QuestionDear Dr. Ramirez,
I am 37 years old and have had one successful pregnancy three years ago. I've had 4 pregnancies total, two m/c's due to blighted ovumm which I did not need a D&C and one termination with a D&C. The last m/c was last year and both ultrasound and blood test showed everything expelled naturally. I am concerned since I had not been able to get pregnant since and whether or not to actively seek treatment. I had day 3 testing for FSH, thyroid, and estradiol and everything was normal. I've been temping that last two months and my waking temps are 96.8-97.2 and the luteal phases temps are ~97.6-98. Not sure where I should go from here. Please advise.
AnswerHello Mary from the U.S.,
Just based on your age, time is working against you. For that reason alone, I think you need to go directly to the expert. Find an infertility specialist in your area, not a general Ob/Gyn, but one who performs all levels of fertility treatments including IVF. They will be able to counsel you the best.
The age factor means that the eggs you have left are debilitated and so successful pregnancy will be harder to attain. Also it means that you have an increased risk of miscarriages due to spontaneous chromosomal breakages during embryo development and division. This does not mean that you can't get pregnant, but only that it will be much more difficult. You have certainly shown that you can get pregnant. As time passes, however, more and more of your eggs become debilitated and so the pregnancy rates decrease further.
I usually will recommend an aggressive treatment plan. If you want to try something more "natural", then I would usually recommend IUI (intrauterine insemination) for no more than four attempts. If that does not work, then we proceed directly to IVF. The chances of pregnancy with IUI at your age is approximately 10% per cycle. The best method, and most aggressive but most successful treatment, is IVF. Your chances of pregnancy in our clinic at your age is 68% per treatment attempt (month). You can see the difference in pregnancy success is the reason IVF is a better treatment, but that doesn't mean than IUI can't work. I have had IUI pregnancies up to 41 years old, but the chances are much lower.
I hope this helps,
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
