QuestionDr Ramirez, my name is Maria Torres-Thorne, my husband and I tried to get pregnant on our own for 14 months, after no success we went to RMA in NJ for help. We had four IUI treatments, after the fourth I went back to the clinic for blood work, the results were positive (happiest day of our lives) but my progesterone levels were low. They put me on endometrium vaginal suppository (which I guess is the same as prometrium). I carried my baby for 5 wonderful months until my 20 week ultrasound when they diagnosed my baby with severe hydrocephalus and had to term the pregnancy. Because of my age 37 (by the time I had the pregnancy termed) and my fertility history the doctors recommended I deliver the baby with natural birth as suppose to a D&C. They also said that I would be most fertile after delivery and could start trying shortly after. My husband and I decided to start trying right away. this happened in September I got my first normal period in October and have been trying since. My OBGYN recommended we try on our own for Oct, Nov and Dec, if nothing we should go back to RMA again in Jan, we have been trying since...my questions to you are:
Can I already be ovulating 1 month after giving birth to an unborn child (i did not breastfeed)?
Since i was on Endometrium to help my progesterone levels will I not get a positive result since I'm not on this medication anymore?
I also have hypothyroid which I do see an endocrinologist to help regulate my levels.
Should I give up on our own and just go back to RMA instead of waiting around.
Any advise would be appreciative
AnswerHello Maria from New Jersey,
My condolences and sympathy for your loss. Because of your age, you are at risk for genetic abnormalities. These are spontaneous abnormalities that occur from a mistake in the division of the embryo during its development. In most cases, the abnormal embryo will not implant or an early miscarriage will occur. However, if the genetic abnormality is slight, as in Down's syndrome, the pregnancy can continue.
The good news is that you were able to get pregnant using a natural method such as IUI. Because of your age, however, I would recommend an aggressive treatment plan and disagree with your Ob's recommendations to just try on your own for a while. Time is not on your side. If your periods have resumed, then I would go back to trying with IUI, but no more than four attempts. In addition to the Endometrin, I would recommend that you take a prenatal vitamin with at least 1 mg of Folic acid and aspirin 81 mg. Taking the progesterone will NOT give you a false positive pregnancy test result, but you may not have a spontaneous period. Therefore, you will have to do a blood pregnancy test, which I usually do at 12-14 days after the IUI.
If the IUI does not work by four attempts, then I would recommend proceeding to IVF. You don't absolutely have to do this but your chances of a successful pregnancy are decreasing with time, even with IVF, and so I would become very aggressive at that point. In addition, I think that IVF does have a better chance of a genetically normal pregnancy than a natural pregnancy because, I believe, the unnatural environment that an abnormal embryo has to go through is too much for it to handle and so the genetical abnormal ones don't make it. Keep in mind that even with IVF, because of your age, it may take several attempts to be successful. If you read my blog, you will see that my wife and I had a similar story as yours and had to do IVF at your age. I certainly can relate!
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
