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Showing posts from February, 2012

Question of the Day: Failed FETs, what to do next?

Question of the Day:

Hello Dr,
I had egg retrieval in sept 2011 5 blastocyst and 6 third day embryo.I ended having OHSS and transfer was cancelled. I had my FET done with one five day embryo in october 2011 which did not work.
I had one more FET done with two embryos from third day. Today is 12th day and I got -ve on HPT.I also gave my blood this morning will have results tomorrow.I am afraid that result may be -ve.
At this I do not know what to do for IVF to work.I have followed all the instructions religiously.

What would you suggest if I was your patient. Or what you do different in my next FET cycle.

DrG answers:

Clearly a very frustrating situation. Here a patient had a great response to IVF medications…so great that she had to freeze all the embryos. The embryo development sounds pretty good as 5 blastocysts and 6 D3 cleavage stage embryos were frozen. Following 2 FET attempts nothing has worked.

However, I don't have all the details. Why were there both D3 and D5 embryos fro…

Question of the Day: Blocked Tubes and IVF

Question of the Day:

My doctor said she will remove my left blocked tube to help IVF without mentioning whether I have a hydrosalpinx. Is it possible that my tube doesn't have this condition? Do they have to remove a blocked tube no matter whether it has a hydrosalpinx? I am frustrated because they don't tell you enough and I cannot ask suitable questions as obviously I don't know enough as a patient.

DrG answers:

So first of all we need to define "hydrosalpinx." This term literally means a water/fluid filled tube as "hydro" is latin for water and "saplinx" means tube. So a hydrosalpinx is a fallopian tube that has become blocked at the end that is furthest from where the tube attaches to the uterus. The far end of the tube has the fimbria which are delicate finger-like projections that allow the tube to capture the egg as it is released from the ovary. Unfortunately, if the fimbria become damaged by infection or trauma (surgery) or inflammation …

Natural Cycle IVF Success After Essure

This has been a busy month for patients with prior tubal ligations. Although some patients with a prior tubal ligation will opt for a surgery to reverse their tubal ligation, most will pursue IVF. The data seems to favor IVF over tubal reversal if the patient is over age 37. Of course, other factors also come into play when making this decision. The presence of male factor infertility, the ovarian reserve of the patient, the desire for additional children etc…

More recently those patients seeking sterilization have undergone hysteroscopic sterilization with Essure. Essure is a procedure in which silicone-free inserts made of a polyester fiber, nickel-titanium and stainless steel alloy titanium coils are placed into the fallopian tubes from the uterus during hysteroscopy. The resulting inflammation causes the fallopian tubes to become blocked as they exit the uterus (proximal occlusion). Patients like Essure because the procedure is done hysteroscopically and is therefore less invasive …

DrG on NBC

This morning one of my favorite patients, Kaet Ruffner, joined me on the Midday Show on NBC channel 4 here in Washington, DC. The topic was the comments that Mr. Gingrich had made concerning oversight of IVF and specifically concern about extra embryos. Of course, there are no extra embryos in Natural Cycle IVF egg, one embryo, one baby. So off we went to NBC to talk about NC-IVF....

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Endometriosis and NC IVF

One thing is true in medicine and that is that you never want to be an interesting patient! Seriously. You should aim to have the condition that your doctor sees all the time and knows exactly what to do. As soon as you start getting a lot of "hmmms" and "wow, that is unusual'" then you may feel free to panic a little bit. Not a lot. Just a little. Because being an interesting patient doesn't preclude a happy outcome! It just means that when you are successful then the medical team feels like they deserve a victory lap. So here is a headline for today's blog about an interesting patient....

NC IVF results in only 2nd pregnancy ever reported in a patient with endometriosis hemorrhagic ascites undergoing IVF!

Ascites is a medical condition in which excess fluid accumulates in the abdomen. Usually we see this in young patients with OHSS. Oncologists see it in patients with cancer. This past year I saw a patient that had recurrent ascites resulting from sever…

Question 61. I had an allergic reaction to the progesterone in oil shots. Does this mean that I cannot do IVF?

We often have drug reps in the office at lunchtime. As there are only really 4 companies that make pharmaceuticals that are used in fertility we get to know the reps pretty well. This past week we were speaking with a couple of reps about vaginal progesterone in lieu of PIO. The data is very good regarding success with vaginal progesterone but honestly some patients just prefer the shots because the suppositories are so messy.

Both Endometrin and Crinone may prove less annoying to patients who want a shot-free 2ww but these products are also more expensive. I advise the husbands that they do NOT have a vote in this decision unless they are willing to take IM injections themselves. Just because I am driving a new car with the vanity plates CR1NONE should not be taken as evidence that my support of a product is based on anything except a careful review of the medical literature. But seriously, I really do not believe that most doctors are swayed to prescribe a drug just because they got…