QuestionQUESTION: Dear Dr.
Am 34 yrs old woman and my husband is 40 yrs. We are TTC since Jan 2010.
In Jan, My husband took sperm analysis and it was very low (frequent laptop user, now he put the laptop on a table). Last month his sperm count was 73 millions and 40% active motility and 15% sluggish. The normal sperm are 80% but agglutination PRESENTS. He took the blood test to see if there is any anti-bodies (result negative). The doc gave him cough medicine to liquidate the sperm, and said IUI may help.
The problem that I have thin endo this month it was between 6.2 mm to 7.9mm (on CD16); where I was taking clomid 100 x 5 days + Progyluton (taking it for the first time). In previous months my endo was between 6 and 7.2mm. Which seems that the oral estradiol valerate 2 mg did not work :( the doc said that he like to see it at least 10 mm.
I have regular period 30days. I Ovulate of my own, but doc decided to put me on clomid to increase the chances of conceiving. I have 3 mature eggs, the dominant size is 28 x 21. Without clomid the egg size usually +20
He gave me duphaston to take from day 14.
How can I enhance my endo? Should I increase the dose of estrogen? Is there is a hope to get pregnant? Does IUI and IVF will work for me. Please please help me.
ANSWER: Hello Nino from Kuwait,
Certainly IUI is an appropriate first line treatment with your husband's abnormal semen analysis. In terms of the lining, we do prefer that it is at least 9 mms. Estrogen used vaginally is probably better way to enhance the lining, rather than taking it orally. This is because when pills are taken orally, most of it is lost as it passes through the liver. There is no reason why it can't be placed vaginally and that is how we use it here.
Also keep in mind that IUI is a "natural process", so it can take several attempts before pregnancy occurs. In the U.S., we don't recommend more than 4 attempts because most women will be pregnant by that time. If no pregnancy occurs,then we recommend proceeding to IVF.
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 follow me on Facebook at http://bit.ly/9Iw9oV
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QUESTION: Thank you Dr. Ramirez. I really appreciate your quick and clear answer :)
I have one more inquiry please :)
I read that many women take Estrace "we don't have this brand here, but I know it", vaginally from CD13 to CD16 (if they O around CD 16 - like myself).
Some take 4mg or more.
My question is, should I keep taking the Progyluton (estradiol valerate) 2mg (vaginally) it to from CD5 or it better to increase the dose from CD13 to 2mg orally and 2mg vavinally? In other word, when and how much should I take?
If you think that estrace will be better, I can order it.
Thank you very much again.
AnswerHello Again,
"Estrace" and estradiol valerate are the same. The endometrial lining needs to be primed by CD#14, so you have to take it BEFORE ovulation, which means starting at the beginning of the cycle. Starting it after ovulation does not help. As mentioned previously, using it vaginally is more effective because the majority of the medication goes directly to the uterine lining, whereas most of it is lost in the liver when taken orally. 1-2 mg vaginally is a sufficient dose. I would recommend 2 mg to start.
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 follow me on Facebook at http://bit.ly/9Iw9oV
