make matters worse, many misguided insurance providers (purely for economic reasons) demand that their female clients who have at least 1 patent Fallopian tube, first undergo several unsuccessful attempts at IUI before becoming eligible for IVF. And they often take this position regardless of cast iron indications that IVF should be the primary treatment of choice.
In summary, it is my opinion that IUI is presently an over-prescribed treatment. As such, we as physicians need to rethink the basis upon which we recommend IUI and educate our patients app
Geoff Sher
Dr. Sher,
Would you ever consider transferring a normal embryo with a mosaic one? Would there be more risks to losing the normal embryo as well? Please let me know your thoughts. Thank you
Absolutely I would do so!
Geoff Sher
Are there any exceptions to the rule where a woman is releasing an egg during the 7th, 8th or 9th month of pregnancy?