Understanding Miscarriage, Clomid & IUI: A Personal Journey

Question
After 9 months of trying to conceive, my husband and I became pregnant.  Unfortunately, I had a natural miscarriage at 6 weeks.  I underwent a HSG and Estradoil blood test which were all normal.  My OB/GYN prescribed Clomid since before my pregnancy, my progesterone level was "low normal".  I was on 50 mg of Clomid for three months.  The first two months I had a normal 32 day cycle.  The third month on 50 mg of clomid my cycle was 40 days so OB upped clomid dosage to 100 mg.  The first two months on 100 mg of Clomid, blood tests showed that I ovulated.  I had an iui on the third month of Clomid.  Unfortunately, the third month on clomid 100 mg and iui, I had  a 42 day cycle so when I had the iui procedure I was not even ovulating.  The next month my OB had me take 100 mg of Clomid and the Ovidrel shot with IUI.  I had my progesterone test on day 21 which showed my progesterone level was only 8.8 but I did have a normal 28 day cycle.  My husband has undergone two sperm analyses.  Everything is normal except on the first test his morphology was 1% normal (strict Kruger) and second test showed morphology at 4%.  Any thoughts??????

Answer
Hello Chrissy from the U.S.,

First, I think it may be time for you to see a real fertilty specialist so that you can get on the right treatment plan.  Second, the morphology of your husband's sperm, of 4%, is severely low.  IUI is not the optimal treatment for this.  That means that only 4% of his sperm are formed normally.  It should be greater than 33%.  If you take the total sperm count and multiply it by 0.04, that will tell you how many sperm are available to fertilize the egg.  If that number is less than 10 million, then IUI won't work.  It would be best to move to IVF with ICSI because there is probably a functional problem as well.

In terms of the Clomid ovulation induction, I invite you to read my blog under "How I do Clomid cycles", which will give you an idea of the ideal way that an ovulation induction cycle is performed.

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