Questionhello sir my name is Jennifer and i struggle with infertility and have been for my 5 years of marriage, thou my husband also has low sperm count and i also have endo, my question is should i just give up have tried 3 rounds of clomid 50mg and then a year later 3 rounds 100 mg cloned. I am only 24 and i know him still young i go to a fertility specialist who told me my only chance would be if since cloned didn't work tho i ovulated all time of taking the medication, i would love to hear your opinion about it, i have had lapascopy in July for the endo, and like most women i feel depressed over this struggle not to conceive. Any advice would be greatly appreciated.
AnswerHello Jennifer,
You have two problems that have to be addressed in the treatment:
1. sperm abnormality
2. endometriosis
Without addressing these three problems, you will not have an increased chance of pregnancy. The laparoscopy was appropriate as part of the evaluation and was probably treated surgically at the same time, but now, too much time has passed. In general, if pregnancy is not achieved within 6 months, the endometriosis will come back and prevent pregnancy again.
The clomid was not specifically indicated for your infertility, because it did not address these two issues. The only reason to have used it would have been to increase your chances of pregnancy right after the laparoscopy to try to get you pregnant before six months. However, this alone did not address the sperm issue. Without knowing how bad the sperm is, at the very minimum, IUI (intrauterine insemination should have been combined with the Clomid cycles).
I don't think that you need to despair. The good news is that you are still young, which means that your eggs are still in good condition and there is time to work with. If you were my patient, I would give you the following options:
1. Repeat laparoscopy to treat any new endometriosis followed by 3 months of Lupron to get rid of any microscopic endometriosis left behind and then proceed directly to Clomid 100-150mg with IUI for 4 cycles.
2. Leave off the laparoscopy and go directly to a 3 month course of Lupron followed by Clomid/IUI.
3. Go directly to IVF (which bypasses the endometriosis and the sperm can be injected directly thereby treatment the sperm problem. I would recommend this one more highly if the sperm count were less than 10 million, the motility less than 35% or the morphology were less than 30%.
Semen analysis, unfortunately, is an indirect way to evaluate the sperm. The numbers given are not important but are the only things we can test on sperm. The more important evaluation is sperm function i.e. can it fertilize your eggs, but we cannot test that. So we use the semen analysis. If the semen analysis is significantly abnormal, we know from IVF studies that these sperm often times have a functional problem. That means that they don't have the ability to fertilize the egg. For this reason, now-a-days, if the analysis is signficantly abnormal, we will recommend going directly to IVF. Just food for thought.
Good luck,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf
